Obesity and Cholesterol in Children

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Given the current epidemic of childhood obesity, national guidelines have sought to screen children for cardiovascular risk factors that come with obesity, such as disorders of cholesterol (which are also known in medical terminology as "dyslipidemias").

Cholesterol Screening for 9-Year-Olds?

In step with measures aimed to curb cardiovascular risk factors early in life, experts have added cholesterol screening to the 9-to-11-year-old childhood pediatric visit.

The idea is not to start a statin medication in every at-risk 9-year-old child. Rather, it’s to screen for inherited cholesterol problems such as familial hypercholesterolemia and, at the same time, intervene early in trying to prevent risk factors for heart disease, including obesity and abnormal cholesterol and/or triglyceride levels.

Heart-healthy Children

Established pediatric guidelines aim to prevent the development of cardiovascular risk factors and optimize cardiovascular health, starting with breastfeeding, but also emphasizing a diet low in saturated fat starting at age 1 year.

Protecting children from tobacco smoke and promoting regular physical activity are also emphasized in pediatric guidelines; however, universal blood cholesterol screening in children is a relatively recent practice recommendation.

Dyslipidemia in Children

Experts note that abnormal levels of cholesterols and/or fats (known collectively as "lipids") in the bloodstream often begin in childhood and adolescence.

Pediatric dyslipidemia contributes to early plaque disease in the arteries (atherosclerosis), and scientists believe this can also lead to premature heart disease.

There is increasing evidence in children and adolescents that elevated low-density lipoprotein (LDL) cholesterol, in particular, contributes to the development of an early cardiovascular disease.

This is why LDL cholesterol is commonly known as the "bad" cholesterol. So, the hope is that identifying dyslipidemia early and successfully improving lipid profiles may reduce the risk of accelerated atherosclerosis and premature heart disease and stroke.

Screening Children and Adolescents

There is still controversy about how screening for pediatric dyslipidemia should be done. However, the American Academy of Pediatrics (AAP) and the American Heart Association (AHA) have endorsed guidelines that recommend universal screening for all children at two different time intervals:

  • The first screening performed between 9 and 11 years of age before puberty.
  • The second screening performed between 17 and 21 years of age after most individuals reach puberty to avoid the changes in high-density lipoprotein cholesterol (HDL-C) and LDL-C that occur during puberty and growth.

In the United States, it’s estimated that about 20 percent of adolescents have dyslipidemia, and the likelihood of dyslipidemia increases as the body mass index rises.

Abnormal Lipid Levels in Children

For reference, threshold high- and low- lipid levels in children are shown here. These are derived from the definition of lipid levels in children from the 2011 Expert Panel Integrated Guidelines for Cardiovascular Health and Risk reduction in Children and Adolescents:

  • Total cholesterol (TC) should not be greater than 200 mg/dL (5.2 mmol/L).
  • LDL cholesterol (LDL-C) should not be greater than 130 mg/dL (3.4 mmol/L).
  • High-density lipoprotein cholesterol (HDL-C) should not be less than 40 mg/dL (1.0 mmol/L).
  • Non-HDL-C should not be greater than 145 mg/dL (3.6 mmol/L).
  • Triglycerides should not be greater than 130 mg/dL (1.7 mmol/L) in children older than 10 years of age and should not be greater than 100 mg/dL (1.47 mmol/L) in younger children.

Correcting Lipid Abnormalities

Although some children with familial hypercholesterolemia will benefit from statin therapy, for children who do not have an inherited dyslipidemia and may be overweight or obese, a little diet and exercise can help quite a bit. Researchers have found that losing just 5% to 10% of body weight (for those who are overweight or obese) can result in a 20% reduction in triglycerides. Once again, this small change in weight can make a big difference for long-term health.

Sources:

Geoffrey RS, Cynthia B, Graham AB, 3rd, et al. 2014 recommendations for pediatric preventive health care. Pediatrics. 2014;133(3):568-570.

Physicians Recommend all Children, Ages 9-11, Be Screened for Cholesterol. http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Physicians-Recommend-all-Children,-Ages-9-11,-Be-Screened-for-Cholesterol.aspx  Accessed January 2015.

Daniels SR, Benuck I, Christakis DA, et al. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Full report, 2011. National Heart Lung and Blood Institute. Available at: http://www.nhlbi.nih.gov/guidelines/cvd_ped/peds_guidelines_full.pdf.

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