By Sue Hubbard, M.D.
I've 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 maintaining a healthy cholesterol level for a long time, there's more and more data available validating the need for children to have their cholesterol monitored.
Current guidelines issued by the National Heart, Lung and Blood Institute, which are also endorsed by the American Academy of Pediatrics, recommend that all children, regardless of family history, have either a non-fasting total cholesterol and HDL level screening or a fasting lipid panel performed between the ages of 9 and 11, and again between the ages of 17 and 21.
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 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 risk factor is an elevated cholesterol level.
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. 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.
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, risk factors such as a family history of obesity, high blood pressure, smoking, Kawasaki disease and early coronary artery disease or sudden cardiac death which should also be considered.
Knowing your child's cholesterol level should help parents institute diet and lifestyle changes for the entire family. If you know your child already has a slightly elevated cholesterol level, 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. Have your child's plate be colorful with a mixture of fruits and vegetables.
Lastly, to help lower cholesterol, build more exercise into your family routine. That's a prescription we doctors should be writing routinely!
I'll have more on cholesterol and the use of statins in children in a future column, so stay tuned!
(Dr. Sue Hubbard is a nationally known pediatrician and co-host of "The Kid's Doctor" radio show. Submit questions at www.kidsdr.com
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This was printed in the July 15, 2012 - July 28, 2012 Edition