Contemporary paediatric lipid percentiles in 5–14-year-olds: a population-based cross-sectional analysis

Background Atherosclerosis begins in childhood, and progression as well as later cardiovascular risk is related to cumulative exposure to plasma low-density lipoprotein cholesterol (LDL-C). Early detection of elevated LDL-C is therefore critical to prevent premature atherosclerotic disease. Objective To describe contemporary age- and sex-specific distributions and percentile curves of LDL-C (and total cholesterol) in children aged 5–14 years undergoing lipid testing within routine preventive care. Methods This cross-sectional analysis used data from a population-based familial hypercholesterolaemia (FH) screening initiative integrated into routine paediatric preventive care. Children aged 5–14 years underwent capillary or venous blood sampling during statutory well-child visits. Total cholesterol (TC), LDL-C, and HDL-C were measured centrally. Smoothed age- and sex-specific percentile curves were generated using generalized additive models for location, scale and shape (GAMLSS). Associations between age and LDL-C were assessed using linear regression. Results In total, 19,222 children were included (9,952 boys; 9,270 girls; median age 9 years). Median LDL-C was 86.7 mg/dL (IQR 30.6) in boys and 90.2 mg/dL (IQR 31.3) in girls. Age was positively associated with LDL-C (β = 0.24 mg/dL per year, 95% CI 0.12–0.36; p < 0.001), but explained little variance (R² = 0.001). Overall, 1,361 children (6.9%) had LDL-C ≥130 mg/dL, 329 (1.7%) ≥160 mg/dL, and 116 (0.6%) ≥190 mg/dL. The LDL-C 95th percentile in boys was 129.0 mg/dL at 5 years and 134.0 mg/dL at 14 years; in girls, 133.0 mg/dL and 138.0 mg/dL, respectively. Among children with body mass index above the age-specific 95th percentile, median LDL-C was 95.5 mg/dL versus 88.2 mg/dL in those below the 95th percentile. Conclusion These data provide large contemporary reference percentiles for LDL-C and total cholesterol in European children aged 5–14 years. They offer a benchmark for clinical decision-making and support universal paediatric lipid screening as a cornerstone of early cardiovascular prevention.