I have been attending a conference for my continuing education (I still love going to school) and one of the topics was “Universal Cholesterol Screening in Children”. While adults have known the importance of healthy cholesterol levels for a long time, there is more and more data to validate the need for children to have cholesterol levels monitored as well.
The current guidelines by the National Heart, Lung and Blood Institute, which are also endorsed by the AAP recommend that ALL children, regardless of family history have either a non-fasting total cholesterol and HDL level or a fasting lipid panel performed between the ages of 9 & 11 years and again between 17-21 years. Again, these are screening tests only.
The recommendations previously supported screening cholesterol levels for children who had a family history of elevated cholesterol levels or those with familial risk factors for coronary artery disease. Knowing that coronary artery disease is the leading cause of death in the U.S., and also realizing that coronary artery disease really begins in childhood, modifying risk factors in childhood will hopefully lead to a reduction in coronary artery disease later in life. One of these risk factors is elevated cholesterol levels.
What is a healthy cholesterol for a child? A non-fasting lipid panel should look at total cholesterol minus the HDL cholesterol, which gives a non-HDL cholesterol total. The current guidelines recommend that the non-HDL cholesterol should be < 145mg/dl and the HDL should be > 40 mg/dl. If a fasting lipid panel is used the LDL should be < 130 mg/dl, HDL > 40 mg/dl and non-HDL cholesterol <145 mg/dl as well.
The guidelines also state that if the cholesterol is abnormal a repeat screen should be done 2 weeks-3 months after the first screening and the results should be averaged before deciding on further investigation or treatment.
Additionally, there are risk factors such as a history of obesity, high blood pressure, smoking, a history of Kawasaki disease and a family history of early coronary artery disease or sudden cardiac death which should also be considered in the context of evaluating a child’s cholesterol.
Knowing your child’s cholesterol should help parents engage in diet and lifestyle changes for the entire family. If you know that your child already has a slightly elevated cholesterol work on dietary changes at home. Try limiting your children’s fat to 25-30% of total calories, and limit saturated fat to 8-10% of calories as well as avoiding trans fat! Encourage high fiber foods. Have your child’s plate be colorful with a mixture of fruits and vegetables.
Lastly, to help lower cholesterol you need to exercise. That is a prescription we doctors should be writing routinely. Get the family out and move!
More on cholesterol and the use of statins in children in a future daily dose. Stay tuned!