ABSTRACT
BACKGROUND: Individuals with FH develop cardiovascular disease due to lifelong cumulative exposure to elevated LDL-C. Effective screening for FH is not yet established. OBJECTIVE: To evaluate the practicability of a FH screening by measuring directly the LDL-C in preschoolers. METHODS: LDL-C measurement through capillary blood sampling during the compulsory routine check-ups by the pediatrician in children aged 2 to 6 years including information on family history as dyslipidemia and/or premature cardiovascular disease in first and second grade of pedigrees. RESULTS: 15,009 children (52.2% males, median age 3.9 years [IQR 3.0-5.1]) participated in the study. Positive family history for hyperlipidemia was stated in 40.9% cases, in 12.0% also in at least one 1st degree relative. In the total cohort, median LDL-C was 93 mg/dL [IQR 79-109 mg/dL]. Boys had significantly higher LDL-C levels than girls (p < 0.0001), whereas there was no difference regarding their age (p = 0.757). Children from families with a positive history for hypercholesterolemia/dyslipidemia had significantly higher LDL-C levels (p < 0.001) and were more frequently among those with LDL-C values above 135 mg/dL (3.5 mmol/L, 96th percentile; 53.2% vs. 40.3%, p < 0.001) and those with LDL-C levels above 160 mg/dL (4.1 mmol/L, 99th percentile; 45.3% vs. 40.7%, p < 0.001) than children without positive family history. CONCLUSIONS: Direct measurement of LDL-C levels in children at ages 2-6 years during the compulsory routine check-ups as well as at any voluntary visits to the pediatrician's office is practicable and delivers reliable information, which can be used for a FH screening strategy in the general population.
Subject(s)
Cardiovascular Diseases , Dyslipidemias , Hypercholesterolemia , Hyperlipoproteinemia Type II , Male , Child , Female , Humans , Child, Preschool , Cholesterol, LDLABSTRACT
BACKGROUND: The SARS-CoV-2 pandemic is ongoing in Germany. Children and adolescents are increasingly being infected, and many cases presumably remain undetected and unreported. Sero-epidemiological studies can help estimate the true number of infections. METHODS: From January 2020 to June 2022, 59 786 persons aged 1-17 years were tested for SARS-CoV-2 antibodies as part of a screening program for presymptomatic type 1 diabetes in the German federal state of Bavaria (the Fr1da study). RESULTS: In June 2022, the seroprevalence in the overall population was 73.5%. The seroprevalence was significantly higher in school-age children (from 5 to 10 years of age) than in preschool children (ages 1-4): 84.4% vs. 66.6%, p <0.001. In contrast, in November 2021, before the appearance of the omicron variant, the overall seroprevalence was 14.7% (16.2% of school-age children, 13.0% of preschool children, p = 0.06). In the overall collective, seroprevalence increased fivefold from the fall of 2021 to June 2022 (by a factor of 5.2 in school-age children and 5.1 in preschool children). Similar seroprevalences, with smaller case numbers, were observed in June 2022 in the corresponding Fr1da studies in Saxony and Northern Germany: 87.8% and 76.7%, respectively. CONCLUSION: Monthly case counts reveal a substantial rise in SARS-CoV-2-infections among children and adolescents from late 2021 to mid-2022. The high percentage of preschool and school-age children who have been infected with SARS-CoV-2, in a population that has low vaccination coverage, should be taken into account in the development of health policies.
Subject(s)
COVID-19 , SARS-CoV-2 , Adolescent , Child, Preschool , Humans , Child , Seroepidemiologic Studies , COVID-19/epidemiology , Educational StatusABSTRACT
BACKGROUND AND AIMS: Lipid disorders are often detected very late, particularly in affected young children. We evaluated the feasibility of a screening for LDL-hypercholesterolemia (highLDL) among toddlers and preschoolers. METHODS: Population-based screening has been offered to all children (2-6 years) living in the State of Lower Saxony, Germany, with capillary blood sampling for detection of elevated LDL-cholesterol (LDL-Câ¯≥â¯135â¯mg/dL). Positive results were confirmed by a second measurement. Follow-up in specialized centers, including disease specific counselling and extended diagnostics, as well as evaluation of psychological distress of the parents, is carried out longitudinally. RESULTS: Up to March 2018, 5656 children have participated in the screening program. 5069/5656 children have completed the screening for highLDL (52.0% boys; median age: 4.0 years [Interquartile range, IQR 3.0-5.1]; mother age: 35 years [IQR 31-38]; father's age: 37 years; [IQR 33-42]). HighLDL was identified in 112 children (2.2%; 40.2% boys; LDL-C 157.6⯱â¯29.5â¯mg/dL, mean⯱â¯SD). In the total cohort, parents stated in 40.9% of the cases a positive family history for hyperlipidemia and in 29.9% a premature cardiovascular event. Children with highLDL had more often both risk factors in their family history; however, in 37% of them none of these factors were reported. CONCLUSIONS: The first results of the screening program showed its feasibility and revealed high prevalence of highLDL in the general population. Furthermore, a large proportion of families of affected children were not aware about their lipid disorders.
