Background: In this study, we aimed to investigate the relationship between single-gender Korean references for non-high-density lipoprotein cholesterol (non-HDL-C) and metabolic syndrome (MetS) in childhood.

Methods: A total of 5742 Korean children aged 10-18 years who participated in a national survey were included. The subjects were classified into three groups based on single-gender non-HDL-C levels as follows: < 120 mg/dL (desirable), ≥ 120 and < 150 mg/dL (borderline high), and ≥ 150 mg/dL (high).

Results: Males in the borderline high non-HDL-C group had odds ratios (ORs) of 2.86 (95% confidence interval, 2.30-3.56) for elevated triglycerides (TG), 1.73 (1.08-1.79) for reduced high-density lipoprotein cholesterol (HDL-C) and 1.73 (1.08-2.78) for MetS compared with males in the desirable non-HDL-C group after adjusting for covariates. Males in the high non-HDL-C group had ORs of 1.65 (1.14-2.41) for elevated blood pressure (BP), 6.21 (4.27-9.05) for elevated TG, and 3.29 (1.49-7.26) for MetS compared with males in the desirable non-HDL-C group. Females in the borderline high non-HDL-C group had ORs of 3.03 (2.43-3.76) for elevated TG, 1.63 (1.13-2.35) for reduced HDL-C, and 4.53 (2.47-8.31) for MetS compared with females in the desirable non-HDL-C group. Females in the high non-HDL-C group had ORs of 1.43 (1.00-2.04) for elevated BP, 6.36 (4.45-9.08) for elevated TG, and 7.64 (3.65-15.96) for MetS compared with females in the desirable non-HDL-C group.