What Is Cholesterol?
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 saturated and trans fats in food, 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.
All children should be screened for high cholesterol between the ages of 9 to 11 years of age. 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.
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. These fats can form from extra calories and sugar in your diet. Alcohol can also raise triglycerides. Choosing whole grains, reducing added sugars, including healthy fats, exercising and maintaining a healthy weight can help lower your triglycerides.
Cholesterol Guidelines for Children 2-19
||Total Cholesterol (mg/dl)
||LDL Cholesterol (mg/dl)
HDL Cholesterol (mg/dl)
||Less than 170
||Less than 110
Greater than 45
Less than 100 (<9>
Less than 130 (10+ yrs)
||200 or greater
||130 or greater
||Less than 40
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. Very low HDL may also be a reason for referral.
Treatment of 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 diet, low in fat, cholesterol and added sugars. 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. The majority of your fat from foods should come from healthy, unsaturated fats such as nuts, avocados, olive oil and canola oil.
An average child should take in about 1,500 to 2,400 calories per day, depending on age and activity level. This would be about 50 to 80 grams of total fat per day with no more than 12-19 grams coming from saturated fat. You should check with your doctor or dietitian to see what is best for your child.
NOTE: It is important to look at nutrition fact labels. Foods labeled "cholesterol free" can still have extra calories, unhealthy fats and added sugars.
- Saturated fats have been shown to increase blood cholesterol levels. They are mainly found in animal products such as meat, poultry, fish, eggs, butter and milk. They are also found in processed and packaged foods, and in desserts.
Plant oils that are high in saturated fats include coconut, palm, and palm kernel oils. Limit the saturated fats to less than 7 percent of your calories.
- Dietary cholesterol should be no more than 200-300 mg per day. Cholesterol comes ONLY from animal sources and is never found in plant foods. Remember to look at total and saturated fat content as well as cholesterol on the food label.
- 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. Increasing soluble fiber (oats, beans, legumes) can help lower blood cholesterol.
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, fruits and vegetables daily can help increase fiber.
- Limit simple sugars, especially if triglyceride levels are high.
Triglyceride levels may be affected by the sugar and starch content of the diet, as well as fat content. Sugar-sweetened beverages like soda, juice, lemonade and sports drinks can be especially troublesome. Refined white flours and added sugars can also raise triglycerides. Using whole grains instead of white flours can be helpful.
Did you know one 12 oz. can of regular soft drink has the equivalent of 10+ teaspoons of sugar in it? Do not "reward" children with food, especially not 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 nutritionally complete, diet low in saturated and trans fat 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 saturated fat and added sugars can be the first step in dietary modification. Choosing fewer processed foods and including more fruits and vegetables can also be a great start.
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, these foods may have extra sugars and starch and often lack vitamins and minerals. We need to remember the nutrient content of the foods we are giving our children and encourage a balanced diet. Healthy unsaturated fats from nuts, seeds, avocado, olive and canola oils can be included in a healthy diet.
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 the goal is not to eliminate all fat from the diet, but to limit intake of unhealthy fats, sugars and junk foods. It also means consuming the right amount of calories to support growth and maintain a healthy weight. 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 processed foods brought into the house of other family members.
- Cooking at home and having meals together around a table is beneficial for the whole family. Meal planning, buying seasonal produce, and including some meatless meals can help you be more successful and keep you from overspending.
- It is harder to control what is in our foods when we eat out. Look for restaurants that offer healthier options like grilled or baked meats and sides of fruits or vegetables. Be aware that condiments can add extra calories, fat and sodium and watch for large portions. Rethink your drink and limit sugary drinks when eating out.
- 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 nutrition.
- Use positive terms when referring to dietary modifications. Negative comments regarding low-fat or "special 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.
- 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.
Favorite foods are not off limits to children, but limiting quantity and frequency of high-fat and high-sugar foods along with implementing 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.