Obesity isn’t a great predictor of high cholesterol in kids

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High LDL cholesterol levels can start in childhood -- and are linked to atherosclerosis (a narrowing of the arteries caused by buildup of plaque on the artery walls) Indeed, there’s evidence that atherosclerosis itself can take root during childhood, according to the American Heart Assn.

So you’d think it would be a good idea to identify kids who are at heightened risk and test their blood cholesterol. Since July 2008, the American Academy of Pediatrics has recommended that kids at high risk get screened, especially since obesity is a risk factor and rates of obesity have sharply risen in children in recent years.

So which kids do you pick to screen? The most obvious high-risk children are those who are overweight. But it’s not as simple as that.

A University of Michigan study looking at national data on kids’ weights and cholesterol level found that ‘using body mass index to find kids with high cholesterol does not work well. There were many overweight and obese kids who had normal cholesterol, and there were a fair number of healthy-weight kids who had high cholesterol,’ said study coauthor Joyce Lee in a statement.

The paper, published this week in the Archives of Pediatric and Adolescent Medicine, found that using weight alone as a decider on whether to screen would miss about 50% of kids who had high cholesterol. And as many as 30% of kids would have an unneeded test.

The authors suggest that the pediatric academy’s screening recommendations may have to be revised to catch more cases and conduct fewer unneeded tests.

Weight is obviously just one part of the cholesterol equation. The Heart Assn.’s website lists a variety of lifestyle habits that will lower the risk of poor cholesterol profiles, atherosclerosis and heart disease:

‘To reduce fatty buildups in arteries in children (and adults):

Cigarette smoking should be discouraged.
Regular aerobic exercise that lasts at least 30–60 minutes on most days of the week should be encouraged.
High blood pressure should be identified and treated.
Obesity should be avoided or reduced.
Diabetes mellitus should be diagnosed and treated.

Children age 2 years and older should be encouraged to eat at least five servings of fruits and vegetables daily as well as a wide variety of other foods low in saturated fat and cholesterol. Doing this will help them maintain normal blood cholesterol levels and promote cardiovascular health.’

And if you want to learn more about the development of atherosclerosis in childhood, the American Academy of Pediatrics’ 1998 clinical report, which includes the screening recommendation, is a good resource.

-- Rosie Mestel