AAP Takes Aim at Cholesterol in Kids

You think of high cholesterol and a young child doesn't come to mind — more like a grown-up fighting the urge to eat that double cheeseburger. But now, in the wake of the ongoing childhood obesity epidemic and rising diabetes rates among kids, the American Academy of Pediatrics (AAP) says tracking youngsters' cholesterol levels at an early age — and treating those that are unhealthy — may help fend off future heart disease, the No. 1 killer of both men and women.

According to the AAP, current research shows that the stage for adult heart disease (also known as cardiovascular disease) is set early on. So, the organization is changing its 10-year-old policy on cholesterol and urging:

• cholesterol-reducing drugs for children as young as 8 with unhealthy cholesterol levels, high blood pressure, or excess weight. Before, the AAP had advised cholesterol-combating drugs for kids 10 and up who hadn't responded to weight-loss attempts.
• cholesterol screening at routine checkups after age 2 and no later than 10 for at-risk kids; that is, only those who are overweight or obese, or have diabetes, high blood pressure, a family history of cholesterol problems or heart attacks at a young age, or an unknown family medical history.
• low-fat milk, instead of whole, starting at 12 months old for tots who are at risk for weight or cholesterol issues (previously, the AAP didn't recommend low-fat or skim milk for these kids until after 24 months of age). Whole milk was considered the go-to beverage for kids come their first birthday, since it provides toddlers with the fat they need for brain growth and development. But now, many toddlers are getting enough extra fat from plenty of other sources, which means kids don't require — and won't be negatively affected if they don't get — the high fat and cholesterol content of whole milk.

Clarifying Cholesterol

A lipid (or fat) made by the liver, cholesterol is one thing we actually don't need to get from any foods at all.That's because the liver produces enough of the waxy substance on its own for the body to function just fine — to build cell walls and form some hormones and tissues. All other added cholesterol comes from the foods we eat like animal fats, hydrogenated oils, egg yolks, and whole-milk dairy products.

But cholesterol doesn't move through the body by itself. It has to combine with proteins to travel through the bloodstream to where it's needed. Cholesterol and protein traveling together are called lipoproteins. The two kinds that are the most important are:

• low-density lipoproteins (LDL), sometimes called "bad cholesterol" — think low-density for "lousy." These 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, forming plaque (a thick, hard substance that can cause blood vessels to become stiffer, narrower, or blocked). If a blood clot forms and gets jammed in a clogged artery, a heart attack or a stroke could follow.
• high-density lipoproteins (HDL), sometimes called "good cholesterol" — think high-density for "happy, healthy, or hard-working." These move cholesterol away from the arteries and back to the liver, where it's processed and sent out of the body.

Here's where understanding cholesterol levels gets a little tricky, though: High levels of LDL (the "bad" cholesterol) increase the risk for heart disease and stroke. But high levels of HDL (the "good" cholesterol) can offset that risk and actually help protect your circulatory system.

In most kids and adults with a high a level of total cholesterol in the blood — known as hypercholesterolemia — it's high levels of "bad" cholesterol that are usually the reason for the high cholesterol level, and this can lead to health problems.

What This Means to You

Kids might not commiserate over their cholesterol levels on the playground like coworkers chatting about weight at a water cooler, but moms and dads do need to be aware of how their kids' cholesterol today may affect them much later.

On top of a diet high in fats, heredity, and obesity — the three major factors contribute to high cholesterol levels — high blood pressure, smoking, and diabetes up kids' risk for heart disease, too.

So, if your child is active, eats healthy foods, isn't overweight, and doesn't have a family history of obesity or potential heart problems, you probably don't have to worry too much.

But, whether your child is at risk or not, it's still wise to:

• Have both your and your child's cholesterol levels checked.
• Read nutrition labels so that you can limit cholesterol and saturated and trans fat intake (it should be add up to less than 300 milligrams a day).
• Avoid foods that are high in saturated fats (all animal fats and some tropical oils) or trans fats (fats formed when vegetable oils are hardened). Choose low-fat dairy products whenever you can. Cook with liquid vegetable oil. And use tub margarine (instead of a stick) at the table.
• Pack healthy school lunches and teach children to forego the junk food (fatty, fried, sugary fare) in the school cafeteria and choose healthier items instead.
• Limit or cut out commercially prepared baked goods and treats.
• Serve snacks like fruit, raw veggies and low-fat dips, plain popcorn or pretzels, low-fat cheese and whole-grain crackers, or low-fat yogurt.
• Scale back on or totally skip soda and sugary fruit drinks — all of that excess sugar will be transformed into fats. When kids do drink juice, make sure it's 100% fruit juice and only about one serving a day.
• Replace some meals of red meat with lean poultry (without the skin), fish, beans, peas, lentils, tofu, and soy products.

And by all means, make exercise a part of your kid's — and your family's — everyday routine. Make fitness time together time — walking, hiking, biking, shooting some hoops, participating in classes (karate, dance, yoga, Pilates). Whatever you do, just keep moving and motivating your kids to do the same. Physical activity helps boost the good cholesterol levels in the blood, which means you'll be far less likely to become a heart disease statistic down the road.

Reviewed by: Steven Dowshen, MD
Date reviewed: July 2008

Source: "Lipid Screening and Cardiovascular Health in Childhood," Pediatrics, July 2008.