High Cholesterol In Children: Types, Causes, Signs & Treatment

Cholesterol plays an important role in various physiological functions, such as hormone production, but excess cholesterol can cause severe health problems over time if left unaddressed. High cholesterol in children, also known as hyperlipidemia, may lead to serious health conditions such as the hardening of the arteries.

Cholesterol is a type of lipid naturally produced by the body’s cells. It is naturally present in several food items, such as coconut oil, poultry, and full-fat dairy (1) (2). According to the Centers for Disease Control and Prevention (CDC), 7% of children and teens between ages six and 19 in the US have high total cholesterol levels (3). Therefore, it is important to keep children’s cholesterol levels under control.

Read this post to learn more about the types, desirable levels of cholesterol, causes of high cholesterol, possible complications, preventive measures, and treatment for high cholesterol in children.

What Are Different Types Of Cholesterol?

Cholesterol is carried to different parts of the body by compounds called lipoproteins present in the blood. Based on the type of carrier lipoprotein, cholesterol can be divided into two types (4) (5).

1. Low-density lipoprotein cholesterol (LDL cholesterol): It makes up for most of the body’s cholesterol. Its high levels are associated with an increased risk of cardiovascular disease and stroke. Thus, it is also known as bad cholesterol.

2. High-density lipoprotein cholesterol (HDL cholesterol): The high-density lipoproteins absorb cholesterol and carry it back to the liver, which breaks down the cholesterol for elimination or other biochemical processes. A healthy level of HDL cholesterol can lower LDL cholesterol and benefit the heart. Since HDL cholesterol is good for the body, it is also known as good cholesterol.

What Are Triglycerides?

Triglycerides (TGs) are a type of fat compound, which works as an energy reserve for the body. The body can obtain TGs from food and are also produced by the liver, which converts surplus consumed calories to TGs stored as body fat (6).

The body needs TGs as reserve fuel for rigorous physical activities and to keep the body warm. However, high triglyceride levels raise the risk of cardiovascular diseases (7). Children and adolescents with high triglyceride levels, along with high LDL levels or low HDL levels, are likely to have a higher risk of developing fatty deposits in the arteries.

What Is The Normal Cholesterol Range For Children?

The normal or healthy cholesterol range for adults and children vary. Below is the healthy cholesterol range for children between two and 18 years and triglyceride range for children up to 19 years (8) (9).

Source: Children’s Hospital of Orange County and American Association of Clinical Chemistry

The individual value and ratio of different cholesterol and triglycerides can help assess the risk of health issues. You may speak to a pediatrician if you feel your child might be at risk of having high LDL cholesterol and triglycerides.

What Are The Complications Of High Cholesterol Level In Children?

High cholesterol in children can lead to several complications in the long run (10). Cardiovascular diseases (CVD) and stroke are some of the leading health issues that could arise due to high cholesterol. Atherosclerosis is a cardiovascular disease in which the cholesterol deposits within the walls of arteries and causes plaque formation.

Over time, the plaque hardens the arterial walls and narrows their circumference. It reduces or stops the blood flow to various organs, raising the risk of health issues, including other cardiovascular diseases and stroke.

What Causes High Cholesterol In Children?

There is no single cause of high cholesterol in children and teens, and it is often due to a combination of different factors, such as (11) (12):

1. Genetics: Familial hypercholesterolemia or FH is a genetic disorder in which the body recycles LDL cholesterol instead of removing it from the body. As a result, the LDL levels in the blood elevate (13). The disorder affects one in 500 children. A child inheriting the gene from both parents is at higher risk of developing cardiovascular diseases (14).

2. Dietary habits: Children and teens consuming processed foods rich in saturated fat and deep-fried foods high in trans fats are at a higher risk of developing high cholesterol levels. A few examples of such foods include commercially baked cookies, cakes, crackers, and buns. Foods naturally high in cholesterol and low in fiber, such as red meat and full-fat dairy, could also increase cholesterol levels (15).

3. Sedentary lifestyle: According to the CDC, children between the ages of eight and ten and 11 and 14 spend six hours and nine hours of screen time each day, respectively. Screen time includes playing video games and watching TV (16). Excess screen time leads to a sedentary lifestyle, which can increase the risk of weight gain, which in turn could increase the chances of having high cholesterol (17).

4. Overweight and obesity: One in three children in the US is overweight or obese. Overweight and obesity in children and teens are linked with abnormal lipid profiles that raise the risk of other health conditions, such as CVD (18) (19) (20). Excessive weight gain could occur due to several reasons, such as poor eating habits, sedentary lifestyle, and genetics.

Apart from these, certain medications can also cause high cholesterol levels in children.

What Are The Symptoms Of High Cholesterol In Children?

High cholesterol is a silent condition with no apparent symptoms (3). Therefore, the American Academy of Pediatrics (AAP) recommends checking the cholesterol of children and teens once between nine and 11 years and again between 17 and 21 years (21) (22).

For children older than two years, cholesterol screening is usually a must, if (23):

• They are overweight or obese.

• They have a parent or other family member with a total cholesterol level of higher than 240mg/dL.

• They have a family history of cardiovascular disease before 55 years in men and 65 years in women.

• They have one or more chronic medical conditions, such as kidney disease, Kawasaki disease, juvenile idiopathic arthritis, an underactive thyroid, and diabetes.

How Is High Cholesterol Diagnosed In Children?

A doctor will diagnose high blood cholesterol based on the blood test (lipid screening or lipid profile test), a child’s medical and family history, and a physical exam.

1. Physical exam: The doctor will check the child’s weight and calculate their BMI. They will look for symptoms, such as fatty bumps on the skin or grayish-white rings around the corneas, to check the presence of conditions, such as familial hypercholesterolemia (10). They may also check for signs of other health conditions, such as liver disease or diabetes that can cause high blood cholesterol.

2. Blood test: A lipid screening or lipid profile test shows total cholesterol, LDL, HDL cholesterol, and triglycerides. A child may have to fast for nine to 12 hours before the test. If initial testing reveals high cholesterol, the pediatrician will check the child’s blood again after two weeks. If the levels are still high, the doctor will determine if the child has an underlying condition.

The doctor will work closely with the child and their family to devise a treatment plan for resolving underlying conditions that may have led to high cholesterol levels.

How Is High Cholesterol Addressed In Children?

The relevant resolution of high cholesterol depends on your child’s age, lipid screening report, and overall health condition. Below are the likely options to normalize high cholesterol in children (14).

1. Dietary counseling: Based on the child’s weight and cholesterol levels, a certified nutritionist will give a diet plan to the family with meal suggestions, a list of low-fat foods, recommended portion sizes, and tips to avoid high-fat foods. The changes will aim to increase good cholesterol and reduce bad cholesterol through healthy weight management/loss.

2. Exercise planning: The CDC recommends 60 minutes or more of moderate-to-vigorous intensity physical activity each day for children between six and 17 years (24). An exercise expert will help plan an exercise/workout routine for the child on the same lines. The planning will depend on the child’s age, weight, health status, time availability, and interest. Research shows that regular exercise can increase good cholesterol and reduce bad cholesterol in the body.

3. Medications: In most cases, dietary changes and exercise are sufficient to manage cholesterol levels. However, if they don’t, the doctor may recommend cholesterol-lowering medication, such as statins and niacin. These medications may be considered in cases of children older than ten years.

Regular checks of the blood’s cholesterol level will determine whether the treatment is working. In most cases, diet and lifestyle changes can lower cholesterol levels in children without the need for medications.

How Is High Cholesterol Prevented In Children?

Below are some tips that you could follow for healthy cholesterol levels in children aged two and older (25) (26) (27) (28).

1. Prepare a well-balanced diet that offers calories appropriate for a child or teen’s age and gender to maintain weight. The recommended calorie intake can also vary depending on the child’s physical activity levels. Speak to a pediatrician or a pediatric nutritionist to determine the calories your child needs.

2. Replace refined grains with whole-grains and millets to promote fiber intake. A high-fiber intake is vital to lower blood cholesterol.

3. Provide various protein-rich foods, such as lean meat, fish, beans, and soy products. Try to balance protein intake from plant and animal sources.

4. Reduce the intake of high saturated fat foods to keep bad cholesterol in check. Red meat, full-fat milk, butter, lard, cream, coconut oil, and palm oil are naturally high in saturated fat. Processed foods, such as cookies, cakes, and biscuits, are also sources of saturated fat.

5. Encourage the consumption of unsaturated fats to increase levels of good cholesterol. Oily fishes, such as salmon and tuna, avocados, nuts and seeds, and olive oil are good sources of unsaturated fats.

6. Serve various seasonal fruits and vegetables at least two to three times a day in snacks or main meals. Encourage children and teens to consume whole fruits and vegetables with edible peel.

7. Train children and teens to read nutrition labels to identify different fat types and limit their intake by making informed choices.

8. Limit intake of processed and deep-fried foods with added sugars and salt.

9. High-sugar beverages, such as soda and fruit juices, could increase triglyceride levels. Serve the child healthy beverages, such as coconut water and homemade lemonade.

10. Discourage a sedentary lifestyle and motivate your child/teen to stay active throughout the day by indulging in various exercises or physical activities, such as gardening. Regular exercise boosts mood and also enhances HDL levels in the blood.

Children and teens have special dietary needs for growth and development. Consulting a nutritionist is necessary to make dietary changes that can help lower cholesterol levels without affecting overall nutrition.

References

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Dr. Wayne HoughMBChB, MMed, FC Paeds

 

Dr. Wayne Hough is a pediatrician with around six years of experience in the field. He is currently based in the Northern Suburbs of Cape Town in South Africa. Dr. Hough got his medical degree from the University of Stellenbosch.

Read full bio of Dr. Wayne Hough