Heart Conditions and Diagnoses

Hyperlipidemia / Cholesterol Problems in Children

What is Hyperlipidemia?

Look up a term in The Heart Center glossary.

Hyperlipidemia is a term that means you have a 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 an association between high blood cholesterol and premature heart attacks. Excess cholesterol in the blood can settle 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 may eventually result in coronary artery disease, heart attacks or stroke.

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What is cholesterol?

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

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

Cholesterol is necessary for life. 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 2-19 years.

If an initial blood test shows a high total cholesterol level, the next step is to do a more detailed analysis to determine the balance of LDLs and HDLs. This is called a lipid profile, which is generally done after a 10-12 hour period of fasting, without any food or beverage.

When your doctor obtains a fasting lipid profile, your results are generally presented as Total cholesterol, Triglyceride, HDL and LDL cholesterol (in some instances you will get a VLDL level as well).

Total cholesterol is a measurement reflecting the presence of three particles 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). Collectively, cholesterol and triglycerides are known as lipids.

HDL and LDL particles are covered with a protein that allows them to dissolve in the bloodstream. LDL particles, commonly referred to as "bad" cholesterol, carry most of the body's cholesterol which may be deposited in the blood vessels to begin formation of plaque.

This process is associated with the development of cardiovascular disease. HDLs, referred to as "good" cholesterol, in contrast, 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.

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Cholesterol Guidelines for Children 2-19 years

Total Cholesterol (mg/dl)	LDL-cholesterol (mg/dl)	Interpretation
Less than 170	Less than 100	Normal
170-200	100-130	Borderline
Greater than 200	Greater than 130	High (Increased risk if male with HDL <45 or female with HDL <50)

The Preventive Cholesterol Treatment Center at Cincinnati Children's Hospital Medical Center recommends treatment for all children with an LDL count of 100 or higher with a family history of coronary artery disease. More aggressive criteria may be used if there have been cardiac events.

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Why treat high cholesterol in children?

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 opportunity now to teach your child healthy behavior patterns that will last a lifetime.

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Treating high cholesterol in kids

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 dietary modifications as a primary 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 1500 to 2400 calories per day, depending on age and activity level which would translate to approximately 50 to 80 grams of total fat per day.
*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 elevate 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 eliminated 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. Including 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-sugary foods have been warned off by dentists for years due to the increased incidence of dental caries.

Triglyceride levels may be effected 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.

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Dietary goals for children

Special "diet" foods are not necessary to meet these goals. A complete, low-fat diet is safe for children over age 2 years and can be easily achieved through consumption of "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 which are lower in fat and saturated fat can be the first step in dietary modification.

These dietary modifications 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.

Tips for keeping kid's cholesterol levels down

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 their 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.

What if diet doesn't work?

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.

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