title: Universal Cholesterol Screening in Childhood: A Systematic Review.
abstract: In 2011, a US expert panel recommended universal cholesterol screening for children ages 9 to 11 years. Controversy exists over this recommendation, especially because the most recent systematic review on universal childhood screening was inconclusive.
  
  
  
  To conduct an updated systematic review on universal cholesterol screening in childhood and effect on health outcomes, clinical management, screening acceptability, and healthcare costs.
  
  
  
  We searched MedLine, EMBASE, Psychinfo, and the Cochrane Registry of Controlled Trials from October 2005 to January 2016. We added new studies identified to those from the previous systematic review (1966-September 2005).
  
  
  
  We included controlled trials, pre-post, cohort, survey, and qualitative studies of universal cholesterol screening in children ages 0 to 18 years.
  
  
  
  Two independent reviewers assessed abstracts and full-text studies, extracted data, and ranked quality. Cost data were inflation-adjusted to 2015 dollars.
  
  
  
  Nine new studies met inclusion criteria, taking the total number of relevant studies to 21. Screening was associated with no change in cholesterol in 1 of 1 study on health outcomes. A positive screen for dyslipidemia was associated with diet and/or exercise changes in 29% to 92% of families in 4 of 4 studies. Adherence with new guidelines for universal screening was low (16%-18%) in 3 of 3 studies. Costs per case of familial hypercholesterolemia detected were $12,500 to $20,300.
  
  
  
  Included studies were heterogeneous in outcomes.
  
  
  
  Universal cholesterol screening might have small, positive effects on lifestyle change, but the effect on health remains understudied.
authors.affiliation: Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: asmit230@jhmi.edu.
authors.forename: Anna Jo
authors.initials: AJ
authors.lastname: Smith
authors.affiliation: Department of Biostatistics & Bioinformatics and Duke Global Health Institute, Duke University, Durham, NC.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Turner
authors.affiliation: Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kinra
mesh_terms: D000293:Adolescent; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D004035:Diet Therapy; D019468:Disease Management; D017048:Health Care Costs; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D015228:Hypertriglyceridemia / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008403:Mass Screening; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D014280:Triglycerides / Q000097:blood
chemical_list: D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides
keywords: cardiovascular diseases; dyslipidemias; health care costs; health services research; hypercholesterolemia; mass screening; patient acceptance of health care; pediatrics; primary health care