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Should kids be tested for high cholesterol?

Here's why lipid screening is usually not necessary for your child.

Your children's primary care doctor is facing an important question about whether to check the fat in your child's blood. In 2011 a Joint Task Force of the National Heart, Lung and Blood Institute and the American Academy of Pediatrics recommended universal blood lipid (fats in blood) screening of children. Last week, the United States Preventive Services Task Force recommended to not screen children for lipids.  Who is right?  What should your children's doctor do?  What should you do?

First, what did each government task force say? The 2011 Joint Task Force recommended four screens that would predict cardiovascular risk factors:

1. Routine measurement of length/height and weight beginning in infancy

2. Calculation of Body Mass Index annually beginning at age 2 years to identify growth trends

3. Yearly assessment of blood pressure from age 3

4. Universal screening for lipid abnormalities by a non-fasting blood test at age 10 years

Along with appropriate diet and regular exercise, these guide lines should minimize preventable causes of cardiovascular disease and with the blood test reveal genetic causes of elevated fat in the blood.  To stay healthy, I tell my patients to follow the 5-2-1-almost none diet (Details about it are below,), and exercise hard enough to work up a sweat at least three hours a week.

The first routine measurements of height and weight from birth, and blood pressure from the third birth date were universally accepted.  All doctors with electronic health records (EHR) have the BMI automatically calculated after the second birth date, but the majority of pediatricians are not checking the lipid panels routinely because they are not sure what to do with the results.

If through the blood testing the doctor finds out the child has genetic disposition for high cholesterol, triglycerides or especially low density lipids (which are the most dangerous fats), then the child will have to be placed on life-long medication usually drugs called "statins."  Although statins will lower the lipids in almost all cases and theoretically lower the child's risk of early heart disease and stroke, no one knows what being on a statin for 50 or more years will do.  All medicines have side-effects and a medicine taken daily for decades could do a lot of damage even with a low yearly chance of problems when you multiply that by low risk per year by many years.

The new task force says exactly that – we simply do not know if early intervention does more good than bad.  Concentrate on life style treatment (better diet, no smoking, regular exercise) which will harm no one, rather than start medicine which may or may not reduce long-term risks after taking the risks of the long term medication.

What is best?  I favor avoiding checking lipids unless there is a family history of early (before the 50th birthday) heart attack or stroke and strive to improve all the life style choices. Below are guidelines to help keep your family healthy.

Healthy Weight Guidelines

1.  Follow "5-2-1- Almost None" rule

Five: Try to eat 5 or more servings of fruits and vegetables every day.

Two: Limit TV, computer, and video game time to no more than two hours every day.

One: Be active for at least one hour every day. Have fun!

Almost none:  Avoid sweet drinks and added sugars.

 2.  Eat regular meals and snacks

Eat three meals, and 1-2 small snacks every day.

Do not skip any major meals.

Breakfast foods should be lower in fat and sugar.  To sweeten cereal, try using fruit or Splenda.  Choose cereals with less than 10 grams of sugar per serving.

 3.  Be mindful of portion sizes. The size of a portion is the size of that person's fist at the most.

It may be helpful to cook enough food for only one serving per person.  This way, it is not as tempting to go back for more food.

Try to make 1/2 of the plate non-starchy vegetables, 1/4 plate starch, and 1/4 plate lean protein

Read the food labels to get a better understanding of the serving size and nutrients per serving.

 4.  Choose healthy snacks

  1. 1 mozzarella cheese stick + 1 piece of fruit

  2. 1 piece of wheat toast + 1 tablespoon of peanut butter

  3. 1 cup of skim milk or light soy milk + 10 almonds

  4. 10 baked chips with ¼ cup of salsa

  5. 1 light yogurt + 1 piece of fruit

  6. 10 baby carrots + 2 tablespoons of hummus

  7. 1 mini bag of light popcorn (ex: Orville Redenbacher "Smart Pop")

  8. 1 rice cake with 1 tablespoon of peanut butter

  9. 1 package of reduced-sugar oatmeal

 5.  Choose healthy drinks

For kids of all ages, water and milk are the best choices. Water has no calories and is a thirst quencher. One cup of milk has 300 milligrams of calcium. When your child drinks too much juice, juice drinks, sports drinks, and soda, these beverages can crowd out the milk they need. Sugary drinks also add calories to your child's diet.

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