International Journal of Epidemiology 2003;32:1105-1110
© International Epidemiological Association 2003
Paediatric Epidemiology |
Negative relationships between growth in height and levels of cholesterol in puberty: a 3-year follow-up study
1 Department of Public Health, Hamamatsu University School of Medicine, Hamamatsu, Japan.
2 Department of Hygiene, Kansai Medical University, Moriguchi, Japan.
Correspondence: Dr Katsuyasu Kouda, Department of Hygiene, Kansai Medical University, 10–15, Fumizono-cho, Moriguchi, Osaka 570-8506, Japan. E-mail: koudak{at}takii.kmu.ac.jp
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Abstract |
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Background Previously, there were only a few reports on the negative relationship between pubertal growth in height and levels of serum lipid in boys. Detailed information on both genders is needed.
Methods We investigated the relationship between pubertal growth in height and serum lipid. Subjects were 1442 boys and 1350 girls followed up from age 10–11 years (the fifth grade level of elementary school) to age 13–14 years (the second year of junior high school). Anthropometric variables and serum lipids were measured by the same protocol at both ages.
Results From cross-sectional analysis, at both ages negative relationships between total cholesterol levels and height were found in both genders. On longitudinal analysis, height at age 10–11 years was one of the factors predicting the level of total cholesterol at age 13–14 years. In addition, negative relationships between increase in height and change in serum lipids (total cholesterol and high density lipoprotein cholesterol) over the 3-year period were obtained in both genders. Thus, pubertal children who experience a large increase in height tended to show a decrease in serum lipids, and children who experience a small increase in height tended to show an increase in serum lipids.
Conclusion In both genders, total cholesterol level in pubertal children is negatively associated with height. Height velocity is inversely associated with dynamic changes in serum lipids during puberty.
Keywords Body height, cardiovascular diseases, child development, growth, hyperlipidaemia, Japan, lipids, longitudinal studies, puberty, schools
Accepted 23 April 2003
Tracking of serum lipids and lipoproteins from childhood to adulthood has been reported.1–3 In the wake of previous findings, it is considered that serum lipid measurements in childhood and adolescence can predict adult values.1–3 In contrast, there are some cases whose serum lipid levels are high in childhood and normal in adulthood.4 Serum lipids levels in schoolchildren are affected by race and sex.5–12 Thus, detailed analysis of serum lipids in child development is needed.
Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels of newborns are very low compared with those of adults, and increase with growth.5 In schoolchildren, dynamic changes in serum lipids are observed during puberty. Serum lipids values peak at 9–10 years of age, and decrease thereafter. In adolescence, serum lipids begin to increase again. These changes in serum lipids during puberty are more remarkable in males than in females.6–12
The decrease in serum lipids levels during puberty are associated with the process of sexual maturation,6,9,13,14 and related to an increase in the plasma testosterone concentration in boys or oestradiol concentration in girls.9,15,16 Growth spurt in height, which is affected by the secretion level of growth hormone (GH), also occurs in this period. It has been reported that basal GH level is positively correlated with high-density lipoprotein cholesterol (HDL-C),17,18 and the administration of GH decreases LDL-C and increases HDL-C.19
There have been only a few reports on the relationship between growth in height and levels of serum lipids. Freedman et al.20 conducted a longitudinal study with 78 boys, and reported that the relationships of change in LDL-C with change in weight were positive. In contrast, the relationship of change in LDL-C with change in height was negative. Chiang et al.21 also reported finding a negative association between change in TC and change in height in 208 white boys and 189 blackboys. From these reports, it is postulated that children who demonstrate a relatively large increase in height might also show a large decrease in serum lipids during puberty. However, these previous reports, which discussed the relationship between change in serum lipids and pubertal growth in height, arose from investigations including only boys. Detailed information on both genders is needed.
In this study, we conducted a 3-year longitudinal study in Japanese schoolchildren (1442 boys and 1350 girls), and examined the relationship between pubertal growth in height and levels of serum lipids in both genders.
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Methods |
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Population
A total of 3219 children aged 10–11 years, who were in the fifth grade of elementary school located in Iwata City in Shizuoka prefecture, Japan, were initially eligible. This group included 569 males and 567 females in 1994, 552 males and 480 females in 1996, and 512 males and 539 females in 1997. We could examine 99.9% of the initially eligible children aged 10–11 years, and could follow a total of 2792 children (1442 males and 1350 females) for over 3 years, until they reached the age of 13–14 years, the second year of junior high school. Children who graduated or moved outside the school district, and children with the same family and given names were lost to follow-up. The retention rate was 86.7%. Concerning the pubertal development in this study population, we have reported previously that the 3.8% of the girls aged 10–11 years in 1996 and 1997 experienced menarche.22 It was reported that peak height velocity (cm/year) was shown to occur around age 9–10 years in girls and 12–13 years in boys in Japanese children in 1997.23
Examinations
The same protocol was used in all examinations of children aged 10–11 years and 13–14 years. At each examination, height to 0.1 cm and weight to 0.1 kg were measured.24 Measurements of height and body weight were made by Yogo teachers who have a Japanese national educational license, and play a role in health education and healthcare in elementary and junior high schools. Body mass index (BMI, kg/m2) was calculated by dividing the weight (kg) by the height (m) squared. For measurements of systolic blood pressure (SBP) and diastolic blood pressure (DBP), an automated device (BP-103N II, Colin Corporation, Komaki, Japan) was used. Serum TC and serum HDL-C were also measured, and atherogenic index [AI = (TC - HDL-C)/HDL-C] was calculated at each examination. TC was determined enzymatically (Pureauto CHO-N, Daiichi Pure Chemicals Co., Ltd., Tokyo, Japan) using a Hitachi 7350 automatic chemistry analyser. HDL-C was measured by a direct method (Cholestest HDL, Daiichi Pure Chemicals Co., Ltd., Tokyo, Japan) on the same analyser.
Statistical analysis
For analysis of baseline and follow-up levels of the variables measured, 95% CI was used to evaluate the difference between the result of each examination at age 10–11 years and the result of each examination at age 13–14 years. Pearson’s correlation test was employed for expressing a 3-year tracking of serum lipids and anthropometric variables. Simple regression analysis and multiple regression analysis were employed for analysis of cross-sectional association between TC and variables at the two ages. These regression analyses were also employed for analysis of factors predicting the levels of TC at the age of 13–14 years from height, weight, SBP, and DBP at age 10–11 years. Simple and multiple regression analyses were also employed for analysis of relationships between changes in serum lipids and changes in anthropometric variables over a 3-year period. Pearson’s correlation test was also employed for expressing correlation coefficients between changes in TC and changes in height over a 3-year period.
All statistical analyses were performed using StatView (version 5.0, SAS institute Inc., Cary, NC, USA).
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Results |
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Table 1
shows the longitudinal change and relationship over a 3-year follow-up period. In boys, TC level decreased from age 10–11 years to 13–14 years. In addition, there were correlations between baseline and follow-up variables.
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Table 2
shows the cross-sectional associations between TC and variables at two ages, 10–11 years and 13–14 years. At both ages, negative regression coefficients of height and TC were found in both boys and girls.
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Table 3
shows the results of regression analyses for predicting the level of TC in children at age 13–14 years from height, weight, SBP, and DBP at age 10–11 years. Height at 10–11 years was the predicting factor of TC level at 13–14 years, and regression coefficients of height were negative in both genders.
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Table 4
shows the results of regression analyses between change in anthropometric variables and change in serum lipids over a 3-year period. In both genders, a negative association was observed between change in height and change in TC. A negative association was also observed between change in height and change in serum HDL-C in both genders.
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Figure 1
shows the relationship between increase in height and change in TC. Pubertal children who experience a large increase in height tended to show a decrease in serum lipids, and children who experience a small increase in height tended to show an increase in serum lipids in both genders.
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Discussion |
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In boys, TC level decreased from age 10–11 years to 13–14 years. It is acknowledged that serum TC and HDL-C values peak at 9–10 years old, and decrease between 10 and 14 years old in boys.5,6,8,9,12,14,25–28 In addition, there were strong correlations between baseline and follow-up levels of anthropometric variables and serum lipids.
Previously, Orchard et al.29 and Chu et al.30 investigated children aged 12–18 years in cross-sectional studies and reported finding a negative correlation between serum lipid and height in boys. However, they did not demonstrate significant relationships in girls. In contrast, in cross-sectional studies, we demonstrated negative associations between height and TC in not only boys but also girls. In Japanese children, in 1997, the peak height velocity (cm/year) was shown to occur at age 9–10 years in girls and 12–13 years in boys.23 Present subjects aged 10–11 years and 13–14 years were around the peak height velocity. In contrast, subjects in previous reports were older than subjects in the present study. This might be one of the reasons why previous studies could not demonstrate the relationship in girls.
Looking at predictive factors for TC level in children at age 13–14 years, height at age 10–11 years was one of these. In addition, the regression coefficients were negative in both genders.
Further, we investigated the changes in anthropometric variables and serum lipids over a 3-year period, and demonstrated that the relationship of change in TC with change in weight was positive, and that the relationship of change in TC with change in height was negative. These results were consistent with previous reports. Freedman et al.20 conducted a longitudinal study in 78 white boys from age 11–12 years to 16–17 years in the Bogalusa Heart Study, and reported finding an inverse correlation of changes in serum lipids with increase in height. Chiang et al.21 also followed 208 white boys and 189 black boys from age 8–12 years to 13–17 years in the Bogalusa Heart Study, and reported finding a negative correlation between changes in serum lipids and increase in height. However, few previous publications have reported any such an association in girls. In the present result, negative relationships between changes in height and changes in serum lipids were shown in both genders. Thus, pubertal children who experience a large increase in height tended to show a decrease in serum lipids, and children who experience a small increase in height tended to show an increase in serum lipids.
In both genders, TC level in pubertal children is negatively associated with height. Height velocity is inversely associated with dynamic changes in serum lipids during puberty.
KEY MESSAGES
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Acknowledgments |
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This work was supported in part by a grant-in-aid ‘Research on the establishment of a healthy lifestyle from childhood’ from the Ministry of Health and Welfare, Japan. The authors thank the school administration in Iwata City for their help.
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References |
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