AbstractBackgroundNon‐high‐density lipoprotein cholesterol (non‐HDL‐C) is now recognized as a strong predictive factor for cardiovascular disease in adults, but there have been few reports on non‐HDL‐C in children.MethodsA total of 5853 4th and 7th grade schoolchildren were included in the screening for lifestyle‐related disease from 2010 to 2011 in Takaoka City. The children underwent anthropometric measurements and non‐fasting blood tests to measure total cholesterol (TC), HDL‐C, triglyceride (TG), and low‐density lipoprotein cholesterol (LDL‐C). The relationship between percent overweight and each lipid level was analyzed, and children above the 97th percentile level with respect to both TC (220 mg/dL) and non‐HDL‐C (152 mg/dL) were compared and assessed. The relationship between non‐HDL‐C and the prevalence of metabolic syndrome was also analyzed among 150 obese children.ResultsNon‐HDL‐C positively correlated with percent overweight and TG rather than did TC (r = 0.273, 0.360 vs 0.118, 0.179, all P < 0.001). In the screening using TC criteria, several subjects with increased HDL‐C were miscategorized as hyperlipidemic, whereas none were miscategorized using the non‐HDL‐C criteria. The sensitivity of the identification of increased LDL‐C was lower when the criteria for TC were used rather than the criteria for non‐HDL‐C (80.8% vs 98.3%). Among obese children, the prevalence of metabolic syndrome increased significantly and was accompanied by an increase in non‐HDL‐C (P = 0.009).ConclusionInstead of TC, non‐HDL‐C would serve as a better and useful cardiovascular risk screening tool for lifestyle‐related disease in school children.