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Kids and Cholesterol

Should You Worry?

When people think of cholesterol, they think of it as solely an adult problem. Think again. The truth of the matter is, high cholesterol strikes an estimated one in 500 children, or 10% of our nation's youth. Many of those young people will go on to develop a host of other health problems as a result of their elevated cholesterol levels.

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“High cholesterol has fast become a growing problem in our society of fast- and low quality-food,” says Julian Nelson, M.D., a pediatrician with Crystal Run Health Care in Middletown. “Our increasingly overweight population is now more than ever at risk for early diabetes, hypertension and coronary artery disease.”

Paul Mark Baker, M.D., a pediatrician at Hudson Valley Pediatrics in Middletown, agreed.“Autopsy studies have shown that atherosclerosis does begin in childhood, though its symptoms, of course, do not show themselves until later,” he says. “An effort is being made to impact these early changes in childhood.”

Indeed, there are steps parents and children can take now to heighten their awareness while lowering their risks, starting with the food they put on the table. Or in the sippy cups. “For children between 12 months and two years of age for whom obesity or overweight are a concern, or with a worrisome family history, reduced-fat milk would be appropriate, for instance,” Dr. Baker says.

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But what is cholesterol? Well, it's a soft, fat-like waxy substance found in the bloodstream as well as all of a person’s cells. A certain level is important to have for producing cell membranes and some hormones along with other bodily functions.

However, too much of it in the blood can serve as a major risk for coronary heart disease, leading to a heart attack or stroke. The medical term for high cholesterol is Hypercholesterolemia, which is literally too much Low Density Lipoproteins (LDL), or “bad” cholesterol, left on the inner walls of the arties. The results for children can be staggering later on in life.

“High cholesterol is not like a rash, easily examined and generally easily treated,” says Dr. Nelson. “Children should be evaluated for risk factors yearly at their annual physicals.” Some 90 percent of parents whose children have high cholesterol possess spiked levels themselves. The statistic speaks to the genetic link of high cholesterol.

Other risk factors are environmental, however, and have a higher chance of being controlled. Some of those risks include smoking, poor eating habits and a lack of exercise. Overweight people tend to have a higher level of LDL cholesterol, potentially placing them at a heightened risk. High blood pressure, along with Diabetes Mellitus, should be diagnosed and treated as soon as possible; both can increase a person’s chances of developing high cholesterol.

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“For many years, the medical community has advised that children with a family history (first generation family members) of dyslipidemia or early onset heart attacks and strokes (men and women less than 45-50 years old at the time of their first heart attack or stroke) have their full cholesterol panels done as early as two years old,” says Orange County pediatric cardiologist Eric D. Fethke, M.D.

“This is because there is a clear genetic tendency for these cholesterol abnormalities to be passed on to future generations. The idea beyond such early screening is that the sooner these abnormalities are noted, the sooner we can intervene to either reverse or delay the child's own tendency to develop a heart attack or stroke. In fact, younger children respond much better to interventions than people do as they get older.”

Because nutrition plays such a pivotal role in the development and prevention of high cholesterol, it's important that parents are versed on what goes into their children's mouths. The focus should be on avoiding foods within the LDL cholesterol group.

They include ones with saturated fat (type of fat found mostly in foods from animals) and cholesterol, which comes only from animal products. Those specific foods include: egg yolks, meat, poultry, seafood, and dairy products, such as milk, cheese and ice cream. Instead of those cholesterol-laden choices, parents should ensure their children have a diet full of fresh fruit and vegetables, whole grains (fiber), lean meats, fish and other low fat options, containing no trans-fats.

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Just as childhood obesity can lead to diabetes, high blood pressure, heart attacks, strokes, and emotional and social problems, early traces of high cholesterol can create a host of long-term residual effects as well. In fact, they can begin surfacing as early as when kids reach their teens and early 20s. Evidence clearly points to children with high cholesterol having an increased risk of developing heart disease as an adult.

“Parents should encourage the development of healthy eating habits by limiting the total caloric intake and teaching kids to eat reasonable portions,” says Paul Woolf, M.D., who practices pediatric cardiology at both Vassar Brothers Medical Center in Poughkeepsie and Northern Dutchess Hospital in Rhinebeck.
He added, “Healthy diet includes limits on saturated and trans-fats, as well as making consumption of foods that are high calorie, but (have a) low nutritious value, routine.”

Once detected, a child’s high cholesterol status should be brought to the attention of the primary doctor, who can then make a referral to a specialist. The next step involves treatment of the condition. Initially this involves, and is usually limited to, diet. One common approach is the American Heart Association's Step 1 regime. This diet includes less than 10% of total caloric intake coming from saturated fat, less than 30% from fat and a total intake of less than 300 milligrams of cholesterol per day.

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Regular, moderate exercise consisting of 30-60 minutes daily is recommended. In some cases, diet might prove ineffective. Medication is then the next logical step to take. It is recommended for children older than 10 years of age who have an LDL level greater than 160 mg/dl, along with a positive history of premature heart disease or two risk factors. Regardless of the drug taken, certain key factors need to be considered when administering them to children.

Coronary heart disease is the leading cause of death in the United States, claiming 450,000 lives annually. A large precursor to those heart problems is high cholesterol, oftentimes beginning in childhood. Much can be done to reduce these unnecessary losses of life. Parents can play an integral role in that process.

Jennifer Warren is a freelance writer living in Orange County.