Health Education

Elevated Cholesterol Levels

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Most people think of adults when they think of problems with an elevated cholesterol level. However, two recent studies have demonstrated that more than 10% of 4th graders had marked elevated cholesterol levels. 50% of children with high cholesterol will go on to have high cholesterol as an adult. When combined with high blood pressure or obesity, an elevated cholesterol level can have significant health implications. And because habits are formed early in life, attention to cholesterol in the first 5-10 years 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)
  3. Triglycerides. LDL and HDL carry cholesterol through your blood.
  4. 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 and Triglycerides are 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. New recommendations suggest that all children, even children without high risk, should be screened between the ages of 9-11 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. Ideally, total cholesterol should be below 170 for children and LDL should be below 110.  Triglyceride levels should be below 150 and HDL should be above 40.

How can high cholesterol be lowered or prevented?

A healthy diet and exercise (yes, you hear this over and over again), is the best way to lower or 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% or less of the fat you eat should be saturated fat. Saturated fat raises your LDL (bad) cholesterol. Saturated fat is found in different amounts in almost all foods but foods like butter, some oils, meat, and poultry contain a lot of 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.
  • Avoid foods with high levels of saturated fats. Because of body build, the range of fat intake per day is fairly wide.  Children ages 4 to 8 need 33 to 78 grams of fat daily; kids ages 9 to 13 require 39 to 101 grams of fat daily; and teens ages 14 to 18 require 50 to 125 grams of fat daily.  No more than 10-12% of the total should be as saturated fats.  Saturated fats are found in high-fat meats, lard, butter, cream, some forms of ice cream and full-fat dairy products, such as whole milk and cheese.  It is particularly high in some forms of processed or sliced cheese and low in ricotta and cottage cheese.

Other changes you may want to consider include:

  • Use 1% or skim (0.5% fat) milk instead of whole milk (3.5% fat). Also, 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 and popsicles instead.
  • Reduce the amount of fried foods, vending machine food, and fast food you eat.
  • 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 a family member or friend exercises with him or her.
  • 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!