Most parents probably don't think about what cholesterol means for their kids. But high levels of cholesterol are a major factor contributing to heart disease and stroke, and medical research shows that cardiovascular disease has its roots in childhood. And with the dramatic increase in childhood obesity, more and more kids are at risk.

Problems associated with high cholesterol generally don't show up for years, so making the connection between kids' health and cholesterol can be difficult. But it's important to know your child's cholesterol levels, especially if there's a family history of high cholesterol or premature heart disease.

Identifying high cholesterol now will let you and your doctor work together to make changes that will lower your child's risk of developing heart disease later.

About Cholesterol

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

If you never ate another bowl of ice cream or another cheeseburger, your body would have enough cholesterol to run smoothly. That's because the 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 we eat.

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

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

Good vs. Bad Cholesterol

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 ones that most of us have heard about.

Low-density lipoproteins, or "bad cholesterol," are the primary cholesterol carriers. Too much LDL in the bloodstream 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 blocks a narrowed artery, the result can be a heart attack or stroke.

Atherosclerosis can also diminish blood flow to other vital organs, including the intestines or kidneys.

High-density lipoproteins, or "good cholesterol," carry cholesterol away from the arteries and back to the liver, where it's processed and sent out of the body, and might even help remove cholesterol from existing plaques.

High levels of LDL increase the risk for heart disease and stroke, whereas high levels of HDL can help protect the circulatory system.

Three major factors contribute to high cholesterol levels:

1. diet: a diet high in fats, particularly saturated and trans fats
   
2. heredity: having parents or a parent with high cholesterol
   
3. obesity: related to both diet and lack of exercise

Kids who are physically active, eat healthy foods, don't have a family history of high cholesterol or heart disease, and aren't overweight have a lower risk for high cholesterol. Your doctor will help decide when your child's cholesterol level should be checked.

Monitoring and Treating High Cholesterol

Current guidelines recommend that all kids be screened for high blood lipids at least once when they're between 9 and 11 years old and again between 17 and 21.

In addition, kids 2 to 8 years old and 12 to 16 years old who are at risk for high cholesterol should be tested. Screening is recommended for kids who:

• have a parent or other close relative with a total cholesterol higher than 240 mg/dL
• have a family history of cardiovascular disease prior to age 55 in men and age 65 in women
• have a certain medical conditions (such as kidney disease, Kawasaki disease, or juvenile idiopathic arthritis)
• are overweight or obese
• have additional risk factors, such as diabetes, high blood pressure, or cigarette smoking

Your doctor can order a simple blood test, usually done fasting (nothing to eat or drink, except water, for 12 hours), to tell you if your child's cholesterol is too high. When screening healthy children without risk factors, a non-fasting blood test can be used.

According to the National Cholesterol Education Program (NCEP) guidelines for children and adolescents, the ranges of total and LDL cholesterol for kids 2 years to 18 years old are:

mg/dL = milligrams per deciliter

Children with LDL cholesterol levels 130 mg/dL or greater should receive individual nutritional counseling that focuses on reducing dietary fat and cholesterol and increasing physical activity.

Kids with high cholesterol levels should be rechecked after 3 to 6 months of lifestyle intervention.

Medication might be considered for kids 10 and older with LDL cholesterol levels of 190 mg/dL or higher if changes in diet and exercise haven't worked. For kids with additional risk factors, treatment may be considered at even lower levels.

10 Ways to Lower Cholesterol

Here are 10 ways to help keep your family's cholesterol at healthy levels:

1. Know your own cholesterol level — and if it's high, ask to have your kids' levels checked.
   
2. Serve a diet rich in fruit, vegetables, and whole grains.
   
3. Choose from a variety of protein foods, including lean meats and poultry, fish, nuts, beans, peas, and soy products.
   
4. Read nutrition facts labels so that you can limit cholesterol and saturated and trans fat intake. The 2010 Dietary Guidelines recommend keeping dietary fat intake between 30%-40% for kids 1-3 years old and between 25%-35% for kids 4 to 18 years, with most fats coming from sources of unsaturated fats, such as fish, nuts, and vegetable oils.
   
   For kids older than 2 years and teens, limit:
   
   • cholesterol to less than 300 milligrams a day
   • saturated fats to less than 10% of calories
   • trans fats as much as possible to less than 1% of calories
     
     
5. Choose nonfat or low-fat milk and dairy products.
   
6. Stay away from solid fats. Use vegetable oil for cooking and soft margarine for table use.
   
7. Limit beverages and foods with added sugars.
   
8. Limit commercially prepared baked goods and serve healthy snacks such as fresh fruit, vegetables with low-fat dip, lite popcorn, and low-fat yogurt.
   
9. Get plenty of exercise. Exercise helps boost HDL levels in the blood — and that's a good thing! Kids and teens should be physically active at least 60 minutes a day.
   
10. Make living healthier a family affair. Kids usually aren't the only ones at risk, so it's important to make this a family effort. The strides you take to improve your family's lifestyle can have a positive effect on your family's health not only now, but far into the future.

Reviewed by: Mary L. Gavin, MD
Date reviewed: January 2012