ORIGINAL ARTICLE Prevalence of dyslipidaemia and associated risk factors among Balearic Islands adolescents, a Mediterranean region MM Bibiloni 1 , R Salas 2 , A Pons 1 and JA Tur 1 BACKGROUND/OBJECTIVES: The increase in overweight and obese children and adolescents may be linked to increased rates of dyslipidaemia. The aim was to assess the prevalence of dyslipidaemia and associated risk factors among the Balearic Islands’ adolescent population. SUBJECTS/METHODS: A random sample (n = 362, 143 boys and 219 girls, aged 12–17 years) was interviewed, anthropometrically measured and fasting blood samples taken. According to the 2011 Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents, dyslipidaemia was defined as the presence of one or more of the following levels (mg/dl): total cholesterol (TChol) ⩾ 200, low-density lipoprotein cholesterol (LDL-chol) ⩾ 130, non-high-density lipoprotein cholesterol (non-HDL-chol) ⩾ 145, high-density lipoprotein cholesterol (HDL-chol) o40 and tryglicerides (TG) ⩾ 130. RESULTS: The overall prevalence of borderline-high+high TChol, LDL-chol, non-HDL-chol and TG was 24.3, 10.4, 13.3 and 14.9%, respectively. The TChol prevalence was higher among girls (27.8%) than the boys (19.1%). The overall prevalence of borderline-low +low HDL-chol was 12.2% (boys 20.7%; girls 6.3%). The overall prevalence of dyslipidaemia was 13.7% (boys 14.9%; girls 12.9%). Low HDL-chol levels were the most prevalent dyslipidaemia in boys (6.4%) and high TChol in girls (9.1%). Overweight/obese subjects were more likely to have at least one abnormal lipid concentration (odds ratio (OR): 2.10; 95% confidence interval (CI): 1.06–4.15) and subjects with abdominal obesity were more likely to have at least one abnormal lipid level (OR: 3.17; 95% CI: 1.04–9.66). CONCLUSIONS: One in ten Balearic Islands’ adolescents has at least one abnormal lipid concentration. Body mass index status and waist-to-height ratio were associated with the prevalence of at least one abnormal lipid level. European Journal of Clinical Nutrition (2015) 69, 722–728; doi:10.1038/ejcn.2014.236; published online 29 October 2014 INTRODUCTION Cardiovascular disease is a major cause of morbidity and mortality worldwide. Atherosclerosis is the major cause of cardiovascular disease (that is, myocardial infarction, stroke, peripheral vascular disease and aortic aneurysm), 1,2 which does not usually develop until middle age, although it begins in childhood. 3,4 The major risk factors for atherosclerosis are hypertension, smoking, diabetes and dyslipidaemia. Dyslipidaemia is an abnormal amount of lipid (that is, cholesterol and fatty acids) and/or lipoprotein in the blood that may be related to other diseases (secondary dyslipidaemia) or to the interaction between genetic predisposition and environ- mental factors, such as unhealthy diet, lack of physical activity and/or weight gain, 5 the most common of which is obesity. 6 The prevalence of overweight and obesity among 12–17-year-old adolescents in Balearic Islands was 17.5 and 10.4%, respectively. 7 The increase in overweight and obesity in children and adolescents, a major health problem in these age ranges, may be linked to increased rates of dyslipidaemia. 6,8 There is no evidence that diagnosis and treatment in childhood and adolescence improves long-term primary outcomes; however, several previous studies have shown that ~ 50% of children with high lipid and lipoprotein levels, abnormal levels will persist over time. 9–12 Adverse serum lipid levels in children predict dyslipidaemia in adulthood and adverse levels of non-high- density lipoprotein cholesterol (non-HDL-chol) are also related to non-lipid cardiovascular risk factors in adulthood. 13 Therefore, the aim of this study was to assess the prevalence of dyslipidaemia and associated risk factors among adolescents (12–17 year-olds) living in the Balearic Islands, a Mediterranean region. MATERIALS AND METHODS Study design The study is a population-based cross-sectional nutritional survey carried out (2007–2008) in the Balearic Islands (Spain), a Mediterranean region. Selection of participants, recruitment and approval This study is part of a larger research project in which the target population solely consisted of inhabitants aged between 12–17 years old living in the Balearic Islands, which has been described in more detail elsewhere. 7,14 The sample population was taken from 12–17-year-old residents registered on the Balearic Islands’ school census. The sampling technique included stratification according to the size of the town, the age and gender of the inhabitants and randomisation into sub-groups, with Balearic Islands’ municipal districts being the primary sampling units, and individuals within these municipal districts making up the final sample units. Participants were invited to provide blood samples in order to determine the biochemical parameters. Three hundred and sixty-two subjects took part in the biochemical phase, and this sample size was considered enough to detect risk factors with 95% confidence and a precision rate of 5.1%. The reasons for not taking part were (a) the subject 1 Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, IdISPa, and CIBERobn (Physiopathology of Obesity and Nutrition CB12/03/30038), Palma de Mallorca, Spain and 2 Faculty of Public Health Nutrition, Autonomous University of Nuevo León, Monterrey, Mexico. Correspondence: Professor Dr JA Tur, Research Group on Community Nutrition and Oxidative Stress, Universitat de les Illes Balears, GuillemColom Bldg, Campus, Palma de Mallorca E-07122, Spain. E-mail: pep.tur@uib.es Received 21 May 2014; revised 16 September 2014; accepted 24 September 2014; published online 29 October 2014 European Journal of Clinical Nutrition (2015) 69, 722 – 728 © 2015 Macmillan Publishers Limited All rights reserved 0954-3007/15 www.nature.com/ejcn