Identify the Risks of Cholesterol in Children

Diseases that affect the heart and blood vessels (cardiovascular diseases) are the leading cause of death globally.^1,2 Cardiovascular diseases can begin early in childhood. Dyslipidaemia is one of the significant risk factors for cardiovascular diseases.³

What is dyslipidaemia?

Dyslipidaemia is a condition in which abnormal lipid (triglycerides and cholesterol) levels are seen in blood. Triglycerides are part of oils and fats.⁴ Cholesterol is a type of body fat, which travels around the body in small protein-covered particles called lipoproteins.⁵ The two main types of lipoproteins present in the body are good cholesterol (high-density lipoprotein cholesterol) and bad cholesterol (low-density lipoprotein cholesterol).⁶

If there is a high level of bad cholesterol in the blood, they gradually start to accumulate on the walls of the blood vessels to form plaques, which narrows the inner space of the blood vessels, a condition known as atherosclerosis.⁶ This leads to restriction of the blood flow to the heart and other organs as well.⁷ An increase in cholesterol levels in the blood is also known to increase the risk of coronary artery disease (blockage in blood supply to the heart).^7,8 The blockage of blood supply to the heart could result in a heart attack.6

Dyslipidaemia in children and adolescents

Studies have shown that cardiovascular diseases begin early on in childhood with dyslipidaemia being an important risk factor. Dyslipidaemia along with a lack of physical activity, unhealthy diet and weight gain necessitates screening and treatment of dyslipidaemia in children and teens for preventing cardiovascular diseases and death.³

When to test my child for dyslipidaemia?

The lipid levels are typically low at birth. The levels increase up to 2 years of age, peaking before puberty. Thereafter, they decrease by 10-20% in the late adolescent stage, followed by a rise in adulthood.⁹

Listed are the recommendations for screening of dyslipidaemia in different age groups:⁸

• Below 2 years: No screening is needed
• 2-8 years: Children should be tested for dyslipidaemia if
  • They have high blood pressure, diabetes or obesity
  • Their parents have dyslipidaemia
  • Their grandparents, parent, uncle, aunt or sibling has premature coronary artery disease
• 9-11 years and 17-21 years: Universal screening is recommended
• 12-16 years: Screening is recommended if there is a change in the family or personal history⁸

How to manage dyslipidaemia in children?

Dyslipidaemia in children and adolescents can be controlled by lifestyle changes, dietary treatments and medications.¹⁰

1. Lifestyle changes: Children and adolescents should engage in moderate or strong physical activity daily. Sedentary habits, such as playing video games, watching television and surfing through the internet, should be minimal.¹⁰
2. Dietary changes: A change in the diet should be the foremost approach to a healthier life. You must inculcate eating habits in your children with foods containing low amounts of total fat, cholesterol, trans-fat and saturated fat.¹⁰ The intake of simple sugars (white sugar, lollipops) should be less, while the intake of complex sugars (starches found in rice, oatmeal, potato) should be increased.^10,11
3. Medication: Paediatricians may advise treatment with medication in children 10 years or older if dietary and lifestyle changes do not yield any result after 6-12 months.¹⁰

Most of the children depend on their parents for their healthy development and safety.¹² Hence, parents need to take collective responsibility along with the healthcare providers in understanding more about dyslipidaemia and risk of cardiovascular diseases in their kids.

References:

1. World Health Organization. Cardiovascular diseases [Internet]. [cited 2020 Jan 03]. Available from: https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1.
2. National Cancer Institute. Cardiovascular diseases [Internet]. [cited 2020 Jan 03]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cardiovascular-disease.
3. Kalra S, Gandhi A, Kalra B, Agrawal N. Management of dyslipidemia in children. Diabetol Metab Syndr. 2009 Dec 8;1(1):26.
4. The John Hopkins Patient Guide to Diabetes. Dyslipidemia (High Cholesterol) [Internet] [cited 2020 Jan 03]. Available from: http://hopkinsdiabetesinfo.org/dyslipidemia/.
5. Harvard Health Publishing. How it’s made: Cholesterol production in your body [Internet]. [updated 2019 July 31; cited 2020 Jan 03]. Available from: https://www.health.harvard.edu/heart-health/how-its-made-cholesterol-production-in-your-body.
6. Centers for Disease Control and Prevention. LDL and HDL Cholesterol: “Bad” and “Good” Cholesterol [Internet] [updated 2017 Oct 31; cited 2020 Jan 03]. Available from: https://www.cdc.gov/cholesterol/ldl_hdl.htm.
7. Centers for Disease Control and Prevention. Coronary Artery Disease (CAD) [Internet] [updated 2019 Dec 09; cited 2020 Jan 03]. Available from: https://www.cdc.gov/heartdisease/coronary_ad.htm.
8. Coronary Artery Disease in Asian Indians. Pediatric Dyslipidemia [Internet]. [cited 2020 Jab 03]. Available from: https://cadiresearch.org/topic/children/pediatric-dyslipidemia.
9. NCBI. Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. [updated 2016 Aug; cited 2020 Jan 03]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK379672/.
10. Yoon JM. Dyslipidemia in children and adolescents: when and how to diagnose and treat? Pediatr Gastroenterol Hepatol Nutr. 2014 Jun;17(2):85-92.
11. KidsHealth. Learning About Carbohydrates [Internet]. [updated 2017 Apr; cited 2020 Jan 03]. Available from: https://kidshealth.org/en/kids/carb.html.
12. NCBI. Parenting Matters: Supporting Parents of Children Ages 0-8 [Internet] [updated 2016 Nov 21; cited 2020 Jan 03]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK402020/.

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