U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

NCHS Data Brief ■ No. 228 ■ December 2015

Abnormal Cholesterol Among Children and Adolescents

in the United States, 2011–2014

Duong Nguyen, D.O.; Brian Kit, M.D., M.P.H.; and Margaret Carroll, M.S.P.H.

Key findings 

Data from the National 

Health and Nutrition 

Examination Survey

● One in five youths had 

high total cholesterol, low 

high-density lipoprotein (HDL) 

cholesterol, or high non-HDL 

cholesterol.

● Prevalence of low HDL 

cholesterol (13.4%) was greater 

than high non-HDL cholesterol 

(8.4%) or high total cholesterol 

(7.4%). 

● Prevalence of high total 

cholesterol, low HDL 

cholesterol, and high non-HDL 

cholesterol was greater in 

adolescents than children. 

● Girls had higher prevalence 

than boys for high total 

cholesterol and high nonHDL cholesterol, but lower 

prevalence for low HDL 

cholesterol.

● Youth with obesity had 

greater prevalence of high 

total cholesterol, low HDL 

cholesterol, and high non-HDL 

cholesterol than youth of 

normal weight.

Cardiovascular disease (CVD) is a leading cause of death among adults in the 

United States. To improve the cardiovascular health of the U.S. population, 

clinical practice guidelines (1,2) recommend screening children and 

adolescents for risk factors associated with CVD, including abnormal blood 

cholesterol levels. This report provides 2011–2014 estimates from the National 

Health and Nutrition Examination Survey (NHANES) on the prevalence of 

high total cholesterol, low high-density lipoprotein (HDL) cholesterol, and 

high non-HDL cholesterol among children and adolescents aged 6–19.

Keywords: Total cholesterol • HDL cholesterol • non-HDL cholesterol • NHANES

What percentage of children and adolescents had high total 

cholesterol during 2011–2014?

The prevalence of high total cholesterol among U.S. children and adolescents 

was 7.4% (Figure 1). The prevalence of high total cholesterol was greater 

Figure 1. Prevalence of high total cholesterol among children and adolescents aged 6–19 years 

by age, sex, race and Hispanic origin, and body mass index: United States, 2011–2014

 

2

Significantly different from boys (p < 0.05). 3

Significantly different from Hispanic (p < 0.05). 4

Significantly different from non-Hispanic white (p < 0.05). 5

Significantly different from normal weight and overweight (p < 0.05).

NOTES: High total cholesterol is 200 mg/dL or more. Body mass index percentiles were categorized as at or above 5th up to

85th (normal weight), at or above 85th up to 95th (overweight), and at or above 95th (obese).

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2014.
NCHS Data Brief ■ No. 228 ■ December 2015

■  2  ■

among adolescents aged 16–19 (8.9%) than children aged 6–8 (6.0%). The prevalence of 

high total cholesterol was lower in boys (5.9%) than in girls (8.9%). The prevalence of high 

total cholesterol was greater among non-Hispanic black and non-Hispanic Asian children and 

adolescents and lower among non-Hispanic white and Hispanic children and adolescents. The 

prevalence of high total cholesterol was greater in children and adolescents with obesity (11.6%) 

than in those of normal weight (6.3%) and in those who were overweight (6.9%).

What percentage of children and adolescents had low HDL cholesterol 

during 2011–2014?

Overall, 13.4% of all children and adolescents had low HDL cholesterol (Figure 2). There was 

an increasing age trend in the prevalence of low HDL cholesterol, from 7.7% for children aged 

6–8 to 18.4% for adolescents aged 16–19. Boys (14.8%) had a higher prevalence of low HDL

cholesterol than girls (12.0%). Both non-Hispanic black (7.4%) and non-Hispanic Asian (8.2%) 

children and adolescents had a lower prevalence of low HDL cholesterol than non-Hispanic white 

(14.4%) or Hispanic (15.6%) children and adolescents. The prevalence of low HDL cholesterol 

increased with increased body mass index (BMI). Furthermore, the prevalence of low HDL

cholesterol among children and adolescents with obesity (33.2%) was almost five times higher 

than for children and adolescents of normal weight (6.8%).

Figure 2. Prevalence of low HDL cholesterol among children and adolescents aged 6–19 years by age, sex, race and 

Hispanic origin, and body mass index: United States, 2011–2014

 

Statistically significantly linear trend (p < 0.05). 2

Significantly different from boys (p < 0.05). 3

Significantly different from non-Hispanic white (p < 0.05). 4

Significantly different from Hispanic (p < 0.05).

NOTES: HDL is high-density lipoprotein. Low HDL cholesterol is less than 40 mg/dL. Body mass index percentiles were categorized as at or above 5th to

less than 85th (normal weight), at or above 85th to less than 95th (overweight), and at or above 95th (obese).

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2014.
NCHS Data Brief ■ No. 228 ■ December 2015

■  3  ■

What percentage of children and adolescents had high non-HDL 

cholesterol during 2011–2014?

The overall prevalence of high non-HDL cholesterol among children and adolescents was 8.4% 

(Figure 3). The prevalence of high non-HDL cholesterol among adolescents aged 16–19 was 

higher than among children and adolescents aged 6–8, 9–11, and 12–15, and no differences were 

seen between children and adolescents in the other age groups. The prevalence of high non-HDL 

cholesterol was greater in girls (9.4%) than in boys (7.5%), but did not differ among race and 

Hispanic origin groups. High non-HDL cholesterol prevalence increased with increased BMI, 

and the prevalence among children and adolescents with obesity (16.7%) was almost three times 

higher than children and adolescents of normal weight (5.7%).

Figure 3. Prevalence of high non-HDL cholesterol among children and adolescents aged 6–19 years by age, sex, race 

and Hispanic origin, and body mass index: United States, 2011–2014

1

Significantly different from ages 6–8, 9–11, and 12–15 (p < 0.05). 2

Significantly different from boys (p < 0.05). 3

Statistically significant linear trend (p < 0.05).

NOTES: HDL is high-density lipoprotein. High non-HDL cholesterol is at or above 145 mg/dL. Body mass index percentiles were categorized as at or above

5th to less than 85th (normal weight), at or above 85th to less than 95th (overweight), and at or above 95th (obese).

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2014.
NCHS Data Brief ■ No. 228 ■ December 2015

■  4  ■

What percentage of children and adolescents had at least one abnormal 

cholesterol measure during 2011–2014?

Overall, 21.0% of children and adolescents in the United States had high total cholesterol, low 

HDL cholesterol, or high non-HDL cholesterol (Figure 4). The prevalence of having at least 

one abnormal cholesterol measure increased with age (14.3% for children aged 6–8 to 26.9% 

for adolescents aged 16–19). No difference was seen in the prevalence of having at least one 

abnormal cholesterol measure between boys (20.9%) and girls (21.0%). Non-Hispanic black 

children and adolescents had a lower prevalence of having at least one cholesterol abnormality 

(17.8%) than non-Hispanic white (21.5%) and Hispanic (22.3%) children and adolescents. The 

prevalence of having at least one abnormal cholesterol measure increased with increased BMI, 

and the prevalence among children and adolescents with obesity (43.3%) was more than three 

times higher than among children and adolescents of normal weight (13.8%). 

Figure 4. Prevalence of high total cholesterol, low HDL cholesterol, or high non-HDL cholesterol among children and 

adolescents aged 6–19 years by age, sex, race and Hispanic origin, and body mass index: United States, 2011–2014 

1

Statistically significantly linear trend (p < 0.05). 2

Significantly different from non-Hispanic white (p < 0.05). 3

Significantly different from Hispanic (p < 0.05).

NOTES: HDL is high-density lipoprotein. High total cholesterol is at or above 200 mg/dL, low HDL cholesterol is less than 40 mg/dL, and high non-HDL 

cholesterol is at or above 145 mg/dL. Body mass index percentiles were categorized as at or above 5th to less than 85th (normal weight), at or above 85th to

less than 95th (overweight), and at or above 95th (obese).

SOURCE: CDC/NCHS, National Health and Nutrition Examination Survey, 2011–2014.
NCHS Data Brief ■ No. 228 ■ December 2015

■  5  ■

Summary

Approximately one out of five children and adolescents (21%) had at least one abnormal 

cholesterol measure (high total cholesterol, low HDL cholesterol, or high non-HDL cholesterol). 

Of the three cholesterol measures examined in this report, low HDL cholesterol was the most 

common abnormality. In general, prevalence of high total cholesterol, low HDL cholesterol, 

and high non-HDL cholesterol was greater in adolescents aged 16–19 compared with children 

aged 6–8. Children and adolescents with obesity had the highest prevalence for all cholesterol 

measures examined, most notably with low HDL cholesterol where prevalence was five times 

greater among those with obesity than for those of normal weight, similar to previous studies (3). 

Some CVD risk factors, including cholesterol, track from childhood into adulthood (4). To 

identify children with abnormal cholesterol values, clinical practice guidelines endorsed by the 

American Academy of Pediatrics recommend monitoring cholesterol for all children, including 

those aged 9–11 years (1,2). In this analysis, 7.4% of children and adolescents aged 6–19 had 

high total cholesterol. Continued monitoring of abnormal cholesterol levels among children and 

adolescents may inform public health interventions to promote long-term cardiovascular health 

and prevent CVD in adulthood.

Definitions

BMI categories: Calculated as weight in kilograms divided by height in meters squared, rounded 

to one decimal place. The age- and sex-specific percentiles of the 2000 CDC growth charts (5) 

were used to categorize BMI. BMI percentiles were categorized as follows: at or above 5th to less 

than 85th (normal weight), at or above 85th to less than 95th (overweight), and at or above 95th 

(obese).

High non-HDL cholesterol: Serum non-HDL cholesterol at or above 145 mg/dL (1). 

High total cholesterol: Serum total cholesterol at or above 200 mg/dL (1). 

Low HDL cholesterol: Serum HDL cholesterol less than 40 mg/dL (1). 

Data source and methods

Data from the 2011–2012 and 2013–2014 NHANES were used for these analyses. NHANES, 

conducted by the Centers for Disease Control and Prevention’s (CDC) National Center for Health 

Statistics (NCHS), is a cross-sectional survey designed to monitor the health and nutritional 

status of the civilian noninstitutionalized U.S. population. The NHANES sample is selected 

through a complex, multistage, probability design. In 2011–2012 and 2013–2014, non-Hispanic 

black, non-Hispanic Asian, and Hispanic persons, and other groups, were oversampled to obtain 

reliable estimates for these population subgroups. The survey consists of interviews conducted in 

participants’ homes and standardized physical examinations, including collection of laboratory 

specimens, conducted in mobile examination centers. Further details regarding NHANES 

protocols and procedures, including laboratory methods, are available elsewhere (6). Data files 

for public use are released in 2-year cycles (6).
NCHS Data Brief ■ No. 228 ■ December 2015

■  6  ■

Statistical analyses were conducted using SAS-callable SUDAAN (SAS version 9.3, SAS 

Institute, Cary, N.C.; SUDAAN, version 10.0, RTI, Research Triangle Park, N.C.) which 

estimates standard errors using Taylor Series Linearization to account for the complex sample 

design. NHANES examination sample weights were used to account for differential probability 

of selection, noncoverage, and nonresponse to produce national estimates of the civilian 

noninstitutionalized U.S. population. Participant ages were based on age at time of examination. 

Analysis is based on measured cholesterol levels only and does not take into account whether 

cholesterol-lowering medications were used. Pregnant females were excluded from analyses. To 

maintain confidentiality, data on pregnancy status for females younger than 20 is not publicly 

released, but may be accessed by contacting the NCHS Research Data Center. Differences 

between groups were tested using a t statistic at the 0.05 level. All differences reported are 

statistically significant unless otherwise indicated. To test for linear trends, the null hypothesis of 

no linear trend was examined using orthogonal polynomials. 

About the authors 

Duong T. Nguyen is with CDC’s Epidemic Intelligence Service assigned to the National Center 

for Health Statistics, Division of Health and Nutrition Examination Surveys. Brian K. Kit and 

Margaret D. Carroll are also with CDC’s National Center for Health Statistics, Division of Health 

and Nutrition Examination Surveys.
NCHS Data Brief ■ No. 228 ■ December 2015

■  7  ■

References

1. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in 

Children and Adolescents. Summary report. Pediatrics 128 Suppl 5:S213-56. 2011.

2. Committee on Practice and Ambulatory Medicine 2013–2014 and Bright Futures Periodicity 

Schedule Workgroup. 2015 recommendations for preventive pediatric health care. Pediatrics 

136(3):e727. 2015. 

3. Kit BK, Kuklina E, Carroll MD, Ostchega Y, Freedman DS, Ogden CL. Prevalence of and 

trends in dyslipidemia and blood pressure among US children and adolescents, 1999–2012. 

JAMA Pediatr 169(3):272-9. 2015.

4. Webber LS, Srinivasan SR, Wattigney WA, Berenson GS. Tracking of serum lipids 

and lipoproteins from childhood to adulthood. The Bogalusa Heart Study. Am J Epidemiol 

133(9):884-99. 1991.

5. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, et al. 2000 

CDC Growth Charts for the United States: Methods and development. National Center for Health 

Statistics. Vital Health Stat 11(246). 2002.

6. National Center for Health Statistics. National Health and Nutrition Examination Survey: 

NHANES 2011–2012. Hyattsville, MD. Available from:

http://wwwn.cdc.gov/nchs/nhanes/search/nhanes11_12.aspx.
NCHS Data Brief ■ No. 228 ■ December 2015

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284

Suggested citation

Nguyen DT, Kit BK, Carroll MD. Abnormal 

cholesterol among children and adolescents 

in the United States, 2011–2014. NCHS data 

brief, no 228. Hyattsville, MD: National 

Center for Health Statistics. 2015.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health and Nutrition 

Examination Surveys

Kathryn S. Porter, M.D., M.S., Director

Ryne Paulose, Ph.D., Associate Director for 

Science

For e-mail updates on NCHS publication 

releases, subscribe online at: 

http://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information

about NCHS:

Tel: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

Internet: http://www.cdc.gov/nchs

Online request form: http://www.cdc.gov/

cdc-info/

ISSN 1941–4927 Print ed.

ISSN 1941–4935 Online ed.

DHHS Publication No. 2016–1209

CS261200

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 5419

Hyattsville, MD 20782–2064

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

For more NCHS Data Briefs, visit:

http://www.cdc.gov/nchs/products/databriefs.htm.