Cholesterol Screening in Children

2008 AAP Guidelines Full PDF

  1. The population approach to a healthful diet should be recommended to all children older than 2 years according to Dietary Guidelines for Americans. This approach includes the use of low-fat dairy products. For children between 12 months and 2 years of age for whom overweight or obesity is a concern or who have a family history of obesity, dyslipidemia, or CVD, the use of reduced-fat milk would be appropriate.
  2. The individual approach for children and adolescents at higher risk for CVD and with a high concentration of LDL includes recommended changes in diet with nutritional counseling and other lifestyle interventions such as increased physical activity.
  3. The most current recommendation is to screen children and adolescents with a positive family history of dyslipidemia or premature (≤55 years of age for men and ≤65 years of age for women) CVD or dyslipidemia. It is also recommended that pediatric patients for whom family history is not known or those with other CVD risk factors, such as overweight (BMI ≥ 85th percentile, <95th percentile), obesity (BMI ≥ 95th percentile), hypertension (blood pressure ≥ 95th percentile), cigarette smoking, or diabetes mellitus, be screened with a fasting lipid profile.
  4. For these children, the first screening should take place after 2 years of age but no later than 10 years of age. Screening before 2 years of age is not recommended.
  5. A fasting lipid profile is the recommended approach to screening, because there is no currently available noninvasive method to assess atherosclerotic CVD in children. This screening should occur in the context of well-child and health maintenance visits. If values are within the reference range on initial screening, the patient should be retested in 3 to 5 years.
  6. For pediatric patients who are overweight or obese and have a high triglyceride concentration or low HDL concentration, weight management is the primary treatment, which includes improvement of diet with nutritional counseling and increased physical activity to produce improved energy balance.
  7. For patients 8 years and older with an LDL concentration of ≥190 mg/dL (or ≥160 mg/dL with a family history of early heart disease or ≥2 additional risk factors present or ≥130 mg/dL if diabetes mellitus is present), pharmacologic intervention should be considered. The initial goal is to lower LDL concentration to <160 mg/dL. However, targets as low as 130 mg/dL or even 110 mg/dL may be warranted when there is a strong family history of CVD, especially with other risk factors including obesity, diabetes mellitus, the metabolic syndrome, and other higher-risk situations.

Calorie estimates are based on sedentary lifestyle. Increased physical activity will require additional calories (0–200 kcal/day if moderately physically active and 200–400 kcal/day if very physically active [1 kcal = 4.2 kJ]). — indicates data not applicable.

a For youth 2 years and older; adapted from Table 2, Table 3, and Appendix A-2 of the 2005 Dietary Guidelines for Americans. (www.healthierus.gov/dietaryguidelines). Nutrient and energy contributions from each group are calculated according to the nutrient-dense forms of food in each group (eg, lean meats and fat-free milk).

b Milk listed is fat free (except for children younger than 2 years). If 1%, 2%, or whole-fat milk is substituted, this will use, for each cup, respectively, 19, 39, or 63 kcal of discretionary calories and add 2.6, 5.1, or 9.0 g of total fat, of which 1.3, 2.6, or 4.6 g are saturated fat.

c For 1-year-old children, 2% fat milk is included. If 2 cups of whole milk are substituted, 48 kcal of discretionary calories will be used.

d Serving sizes are> 1/4> cup for 1 year of age,> 1/3> cup for 2 to 3 years of age, and> 1/2> cup for ≥4 years of age. A variety of vegetables should be selected from each subgroup over the week.

e Half of all grains should be whole grains.

Adapted with permission from American Heart Association. Table: dietary recommendations for children. Available at: www.americanheart.org/presenter.jhtml?identifier=3033999.

Source: Lipid Screening and Cardiovascular Health in Childhood. Stephen R. Daniels, MD, PhD, Frank R. Greer, MD and the Committee on Nutrition. PEDIATRICS Vol. 122 No. 1 July 2008, pp. 198-208 (doi:10.1542/peds.2008-1349)

Now what??? (Per old 1998 AAP Guidelines)

Drug therapy?

AHA Step 1 Diet - AHA Step 2 Diet:

  Step 1 Step 2
Total fat <=30% (and more than 20%)
polyunsaturated fat <=10%
saturated fat <10% <7%
cholesterol < 300 mg/day <200 mg/day


We hope this is useful. Don't forget to think about this topic when seeing your kids in GPS, even if the parents have no complaints or are not concerned. Obesity, HTN, and therefore, cardiovascular disease is becoming endemic in society- and it is our jobs to address the issue as early as possible.

Chief Resident Pearl, 2004. Based on National Cholesterol Education Program.