Background: This study investigates the associations between lipid profiles, including triglycerides (TGs), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), and vitamin A (VA) and vitamin D (VD) deficiencies among children and adolescents in Zhejiang Province, China. Methods: This cross-sectional study was conducted from 2022 to 2024 and included 9039 children and adolescents aged 6–17 years who participated in the provincial nutrition surveillance in Zhejiang Province. Blood samples were collected to measure the concentrations of TG, TC, HDL-C, LDL-C, VA and VD. Results: The prevalence of elevated TG, elevated TC, low HDL-C, and elevated LDL-C was 21.0%, 11.6%, 4.7% and 5.1% among children and adolescents aged 6–17 years, respectively. There were significant differences with respect to elevated TG and low HDL-C prevalence between sex (χ
2 = 10.303 and 7.27,
p = 0.006 and 0.026). There were significant differences with respect to elevated TC and low HDL-C prevalence between urban areas and rural areas (χ
2 = 13.289 and 10.195,
p = 0.001 and 0.006). There were significant differences with respect to elevated TG, elevated TC, low HDL-C, and elevated LDL-C prevalence among children with or without obesity/overweight (χ
2 = 209.828, 58.54, 171.972, and 146.256,
p < 0.001). There were significant differences with respect to elevated TC and low HDL-C prevalence among children with or without vitamin D deficiency/vitamin D insufficiency (χ
2 = 33.37 and 56.848,
p < 0.001). Ordinal regression analysis revealed that sex and obesity/overweight were associated with critical/abnormal TG (χ
2 = 340.03,
p < 0.001), sex, age group, location and obesity/overweight were associated with critical/abnormal TC (χ
2 = 255.125,
p < 0.001), age group, location, obesity/overweight and vitamin D deficiency/vitamin D insufficiency were associated with critical/abnormal HDL-C (χ
2 = 458.527,
p < 0.001), and age group, obesity/overweight were associated with critical/abnormal LDL-C (χ
2 = 164.380,
p < 0.001). Conclusions: Elevated TG, elevated TC, low HDL-C, and elevated LDL-C are prevalent in this population, with notable differences based on sex, urban vs. rural residence, and obesity/overweight status. Furthermore, vitamin D deficiency was linked to elevated TC and low HDL-C prevalence. Future interventions should focus on targeted public health strategies to mitigate these disparities and promote healthier lipid profiles in children and adolescents.
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