Cholesterol in Kids
Most families have heard lots of information about cholesterol and related blood fat (or “lipid”) levels, but its significance isn’t always all that clear. Over the last years, we’ve learned a lot about these levels and how they may impact kids as they grow up.
Cholesterol is a fat that is transported in our bloodstreams and has many important metabolic roles in our systems. Sometimes though, levels may be abnormal and may signal an increased future risk to the heart, blood vessels and brain. Cholesterol levels in the blood are composed largely of Low-Density Lipoprotein (LDL) and High-Density Lipoprotein (HDL). We think of LDL as the “bad” type of cholesterol that can build up in blood vessel walls, and HDL as the “good” type of cholesterol that can help clear that buildup. As a result over the years, too much LDL can reduce blood flow to vital organs, whereas normal or high levels of HDL can help improve blood flow.
There are basically two sources of cholesterol in the bloodstream.
1. The first relates to one’s diet.
A diet that is high in saturated fat (for example butter, whole milk, animal fats, hydrogenated vegetable fats) and to a lesser extent, cholesterol itself, is more likely to trigger an LDL cholesterol elevation. A diet that consists of more fruits, vegetables, lean meats, and unsaturated fats (like canola oil, olive oil or safflower oil) is healthier and tends to lower the likelihood of high LDL cholesterol.
2. The second source of cholesterol in our bloodstreams is our own internal production in the liver.
This pattern is one often seen in families (just as is the converse, where HDL elevation can sometimes be seen among family members) and tends not to be diet-related.
In our office, we follow guidelines from the National Heart, Lung and Blood Institute, screening children for cholesterol abnormalities at 9 years of age and again at 17 years of age. In these tests, we do a quick fingerstick blood test and can pick up many abnormalities in total cholesterol and HDL. If either is abnormal, we will suggest a fasting lipid panel to be done through an outside lab. This testing gives us more detailed information about total cholesterol, HDL, LDL and triglycerides. Triglycerides are a different kind of fat transported in our bloodstream that can likewise cause reduced blood flow in our arteries if present in excess. A diet high in sugar or refined carbohydrates can cause elevated triglycerides levels.
If the results of the fasting blood studies are abnormal, your provider would typically make some lifestyle recommendations that may help reduce the risk of problems over the decades to come. Dietary suggestions to limit saturated fat intake, calories and/or refined carbohydrates may come from your provider or a dietitian. Alternative child-friendly or teen-friendly meal plans may be suggested. Avoidance of frequent fast-food trips can be a cornerstone of this, and limiting restaurant visits will likely be a good place to start. Beverage choices are another way to limit exposure to sugar and calories. Juices and sodas should be replaced by water or low-fat milk. Snack choices can be shaped by parental buying patterns at the supermarket.
Another lifestyle recommendation relates to exercise. For so many reasons, it is important for kids and teens to be outside experiencing a mixture of cardio and isometric exercise. Their positive effects on HDL cholesterol levels are well known. In addition, we also can see a reduction of LDL cholesterol levels in children who have increased their exercise levels.
Over the years, if implementing these lifestyle changes is unsuccessful in normalizing blood lipid levels, the possibility of medication comes into focus. Although this is an intervention rarely necessary in children or adolescents, there is a growing clinical experience in use of statins in adolescents and young adults with persistent lipid abnormalities. These medicines have been used in adults for several decades, and their adverse effects have been well described.
We know that cardiovascular disease and stroke have led to persistent unnecessary disability and death among adults. At Annapolis Pediatrics, we continue to be optimistic that early screening for blood lipid problems in childhood may lead to important lifestyle changes that will help counter these trends. We invite all of our families to discuss this matter further with your child’s provider should you have any questions.