What are the recommended preventative lab tests for a 16-year-old?

Recommended Preventative Laboratory Tests for 16-Year-Olds

For a healthy 16-year-old adolescent, the recommended preventative laboratory tests include lipid screening, screening for diabetes in those with risk factors, and consideration of other targeted screenings based on individual risk factors.

Core Preventative Laboratory Tests

Lipid Screening

• Universal lipid screening is recommended for all adolescents between ages 17-21 years 1
• If not previously done between ages 9-11 years, lipid screening should be performed at age 16 1
• Initial screening can be done with a non-fasting lipid profile, measuring:
  • Total cholesterol
  • LDL cholesterol
  • HDL cholesterol
  • Triglycerides
  • Non-HDL cholesterol (calculated)
• If initial results are abnormal, confirmatory testing with a fasting lipid panel is recommended 1

Diabetes Screening

• Risk-based screening for prediabetes and type 2 diabetes should be performed in adolescents who are:
  • Overweight (BMI ≥85th percentile) or obese (BMI ≥95th percentile) AND
  • Have one or more additional risk factors 2:
    • Family history of type 2 diabetes in first- or second-degree relatives
    • High-risk race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
    • Signs of insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS)
    • Maternal history of diabetes or gestational diabetes during the child's gestation
• Screening tests include:
  • Fasting plasma glucose
  • 2-hour plasma glucose during 75g oral glucose tolerance test
  • HbA1c 2

Additional Risk-Based Laboratory Tests

Hepatic Function Tests

• AST and ALT should be considered in adolescents with:
  • Obesity
  • Features of metabolic syndrome
  • Family history of non-alcoholic fatty liver disease 2

Anemia Screening

• Consider hemoglobin/hematocrit screening in:
  • Females with heavy menstrual periods
  • Those with poor dietary intake
  • Athletes (especially females)
  • Those with chronic diseases 3

Thyroid Function Tests

• Consider TSH screening in adolescents with:
  • Unexplained weight changes
  • Growth abnormalities
  • Menstrual irregularities
  • Family history of thyroid disease

Special Considerations

For Females

• Consider screening for polycystic ovary syndrome with appropriate laboratory studies if indicated by clinical features (irregular periods, hirsutism, acne) 2
• Consider testing for sexually transmitted infections if sexually active

For High-Risk Individuals

• If hypertension is present, consider additional testing:
  • Basic metabolic panel (electrolytes, BUN, creatinine)
  • Urinalysis 2

Follow-up Recommendations

• If all screening tests are normal, repeat lipid screening at age 17-21 years 1
• For diabetes screening, if tests are normal, repeat testing at minimum 3-year intervals or more frequently if BMI is increasing 2
• Abnormal results should prompt appropriate management and more frequent monitoring

Common Pitfalls to Avoid

1. Missing high-risk individuals: Don't rely solely on family history for lipid screening decisions, as up to 30% of children with abnormal lipids have no identifiable risk factors 1

2. Improper timing: Recognize that total cholesterol and LDL-C levels decrease 10-20% during puberty, which may affect interpretation of results 1

3. Inadequate follow-up: Even normal results require periodic reassessment as cardiovascular risk factors can change dramatically during adolescence 1

4. Overlooking socioeconomic factors: Consider food insecurity, housing stability, and financial barriers when interpreting results and planning interventions 2

By implementing these evidence-based laboratory screening recommendations, clinicians can identify risk factors early and initiate appropriate interventions to prevent future disease.