How Important is Fasting for Pediatric Routine Cholesterol Screening?

• April 02, 2021
• Andrew Tran, MD

A nonfasting lipid panel is a great first-line screening tool to use. While it is ideal to have a fasting lipid panel, this can be difficult to obtain in practice. For the purposes of screening, I think that it is much more important to go ahead and get the nonfasting lipid panel while the patient is in the clinic rather than delay the screening for a fasting panel and have the patient potentially no-show.

Triglycerides (TG) are the main cholesterol parameter affected by a non-fasting state and can vary greatly between the fasting and non-fasting state. On the other hand, total cholesterol (TC) and HDL-C are not as affected by fasting. Rather than being directly measured, LDL-C is calculated using the Friedewald Formula (LDL-C = TC – [TG/5] – HDL-C) so variations in the TG level will also affect LDL-C. A directly measured LDL-C is also possible to order if needed.

If the non-fasting lipid panel is normal then there is no need for a fasting lipid panel. However, if the non-fasting panel is abnormal, a fasting lipid panel should be obtained to confirm the test.

Since TG and LDL-C are less reliable on the non-fasting panel, non-HDL-C levels (Non-HDL-C = TC – HDL-C) and HDL-C levels are used to determine if the panel is abnormal. If non-HDL-C is ≥145 mg/dL or HDL-C <40 mg/dL, a fasting lipid panel should be obtained.

When to Get a Fasting Lipid Panel

When to Refer
Please see the table below for abnormal fasting cholesterol levels. If the fasting lipid panel is abnormal, patients should attempt diet and lifestyle changes for 6 months with a repeat fasting lipid panel at the end of that time to check for improvement.

Urgent Referrals to Preventive Cardiology

Please also refer if you would like evaluation of cardiovascular risk in patients at ANY cholesterol level in the setting of:
• Family history of early cardiovascular events (males <55 years; females <65 years)
• Predisposing condition: Diabetes, chronic kidney disease, post-Kawasaki disease with coronary aneurysm, heart transplant
• ≥ 2 cardiovascular risk factors such as:

• Hypertension
• Current smoker
• Obesity
• Chronic inflammatory disease

The Preventive Cardiology Program is a multidisciplinary team including dietitians and exercise physiologists committed to helping patients reduce their cardiovascular risk. We have also partnered with the Center for Healthy Weight and Nutrition to care for patients with high cholesterol so all referrals are reviewed to help determine which program would most benefit each patient.

References:

1. National Heart, Lung, and Blood Institute – Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Full Report: U.S. Department of Health and Human Services National Institutes of Health (2012) https://www.nhlbi.nih.gov/files/docs/guidelines/peds_guidelines_full.pdf
2. Nationwide Children’s Hospital Lipid Screening Guidelines in Children and Adolescents https://www.nationwidechildrens.org/specialties/heart-center-cardiology/services-we-offer/programs/preventative-cardiology-clinic

Image credit: Adobe Stock

About the author

Andrew Tran, MD

Dr. Andrew Tran is an assistant professor in The Heart Center at Nationwide Children's Hospital with a focus on Pediatric Cardiology and Preventive Cardiology, helping to care for children with cholesterol disorders and hypertension. Before joining Nationwide Children's, Dr. Tran completed his cardiology fellowship in Dallas, TX at the University of Texas Southwestern and a preventive cardiology fellowship in Cincinnati, OH at Cincinnati Children’s Hospital Medical Center. Dr. Tran is passionate about understanding vascular changes in children with cardiovascular risk factors and being creative in providing cardiovascular preventive care.

• Andrew Tran, MD

  https://pediatricsnationwide.org/author/andrew-tran-md/

  

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