Dislipidemias en niños y adolescentes: factores determinantes y recomendaciones para su diagnóstico y manejo

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Abstract

RESUMEN El presente artículo tiene como objetivo identificar los factores y determinantes que inciden en la dislipidemia infantil y adolescente, así como las recomendaciones existentes sobre el diagnóstico, manejo y seguimiento clínico. Se realizó una revisión narrativa consultando en PubMed, Web of Science y SciELO de artículos publicados entre 2010-2017, en población infantil y adolescente, que incluyan descripción de la patología, programas, manejo y tratamiento. Se hallaron 193 artículos. Se seleccionaron 32 que cumplían los criterios de inclusión, distribuidos en 2 grupos: uno que contiene 19 estudios originales describiendo factores para la aparición de esta patología y otro que agrupa 13 estudios correspondientes a recomendaciones para su diagnóstico y manejo. Respecto a los determinantes de las dislipidemias, el sobrepeso y/u obesidad en niños se ha descrito como el principal factor desencadenante. Aunque se observan avances sobre los tratamientos recomendados y cierto consenso acerca de las fases del mismo, todavía no existen recomendaciones unificadas con respecto a su detección precoz. Algunos autores apoyan la realización del cribado en toda la población infantil, mientras otros únicamente lo consideran necesario en niños con riesgo elevado. El tratamiento de primera línea se basa en cambios dietéticos y de actividad física, relegando al farmacológico como última opción.

Translated abstract

ABSTRACT The present article aims to identify the factors and determinants that affect childhood and adolescent dyslipidemia, as well as the existing recommendations on diagnosis, management and clinical follow-up. A narrative review was carried out in PubMed, Web of Science and SciELO of articles published between 2010-2017, in children population, including description of pathology, programs, management and treatment. Found 193 articles. We selected 32 who fulfilled the inclusion criteria, distributed in 2 groups: One of them containing 19 original studies describing factors for the onset of this pathology and the other one lists 13 studies corresponding to recommendations for diagnosis and management. Regarding the determinants of dyslipidemia, overweight and/or obesity in children has been described as the main triggering factor. Although there is progress on recommended treatments and some consensus on the phases of the treatments, there are still no unified recommendations regarding their early detection. Some authors support screening in the entire child population, while others only consider it necessary in children at high risk. First-line treatment is based on dietary changes and physical activity, relegating to pharmacological as the last option.

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Lipid screening and cardiovascular health in childhood.

Stephen R Daniels, Frank R. Greer (2008)

This clinical report replaces the 1998 policy statement from the American Academy of Pediatrics on cholesterol in childhood, which has been retired. This report has taken on new urgency given the current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults. The approach to screening children and adolescents with a fasting lipid profile remains a targeted approach. Overweight children belong to a special risk category of children and are in need of cholesterol screening regardless of family history or other risk factors. This report reemphasizes the need for prevention of cardiovascular disease by following Dietary Guidelines for Americans and increasing physical activity and also includes a review of the pharmacologic agents and indications for treating dyslipidemia in children.

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Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study.

Shengxu Li, Wei Chen, Sathanur R. Srinivasan … (2003)

Carotid artery intima-media thickness (IMT) is associated with cardiovascular risk factors and is recognized as an important predictive measure of clinical coronary atherosclerosis events in middle-aged and elderly populations. However, information on the association of carotid IMT in young adults with different risk factors measured in childhood, adulthood, or as a cumulative burden of each of the risk factors measured serially from childhood to adulthood is limited. To examine the association between carotid IMT in young adults and traditional cardiovascular risk factors measured since childhood. A cohort study of 486 adults aged 25 to 37 years from a semirural black and white community in Bogalusa, La (71% white, 39% men), who had at least 3 measurements of traditional risk factors since childhood, conducted between September 1973 and December 1996. Association of carotid IMT with risk factors, including systolic blood pressure, lipoprotein levels, and body mass index. Male vs female (0.757 mm vs 0.719 mm) and black vs white (0.760 mm vs 0.723 mm) participants had increased carotid IMT (P<.001 for both). In multivariable analyses, significant predictors for being in top vs lower 3 quartiles of carotid IMT in young adults were childhood measures of low-density lipoprotein cholesterol (LDL-C) level (odds ratio [OR], 1.42, corresponding to 1-SD change specific for age, race, and sex; 95% confidence interval [CI], 1.14-1.78) and body mass index (BMI; OR, 1.25; 95% CI, 1.01-1.54); adulthood measures of LDL-C level (OR, 1.46; 95% CI, 1.16-1.82), high-density lipoprotein cholesterol (HDL-C) level (OR, 0.67; 95% CI, 0.51-0.88), and systolic blood pressure (OR, 1.36; 95% CI, 1.08-1.72); and long-term cumulative burden of LDL-C (OR, 1.58; 95% CI, 1.24-2.01) and HDL-C (OR, 0.75; 95% CI, 0.58-0.97) levels measured serially from childhood to adulthood. An increasing trend in carotid IMT across quartiles of LDL-C level measured in childhood was observed, with a mean value of 0.761 mm (95% CI, 0.743-0.780 mm) for those at the top quartile vs 0.724 mm (95% CI, 0.715-0.734 mm) for those in the lower 3 quartiles (P<.001). Childhood measures of LDL-C level and BMI predict carotid IMT in young adults. The prevention implications of these findings remains to be explored.