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Children and Cholesterol: Should We Worry?

Lifestyle, Heredity Play Role In Lipids When It Comes To Children and Cholesterol

By Maureen Salamon

Updated October 04, 2008

(LifeWire) - The relationship between children and cholesterol is clear - a high fat diet and sedentary lifestyle in children could cause heart disease later on in life.

If you picture someone with high cholesterol, you probably think of a middle-aged, overweight, sedentary adult. But children are by no means immune to this condition. Approximately 10% of school-aged children in the United States have high cholesterol and another 28% have borderline levels.

Current health guidelines do not recommend cholesterol tests for most children. The value of routinely testing children remains unclear. And the benefits of such testing do not appear to justify the cost. But should your child be tested?

Parents are rightly worried that high cholesterol levels in their children could mean dire consequences down the road. Most people are aware that unhealthy cholesterol levels can have serious consequences for adults. Studies also show that the buildup of fatty, hard lesions on artery walls, known as atherosclerosis, can begin in childhood.

There are numerous reasons why so many children have high cholesterol levels. The prevalence of childhood obesity is much greater now than in prior generations, which automatically increases the likelihood that these children will have cholesterol problems. In addition, a little-known genetic trait, termed familial hypercholesterolemia, leaves some children more vulnerable to high cholesterol levels well before they reach adulthood.

According to the American Academy of Pediatrics, approximately 1 in every 500 adults is affected by this genetic condition. In addition to genetics, a number of other factors, including diet, activity level, and family history of heart disease, may influence whether a child develops high cholesterol.

The AAP and the American Heart Association (AHA) urge children at high risk for heart disease to undergo cholesterol screening by the time they are two years old.

High-risk children include those who have a parent, sibling, aunt, uncle or grandparent with high cholesterol or early heart disease. Early heart disease is classified as a heart attack, stroke, angina (chest pain), or bypass surgery in men under 50 years old or women under 60 years old. Other risk factors for developing high cholesterol include obesity, a diet high in fats, and an unknown family history.

Cholesterol levels are measured by blood tests. For children ages 2 to 19, an acceptable level of total cholesterol is under 170 milligrams per deciliter (mg/dL). Total cholesterol levels between 170 mg/dL and 199 mg/dL are considered borderline and levels of 200 mg/dL or higher are considered high. Levels of HDL, or high-density lipoproteins, the "good cholesterol", should be 35 mg/dL or higher, and triglycerides (of which body fat is comprised) should not exceed 150 mg/dL.

High-risk children with acceptable blood cholesterol levels should be retested every five years. However, if a child's total cholesterol is borderline, the doctor may order a fasting test, which usually involves fasting for 12 hours before the blood is drawn.

Children with a total cholesterol level above 200 mg/dL will receive both a fasting test and a lipoprotein analysis, which provides a more accurate breakdown of HDL, LDL (low-density lipoprotein, the "bad cholesterol") and triglyceride levels. After three months, the child's cholesterol levels should be retested.

The most important class of cholesterol-lowering drugs is the statins, which reduce both "bad cholesterol" or LDL levels, and triglyceride levels by impeding their production by the liver. Over the past decade, there has been considerable research on how children react to statins. And the good news is that children appear to tolerate stains as well as adults, with similar safety and effectiveness levels, as noted in the AHA's March 2007 scientific statement on the subject.

"If you lower cholesterol in these kids, you can improve the function of their arteries and reverse early atherosclerotic change," Brian McCrindle, MD, lead author of the scientific statement, said in an AHA press release. However, the association still emphasizes the importance of lifestyle changes as the first line of attack.

In fact, even without medications or cholesterol testing, parents can help their children avoid cholesterol problems. Parents can encourage healthy lifestyle choices by serving low-fat and low-cholesterol foods, such as fruit, oatmeal, yogurt, vegetables, nuts, and whole-grain breads and pastas.

Parents can also encourage kids to avoid the "empty calories" of bad carbohydrates, including sugar-sweetened drinks, white flour, and refined sugars, which are typically found in commercially prepared cookies, cakes, candy, and white bread.

In addition to dietary changes, the most beneficial lifestyle change for cholesterol problems (and problems with obesity) is physical activity. At-risk children should get plenty of aerobic exercise -- biking, running, swimming, walking and so on. Parents should also limit sedentary activities, such as watching TV, playing video games and using the computer. In fact, the U.S. Surgeon General recommends in "The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity" that TV time should be limited to less than two hours per day.

AHA guidelines for monitoring children with high cholesterol include keeping track of height, weight, body mass index, and onset of puberty, since cholesterol levels can change with physical and sexual development.


Strasburger, Victor. Adolescent Medicine: A Handbook for Primary Care. Lippincott Williams & Williams, 2005.

"Statement Addresses Use of Cholesterol Drugs in Children: American Heart Association Scientific Statement." American Heart Association. 21 Mar. 2007. 18 Feb 2008 <http://www.americanheart.org/presenter.jhtml;jsessionid=IEW5XJF1EK1LOCQFCXQCDSQ?identifier=3046288>.

"High Cholesterol in Children." Cleveland Clinic. 7 Dec 2004. 18 Feb 2008 <http://www.clevelandclinic.org/health/health-info/docs/3700/3711.asp?index=12113>.

"Cholesterol and Atherosclerosis in Children." American Heart Association. 15 Feb 2008. 18 Feb 2008 <http://www.americanheart.org/presenter.jhtml?identifier=4499>.

Gidding, Samuel. "Cholesterol Guidelines Debate." Pediatrics 107(2001): 1229-1230.

Frazao, Elizabeth. "Nutrition and Health Characteristics of Low-Income Populations: Clinic Measures of Iron, Folate, Vitamin B12, Cholesterol, Bone Density and Lead Poisoning." Agriculture Information Bulletin 796-5 (2005) 18 Feb 2008. <http://papers.ssrun.com/sol3/papers.cfm?abstract_id=751945>.

"The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity: Overweight in Children and Adolescents." U.S. Department of Health and Human Services. Last updated: 11 Jan. 2007 28 Feb. 2008 <http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm>.
LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Maureen Salamon is a freelance writer who has written for newspapers, websites and hospitals. A graduate of Penn State University with a journalism degree, her work also appears in the Chicken Soup for the Soul book series and she is co-authoring the memoir of the pediatrician who first discovered the AIDS virus in children.

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