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Lipid, Lipoprotein and APO-A and APO-B Lipoprotein Distribution in Italian and Swiss Schoolchildren

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Lipid, Lipoprotein and APO-A and APO-B Lipoprotein Distribution in Italian and Swiss Schoolchildren Pediatr. Res. 16: 665-669 (1982) Lipid, Lipoprotein and APO-A and APO-B Lipoprotein Distribution in Italian and Swiss Schoolchildren. The Geneva Survey I. OBERHANSLI,'~~'D. POMETTA, H. MICHELI, L. RAYMOND, AND A. SUENRAM Clinique de Pidiatrie et Service de Sanre de la Jeunesse [I. 0.1, Division de Diabirologie, Departement de Medecine [D.P., H.M., A.S.], and Instirut de Medecine Sociale er Preventive, [L.R.] Universite de Gendve, Geneva, Swirzerland Summary born mainly in Switzerland. All of them lived for several years (7-12 yearsj in Geneva and all participants belonged to thLblue and trigl~ceridelipid, lipoprotein as well as a~oli~o-collar class. They were randomly selected from the official school protein A and levels, are presented for Italian and Swiss lists, which indicated the socio-economic and professional status schoolchildren of similar socio-economic origin, living in Geneva, of the head of the family, nationality, birth date and sex. and ranging in age from 8-9 and 14-15 years. From the solicited population approximately % agreed to par- This cross-sectional study revealed some differences associated ticipate in the study. The reason for refusal was the venous with the ethnic origin of the participants. Furthermore subtle punctures for the blood sampling, No differences were found changes were age, with puberty and were between participating and nonparticipating children sex-specific. anthropometric measurements, family history and morbidity. A~O1i~O~rOteinA and levels were found to be significantly Investigations and laboratory examinations were standardized age and less significantly to sex, whereas apolipoprotein according to the WHO protocol with detailed documentation of A levels decrease with puberty, apolipoprotein B levels h~rease the procedure (41). Informed consent was obtained from the slightly. parents of the participants. After a 10-12 h overnight fast, six to Of the 387 Italian and the 416 Swiss participants, 173 Italian eight were examined per morning at the school health and 193 Swiss children had a complete lipoprotein examination service center. ~~i~h~and body weight were measured and a including apolipoprotein determination, whereas serum cholesterol venous blood sample was withdrawn. After breakfast, an extensive and serum triglycerides were studied in the total group. medical, family and nutritional history, including detailed drug history and physical examination including blood pressure and anthropometric measurements were performed. There is increasing evidence that atherosclerotic lesions start in Ninety-eight Italian and 11 1 Swiss boys, 98 Italian and 103 childhood (3, 13, 25, 30, 35). Consequently, primary prevention Swiss girls aged 8-9 years; 96 Italian and 102 Swiss boys, 95 has to begin early in life and affect behavior (diet, smoking, Italian and 100 Swiss girls aged 14-15 years were studied. physical activity, etc.) (4, 11, 22, 23, 37). Lipid and lipoprotein measurements. Cholesterol was measured Among risk factors associated with coronary heart disease and enzymatically after hydrolysis with ethanolic KOH and nonane stroke, LDL cholesterol, VLDL triglyceride, low HDL cholesterol, extraction (33). Triglycerides were determined according to Soloni lipid and lipoprotein concentrations have been shown to correlate (36). closely with the development of atherosclerosis in adults (5, 14, Lipoproteins were separated after preparative ultracentrifuga- 18, 19, 20, 28, 42). tion as previously described (27). In children, precursors of cardiovascular risk factors can be The cholesterol and triglyceride measuring methods had previ- identified. In several countries investigations in this field have ously been standardized by four European laboratories (24); they been recently accomplished (15, 16, 17, 35, 38), but results of were rechecked during the study. plasma lipoprotein lipids have been reported (6, 10, 21,32,40) in Serum apolipoproteins A and B were determined by electroim- limited numbers. munoassay according to Curry et al. (7, 8) using a commercially Apolipoproteins have recently been investigated in adults (1, 2) available "anti-alpha-lipoproteifl serum (Boehhger No. 2792 whereas normal values in children have to our knowledge not yet and No. 3301) and a monospecific "anti-beta-lipoprotein" serum. been published. Specificity and purity of the antisera was checked by immunoe- Differences in lipid and lipoprotein levels have been shown lectrophoresis. With each run, at least two dilutions of a reference among individuals of differeht countries, different races and/or plasma were included; these reference sera had been standardized ethnic groups (10, 14, 18, 21, 24); therefore, it was of interest to against pure HDL and LDL preparations. study the influence of ethnic and environmental factors on serum For HDL the total protein content was referred to as Apo-A lipids, lipoproteins and apolipoproteins A and B in schoolchildren (90-95% of HDL apolipoprotein) whereas the Apo-B concentra- of Italian and Swiss origin, living in Geneva, under comparable tion is given in arbitrary units. socio-economic conditions. Although total plasma cholesterol and total plasma triglyceride determination was carried out in all children, HDL, LDL, VLDL MATERIALS AND METHODS and Apo-A and Apo-B lipoproteins were measured in a randomly selected subgroup of participants: 46 Italian and 48 Swiss boys; 46 Schoolchildren of Italian and Swiss nationality, living in Ge- Italian and 47 Swiss girls aged 8-9 years, as well as in 38 Italian neva, were investigated during the school year 1977-78 at the age and 47 Swiss boys and 43 Italian and 51 Swiss girls aged 14-15 of 13 years 9 months up to 15 years 5 months and at the age of 8 years. years 9 months up to 10 years 5 months. Although most of the Heights and weights were measured in a standardized fashion older Italian participants were born in Italy, the younger were (41): the height in the standing position, without shoes, in centi- 665 666 OBERHANSLI ET AL. meters to the nearest 0.1 cm, the back against a board, eyes Table 1 shows the measurements of central tendency (mean t- looking straight ahead with a set square resting on the scalp and S.D.) and selected positional values (percentiles) for serum and against the board. The weight was measured in kilograms to the lipoproteins cholesterol and triglyceride lipoproteins, presented nearest 0.1 kg, the subjects wearing only light underwear and no for the combined Italian and Swiss boys and girls of the two age shoes. The scales were calibrated to zero before the beginning of groups. each days screening. The ponderal index used was the Quetelet There are only slight variations between the mean and the 50th weight in kg percentile values. index: x 1000 (height in ~m)~ Comparative results of Apo-A and Apo-B lipoproteins are The statistical package for the socal sciences was used for the shown in Table 2 together with the Quetelet ponderal index, total statistical analysis. serum cholesterol and triglycerides as well as HDL cholesterol To assess differences between Italian and Swiss children a values for children in whom the complete study of all lipoprotein covariance analysis was performed. fractions was performed. Some minor differences in apolipopro- Serum triglyceride, VLDL triglycerides and VLDL cholesterol teins between Swiss and Italian children were statistically not values were expressed in natural logarithmic transformation. significant. Age-related differences were observed in both ethnic groups: RESULTS serum cholesterol and lipoprotein cholesterol levels are higher in the 8-9-year-old children than in the 14-15-year-old. Serum tri- The mean values for total serum cholesterol and lipoprotein glyceride and lipoprotein triglycerides are lower in the younger cholesterol (HDL, LDL, VLDL) as well as for total serum triglyc- age group than in 14-15-year-old girls and boys and increased erides and lipoprotein triglycerides (HDL, LDL, VLDL) were with age. compared between Italian and Swiss participants of the same sex Sex differences are observed in Italian and Swiss children of and age. both age groups. The girls show higher serum lipoprotein choles- Total serum cholesterol and total serum triglyceride measure- terol and triglyceride levels. ments tend to be higher in Swiss schoolchildren; however, statis- Apolipoprotein A values were markedly lower in the 14-15- tical significance is reached only for the triglycerides of the 14-15- year-old children of both ethnic origins than in the 8-9-year-old, year-old group and the 8-9-year-old girls (Fig. 1-4). High serum whereas apolipoprotein B levels showed a tendency to be lower in triglyceride levels reflect an increase of both VLDL and LDL the younger children. Apolipoproteins A and B have no significant triglyceride in boys and in girls. sex specific differences in the Geneva study group. Serum- and Lipoprotein Cholesterol Serum- and Lipoprotein Cholesterol in 8-9 year old children in 14-15 year old children g/l Q d (meant SEMI mmolll (mean 2 SEM) rnmolll Serum-C VLDL-C LDL-C HDL-C Serum-C VLDL-C LDL-C HDL-C Fig. 1 Fig. 3 Serum- and Lipoprotein Triglycerides Serum- and Lipoprotein Triglycerides in 8-9 year old children in 14-15 year old children (meant SEMI (mean 2 SEMI 0 Itallan mm0lll Q cf EB s~155 P'OOI mmOlll mmo~~~ 0.8 0 8 0.L 0 L 0 L5 L8 L5 L8 15 L8 O 95 100 96 102 13 51 18 L7 13 51 38 67 13 51 38 17 Serum-T VLDL-T LDL-T HDL-T Serurn-T VLDL-T LDL-T HDL-T Fig. 2 Fig. 4 Fig. 1-4. Serum and lipoprotein cholesterol and serum and lipoprotein triglyceride values in Italian and Swiss schoolchildren are shown, separated according to sex, ethnic group and age. The colums indicate the mean values + 1 S.E. of the mean (SE). The numbers show the analyses in participants done for each group.
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