The face of cholesterol testing just got a lot younger.
The American Academy of Pediatrics recently revised guidelines for annual well-child visits, adding a recommendation that all children between the ages of 9 and 11 get a dyslipidemiascreen, which calculates total cholesterol, including high-density lipoprotein ("good" cholesterol, aka HDL), low-density lipoprotein ("bad" cholesterol, aka LDL or non-HDL) and triglycerides in the blood.
It's the result of a 2012 report from the National Heart, Lung, and Blood Institute, which urged the universal childhood test based on evidence that elevated triglycerides and LDL raise the risk of later cardiovascular disease, which afflicts at least 40 percent of the U.S. population. It cited evidence that early intervention can substantially reduce that risk.
The test recommendation has been incorporated into the AAP's Bright Futures Recommendations for Preventive Pediatric Health Care, said Dr. Joseph Hagan, co-editor of those guidelines and a primary care pediatrician in Vermont.
"There are a couple of thoughts behind screening at that age," Hagan said. "One is that, during adolescence, the sex hormones lower cholesterol numbers (by 10 to 20 percent, according to the institute). So you get a number that's harder to interpret. The best time to get a baseline number is before puberty."
In the past, children were tested only if there were red flags such as obesity, diabetes or a family history of heart disease. But studies over time indicated that the risk-assessment questions were failing to identify 30 to 60 percent of disorders, according to the institute.
Rising obesity rates are undeniably a force behind the recommendation, Hagan said. Obesity is commonly associated with elevated triglycerides and non-HDL, and low levels of HDL.
"It is the non-HDL we are concerned with," Hagan said.
The baseline blood draw does not require the child to fast beforehand. The institute considers an acceptable non-HDL result for children and adolescents to be below 120. Borderline is 120-144. High is 145 or above.
Hagan adopted the testing guideline a year ago in his practice.
"We have picked up not a whole lot of kids with high cholesterol, but we've picked up a remarkable cohort with high triglycerides," Hagan said. "One child's triglyceride number was unreportable — something like 700. (Acceptable at that age is below 140.) That child's life has been changed."
Cynics might suspect doctors and pharmaceutical companies want to push statin prescriptions.
"That's not the goal here," Hagan said. "I have put only one patient on statins in a year, and it was a 22-year-old who I still care for who had really failed lifestyle changes."
Exercise and diet changes are the most effective interventions.
"Cholesterol is very sensitive to dietary change, and it makes a bigger difference in kids than adults," he said. "Get them outside. Turn off the technology. Eat less fast food and more salmon. Omega 3s are very good for lowering triglycerides."
At least 60 minutes of moderate-to-vigorous physical activity daily can benefit children's health, according to the institute's report, particularly in tandem with a healthy diet.
Dr. Anita Chandra-Puri, a pediatrician with Northwestern Medicine in Chicago and a spokeswoman for the AAP, said a handful of her patients have shown elevated cholesterol in the past year. She has not prescribed medications.
"Parents are shocked at the thought of checking their child's cholesterol level at the age of 9," she said, "but it is an important piece of information when counseling them about their child's current or potential risk for childhood obesity and cardiac disease. That is a very important part of this process too."
Establishing healthy eating habits
Parents have a new ally in the effort to clean up their kitchens and improve their children's eating habits — and their own.
"Kids are hugely interested in the cooking shows — 'Iron Chef,' etc.," said Jodie Shield, co-author of "Healthy Eating, Healthy Weight for Kids and Teens" (Academy of Nutrition and Dietetics, 2011) and a registered dietitian in Chicago.
Seize that as an impetus to cook and eat more at home.
A diet with total fat at 25-30 percent of calories, saturated fat less than 10 percent of calories, and cholesterol intake less than 300 mg has been shown to reduce low-density lipoprotein levels (LDL, the bad kind of cholesterol) in healthy children older than 2.
Shield recommends referring to ChooseMyPlate.gov, the U.S. Department of Agriculture's heir to the food pyramid.
Shield outlined some healthy eating habits that parents can establish.
Start with dairy. An 8-oz glass of 2 percent milk has 120 calories, 5 grams total fat, 3 of which are saturated, and 20 mg of cholesterol. Skim has 80 calories, 0 grams of fat and 5 mg of cholesterol.
"If kids are drinking four cups of milk a day, it's very healthy for them to make that change," Shield said.
Make vegetables tasty. They don't have to be raw. "But you don't have to cook them in butter. If you're going to add fat, try olive or canola oil. It still has calories, but it's much healthier."
She is not above cooking green beans in bacon fat — once in a while.
"If you give kids a little ranch dressing and they eat a few more, that's OK too. The point is to get them to love to eat healthy foods."
Direct the sweet tooth to fruits or low-fat dairy. "Fruits are fat-free and wonderful," Shield said. And they don't have to be organic. "There's no science that shows organic is healthier."
For yogurt, look for low-fat or fat-free, and consider the smaller 6-ouncers.
Seek fiber; watch sugar. Soluble fiber, as in oatmeal, beans and many fruits, can make you feel more full and lower LDL. "Oatmeal is one of the best cereals kids can eat," Shield said. "Instant oatmeal is still good, but I'd get plain and add my own sugar or whatever else."
Half of the grains you eat should be whole grains, as in some boxed cereals. Those have insoluble fiber, which can help prevent constipation.
Some cereals and oatmeal packets can be loaded with sugar.
Divide the grams of sugar by 4 to find out how many teaspoons of sugar are in a serving. Aim to keep that number under 2 teaspoons.
Meat, poultry and fish. Choose lean cuts of meat, such as loins and rounds. Buy skinless chicken. "Skin doubles the fat," she said. Though they are higher in cholesterol than boneless skinless breasts, boneless skinless chicken thighs are less expensive, have more flavor and are more forgiving of overcooking.
Eat fish, rich in omega 3 fatty acids, at least twice a week. Not fried catfish and coconut shrimp, but grilled or baked fish such as cod, flounder, tilapia, shellfish and salmon (if it's not too strong for your family's tastes). Present unfamiliar foods in a familiar way to improve kids' reception. Shield's kids loved fish tacos.
For more: bestfoodfacts.org or healthyeatingforfamilies.com
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