Titis Prawitasari

Nutrition & Metabolic Disease Working Group

 Screening definition & principles

 Magnitude of dyslipidemia

 Etiologies & risk factors of dyslipidemia

 To screen or not?

 Suggestion & recommendation

 SCREENING: the presumptive identification of unrecognized disease
or defect by the application of tests, examinations, or other procedures
which can be applied rapidly
 MASS/UNIVERSAL SCREENING: used to indicate the large-scale
screening of whole population groups
 SELECTIVE SCREENING: term for the screening of selected high-risk
groups in the population
 SURVEILLANCE ≠ SCREENING

 Surveillance means closely monitor

1. The condition sought should be an
important health problem
2. There should be an accepted
treatment for patients with
recognized disease
3. Facilities for diagnosis and
treatment should be available
4. There should be a recognizable
latent or early symptomatic stage
5. There should be a suitable test or
examination
6. The test should be acceptable to
the population
7. The natural history of the
condition should be adequately
understood
8. There should be an agreed
policy on whom to treat as
patients
9. The cost of case-finding should
be economically balanced in
relation to possible expenditure
on medical care as a whole
10. Case-finding should be a
continuing process and not a
"once and for all" project
 A set of conditions that include several monogenic disorders as
well as dyslipidemias caused by a variety of factors, both genetic
and environmental

 Abnormal level of lipid and lipoprotein

 based on age, gender and others (race & genetic disorders)

 primary or secondary caused (mostly obesity)

 Elevations in TC and LDL-C concentrations in children and adolescents
are important
 role of these lipids in cardiovascular disease in adults and in atherogenesis
even at young ages
 Elevated LDL-C and TC concentrations appear to be associated with
measures of adiposity, such as body mass index (BMI) and waist
circumference.5
 however, the strongest association of BMI is with triglyceride concentrations

 Non–HDL cholesterol has emerged as the best marker of atherogenic risk

in adults
 non–HDL-C = the difference between TC concentration and the HDL-C
concentration
Riskesdas 2013
Riskesdas 2013
 HIPERKOLESTEROLEMIA
pada remaja dan dewasa muda
kolesterol total kolesterol LDL

23 KT > 170 19 LDL > 110

40 KT < 170 [VALUE LDL < 110
]

• Riwayat orang tua PJK ≤ 55 tahun.

• 97% mempunyai lebih dari 1 Faktor risiko

Andriastuti, et al, 2002

• High = > 95th percentile; by age & gender
• Sensitivity 50-69% and specificity 90-98% to predict LDL-C
elevation in adult
 NCEP, 1992: against universal screening, but the panel recommended selective screening
based on a family history of premature CHD, first with TC concentrations and second, if TC
concentrations were elevated, obtaining a fasting lipid panel (repeated if abnormal).
 USPSTF, 2007: insufficient evidence to recommend for or against either routine selective or
universal screening of infants, children, adolescents, or young adults up to age 20 years, and
cited a lack of evidence
 AAP, 2008: recommended that treatment with bile-sequestering agents, statins, cholesterol
absorption inhibitors, or fibrates be considered for those age 8 years and older who had:
 1. LDL-C concentrations greater than 190 mg/dL, 2. LDL-C concentrations greater than160 mg/dL with
family history of CHD and cardiac risk factors, or 3. LDL-C concentrations greater than 130 mg/dL and
diabetes
 NHLBI, 2011: two-step screening, in which children with an initial fasting LDL-C concentration
greater than 130 mg/dL undergo a second fasting LDL-C measurement; the two measurements
are averaged, and children with values greater than 130 mg/dL are treated for dyslipidemia.
 the panel recommended the CHILD-2 diet, increasing physical activity, reducing screen time, and
consideration of the use of plant stanols and sterols and psyllium
 Fasting plasma lipid concentrations change during childhood and
adolescence and differ with sex and age
 Insufficient evidence to recommend for or against either routine
selective or universal screening of infants, children, adolescents
 No direct effects evidence on treatment or health outcomes

 Selective screening might have benefit for 2-18 years children with:
 Family history of myocardial infarction, stroke, peripheral arterial disease prior
to age 55 years in men or 65 years in women in parents or grandparents
 Family history of elevated TC > 240 mg/dL
 Other CV risks factor: hypertension, DM, cigarette smoking, obesity