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Cholesterol & Triglycerides |
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Cholesterol & Triglycerides |
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Cholesterol is a waxy substance that is found in all parts of the body. A certain amount of cholesterol is important to healthy body function. It aids in the production of cell membranes, some hormones and vitamin D. Too high a level of cholesterol in the blood, known as hypercholesterolemia, is a major risk factor for heart disease and can lead to heart attack in adulthood.
All and sometimes more of the cholesterol the body needs is produced in the liver. It also is found in the foods we eat. Animal products such as egg yolks, red meats, poultry, seafood and whole milk dairy products have cholesterol, while plant foods such as fruits, vegetables and whole grains do not.
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Triglycerides are a class of lipids (fats) in the bloodstream and in all the cells of the body. Triglycerides come directly from the fats you eat or from carbohydrates that are not used immediately for energy. These carbohydrate calories are converted to triglycerides for storage in fat cells, and are an important source of triglycerides in some children.
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As with fats like triglycerides, cholesterol is transported through the bloodstream in the form of round particles called lipoproteins. The two most commonly known lipoproteins are:
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- Low-density lipoproteins (LDL) - This type of cholesterol is commonly called "bad cholesterol" (think "L" for "Lousy"). It can contribute to the formation of atherosclerosis.
- High-density lipoprotein (HDL) - This is the "good cholesterol" (think "H" for "Happy" or "Healthy"). It helps remove bad cholesterol from the blood, preventing the fatty buildup and formation of plaque.
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The following guidelines set by the American Academy of Pediatrics and the National Cholesterol Education Program establish acceptable, borderline and high ranges for total and LDL cholesterol in children between the ages of 2 and 19. If your child's LDL cholesterol level is near or in the high range, contact the Preventive Cardiology Clinic to learn more about its targeted intervention program.
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Less than 170
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Less than 110
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170-199
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110-129
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200 or higher
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130 or higher
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While too much "bad cholesterol" is worrisome, too little HDL or "good cholesterol" is also cause for concern.
A study by researchers at Children's Hospital Boston of nearly 2,000 adolescents found low HDL to be the most common risk factor of five major risk factors for atherosclerosis. Evidence shows that a HDL level in adults greater than or equal to 40 mg/dL is protective, while values below 40 mg/dL are considered a risk factor for coronary heart disease. Most children should have HDL levels of 50mg/dL or more. Triglycerides should be less than or equal to 150 mg/dL.
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If your child's cholesterol LDL levels are high, triglycerides are high and/or HDL is low, the Preventive Cardiology team will develop a plan for your child that includes healthy eating exercise, and, in some cases, medication. These three components are outlined below.
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A Children's Hospital nutritionist will offer you and your family a healthy eating plan that incorporates American Heart Association dietary guidelines for lowering LDL and raising HDL, which are as follows:
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- Lower saturated fat intake - Saturated fats (unhealthy fats that come mostly from animal products) are known to raise LDL-cholesterol levels. To help lower LDL to an acceptable range, your child should consume 12-15 grams of saturated fat per day. That means limiting consumption of animal products, such as:
- red meats and pork
- whole milk dairy products
- cheeses and butter
- the skin of poultry
- coconut oil, palm oil, palm kernel oil and cocoa butter
- Avoid trans-fatty acid - Trans-fatty acids are artificial fats, created by scientists who, in the early 1900s, manufactured margarine and shortenings as a cheap alternative to butter. They did so by a process called hydrogenation, which gives polyunsaturated fats attributes of saturated fats. For instance, when a vegetable oil, normally a good fat, is hydrogenated it solidifies, like a bad fat. The Institute of Medicine recently deemed trans-fatty acids worse than saturated fats. The IOM found that, unlike LDL cholesterol, trans-fatty acids have no health value whatsoever. In fact, in addition to increasing LDL cholesterol, trans-fatty acids decrease HDL levels. Unfortunately, trans-fatty acids are found in many packaged snacks, such as crackers and cookies. Food manufacturers soon will be required to list trans-fats on food labels. Until then, check ingredients on food products and look for the words "hydrogenated" or "partially-hydrogenated" and avoid these foods.
- Consume good fats - You may be surprised to learn that not all fats are bad. Two kinds of "unsaturated" or good fats, known as polyunsaturated or monounsaturated fats, can help lower LDL by raising the level of HDL in your bloodstream. Sources of monounsaturated fats include fish, certain types of vegetable oils, nuts and natural nut butters, and avacado.
- Lower cholesterol intake - One way to lower bad cholesterol is to be sure you are lowering your intake of cholesterol from food. Cholesterol intake should be reduced to less than 200 mg of cholesterol per day. Foods high in saturated fat also are high in cholesterol.
- Increase dietary fiber - 25-30 grams of dietary fiber are recommended each day. Dietary fiber can be found in vegetables, whole grain foods, beans and legumes. The fiber in these foods refers to a part of plants that your body cannot digest and therefore has no caloric value. Still, fiber helps your body eliminate waste by bringing water to the colon and making waste softer and easier to eliminate. For important information about fiber and lists of food sources, see facts about fiber).
- Reduce caloric intake - Children with elevated triglycerides or low HDL cholesterol are often overweight or obese. A weight loss plan, in and of itself, should help normalize lipid levels. In addition to reducing fat and cholesterol intake, it is important to watch caloric intake. Strategies for limiting calories include reducing portion sizes and removing high calorie snacks and junk foods from the home (see how to stock a healthy kitchen)Children with elevated triglycerides are advised to decrease intake of simple sugars and refined carbohydrates such as white breads, rice and potatoes, pasta, and sweet foods.
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Regular physical activity is just as important as healthy eating for obtaining a healthy weight and healthy life. Regular exercise helps burn fat, lowers LDL cholesterol, lowers triglycerides and ultimately reduces the risk of heart disease and some cancers. The Preventive Cardiology staff will help you and your child develop an exercise schedule with a goal of 30-60 minutes of vigorous exercise at least five days a week.
Exercise that meet this criteria can include organized sports or participating in other organized activities that promote exercise such as dance, gymnastics or ice skating. Some children may prefer to exercise on a treadmill or exercise bicycle, perhaps in front of the television.
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Some children with severe cholesterol and triglyceride problems cannot reduce LDL cholesterol with diet management alone, particularly children who have a familial form of high cholesterol, known as familial or genetic hyperlipidemia.
Either of the following medications may be prescribed for your child, if he or she is older than 10, and despite diet modification has high LDL cholesterol and other risk factors, such as hypertension, low HDL cholesterol, diabetes, obesity, physical inactivity or strong family history of premature coronary artery disease.
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- Cholestyramine - This drug is the oldest cholesterol medication available today, with a long track record for safety, reliability and minimal side effects. It is known as a "bile acid resin binder" because it prevents bile acids from being reabsorbed from the intestines back into the bloodstream and traveling to the liver, where they would be converted to cholesterol. These drugs are sometimes difficult to take because they come in large pills or powder form, which may pose a problem for some children.
- Statins - These drugs are also known as "HMG-CoA reductase inhibitors" because they work against a liver enzyme known as HMG-CoA reductase, which produces cholesterol. Statins are prescribed primarily to children with a severe familial form of hyperlipidemia or to those with other systemic disorders that put them at high risk for atherosclerosis, such as diabetes mellitus, kidney failure or cardiac transplantation. Short-term clinical trials and observational studies have reported that the use of statins in children is safe and effective. Most statins available are approved by the Food and Drug Administration for use in children older than 10 years. Many practitioners prefer to wait until girls have begun menstruating before starting a statin, if possible.
- Ezetimibe - This is a new medication that often is used in conjunction with a statin, if a statin alone is not sufficiently effective. Ezetimibe also can be used alone in some situations. It blocks an intestinal receptor for cholesterol and has been generally free from significant side effects in adult studies. Recommendations for starting ezetimibe are generally similar to those for the statins.
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