All children ages 9 to 11 should be screened at least once for high cholesterol, according to new guidelines; although some say this advice may amount to unnecessary testing.
The new recommendations are intended to prevent heart disease, which is rare in children, but more likely to develop in adults who had high cholesterol as kids.
"The more we learn about heart disease and stroke in adults, the more we know that the process begins in childhood and progresses over time," Dr. Stephen Daniels, chair of the panel that wrote the guidelines, said in a statement. "By working with families, we can keep kids at a lower lifetime risk and prevent more serious problems in adulthood."
The new guidelines, issued by the National Heart, Lung and Blood Institute and approved by the American Academy of Pediatrics, are a change from earlier recommendations that advised cholesterol screening only for children with a family history of heart disease or high cholesterol. However, some experts disagreed today that a changed was needed.
But recent research has suggested such screening misses 30 to 60 percent of children with high cholesterol, Daniels said, and an increase in childhood obesity has lead to a much higher proportion of kids who have high cholesterol.
Testing can lead to treatment
Some experts disagreed with the universal recommendation.
Testing children's cholesterol levels has no value if those with high cholesterol aren't going to be placed on medication, said Dr. Chad Teeters, a cardiologist at the University of Rochester Medical Center.
And there is no evidence that treating kids with medications for high cholesterol prevents or slows the progression of heart disease later in life, Teeters said. Moreover, starting kids on drugs that they may need to take for their entire lives could have deleterious side effects, Teeters said. And although the screening test — which would involve a blood sample or finger prick — is relativity inexpensive, the cost to apply it nationwide would likely be expensive.
"You're probably talking about an immense amount of cost every year, with limited to no benefit, and the potential to cause harm," Teeters said. "I don't think they're any benefit to testing just for the sake of testing at this time," he said.
The U.S. Preventative Service Task Force says currently there is not enough evidence to recommend for or against cholesterol screening in children and young adults up to age 20.
Lifestyle changes can lower cholesterol too
Most kids found to have high cholesterol would first be advised to change their diet and increase their physical activity, Daniels said. Only about 1 percent would qualify for treatment with medications.
But Teeters said guidelines already recommend that all children get between 30 and 45 minutes of exercise per day and stay away from fatty and fried foods.
This is the best way to keep kids' hearts healthy, and "I don’t see [that] doing the test would change my recommendation," Teeters said. The new guidelines recommend screening before puberty because during puberty, children will naturally experience an increase in cholesterol levels. Cholesterol levels in 9- to 11-year-olds are relativity stable.
The guidelines also recommend breast-feeding babies, and that parents emphasize a diet low in saturated fat starting at age 1 to prevent heart disease risk factors. Children who are overweight and have at least two risk factors for diabetes (such as a family history of the condition) should be screened for diabetes every two years starting as young as age 10.
The recommendations are published online today (Nov. 11) in the journal Pediatrics.