Distributions and trends of serum lipid levels among United States children and adolescents ages 4-19 years: data from the Third National Health and Nutrition Examination Survey

Prev Med. 1998 Nov-Dec;27(6):879-90. doi: 10.1006/pmed.1998.0376.


Background: Atherosclerosis begins in childhood and progresses into adulthood. The reduction of cardiovascular risk factors, such as elevated serum total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels, in childhood may reduce cardiovascular morbidity and mortality in adulthood. Lipid distributions among children and adolescents were examined using the most recent nationally representative data.

Methods: Data from 7,499 examinees in NHANES III (1988-1994) were used to estimate mean and percentile distributions of serum total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides in children and adolescents aged 4 to 19 years. The estimates were analyzed by age, sex, and race/ethnic groups. Trends in mean total cholesterol were examined for 12- to 17-year-olds using data from NHES III (1966-1970), NHANES I (1971-1974), and NHANES III (1988-1994).

Results: For children and adolescents 4 to 19 years of age, the 95th percentile for serum total cholesterol was 216 mg/dL and the 75th percentile was 181 mg/dL. Mean age-specific total cholesterol levels peaked at 171 mg/dL at 9-11 years of age and fell thereafter. Females had significantly higher mean total cholesterol and LDL-C levels than did males (P < 0.005). Non-Hispanic black children and adolescents had significantly higher mean total cholesterol, LDL-C, and HDL-C levels compared to non-Hispanic white and Mexican American children and adolescents. The mean total cholesterol level among 12- to 17-year-olds decreased by 7 mg/dL from 1966-1970 to 1988-1994 and is consistent with, but less than, observed trends in adults. Black females have experienced the smallest decline between surveys.

Conclusions: The findings provide a picture of the lipid distribution among U.S. children and adolescents and indicate that, like adults, adolescents have experienced a fall in total cholesterol levels. Total cholesterol levels in U.S. adolescents declined from the late 1960s to the early 1990s by an average of 7 mg/dL. This information is useful for planning programs targeting the prevention of cardiovascular disease beginning with the development of healthy lifestyles in childhood.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Child
  • Child, Preschool
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Ethnicity
  • Female
  • Humans
  • Hyperlipidemias / blood*
  • Hyperlipidemias / epidemiology*
  • Male
  • Nutrition Surveys
  • Population Surveillance
  • Racial Groups
  • Sex Distribution
  • Triglycerides / blood
  • United States / epidemiology


  • Cholesterol, HDL
  • Cholesterol, LDL
  • Triglycerides
  • Cholesterol