Most people think of adults when they think of problems with an elevated cholesterol level. However, two recent studies have identified more than 10% of 4th graders with cholesterol levels more than the 95th%. 50% of children with high cholesterol will go on to have high cholesterol as an adult. When combined with high blood pressure, obesity or poor exercise, an elevated cholesterol level can have significant health implications. And because habits are formed early in life, attention to cholesterol in the 5-10 year old is likely to have a significant impact on adult health.
What is cholesterol?
Cholesterol refers to the fat that is carried in your blood stream. It is important for many bodily functions including hormone production and building and maintaining nerve cells. There are three main types of cholesterol; 1) LDL (low-density lipoproteins), 2) HDL (high-density lipoproteins), and 3) Triglycerides. LDL and HDL carry cholesterol through your blood. LDLs carry a lot of cholesterol, leave behind fatty deposits on your artery walls, and contribute to heart disease. HDLs do the opposite. They clean the artery walls and remove extra cholesterol from the body, thus lowering the risk of heart disease. LDL is called "bad" cholesterol and HDL is called "good" cholesterol. It is good to have low levels of LDL and high levels of HDL.
Why is cholesterol bad? An elevated cholesterol level over time can lead to coronary artery disease (CAD) or heart attacks. This occurs when deposits of fat in the blood (plaque) form inside blood vessel walls as well as to cerebrovascular disease (CVD) or stroke.
What causes high cholesterol? High cholesterol may be genetic but is mostly related to the amount of cholesterol and saturated fat we eat in our diet. Your liver makes most of the cholesterol in your blood from the fats, carbohydrates, and proteins you eat. You also get cholesterol by eating animal products such as meat, eggs, and dairy products.
When should cholesterol be tested? Children with risk factors, such as a family history of high cholesterol should be screened as early as age two. 2008 recommendations suggest that even children without high risk for elevated cholesterol, should be screened between the ages of 6-10 years and then every 5 years afterwards.
What are the normal and abnormal levels?
Because many people can have a normal cholesterol but low HDL cholesterol (a risk factor for heart disease) or high triglyceride levels (also a risk factor for heart disease), a lipid profile, which includes LDL, HDL, and triglyceride levels is recommended. Triglyceride levels should be below 150.
How can high cholesterol be prevented?
A healthy diet and exercise (yes, you hear this over and over again), is the best way to prevent high cholesterol. The following guidelines can be applied to children over the age of two.
- Eat less fat. Fats should contribute no more than 30% of your daily calories. Only 10% of the fat you eat should be saturated fat.
- Try to consume polyunsaturated and monounsaturated fats rather than saturated fats. Monounsaturated fats are found in olive oil, canola oil, and avocados. Polyunsaturated fats are found in fish and some vegetable oils. Saturated fat raises your LDL (bad) cholesterol although it raises your HDL (good) cholesterol. Saturated fat is found in different amounts in almost all foods. Butter, some oils, meat, and poultry fat contain a lot of saturated fat.
- Avoid foods with high levels of trans fats. Trans fats are partially hydrogenated fats meaning that they have been chemically modified with extra hydrogen molecules. Trans fats are the most harmful because they raise your LDL (bad) cholesterol and reduce your HDL (good) cholesterol. Trans fats provide the creaminess in food and used to be found in sandwich cookies, ranch dressings, and gooey cakes. A recent law made manufacturers responsible to list trans fats as well as saturated fats on all nutrition labels. It is the combination of the two (saturated fats and trans fats) that is the most damaging. Truth be told, all trans fats contribute to heart disease and so, all trans fats should be eliminated.
- Use sunflower, safflower, soybean, canola, corn, or olive oil rather than tropical oils such as palm or coconut.
- Use salad dressings and margarine made with polyunsaturated and monounsaturated fats.
- Use 1% or skim (0.5% fat) milk instead of whole milk (3.5% fat). Replace whole-milk dairy products with nonfat or low-fat cheese, spreads, and yogurt.
- Eat skinless chicken, turkey, fish, and meatless entrees more often than red meat.
- Choose lean cuts of meat and trim off all visible fat. Keep portion sizes moderate.
- Avoid fatty desserts such as ice cream, cream-filled cakes, and cheesecakes. Choose fresh fruits, nonfat frozen yogurt, Popsicles, etc.
- Reduce the amount of fried foods, vending machine food, and fast food you eat. Limit the amount of nuts you eat, especially nuts high in saturated fat. Examples of nuts that are especially high in saturated fat are cashews, pistachios, and Brazil and macadamia nuts.
- Eat fruits and vegetables (especially fresh fruits and leafy vegetables), beans, and whole grains daily. The fiber in these foods helps lower cholesterol.
- Exercise controls weight, decreases your total cholesterol level, decreases your LDL (bad cholesterol), and increases your HDL (good cholesterol). A child is much more likely to exercise if you exercise with him. (See BMI handout for age specific suggestions.)
- No Smoking! Not smoking is good for many reasons including lowering cholesterol. Please talk to your kids about not smoking and set a good example!