Why worry about cholesterol in children? Aren’t heart disease and stroke diseases of older persons? Wrong! You don’t get heart disease all of a sudden, even though the heart attack or stroke may be a surprise. Cardiovascular disease begins slowly, one cholesterol molecule at a time. Consider these facts:
- The importance of controlling cholesterol in kids is supported by evidence from the Korean war era, when autopsies of soldiers in their late teens and early twenties revealed build-up of cholesterol-related plaque and narrowing of the arteries, even though on the surface these were healthy men.
- Fatty streaks have been found in autopsies of children as young as three years of age, and autopsy studies have shown fatty accumulations in the coronary arteries in more than half of children ages 10 to 14. Also, studies have shown that in countries with high rates of coronary artery disease, both children and adults have higher cholesterol levels.
- Studies have also shown that children and adolescents with elevated cholesterol levels are more likely to have high levels as adults. Autopsy studies in children have also shown a relationship between LDL cholesterol levels (obtained before death) and the presence of fatty streaks in coronary arteries. (High cholesterol and fat deposits in the arteries upon autopsy also correlate well in adults.)
- Children with high cholesterol levels are three times more likely to have high cholesterol levels as adults than kids with normal cholesterol levels. Even though there have been no long-term studies demonstrating the value of lowering children’s cholesterol levels to prevent coronary artery disease in adulthood, we can rely on common sense: children growing up with a healthy diet are more likely to grow up to be adults with healthy hearts. As a general guide, children shouldn’t eat more than 100 milligrams of cholesterol per 1,000 calories in their diet.Should children have routine cholesterol testing? Currently, the Committee on Nutrition of the American Academy of Pediatrics recommends:
- No infants, regardless of family history, should be put on a low-cholesterol diet under one year of age. (We believe under two years of age would be wiser.)
- If there is a family history of hypercholesterolemia (a metabolic quirk causing very high cholesterol and fatty deposits in the skin), children should have their cholesterol checked and monitored beginning at age two years and rechecked annually.
- Children whose parents or grandparents (under 55 years of age) have a history of coronary artery or cerebrovascular disease should have their cholesterol checked before entering school and every few years thereafter.
- Children with parents whose cholesterol level is 240 milligrams or more should be tested anytime after age two and tested again five years later.For school-age children, an acceptable blood cholesterol level would be below 170 milligrams. In a child with a serum cholesterol above this level or with a positive family history for any of the above risk factors, a complete blood lipoprotein panel (i.e., HDL, LDL, total cholesterol, and triglycerides) should be done on blood samples drawn in the morning after a 12-hour fast. (To avoid the discomfort of fasting, do a routine nonfasting blood-cholesterol-level test first. If the result is borderline or high, get the complete profile, which needs to be done after fasting.)
The AAP does not believe that routine cholesterol tests are necessary for every child. Every child over two should be on a low-cholesterol diet anyway, and foods high in cholesterol (for example, a Big Mac contains 103 milligrams, a Whopper contains 90 milligrams, and a Double Whopper with cheese contains 195 milligrams) should be discouraged for many nutritional reasons. The foods that children should eat more of (fruits, vegetables, grains, lowfat dairy, and fish) tend to be already low in cholesterol.
Though it’s not healthy to have a cholesterol phobia, the earlier you help your children learn to be cholesterol conscious, the better for their hearts. Eating habits developed in childhood are likely to carry over into adulthood. Children who grow up on a high-fat, high cholesterol diet are likely to continue this fat preference, whereas children who grow up with a healthy diet are more likely to choose healthy foods as adults.
When fast-food establishments boast that their french fries are “cooked in cholesterol-free, 100 percent vegetable oil,” they are often referring to hydrogenated vegetable oil. This stuff stands up better to both life on a shelf and the heat of the fryer, but the effect on your blood cholesterol levels is similar to that of lard.
* The cholesterol that is attached to the LDL’s is actually the same as the cholesterol that is joined to the HDL’s. There are not two different kinds of cholesterol, “good” and “bad.” These terms are used to refer to the possibly helpful or harmful effects of the lipoprotein-cholesterol combination.