Cholesterol, LDL, HDL, and Triglycerides in Children and Adolescents

Facts about cholesterol

Cholesterol is a fat-like, waxy substance that can be found in all parts of the body. It aids in the production of cell membranes, some hormones, and vitamin D. The cholesterol in blood comes from two sources: the foods your child eats and his or her liver. However, your child's liver can make all of the cholesterol he or she needs.

Cholesterol and other fats are transported through the blood in the form of round particles called lipoproteins. The two most commonly known lipoproteins are low-density lipoproteins (LDL) and high-density lipoproteins (HDL).

What is LDL (low-density lipoprotein) cholesterol?

What is HDL (high-density lipoprotein) cholesterol?

This type of cholesterol is commonly called "bad" cholesterol, but it is a necessary one as well. If your LDL level is high, it can contribute to the formation of plaque in the arteries, known as atherosclerosis. LDL levels should be low. To help lower LDL levels, help your adolescent: Avoid foods high in saturated fat, dietary cholesterol, and excess calories in general, including sugars and processed carbohydrates Increase exercise Maintain a healthy weight

This type of cholesterol is known as "good" cholesterol, and is a type of fat in the blood that helps to remove cholesterol from the blood, preventing the fatty build up and formation of plaque in your blood vessels. HDL should be as high as possible. It is often possible to raise HDL by: Exercising for at least 20 minutes, 3 times a week Avoiding saturated fat intake Decreasing body weight

What are triglycerides?

Triglycerides are another class of fat found in the blood. The bulk of your adolescent's body fat tissue is in the form of triglycerides.

Elevated triglycerides are associated with increased cardiovascular risk. However, many children and adolescents with high triglyceride levels also have other risk factors such as high LDL levels or low HDL levels.

What causes elevated triglyceride levels?

Elevated triglyceride levels may be caused by medical conditions such as diabetes, hypothyroidism, kidney disease, or liver disease. Dietary causes of elevated triglyceride levels may include obesity and high intake of fat, alcohol, and concentrated sweets. Inherited genetic abnormalities can lead to familial hypertriglyceridemia.

For adults, a healthy triglyceride level is less than 150 mg/dL.

Checking blood lipid levels

A lipid screening is an overall look at the fats in the blood. In the past, doctors felt that children and adolescents were at little risk for developing high cholesterol levels and other risk factors for heart disease until later in life. However, we now know that children and adolescents are at risk for having high blood cholesterol levels as a result of one, or more of the following:

• Sedentary lifestyles (playing video games, watching TV, not participating in vigorous exercise)

• High-fat or high-sugar "junk food" diets

• Obesity

• Family history of high cholesterol levels

Children and adolescents with high cholesterol are at higher risk for developing heart disease as adults. Keeping blood cholesterol levels in the normal range throughout one's lifetime reduces the likelihood of developing heart and blood vessel diseases, such as coronary artery disease (blockages in the arteries that supply blood to your heart) and high blood pressure.

Lipid testing for children

• For children under the age 2, lipid screening is not recommended.  

• From age 2 to 8, screening is recommended if other risk factors for cardiovascular disease are present.  This includes a personal history of diabetes, high blood pressure, BMI greater than the 95th percentile, or smokes cigarettes or a family history of early coronary artery disease or lipid disorder, high blood pressure, obesity, tobacco exposure, diabetes, kidney disease, or other chronic inflammatory conditions. 

• From age 9 to 11 universal screening is recommended with either a fasting or non-fasting lipid profile.

• From age 12 to 16, universal screening is not recommended because of changing lipid levels during puberty.  However, if risks factors mentioned above are present, then screening is recommended.

• From age 17 to 21, universal screening is recommended as lipid levels are more stable after puberty.

A full lipid profile shows the actual levels of each type of fat in the blood, such as LDL, HDL, triglycerides, and total cholesterol. Your child's doctor may recommend fasting before the blood test depending on the type of lipid panel needed. Your child's doctor can also tell you what the normal values should be for all the lipids after considering age and the number of risk factor's present.

What is a healthy blood cholesterol level?

Blood cholesterol is very specific to each person. A full lipid profile can be an important part of your adolescent's medical history and important information for your adolescent's doctor to have. In general, healthy levels are as follows:

• LDL of less than 130 mg/dL

• HDL of greater than 35 mg/dL (less than 35 mg/dL puts your adolescent at higher risk for heart disease)

The National Heart Lung and Blood Institute recommends the following guidelines for cholesterol levels in children and teenagers (ages 2 to 19) from families with high blood cholesterol or early heart disease:

	Total cholesterol	LDL-cholesterol
Acceptable	Less than 170 mg/dL	Less than 110 mg/dL
Borderline	170 to 199 mg/dL	110 to 129 mg/dL
High	200 mg/dL or greater	130 mg/dL or greater

Statistics about cholesterol

Elevated cholesterol is a risk for many Americans. Consider the following information from the CDC:

• 13.4% of U.S. adults—or 1 in every 6—have high total cholesterol.

• The average cholesterol level for U.S. adults is 200 mg/dL.

Treatment of high cholesterol

If the results of your child's lipid tests are abnormal, your child's doctor will work closely with you to devise a treatment plan. Most children and adolescents will not need medicine. Often, a healthy diet, weight loss, and increased physical activity are enough to return blood lipid levels to normal. Your child's doctor will continue to closely monitor any lipid levels that were abnormal and help your child make lifestyle changes. Your child's doctor will discuss medicine with you when needed.