Low-density lipoprotein cholesterol versus particle number in middle school children

J Pediatr. 2013 Aug;163(2):355-62. doi: 10.1016/j.jpeds.2013.01.012. Epub 2013 Feb 14.


Objectives: To characterize lipids and lipoproteins in a diverse school-based cohort and identify features associated with discordance between low-density lipoprotein cholesterol (LDL-C) and LDL particle (LDL-P).

Study design: Sixth-grade children enrolled in the HEALTHY trial (n = 2384; mean age 11.3 ± 0.6 years; 54.2% female) were evaluated for standard lipids, lipoprotein particles measured by nuclear magnetic resonance, and homeostatic model of insulin resistance. Characteristics of subgroups with values of LDL-C and LDL-P discordant by >20 percentile units, an amount reasoned to be clinically significant, were compared.

Results: Four-hundred twenty-eight (18%) of children were in the LDL-P < LDL-C subgroup and 375 (16%) in the LDL-P > LDL-C subgroup. Those with LDL-P > LDL-C had significantly greater body mass index, waist circumference, homeostatic model of insulin resistance, triglycerides, systolic and diastolic blood pressure, and reflected a greater Hispanic ethnic composition but fewer of black race than both the concordant (LDL-P ≅ LDL-C) and opposite discordant (LDL-P < LDL-C) subgroups.

Conclusions: There is as much lipoprotein cholesterol compositional heterogeneity in sixth graders as has been described in adults and a discordant atherogenic phenotype of LDL-P > LDL-C, common in obesity, is often missed when only LDL-C is considered. Conversely, many children with moderate-risk cholesterol measures (75th to 99th percentile) have a lower LDL-P burden.

Trial registration: ClinicalTrials.gov NCT00458029.

Keywords: Apolipoprotein B; BMI; Body mass index; CVD; Cardiovascular disease; HDL-C; HDL-P; HOMA-IR; High-density lipoprotein cholesterol; High-density lipoprotein particle; Homeostatic model of insulin resistance; LDL; LDL-C; LDL-P; Low-density lipoprotein; Low-density lipoprotein cholesterol; Low-density lipoprotein particle; NMR; Nuclear magnetic resonance; TC; TG; Total cholesterol; Triglycerides; VLDL; VLDL-P; Very-low-density lipoprotein; Very-low-density lipoprotein particle; apoB.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Cholesterol, LDL / blood*
  • Female
  • Humans
  • Lipoproteins, LDL / blood*
  • Male
  • Particle Size


  • Cholesterol, LDL
  • Lipoproteins, LDL

Associated data

  • ClinicalTrials.gov/NCT00458029