Cholesterol screening and treatment recommended for overweight children

Cholesterol screening and treatment recommended for overweight children

Because of the urgent need to address the childhood obesity epidemic, the American Academy of Pediatrics is revising its 10 year old policy statement on cholesterol in childhood and recommending that overweight children receive cholesterol screening and treatment regardless of family history or other risk factors.

The AAP policy review is published as an article in the 1st July issue of Pediatrics.

The 1998 policy will be updated to recommend that all overweight children, starting as early as 8 years old, and regardless of their other risk factors, be included in cardiovascular prevention programmes, which apart from cholesterol screening includes following dietary guidelines, increasing physical activity and the use of cholesterol busting medication (statins), where appropriate.

Young children that are obese have a much greater chance of developing type 2 diabetes, high blood pressure and cardiovascular disease when they are older. With 30 per cent of American children now in the obese category, this is a huge public health concern.

Dr Jatinder Bhatia, a member of the AAP nutrition committee that carried out the policy review, and professor and head of neonatology at the Medical College of Georgia in Augusta, told the New York Times that:

"We are in an epidemic."

"The risk of giving statins at a lower age is less than the benefit you're going to get out of it," said Bhatia, adding that although there wasn't much research information on pediatric use of drugs for lowering cholesterol, recent studies have shown they are in the main safe for use in children.

Statins have only been in use as cholesterol busters since the 1980s, which does not give enough time to assess their long term effects (good and bad) in middle aged adults who started taking them or took them for a while when they were children.

According to the Times, this rather aggressive push to screen and medicate children for high cholesterol is bound to create a lot of controversy in a camp that is divided about how much medication children should take at a young age, versus other ways to protect against heart disease in adulthood.

The older version of the policy said that cholesterol medication should only be used in obese children over 10 years of age and then only if a 6 to 12 month weight loss regime fails. But in their latest review, the AAP found that 30 to 60 per cent of children with high cholesterol would be left out altogether unless the policy were revised.

The new recommendations propose that children should be screened for cholesterol at the age of 2, and no later than the age of 10, if they have risk factors such as a family history of high cholesterol or heart attacks in men before the age of 55, or 65 in women.

Children whose family history is unknown, or have other risk factos such as having diabetes, or being in the heaviest 15 per cent, should also be screened for cholesterol, said the APP, with retesting for all children who tested normal every three to five years.

The new policy recommends changing lifestyle as the first priority, but medication should also be considered in the case of children 8 years old and over who have bad cholesterol levels of 190 mg/dl, and who have a family history of heart disease striking early, or two other risk factors.

Another change in the policy that may cause controversy is the recommendation that overweight babies should be given low fat milk from the age of 12 months; the reason being that they consume so much fat anyway it shouldn't affect brain development. Fat consumption is considered essential for brain development in infants and young children.

Dr Frank Greer, co-author of the review and head of the AAP nutrition committee told the Baltimore Sun that:

"This policy seems to say -- screen everyone -- but it actually stops short of universal screening."

"It exempts those patients with no risk of cardiovascular disease, either in themselves or their families. But most everyone will qualify for screening," he added.

"Lipid Screening and Cardiovascular Health in Childhood."

Stephen R. Daniels, Frank R. Greer, and the Committee on Nutrition.

PEDIATRICS Vol. 122 No. 1 July 2008, pp. 198-208


Click here for Abstract.

Source: New York Times, journal abstract, Baltimore Sun.

Preventing Obesity in Children (Video Medical And Professional 2020).

Section Issues On Medicine: Medical practice