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American Journal of Epidemiology 2005 161(7):691-699; doi:10.1093/aje/kwi074
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved

ORIGINAL CONTRIBUTIONS

Association of Serum Cholesterol and History of School Suspension among School-age Children and Adolescents in the United States

Jian Zhang1, Matthew F. Muldoon2, Robert E. McKeown3 and Steven P. Cuffe4

1 Division of Health and Family Studies, Institute for Families in Society, University of South Carolina, Columbia, SC
2 Center for Clinical Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, PA
3 Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
4 Department of Neuropsychiatry and Behavioral Science, Division of Child and Adolescent Psychiatry, University of South Carolina School of Medicine, Columbia, SC

Correspondence to Dr. Jian Zhang, 4770 Buford Highway, MS K-24, Atlanta, GA 30341 (e-mail: bvw2{at}cdc.gov).

The dietary guidelines developed for adults have been extended to children, but the role of serum cholesterol in the neurodevelopment of children is poorly understood. In the Third National Health and Nutrition Examination Survey (1988–1994), serum total cholesterol was measured in 4,852 children aged 6–16 years. Psychosocial development was evaluated by interviewing the mother regarding the child's history of school suspension or expulsion and difficulty in getting along with others. After adjustment for family socioeconomic status, maternal marital status and education, children's nutrition, and academic performance, the odds ratios of children with various concentrations of total cholesterol showed the children to be equally comfortable in their own peer subculture and not to be different in the proportion that had seen a mental health professional. However, non-African-American children with a serum total cholesterol concentration below the 25th percentile (<145 mg/dl) were almost threefold more likely to have been suspended or expelled from schools than their peers with total cholesterol at or above the 25th percentile (odds ratio = 2.96, 95% confidence interval: 1.55, 5.64). The authors concluded that, among non-African-American children, low total cholesterol is associated with school suspension or expulsion and that low total cholesterol may be a risk factor for aggression or a risk marker for other biologic variables that predispose to aggression.

adolescent psychology; child psychology; cholesterol; juvenile delinquency; United States


Abbreviations: CI, confidence interval; DISC, Dietary Intervention Study in Children; NHANES III, Third National Health and Nutrition Examination Survey; STRIP, Special Turku Coronary Risk Factor Intervention Project; WRAT-R, Wide Range Achievement Test, Revised


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