By BRUCE A. EPSTEIN
© St. Petersburg Times, published July 5, 2001
When most people think of high cholesterol, they think of overweight adults, hardening of the arteries and heart disease, but high cholesterol, known medically as hypercholesterolemia, is not only an adult problem; about 10 percent of children have cholesterol levels that are above the recommended range.
Although there may be no immediate threat to their health, there is evidence that these youngsters run an increased risk of developing heart disease as adults.
Everyone needs to have cholesterol in the blood. Cholesterol is a waxy, fat-like substance found in all parts of the body, including the brain, nerves, muscle, skin, liver, intestines and heart.
The liver produces most of the cholesterol the body needs, and we use cholesterol to produce many hormones, vitamin D and the bile acids that help to digest fat.
If a person has too much cholesterol in the bloodstream, the excess is deposited in arteries, including the coronary (heart) arteries, where it contributes to the blockage of blood flow to the heart. With less blood, the heart gets less oxygen, causing chest pain (angina), a heart attack (myocardial infarction) or even death.
In order to travel through the blood, cholesterol must be coated by a layer of protein to make a lipoprotein, of which there are two types, high-density lipoproteins (HDL) and low-density lipoproteins (LDL). The HDL component is called the "good" cholesterol because it carries cholesterol away from the arteries to the liver, where the body rids itself of the excess.
LDL is called the "bad" cholesterol. Too much LDL leaves cholesterol on the inner walls of the arteries.
The effects of high cholesterol throughout childhood can begin showing up as the early stages of heart disease by the time kids reach their teens and early 20s.
Many factors help determine whether a child's LDL cholesterol level is high or low. The most important are:
Heredity: Genes influence how high the bad LDL cholesterol is by affecting how fast LDL is made and removed from the blood.
What kids eat: Two main nutrients in the foods children eat makes their LDL cholesterol level go up: saturated fat, a type of fat found mostly in foods that come from animals, and cholesterol, which comes only from animal products.
Weight: Children who are overweight tend to have higher levels of LDL cholesterol.
Physical activity and exercise: Regular physical activity may lower LDL cholesterol and raise HDL cholesterol levels.
For children, total cholesterol should be less than 170 with LDL readings below 110. Total cholesterol counts of 170 to 200 with LDL levels of 110 to 130 are considered borderline, and levels exceeding 200 with LDL above 130 are considered too high.
Levels of HDL, which we want to be high, should be more than 45 milligrams per deciliter in children.
The American Academy of Pediatrics and the American Heart Association recommend that children who are at high risk for coronary heart disease be screened soon after they are 2 years old since the normal diet of children younger than 2 is high in fat and therefore high in cholesterol. It is not appropriate to test children younger than 2 years.
These children and adolescents should have their cholesterol checked:
Children and adolescents whose parents or grandparents at 55 or younger were found by cardiac catheterization to have coronary arteriosclerosis. The information about grandparents is important because other relatives might not yet be old enough to have developed heart disease.
Screen children and adolescents whose parents or grandparents at 55 or younger had a documented myocardial infarction, angina pectoris, peripheral vascular disease, cerebrovascular disease or sudden cardiac death.
Screen the offspring of a parent with an elevated blood cholesterol level (240 milligrams per deciliter or higher).
For children and adolescents whose parental history is unobtainable, particularly for those with other risk factors, physicians may choose to measure cholesterol levels to identify those in need of nutritional and medical advice. More than half of the children who have high cholesterol levels are found by testing children with these high risk factors.
Doctors do not agree on when to check the cholesterol levels of children who are not high risk.
The main reason for testing everyone is to identify children with high cholesterol, since eating and exercise habits that lower cholesterol levels need to be started early. The main arguments against testing all children are that it is costly, not all high cholesterol levels found in kids persist into adulthood, and healthy diets can be started for children without knowing their cholesterol levels.
Parents should check with their pediatrician or family doctor to see if it is advisable to have their child's cholesterol checked. When a child has high cholesterol, the preferred course of treatment is to try to bring it down through lifestyle changes, including eating a low-cholesterol, low-fat diet and getting more exercise. A consultation with a registered dietitian can help in suggesting easy, practical suggestions that can make for significant changes in cholesterol levels.
Only in rare cases, when lifestyle changes are unsuccessful, is drug therapy introduced. Even then it is recommended only for children 10 and older.
It is important to remember that, while high cholesterol should be a concern for parents, children younger than 2 years need to have a high percentage of calories from fat to grow and develop at normal rates. Their diets should restricted only on the advice of the child's doctor.
Bruce A. Epstein practiced pediatrics in St. Petersburg for 26 years. He edits the Web site http://www.kidsgrowth.com.