Cholesterol and Your Child

When it comes to their kids, many parents don't even think about cholesterol. But high levels of cholesterol are known to be a major factor contributing to heart disease and strokes, and the latest medical research shows coronary artery disease has its roots in childhood.

Childhood cholesterol levels weren't tracked until recently, but some experts think that high cholesterol in kids is a major underreported public health problem. In the past few years, studies have shown a dramatic increase in obesity in children and the problems that result from being overweight. And some pediatricians report seeing a significant increase in the number of children with elevated cholesterol levels than they did years ago.

Because the problems associated with high cholesterol generally don't show up for years, making the connection between kids' health and cholesterol is difficult for many people. So it's important to be aware of your child's cholesterol levels, especially if either parent has high cholesterol.

What Is Cholesterol?

Cholesterol is a waxy substance produced by the liver. It's one of the lipids, or fats, your body makes and is used to build cell walls and form some hormones and tissues.

If you never ate another bowl of ice cream or another cheeseburger, your body would have enough cholesterol to run smoothly. That's because your liver makes enough for healthy body function. In fact, the liver produces about 1,000 milligrams of cholesterol a day. The rest comes from the foods you eat.

Although vegetables, fruits, and grains don't have any cholesterol, the following foods from animals do:

• egg yolks
• meat
• poultry
• seafood
• whole-milk dairy products (including milk, cheese, and ice cream)

How Does Cholesterol Work?

Cholesterol doesn't move through the body on its own. It has to combine with proteins to travel through the bloodstream to where it's needed. Cholesterol and protein traveling together are called lipoproteins.

Two kinds - low-density lipoprotein (LDL) and high-density lipoprotein (HDL) - are the most important and the ones people talk about a lot. Around the water cooler or in the break room at work, you may have heard a coworker say, "My doctor told me my LDL is high, and my HDL is low." Someone responds, "Tsk, tsk, tsk," and nods knowingly. But what are they talking about?

Low-density lipoproteins, sometimes called "bad cholesterol" (think low-density for "lousy"), are the primary cholesterol carriers. If there's too much LDL in the bloodstream, it can build up on the walls of the arteries that lead to the heart and the brain. This buildup forms plaque - a thick, hard substance that can cause blood vessels to become stiffer, narrower, or blocked. Atherosclerosis is the name for hardening of the arteries. If a blood clot forms and gets jammed in a clogged artery, you could have a heart attack or a stroke. Atherosclerosis can also diminish blood flow to other vital organs, including your intestines or kidneys.

High-density lipoproteins, sometimes called "good cholesterol" (think high-density for "happy, healthy, or hard-working"), move the remaining one fourth to one third of your body's cholesterol. HDL carries the cholesterol away from the arteries and back to the liver, where it's processed and sent out of the body.

High levels of LDL increase the risk for heart disease and stroke. But high levels of HDL can offset that risk and help protect your circulatory system. However, in general, too high a level of cholesterol in the blood is known as hypercholesterolemia, which can lead to health problems.

Should I Worry About My Child's Cholesterol?

Three major factors contribute to high cholesterol levels:

• diet - a diet high in fats, particularly saturated and trans fats, which are common in baked treats and commercial snack products
• heredity - having parents or a parent with high cholesterol
• obesity - related to both diet and lack of exercise

Other risk factors for coronary artery disease include high blood pressure, smoking, and diabetes mellitus.

If your child is active, eats healthy foods, doesn't have a family history of high cholesterol, and isn't overweight, you probably don't have much cause for concern.

How Is High Cholesterol Monitored and Treated?

Current recommendations encourage cholesterol screening in only those children, starting at 2 years old, who are at risk for having high cholesterol. Factors that would make a cholesterol screening necessary are if your child:

• has a parent with a total cholesterol higher than 240 mg/dL
• has a parent or grandparent who had a history of heart disease prior to the age of 55
• has an unknown family history
• is overweight or obese

Your child's doctor can use a simple blood test to tell you if your child's cholesterol is too high. According to the American Heart Association, the ranges of total cholesterol for children 2 years to 19 years old are:

Category	Total cholesterol (mg/dL*)
Acceptable	Less than 170
Borderline	170-199
High	200 or greater

*Mg/dL means milligrams per deciliter. A milligram is one thousandth of a gram, which is 1/28th of an ounce. A deciliter is 1/10th of a liter, which is a little more than a quart.

If the results are considered "acceptable," then your child should be screened every 5 years. If your child's total cholesterol is 170 or higher, then your child's doctor will probably have your child fast for 12 hours and then repeat the test (called a fasting cholesterol). If your child's initial cholesterol level is greater than 200, then your child's doctor will order both a fasting cholesterol and a lipoprotein analysis (which would identify your child's HDL and LDL levels).

Although it's believed that the problems caused by high cholesterol can start in childhood, it still isn't entirely clear what high cholesterol levels indicate for a child. Therefore, the recommendations focus primarily on good eating and exercise behaviors for everyone, but especially those who have higher cholesterol and lipoproteins.

Medication should only be considered for children over 10 years old after changes in diet and exercise have been tried but haven't had the desired effect. After 3 months of dietary changes or medication, a child's cholesterol levels should be retested.

10 Ways to Lower Your Family's Cholesterol

Here are some simple steps you can take to keep your family's cholesterol at healthy levels:

1. Have the cholesterol levels of both you and your child checked.

2. Read labels so that you can limit cholesterol and saturated and trans fat intake. It's recommended that cholesterol intake be less than 300 milligrams a day. To determine how much cholesterol is in the foods your family eats, read nutrition labels. Also, the American Heart Association recommends that total fat intake should be 30% or less of your total calories and that saturated fat should be 10% or less. Because they usually contain substantial amounts of cholesterol, you and your family should try to avoid, as often as possible:

• saturated fats - all animal fats and some tropical oils
• trans fats - fats formed when vegetable oils are hardened into margarine or shortening (In 2006, the amount of trans fats in foods will begin to appear on nutrition labels. For now, when checking labels, look for the word "hydrogenated.")

3. Eat healthy snacks that are low in fat and cholesterol, such as:

• fruit
• raw vegetables and low-fat dips
• plain unsalted popcorn or pretzels
• low-fat yogurt and gelatin

4. Replace some meals of red meat with:

• poultry
• fish
• beans
• peas
• lentils
• tofu
• soy products (many on the market today are very tasty and mimic hamburgers, hot dogs, chicken fingers, etc.)

5. Stay away from butter or stick margarine. Use liquid vegetable oil for cooking and tub margarine for table use.

6. Limit intake of commercially prepared baked goods and treats.

7. Avoid soda and sugary fruit drinks because excess sugar is transformed into fats.

8. Pack healthy lunches and teach children to pick the healthiest items in their school cafeterias or vending machines.

9. Get plenty of exercise. Go for walks as a family. Go hiking or biking, or play soccer, basketball, or ice hockey. Exercise helps boost HDL levels in the blood - and that's a good thing!

10. Make controlling your cholesterol levels and living healthier a family affair. Kids usually aren't the only ones at risk, so it's important to make this a family effort. And parents who don't know their own cholesterol levels should get them checked. The strides you take to improve your family's lifestyle can have a huge effect on your health not only now, but far into the future.

Reviewed by: Barbara P. Homeier, MD