Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents

1991 ◽  
Vol 91 ◽  
pp. A-156
Keyword(s):  
Children And Adolescents ◽  
Expert Panel ◽  
Blood Cholesterol ◽  
Cholesterol Levels

National Cholesterol Education Program (NCEP): Highlights of the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 495-501 ◽  
Author(s):  
Keyword(s):  
Risk Factors ◽  
Children And Adolescents ◽  
Expert Panel ◽  
The United States ◽  
Blood Cholesterol ◽  
Childhood And Adolescence ◽  
Cholesterol Levels ◽  
Chd Risk ◽  
Atherosclerotic Process ◽  
Chd Risk Factors

Compelling evidence exists that the atherosclerotic process begins in childhood and progresses slowly into adulthood, at which time it leads frequently to coronary heart disease (CHD), the major cause of death in the United States. Despite substantial success in reducing CHD mortality in the past two decades, the disease is still responsible for more than 500 000 deaths annually. About 20% of hospital discharges for acute CHD are for premature disease, ie, in patients younger than 55 years of age. Many of these adults have children who may have CHD risk factors that need attention. Estimates of the annual cost of CHD range from $41.5 to $56 billion. The Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents (which appears as a supplement to this issue of the journal) reviews the evidence that atherosclerosis or its precursors begin in young people; that elevated cholesterol levels early in life play a role in the development of adult atherosclerosis; that eating patterns and genetics affect blood cholesterol levels and CHD risk; and that lowering levels in children and adolescents will be beneficial. Cholesterol is the focus of the report, but other risk factors for atherosclerosis and CHD may originate early in life and should be addressed as well. Specifically, cigarette smoking should be discouraged; hypertension should be identified and treated; obesity should be avoided or reduced; regular aerobic exercise should be encouraged; and diabetes mellitus should be diagnosed and treated. SIGNIFICANCE OF BLOOD CHOLESTEROL LEVELS IN CHILDHOOD AND ADOLESCENCE

III. The Individualized Approach: Detection/Diagnosis/Evaluation

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 545-554
Keyword(s):  
Children And Adolescents ◽  
Familial Aggregation ◽  
Significant Risk ◽  
Blood Cholesterol ◽  
Selective Screening ◽  
High Blood Cholesterol ◽  
Cooperative Effort ◽  
Cholesterol Levels ◽  
Increased Risk ◽  
Individualized Approach

The individualized approach to cholesterol lowering among children and adolescents focuses on those who appear to be destined to become adults with high blood cholesterol and an increased risk of coronary heart disease (CHD). This approach calls for the cooperative effort of the entire health professional team to identify, treat, and monitor individual children and adolescents who have high serum cholesterol levels, with the ultimate objective of preventing formation of atherosclerotic lesions in the coronary arteries. Because tracking of cholesterol levels from childhood to adulthood occurs but is imperfect, the panel sought ways to identify those children and adolescents whose elevated cholesterol levels are likely to indicate significant risk. The panel reached consensus that a low density lipoprotein (LDL)-cholesterol value of 130 mg/dL or higher (95th percentile), when associated with family history of cardiovascular disease (CVD) or parental hypercholesterolemia, is sufficiently elevated to warrant further evaluation and probable treatment and followup. The panel deliberately targeted the family unit and the familial aggregation of CVD and/or inherited lipid problems because hypercholesterolemia in a child from such a family is of clinical significance. Children with parents and grandparents who have premature CVD often have high cholesterol levels. Thus cholesterol levels in a child are linked to familial CVD.65,67,69,158 CHOLESTEROL MEASUREMENT: RECOMMENDATIONS FOR SELECTIVE SCREENING Who Should Have Cholesterol Measurements? The panel makes the following recommendations for the detection (selective screening), in the context of continuing health care, of children and adolescents likely to become adults with high blood cholesterol levels and increased risk for CVD.

Are Parents' Self-reported Total Cholesterol Levels Useful in Identifying Children With Hyperlipidemia? An Examination of Current Guidelines

PEDIATRICS ◽  
1993 ◽  
Vol 92 (3) ◽  
pp. 347-353
Author(s):  
Ken Resnicow ◽  
Donna Cross
Keyword(s):  
Children And Adolescents ◽  
Total Cholesterol ◽  
Screening Program ◽  
Blood Cholesterol ◽  
Family Risk ◽  
Factor Screening ◽  
Cholesterol Levels ◽  
Premature Cardiovascular Disease ◽  
Risk Factor Screening ◽  
History Of

Objective. Recently, the American Academy of Pediatrics (AAP) Committee on Nutrition adopted the recommendation of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents (NCEP) that children and adolescents with a family history of premature cardiovascular disease or parental hypercholesterolemia (≥240 mg/dL) be screened for hyperlipidemia. The rationale for using parental hypercholesterolemia as a screening trigger is based on sensitivity estimates using parents' actual lipid values. However, in clinical practice pediatricians may often have to rely on parents' self-reported cholesterol levels to determine a child's family risk history. This study examines the feasibility and utility of parental self-reported cholesterol levels as a means of identifying children with elevated total cholesterol levels. Methods. As part of a school-based risk factor screening program that included total cholesterol measurement, conducted in nine elementary schools between 1989 and 1991, parents of participating children were asked if they had their cholesterol tested in the past year and if they had, to provide their total cholesterol values. Results. If only the children who had one parent with a self-reported total cholesterol value ≥240 mg/dL would have been screened, between 90% and 93% of children with elevated total cholesterol values, either ≥170 mg/dL or ≥200 mg/dL, would have been missed. Conclusions. These data suggest that parents' self-reported cholesterol values are an ineffective means of identifying children with elevated total cholesterol and modification of the current AAP and NCEP guidelines for selective cholesterol screening in children may be warranted.

I. Rationale for Attention to Cholesterol Levels in Children and Adolescents

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 528-536
Keyword(s):  
United States ◽  
Expert Panel ◽  
Artery Bypass ◽  
Saturated Fatty Acids ◽  
The United States ◽  
Blood Cholesterol ◽  
Office Visits ◽  
Eating Pattern ◽  
Cholesterol Levels ◽  
Chd Risk Factors

Compelling evidence exists that the atherosclerotic process begins in childhood and progresses slowly into adulthood, at which time it leads frequently to coronary heart disease (CHD), the major cause of death in the United States. Despite an impressive decline in mortality during the past 20 years, CHD is still responsible for more than 500 000 deaths annually. Each year, approximately 1.25 million Americans suffer a myocardial infarction, and about 300 000 coronary artery bypass operations are performed. Moreover, an estimated 7 million Americans have symptomatic CHD, accounting for more than 10 million office visits and more than 2 million hospitalizations per year. About 20 percent of hospital discharges for acute CHD are for premature disease, ie, in patients younger than 55 years of age. Many of these adults have children who may have CHD risk factors that need attention. Estimates of the annual cost of CHD range from $41.5 to $56 billion. Elevated blood cholesterol levels are an important cause of atherosclerosis and CHD according to numerous studies. The need to lower blood cholesterol levels in adults was addressed in 1988 when the National Cholesterol Education Program (NCEP) published the Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. That report presented recommendations for lowering high cholesterol levels in individuals 20 years of age or older.1 The NCEP also has addressed blood cholesterol levels in the population as a whole; the Report of the Expert Panel on Population Strategies for Blood Cholesterol Reduction recommended an eating pattern low in saturated fatty acids (SFA), total fat, and cholesterol for all healthy Americans over the age of approximately 2 years2 to reduce average blood cholesterol levels in the United States.

Statement on Cholesterol

PEDIATRICS ◽  
1992 ◽  
Vol 90 (3) ◽  
pp. 469-473 ◽  
Author(s):  
Keyword(s):  
Risk Factor ◽  
Family History ◽  
Vascular Disease ◽  
Children And Adolescents ◽  
Dietary Fat ◽  
Blood Cholesterol ◽  
Atherosclerotic Vascular Disease ◽  
Cholesterol Levels ◽  
Coronary Vascular Disease ◽  
Obesity And Diabetes

Increased blood cholesterol levels have been found to be a risk factor for coronary vascular disease in adult populations, and the reduction of cholesterol levels in adults decreases the risk. Because no comparable studies have been carried out in childhood populations, the significance of cholesterol as a risk factor for coronary vascular disease must be inferred from less direct evidence. It is also important to note that a number of other factors including cigarette smoking, hypertension, obesity, and diabetes mellitus are important in their causative relationship to atherosclerotic vascular disease. A family history of premature coronary vascular disease is also a risk factor for early onset coronary vascular disease. The American Academy of Pediatrics (AAP) last published its recommendations regarding dietary fat and cholesterol in 19861 and suggested indications for cholesterol testing in children and adolescents in 1989.2 Very recently the Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program (NCEP), in a comprehensive report, recommended that all children and adolescents eat a diet that on average contains no more than 30% of total calories from fat, less than 10% of total calories from saturated fat, and less than 300 mg of cholesterol per day.3 The panel recommended screening blood cholesterol levels only in those children and adolescents whose risk of developing coronary vascular disease as adults could be identified by family history or by the coexistence of several risk factors. In this statement the earlier recommendations of the AAP are reviewed in the context of the recent NCEP report and provide current guidelines regarding dietary fat and cholesterol, cholesterol screening, and management of elevated blood cholesterol levels in children.

IV. The Individualized Approach: Treatment

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 555-584
Keyword(s):  
Children And Adolescents ◽  
Total Cholesterol ◽  
Ldl Cholesterol ◽  
Saturated Fatty Acids ◽  
Dietary Cholesterol ◽  
Diet Therapy ◽  
Blood Cholesterol ◽  
Healthy Children ◽  
Eating Pattern ◽  
Cholesterol Levels

DIET THERAPY The general aim of diet therapy is to reduce elevated blood cholesterol levels while maintaining a nutritionally adequate eating pattern. The primary emphasis is on decreasing the level of saturated fatty acids (SFA), total fat, and cholesterol and on consuming only enough calories to achieve or maintain desirable body weight. Diet therapy is presented in two steps, the Step-One and Step-Two Diets, which are designed to reduce progressively intakes of SFA and dietary cholesterol. Definition of Total and Low-Density Lipoprotein (LDL) Cholesterol Initiation Levels for Diet Therapy The panel's recommended initiation levels (cutpoints) for dietary intervention in children and adolescents with a family history of cardiovascular disease (CVD) or parental hypercholesterolemia are shown in Table 4-1. Children and adolescents with total cholesterol levels <170 mg/dL or LDL cholesterol levels <110 mg/dL have acceptable levels. These young people should receive education on the recommended population eating pattern (see Section II, "The Population Approach: Nutrition Recommendations for Healthy Children and Adolescents") and risk factor reduction. Therapeutic dietary instruction is indicated in all children and adolescents with a total cholesterol level ≥l70 mg/dL or an LDL cholesterol ≥ll0 mg/dL. Those with borderline total blood cholesterol levels 170 to 199 mg/dL or borderline LDL cholesterol levels 110 to 129 mg/dL (about the 75th to 95th percentile) require advice that consists of instruction on the Step-One Diet and other risk factors by a physician, registered dietitian or other qualified nutrition professional, or other appropriately trained health professional, with reevaluation in 1 year (Fig 4-1).

Overview and Summary

PEDIATRICS ◽  
1992 ◽  
Vol 89 (3) ◽  
pp. 525-527
Keyword(s):  
Children And Adolescents ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Blood Cholesterol ◽  
Childhood And Adolescence ◽  
Low Density ◽  
High Blood Cholesterol ◽  
Cholesterol Levels ◽  
Atherosclerotic Process

A variety of studies indicate that the process of atherosclerosis begins in childhood, that this process is related to elevated levels of blood cholesterol, and that these levels are often predictive of elevated blood cholesterol in adulthood. Despite substantial success in reducing mortality due to coronary heart disease (CHD) in the past two decades, this disease remains the leading cause of death in the United States. Preventing or slowing the atherosclerotic process in childhood and adolescence could extend the years of healthy life for many Americans. THE SIGNIFICANCE OF BLOOD CHOLESTEROL LEVELS IN CHILDHOOD AND ADOLESCENCE High blood cholesterol levels clearly play a role in the development of CHD in adults. This has been established by many laboratory, clinical, pathologic, and epidemiologic studies. A variety of studies also have demonstrated that the atherosclerotic process begins in childhood and is affected by high blood cholesterol levels. The evidence can be summarized as follows: • Compared to their counterparts in many other countries, US children and adolescents have higher blood cholesterol levels and higher intakes of saturated fatty acids and cholesterol, and US adults have higher blood cholesterol levels and higher rates of CHD morbidity and mortality. • Autopsy studies demonstrate that early coronary atherosclerosis or precursors of atherosclerosis often begin in childhood and adolescence. • High serum total cholesterol, low-density lipoprotein (LDL) cholesterol, and very-low-density lipoprotein (VLDL) cholesterol levels, and low high-density lipoprotein (HDL) cholesterol levels, are correlated with the extent of early atherosclerotic lesions in adolescents and young adults. • Children and adolescents with elevated serum cholesterol, particularly LDL-cholesterol levels, frequently come from families in which there is a high incidence of CHD among adult members.

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