I recently attended a conference for my continuing education 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’s more and more data to validate the need for children to have their cholesterol levels monitored as well.
The current guidelines from the National Heart, Lung and Blood Institute, which are also endorsed by the American Association of Pediatrics, 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 and 11, and again between ages 17 and 21. Again, these are screening tests only.
The recommendations previously supported screening cholesterol levels for children with 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 United States, 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 risk factor is elevated cholesterol levels.
What is a healthy cholesterol level 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 two weeks to three 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 percent to 30 percent of total calories, and limit saturated fat to 8 percent to 10 percent of calories, as well as avoiding trans fat. Encourage high fiber foods and make sure your child’s daily diet includes a colorful mix of fruits and vegetables.
Lastly, to help lower cholesterol, encourage your whole family to exercise. This is a prescription we doctors should be writing routinely.
Dr. Sue Hubbard is a nationally known pediatrician.