During children’s physical examinations,it is often found that some children have abnormal blood lipid levels.
Many parents’ initial reaction is one of disbelief, and upon further reflection, they realize they know very little about it, which leads to some panic.
Indeed, in the world of adults, “hyperlipidemia” has long attracted widespread attention; it is well known to be a clear risk factor for ‘atherosclerotic cardiovascular disease’, a “silent killer” for the health of middle-aged and older individuals. However, there is not enough attention paid to children’s blood lipid levels, and there are many misconceptions about pediatric hyperlipidemia.
In fact, a large number of studies have shown that atherosclerotic changes may begin in early childhood, laying the foundation for adult atherosclerotic cardiovascular diseases.
Many longitudinal studies have confirmed that the presence of traditional atherosclerotic cardiovascular disease risk factors in childhood(namely, lipid abnormalities, obesity, hypertension, cigarette exposure, and diabetes) is associated with premature atherosclerosis in adulthood.
Moreover, for most children, adhering to a healthy lifestyle can minimize or even prevent the occurrence of atherosclerosis. Therefore, the early detection of pediatric hyperlipidemia is crucial, providing an opportunity for early intervention to prevent cardiovascular diseases in adulthood.
Hyperlipidemia in Children is Not Uncommon
Statistical data from the United States show:
Approximately 20% of children aged 6-19 have at least one abnormal blood lipid level, and this proportion increases with age. Specifically, about 15% of children aged 6-11 have one abnormal blood lipid level, while this proportion rises to 25% among adolescents aged 12-19.
Reports from other countries show that the incidence of abnormal blood lipid levels in children is roughly comparable to the data from the United States.
This indicates that hyperlipidemia is not a health problem exclusive to adults. In fact, the risk of blood lipid abnormalities begins to manifest during childhood.
Many parents believe that only “chubby” children are prone to hyperlipidemia. As a result, children with normal or thin body types seem to be considered safe.
However, this view is also inaccurate. Let’s look at a set of data:
Among adolescents with healthy weight, overweight(BMI between the 85th and 95th percentiles), and obesity(BMI above the 95th percentile), the incidence of blood lipid abnormalities is 14%, 22%, and 43%, respectively.
Even among adolescents with normal BMI(body mass index), there is a considerable incidence of blood lipid abnormalities. For example, among adolescents with elevated TC(total cholesterol), about 52% have normal BMI, 38% of adolescents with reduced HDL-C(high-density lipoprotein) are of normal weight, and about 41% of adolescents with elevated non-HDL-C(non-high-density lipoprotein) are of normal weight.
This means that even children who appear to have a normal body type are at a higher risk of blood lipid abnormalities.
Many children, although not overweight, are affected by factors such as family genetics, unhealthy eating habits, and insufficient physical activity, which can also affect blood lipid levels and create potential health risks.
Why do children also suffer from hyperlipidemia?
The causes of pediatric hyperlipidemia are complex and usually related to genetics, lifestyle, diseases, and various other factors.
Genetic factors
Genetics play an undeniable role in pediatric hyperlipidemia. Hereditary dyslipidemia diseases such as FH can lead to children facing a higher risk of disease from birth.
This is an autosomal dominant inherited disease, where the LDL-C levels in affected children are usually significantly elevated, with early onset and significant health hazards.
Unhealthy lifestyle habits
Consuming excessive amounts of saturated and trans fats is an important cause of elevated LDL. Excessive intake of refined carbohydrates and monosaccharides can increase triglycerides.
The widespread use of electronic products has led to a severe lack of physical activity in children, and a lack of sufficient outdoor activities also exacerbates the occurrence of dyslipidemia.
Disease
For example,endocrine diseases such as hypothyroidism and growth hormone deficiency can also affect fat metabolism, increasing the risk of hyperlipidemia.
Other diseases can also cause hyperlipidemia in children, such as nephrotic syndrome, type 2 diabetes, which can affect blood lipid levels, leading to increased triglycerides and decreased HDL-C.
How to determine if a child has hyperlipidemia?
To answer this question, we first need to understand what is dyslipidemia?
Dyslipidemia refers to the disorder of lipoprotein metabolism, including the following:
Elevated total cholesterol (TC)
Elevated LDL-C (low-density lipoprotein)
Elevated non-HDL-C
Elevated triglycerides (TG)
Decreased HDL-C (high-density lipoprotein)
The diagnosis of pediatric hyperlipidemia is not as simple as in adults.The normal range of blood lipid levels in children varies with age and gender.
NHANES (National Health and Nutrition Examination Survey) surveyed the blood lipid levels of 7000 children and divided pediatric dyslipidemia into “acceptable,” “borderline,” and “abnormal” threshold values, as shown in the table below.
The criteria for increased blood lipids in children are lower than those for adults, but the normal values on test reports are often for adults, so,when receiving children’s blood lipid results, it is necessary to compare with this result to determine whether it is normal.
How to reasonably screen for pediatric hyperlipidemia?
Early detection of pediatric hyperlipidemia is so important, but most cases of dyslipidemia have no obvious clinical manifestations. Therefore, how to reasonably screen, to neither miss a diagnosis nor overdo it, is a question worth considering.
The American Academy of Pediatrics and several other authoritative guidelines recommend the same approach:
Children with risk factors for atherosclerotic cardiovascular disease
Such as obesity, hypertension, family history of diabetes, secondhand smoke exposure, etc., it is recommended to undergo regular blood lipid screening.
Usually start screening blood lipids every 1-3 years from the age when the above risk factors are first identified in the child. As long as the risk factors persist, continue to screen.
Children with a family history of familial hypercholesterolemia or premature atherosclerotic cardiovascular disease
Usually start screening at 2 years old.
1. Be vigilant for familial hypercholesterolemia in the following situations:
If the family history is unclear, but the child’s LDL-C level is significantly elevated, ≥190mg/dL (4.9mmol/L), it suggests familial hypercholesterolemia.
Those with a family history of hypercholesterolemia and/or premature atherosclerotic cardiovascular disease, LDL-C levels ≥160mg/dL (4.1mmol/L) also suggest familial hypercholesterolemia.
Increased plasma LDL-C levels in family members.
2. Premature atherosclerotic cardiovascular disease is usually defined as:
Men under 55 years old or women under 65 years old experiencing any of the following: myocardial infarction, angina, intervention for coronary artery disease, sudden cardiac death, ischemic stroke.
Children without risk factors for atherosclerotic cardiovascular disease
It is recommended to conduct routine screening for dyslipidemia between the ages of 9-11 and 17-21. If the initial screening result is abnormal, a fasting blood test should be conducted 2 to 3 months later to further confirm the diagnosis.
How to stratify the management of children with hyperlipidemia?
Children with abnormal initial screening results need to be rechecked to confirm dyslipidemia and determine whether intervention is needed.
Extremely high cholesterol levels suggest familial hypercholesterolemia, that is, LDL-C≥250mg/dL (6.5mmol/L), such children need to be taken very seriously and require further assessment and treatment.
If the child’s blood lipid screening level is within the “acceptable” range, no further assessment is needed, but regular cardiovascular health assessments should continue.
If the child’s blood lipid screening result reaches the borderline value, strengthen the implementation of heart-healthy lifestyle recommendations. It is recommended to recheck after 1 year.
For those children with initially high blood lipid screening results or low high-density lipoprotein, fasting blood lipid measurements should be taken at two time points, 2 to 3 weeks apart. Whether medication is needed depends on the LDL-C results obtained from at least two fasting blood lipid measurements.
The American Heart Association recommends adopting a risk stratification model, classifying children’s blood lipid levels and related risk factors into “high risk,” “moderate risk,” or “at risk,” and adopting stratified management strategies.
Lifestyle interventions
The initial treatment for all children with hypercholesterolemia includes heart-healthy lifestyle interventions, that is, dietary adjustments, exercise, weight control, increasing quality sleep, and avoiding secondhand smoke exposure.
1. Heart-healthy diet
Control the intake of fats, especially saturated fatty acids. Eat less animal offal, cream pastries, and appropriately control the intake of beef and mutton, as these foods are rich in saturated fatty acids, which are not conducive to blood lipid control.
Avoid the intake of trans fatty acids, such as fried foods, products containing artificial cream, plant butter, and creamer.
Consume more healthy fats,eat more foods rich in unsaturated fatty acids, such as fish, nuts, olive oil, etc., which can help lower blood lipids.
At the same time, increase the intake of dietary fiber, eat more fruits, vegetables, whole grains, etc.
Dietary fiber can bind with cholesterol, reduce the absorption of cholesterol, and thus lower blood lipids.
Dried plums, oats, broccoli, etc., are good sources of dietary fiber.
2. Exercise
Moderate exercise is essential.
Develop a suitable exercise plan for them according to the child’s age and interests. For example, for young children, engage more in outdoor activities, such as skipping rope, shuttlecock kicking, cycling, etc.
Ensure at least 60 minutes of activity time per day.
Older children can participate in some sports, such as basketball, soccer, swimming, etc., exercising at least 3-5 times a week, each time for more than 30 minutes.
Exercise not only consumes excess body fat but also enhances cardiopulmonary function and improves the body’s metabolic capacity. Active daily exercise and reducing sedentary behavior can improve blood lipid levels and reduce the risk of atherosclerotic cardiovascular disease.
3. Regular routine, weight loss, avoid nicotine exposure
Ensure adequate sleep and develop good sleep habits to help regulate metabolism in the body.
For obese children with dyslipidemia, weight loss can significantly improve blood lipid levels. In addition,avoiding nicotine exposure is particularly important for children with dyslipidemia.
Pharmacological treatment (mainly statins)
Children with high-risk factors for atherosclerotic cardiovascular disease, a significant family history of premature atherosclerotic cardiovascular disease, or severe primary hyperlipidemia, as well as children whose blood lipids have not reached the target level after lifestyle interventions, need regular pharmacological treatment.
In summary, pediatric hyperlipidemia, as a hidden health threat, is often overlooked, but it has a potential profound impact on the child’s future health.
We should strengthen the focus on children’s blood lipid health, starting with diet, exercise, and avoiding secondhand smoke, to help children develop a healthy lifestyle. At the same time, screen blood lipid levels according to risk stratification, identify problems in a timely manner, and take intervention measures to safeguard the healthy growth of children.
Through these comprehensive measures, we can lay a solid foundation for the future health of our children, allowing them to be free from the troubles of hyperlipidemia and grow into a healthy and vibrant next generation.
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