Association Between Serum Folate Concentrations and Dyslipidemia Among Children and Adolescents in Zhejiang Province, China: A Cross-Sectional Study

Background: Dyslipidemia can emerge during childhood and persist into adulthood. Although folate is involved in pathways relevant to lipid metabolism, its association with lipid abnormalities in children and adolescents remains unclear. We examined the associations of serum folate concentrations with lipid parameters and dyslipidemia subtypes in this population. Methods: This cross-sectional study included 1379 participants aged 6–17 years from the 2024 Zhejiang Provincial Nutrition and Health Surveillance Program, China. Serum folate was measured by liquid chromatography–tandem mass spectrometry. Associations with seven lipid parameters and four dyslipidemia subtypes were evaluated using multivariable regression, with additional restricted cubic spline, subgroup, and sensitivity analyses. Results: In fully adjusted models, serum folate was positively associated with TC (β = 0.009, 95% CI: 0.002–0.016), HDL-C (β = 0.007, 95% CI: 0.004–0.010), and ApoA1 (β = 0.003, 95% CI: 0.001–0.005) and inversely associated with TG (β = −0.011, 95% CI: −0.016 to −0.006). Each 1 ng/mL increment was associated with lower odds of hypertriglyceridemia (OR = 0.96, 95% CI: 0.94–0.99) and low HDL-C (OR = 0.91, 95% CI: 0.82–0.99). Quartile and restricted cubic spline analyses supported the hypertriglyceridemia association. Conclusions: Higher serum folate concentrations were associated with lower TG, higher HDL-C, and lower odds of hypertriglyceridemia. Evidence for an association with low HDL-C was limited and inconsistent across analyses. Prospective studies are needed to establish temporality.