Hyperlipidemia / Cholesterol Problems in Children

Look up a term in The Heart Center glossary.

Hyperlipidemia is a condition where there are high level of lipids (fats / cholesterol) circulating in the blood. There are different types of hyperlipidemias, all of which are risk factors for developing heart disease.

Other factors such as genetics, environment, habits and the presence of other diseases such as diabetes and hypertension may also contribute to the development of heart disease. Some of these factors are within our control; others are not. 

Studies have shown a link between high blood cholesterol and premature heart attacks. Too much cholesterol in the blood can collect in the arteries and form a plaque (a raised lesion on the inside of an artery).

Over time, this plaque can build up and narrow the arteries, which in turn may clog the flow of blood. This process can begin in early childhood and over time may result in coronary artery disease, heart attacks or stroke.

Cholesterol is a naturally occurring substance found in all foods from animals such as meat, poultry, seafood, eggs and dairy products. Cholesterol is not present in foods that come from plants.

Humans also make cholesterol in our bodies. Dietary cholesterol, as well as other fats in the diet, may be absorbed by the body and raise blood cholesterol. 

Our bodies need cholesterol. It is a building block for hormones and a component of cell membranes. The goal of treating patients with elevated blood cholesterol levels is not to eliminate cholesterol from the blood, but to achieve and maintain a safe level. 

Doctors generally recommend that total blood cholesterol be below 170 mg/dl for children 2 to 19 years old.

If an initial blood test shows a high total cholesterol level, the next step is to do a more detailed test to find out the balance of two types of cholesterol: LDL and HDL. This is called a lipid profile, which is typically done after a 10- to 12-hour period of fasting without anything to eat or drink. 

When your doctor gets the results from a fasting lipid profile, it will have numbers for total cholesterol, triglyceride, HDL and LDL cholesterol. (In some instances you will get a VLDL level as well.)

Total cholesterol measures three particles found in the blood:

  • High density lipoprotein (HDL)
  • Low density lipoprotein (LDL)
  • Very low density lipoprotein (VLDL) 

HDLs and LDLs are two different kinds of cholesterol particles, and VLDLs are rich in triglycerides (or fats). Together, cholesterol and triglycerides are known as lipids. 

HDL and LDL particles are covered with a protein that lets them dissolve in the bloodstream. LDL particles, commonly called “bad” cholesterol, carry most of the body's cholesterol and can begin to form plaque in the blood vessels.

This process is linked with the development of cardiovascular disease. HDLs, also called “good” cholesterol, seem to offer protection against cardiovascular disease by carrying some of the cholesterol out of the bloodstream and preventing it from being deposited.

Triglycerides are fats circulating in your bloodstream.

Total Cholesterol (mg/dl)

LDL Cholesterol (mg/dl)

Interpretation

Less than 170Less than 100Normal
170-200100-130Borderline
Greater than 200Greater than 130High (Increased risk if male with HDL <45 or female with HDL <50

The Lipid Clinic at Cincinnati Children's recommends evaluation for all children with an LDL count of 130 or higher or a triglyceride level of 200 mg/dl or higher. More aggressive criteria may be used if there have been cardiac events.

Evidence suggests that children with high cholesterol are likely to have high cholesterol when they are adults. Concern about developing disease is greater if there is a family history of heart disease, since the evidence is strong that heart disease runs in families.

Autopsies of healthy individuals killed in accidents or wars have shown noticeable damage to the arteries of young adults. The damage appears to be related to cholesterol levels in the blood. This evidence suggests that the process that leads to heart disease and heart attacks begins during childhood and the teenage years.

Behavior is learned. While we cannot change our genetic heritage, we can stop smoking, exercise regularly, and choose to eat a healthful, nutrient-dense, low-fat, low-cholesterol diet. You have the chance now to teach your child healthy behavior patterns that will last a lifetime.

The first step in treatment of high cholesterol is to set reasonable, attainable goals for your child and your family and to modify your family's diet to achieve these goals.

The National Cholesterol Education Program (NCEP) recommends making changes to the diet as a main treatment for anyone with elevated cholesterol. Initial dietary guidelines to lower your blood cholesterol are outlined below:

  • Total fat in the diet should be reduced to no more than 30 percent of your calories. Total fat consists of all the fats you eat regardless of the type. An average child should take in about 1,500 to 2,400 calories per day, depending on age and activity level, which would be about 50 to 80 grams of total fat per day.  You should check with the doctor to see what is best for your child.

NOTE: Be careful to look at labels for total fat content. Avoid choosing foods that are simply labeled “cholesterol free” because a product can be cholesterol free and still be very high in fat. Dietary fat can be converted to cholesterol in our bodies.

  • Saturated fats have been shown to increase blood cholesterol levels. They are mainly found in animal products − any meat, poultry or fish and anything that comes from an animal such as dairy products.  Plant oils that are high in saturated fats include coconut, palm, and palm kernel oils. Saturated fats need not be removed from the diet but should be limited to less than 10 percent of your calories.
  • Dietary cholesterol should be no more than 200-300 mg per day. Cholesterol ONLY comes from animal sources and is never found in vegetable products. Remember to look at fat and saturated fat contents as well as cholesterol contents.
  • Fiber should be included daily. It is recommended that we get 25-30 grams of fiber per day. Most Americans do not meet this goal. Fiber can act like a sponge in taking some of the fat out of the body without letting it get absorbed into the bloodstream. Eating whole grains, beans, high fiber cereals and vegetables daily can help increase fiber.
  • Simple sugars should be limited, especially if triglyceride levels are high. High-sugar foods have been discouraged by dentists for years due to the increased incidence of tooth decay.
    Triglyceride levels may be affected by the sugar content of the diet as well as by the fat content. Regular soft drinks and other sugar-sweetened beverages can be especially troublesome. Did you know one 12 oz. can of regular soft drink has the equivalent of 10+ teaspoons of sugar in it? Try not to “reward” children with high-fat or high-sugar treats. Stickers, crayons, books or small toys work well as positive incentives.

You do not need special “diet” foods to meet these goals. A complete, low-fat diet is safe for children over age 2 years and can be easily achieved by eating “normal” foods. 

Providing a well-balanced diet including a variety of foods sounds too simple to be true. In reality, this is the solution.

There are no magical "good" foods or "bad" foods that will change your child's cholesterol. Teaching your children to select a wide variety of foods that are lower in fat and saturated fat can be the first step in dietary modification.

These dietary changes need to be more than switching high fat "junk" food to fat-free "junk" food. While it is nice to have so many good tasting fat-free products out on the market, we need to remember the nutrient content of the foods we are giving our children.

Obesity is a growing concern among American children today and has been recognized by the Centers for Disease Control as an epidemic in the United States. It is important to recognize that even though you may be purchasing all fat-free products, this does not mean they are calorie free and they still need to be limited in quantity. New growth charts have been developed incorporating body mass index (BMI) information to allow careful monitoring of weight. They can be viewed at www.cdc.gov/growthcharts.

  • Encourage the whole family to participate in dietary modification. Your child will be much more successful if they are not tempted by high-fat foods brought into the house of other family members.
  • Set good examples -- children live what they learn and learn by example. If parents have poor eating habits, their children are likely to mimic those habits. This goes for exercise, as well as dietary intake.
  • Use positive terms when referring to dietary modifications. Negative comments regarding low-fat or healthy foods should be kept to yourself. Avoid the term "diet" as this refers to a temporary solution. Make dietary modifications for a lifetime.
  • Make foods appealing to kids. Use colorful veggies or fruits. Cut things into special shapes kids enjoy.
  • If you are carefully controlling what your child eats at home, your child will have more flexibility when eating away from home.
  • Be creative and get kids involved in meal planning and preparation. Teach your children to read labels and what to look for on the label.
  • Help your child maintain his or her desirable body weight. Encourage physical activities and limit sedentary activities. Offer a wide variety of tasty low-fat, nutrient-dense foods to your family. Limit intake of "empty calorie" foods.

It is unrealistic to expect anyone to eat only healthy food, but limiting quantity and frequency of high-fat and high-sugar foods along with regular exercise can help kids lower their cholesterol levels and decrease their risk for developing coronary artery disease later in life.

If dietary treatment does not lower your child's cholesterol after you and your child make a concentrated effort for a significant length of time -- up to a year -- drug therapy will be considered.


Last Updated 07/2013