High Cholesterol In Children

You may know about high levels of lipids in adults, but you may not know that they can occur in children too! Non-communicable diseases are important in our society; however, some conditions can be found in children and adolescents, and we have to be aware of them. We will introduce you to "high cholesterol in children".

So what is high cholesterol in children? It is when the cholesterol levels in children are too high. We typically discuss those conditions in adults or the elderly, but in some cases, they can happen in children and adolescents as well. This article will take you through the medical science behind high cholesterol in children. If you or your family are at risk, we will also provide suggestions on how you can manage those risks and prevent them early!

Overview

We are living in an era of non-communicable diseases (NCDs), due to socioeconomic development and behavioural shifts into a life with fewer physical activities and more calorie intake.¹ Even though obesity is an important factor leading to NCDs, some biological factors are also involved in the development of these conditions, for instance, genetic variations or diseases. In children and adolescents, obesity should not be ignored and can lead to diseases, as well as high cholesterol in their bloodstream.

There are two major types of lipids or fats: cholesterol and triglycerides. Abnormalities of blood lipid levels consist of:

• 1. High total cholesterol level (TC)
• High LDL cholesterol level "bad cholesterol"
• High non-HDL cholesterol level
• Low HDL cholesterol "good cholesterol"
• High triglyceride levels (TG)

For over two decades, studies have shown that high levels or abnormal levels of lipids in children and adolescents are associated with atherosclerosis, even when clinical signs are not present. Atherosclerosis, largely caused by dyslipidemia and high blood pressure, occurs when blood vessels become occluded by substances like fat. This leads to abnormal blood flow and can result in future cardiovascular diseases, such as coronary heart disease (ischaemic heart disease/heart attack).

Causes of high cholesterol in children

Dietary causes:

The consumption of saturated fat and trans fat leads to high cholesterol, especially the rise of LDL cholesterol levels or bad cholesterol. Those fats inhibit the liver’s ability to remove cholesterol, so it builds up in the blood. Foods that contain high amounts of saturated fat are processed and fatty meats, or hard cheese and cream, and trans fat could be found in fried foods and takeaways, snacks, pastries, and margarine.

Secondary causes:

Somehow, if the children have certain conditions, these can lead to elevated cholesterol as well, especially obesity, type 2 diabetes mellitus (DM), nephrotic syndrome (a type of kidney disease), or hypothyroidism.

Genetic causes:

Familial hypercholesterolemia (or familial hypercholesterolaemia: FH) is a single-gene inherited high cholesterol condition. Its incidence in the UK population is about 1 in 250 people. This condition can be diagnosed in children and adolescents significantly up to the age of 11 and can significantly lead to heart disease in the future. Other single-gene diseases such as familial defective apolipoprotein B or PCSK9, or other polygenic diseases, also cause high cholesterol.

Signs and symptoms of high cholesterol in children

It’s crucial to note that high blood cholesterol levels or abnormal cholesterol must be screened and diagnosed by laboratory tests. Some clinical signs and symptoms, which are rare, indicate a more severe form of hyperlipidemia.³

For instance, xanthoma occurs when excess cholesterol-forming swelling parts appear on knuckles, knees, or at the back of the ankle. Some other forms are mentioned below.³

• Arcus corneae –pale white rings around children's iris
• Xanthelasmas–the skin around the eyes or eyelids have pale or yellow small lumps of cholesterol
• Chest pain, history of heart attack (ischaemic heart disease), or stroke at a young age
• High blood pressure, caused by atherosclerosis
• When a routine blood test shows the children have a high cholesterol level

Or else, a family history also gives a  suspicion for familial hypercholesterolemia, like:

• A history of premature heart disease or stroke
• Have been diagnosed with familial hypercholesterolemia
• Similar signs and symptoms

Diagnosis

American Heart Association and the US National Cholesterol Education Program (NCEP) defined dyslipidemia as follows (by a blood test for a non-fasting lipid profile):²

•  Total cholesterol ≥200 mg/dL
•  LDL cholesterol ≥130 mg/dL
•  non-HDL cholesterol ≥145 mg/dL
•  HDL cholesterol <40 mg/dL

Management and treatment for high cholesterol in children

Early screening

As the condition should not wait until the signs and symptoms occur, screening in healthy children and adolescents should be performed.⁴

• Selective screening should be conducted for children and adolescents who have risk factors, i.e., obesity, diabetes (both type 1 and 2), family history of early heart diseases, or family history of inherited high cholesterol or lipid disorders
• Universal screening–according to the US National Heart, Lung, and Blood Institute's report,30-60% of the children could be missed if we rely only on family history screening. It is recommended to perform it on children once between ages 9-11 years and once between ages 17-21.⁶ The British Heart Foundation has also provided funds for many familial hypercholesterolemia testing sites across the UK

If familial hypercholesterolemia is suspected, a diagnosis should be pursued. According to the UK NICE guideline and the British Heart Foundation, children and adolescents with a total cholesterol level greater than 290 mg/dL (7.5 mmol/l) or a personal or family history of early coronary heart disease should be screened.

Treatment:

• Lifestyle changes for children are the most crucial and effective approach.⁸ These changes include dietary modifications, physical activities, and weight management
• Medical treatment is crucial, particularly for children diagnosed with familial hypercholesterolemia, which should not be limited to lifestyle modification. Children and adolescents aged 10 and over with high LDL cholesterol or with clinical symptoms, should be treated with statin, the cholesterol-lowering drug, as recommended by NICE and the British Heart Foundation

Risk factors for cardiovascular diseases include:

Below are risk factors, along with high blood cholesterol levels, that can lead to cardiovascular diseases.⁸ 

• Diabetes, type 1 or type 2
• High blood pressure, which requires drug treatment
• Smoking
• Obesity

Complications can include:

• Subclinical atherosclerosis, or having clogged arteries due to high-fat content
• Heart abnormality
• Early heart disease, e.g. heart attacks
• Early strokes
• Adult morbidity and mortality

FAQs

Can high cholesterol in children be prevented?

In children without inherited high cholesterol disease, the elimination of risk factors should be considered by making healthy lifestyle choices.

• Healthy food consumption, with avoidance of trans fat or saturated fat sources
• Lifestyle changes, including physical activities, avoiding alcohol consumption and smoking
• Weight management

How common is high cholesterol in children?

In 2011-2012, approximately 1 in 5 US children and adolescents aged 8–17 years had abnormal cholesterol levels.⁵

In a study, among 823 obese children and adolescents, 353 (42.9%) met the criteria of dyslipidemia as well.⁷

When should I see a doctor?

• Children and adolescents who have not ever had a blood lipid profile screened
• When children or the family have a suspicious history of early heart diseases or strokes
• Listed symptoms in children and adolescents

Summary

Health is essential for everyone, including children, adolescents, adults, and the elderly. Some health issues are avoidable, and some are unavoidable, such as inherited conditions. High cholesterol in children can occur in both ways. However, the number of preventable cases is growing. Prevention and early detection are key to maintaining healthy children and preventing future diseases.