In a study of urban middle school students, cardiovascular risk screening revealed high rates of dyslipidemia and abnormal hemoglobin A1c (HbA1c) levels, including 2 cases of diabetes. The pilot study, published in the Journal of Pediatrics, provides additional evidence supporting the routine screening of older school-age children for cardiovascular risk factors.
Despite recommendations from the American Academy of Pediatrics and the American Heart Association in favor of screening for weight status, abnormal lipid profiles, and diabetes in children, few are receiving screening in routine primary care. To better understand the feasibility of comprehensive cardiovascular screening in a school setting, researchers conducted a pilot study in which 45 students (mean age, 13.7 years) at a single middle school were assessed for several cardiovascular risk factors. Screening of students was performed at the beginning of the school day, during which a nonfasting blood sample was taken to measure HbA1c, total cholesterol, high-density lipoprotein cholesterol, and triglycerides.
The results showed that 42% of children were overweight/obese (body mass index [BMI] ≥85th percentile for age and sex) and 34.8% had a lipid level or HbA1c out of the normal range. There were no significant differences in laboratory values between students with normal vs high BMI. With regard to lipid profiles, 2 students had a total cholesterol level >200 mg/dL with low-density lipoprotein cholesterol >140 mg/dL.
The researchers found that 2 students had HbA1c >5.6%. After evaluation by a pediatric endocrinologist, 1 case (normal BMI, HbA1c 8.5%) was diagnosed as maturity onset diabetes of the young type 1 and the other case (BMI >99th percentile, HbA1c 8.8%) was diagnosed as type 2 diabetes.
The study’s results are somewhat limited because of a low screening rate and the students’ ages being slightly higher than those recommended for universal lipid screening (9-11 years) and diabetes screening (10 years).
Despite these limitations, the researchers concluded that the “‘1-building’ approach of using the middle school where all children of the same age are together worked well… there are potential advantages that make screening in the middle school setting attractive such as the inherent efficiency of having a large number of children clustered in 1 setting for the testing.”
Siegel RM, Strasser K, Faust M, Hudgens M, Robison D, Urbina EM. A pilot study of school-based comprehensive cardiovascular screening in middle school children [published online March 15, 2019]. J Pediatr. doi:10.1016/j.jpeds.2019.01.034