ABC | Volume 114, Nº1, January 2019

Original Article Gomes et al. Characterization of dyslipidemias in the youth Arq Bras Cardiol. 2020; 114(1):47-56 segment in Campinas. 9 However, there are still gaps regarding their characterization in regional terms. Thus, this study was designed to characterize the frequencies, types and severity of dyslipidemias in children and adolescents attended at the Basic Health Units (UBS) in Campinas, SP. Methods This is a retrospective cross-sectional study based on monthly lipid profile databases, which were periodically sent to the Lipid Laboratory of the School of Medical Sciences of UNICAMP through an academic agreement with the Municipal Health Department of Campinas. Between 2008 and 2015 312,650 results of serum laboratory tests were obtained from 62,530 individuals of both sexes, aged between one day and 19 years who visited UBS in the city of Campinas, SP, for medical outpatient care. The UBS are distributed over five regions or health districts of the city. Only individuals with measured serum lipid profile were included in the study, with the following parameters: TC, triglycerides (TG), LDL-C, high-density lipoprotein cholesterol (HDL-C) and non-HDL-C (NHDL-C). These analyses were performed by enzymatic-colorimetric and/or direct homogenous methods for LDL, according to the quality control standards of the Brazilian Society of Clinical Pathology, including the blood collection stage in the UBS. NHDL-C was calculated. 10 A single chemical analyzer, Modular® Analytics Evo (Roche Diagnostics, Burgess Hill, West Sussex, UK), and reagents fromRoche Diagnostics® (Mannheim, Germany) were used during the study period. Dyslipidemias were classified biochemically in consonance with the cut-off values for age advocated by the current DBD 3 as: isolated increases of LDL-C, TG, NHDL or reductions of HDL-C; mixed dyslipidemias, defined as lipid combinations of increased LDL-C and TG and/or increased LDL-C and reduced HDL-C and/or increased TG and reduced HDL-C. We used the reference values of Kwiterovich PO 11 for infants (children from one day to 23 months of age), once there are no DBD recommendations for this age group, except for TG in the 0-9 years of age group. For NHDL-C in all age groups, also absent in DBD recommendations, the desirable and undesirable values (<123 and ≥144) of Kwiterovich PO were used as well. In order to determine the groups of children (2-11 years of age) and adolescents (12 to 19 years of age) we followed the Brazilian Child and Adolescent Statute definitions (Law n°. 8.069/90 updated with Law no. 12.010 of 2009), with adaptation of the upper limit for adolescents because of DBD, and the recommendations therein, between two and 19 years of age. 3 The cut-off values (mg/dL) used as desirable and undesirable are shown in Table 1. Lipid profiles were also evaluated for LDL-C ≥ 190 mg/dL, without concomitant hypertriglyceridemia, for laboratory characterization of possible cases of Familial Hypercholesterolemia (FH). 10 The city of Campinas is a Sao Paulo inland city that has approximately 1.1 million residents, 12 with 63 UBS distributed over five health districts: East (E), Northwest (NW), North (N), Southwest (SW) and South (S). 13 Statistical analysis The variables, either continuous or categorical, were analyzed using descriptive and comparative tests in software SPSS 24.0 (SPSS Inc., USA) and SAS 9.4 (Inc, Cary, NC, USA). Since there was only one lipid profile available for some individuals and for others several were available during the study, only a single and first lipid profile per year were used in the study period (2008-2015). Tests were performed to verify the normality of data distribution (Kolmogorov-Smirnov). The groups were then compared by the Mann-Whitney and Kruskal-Wallis tests with Bonferroni post-test, with data presented as median and interquartile ranges for the continuous variables, and chi-square (X 2 ) test with the post-test for multiple comparisons in contingency tables based on permutations for categorical variables. Values of p < 0.05 were considered significant. Results Figure 1 shows the distribution of the five health districts of Campinas with the respective numbers observed for Table 1 – Reference values for lipids and lipoproteins in children and adolescents Lipidic variables Values (mg/dL) Desirable Undesirable (1 day to 23 months) Undesirable (2 to 19 years) TC < 170 ≥ 200 ≥ 170 LDL-C < 110 ≥ 130 ≥ 110 NHDL-C < 123 ≥ 144* - TG 0-9 years < 75 ≥ 100 ≥ 75** 10-19 years < 90 ≥ 130 ≥ 90 HDL-C > 45 < 35 ≤ 45 Reference values for 1 day to 23 months old: *NHDL-C ≥ 144 1 day to 19 years old.**TG ≥ 75 according to current DBD. TC: total cholesterol; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; NHDL-C: non high-density lipoprotein cholesterol; TG: triglycerides. 48