F. Screening Tests
--Hearing Screening in Children
--Vision Screening in Children
--Glossary of Ophthalmologic Terms
--FEP in the Diagnosis of Iron Deficiency and Iron Deficiency Anemia
--Lead Poisoning: When, How and At What Ages to Screen

Cholesterol Screening - A Good Idea?

Kathryn McLeod, MD (Ref: PREP March 1996, AAP: Peds Jan 98)

Introduction: There is much disagreement in the literature about whether screening for cholesterol in children is desirable. Most agree that if the parents have cholesterols over 240, or if the parents or grandparents had early heart attacks (< 50 yrs.), screening should be done. An average cholesterol for children is 150 mg/dl. Interventions have been demonstrated to have harmful psychological effects on families; thus some authors recommend no screening unless above criteria met. Others state that should wait until adolescence and screen them universally.

Causes of High Cholesterol: Increased intake or impaired regulation. Need to screen for or consider the following if the total cholesterol is high:

a. endocrine disorders: hypothyroidism, diabetes mellitus, and Cushing’s syndrome
b. renal disease
c. drugs: steroids, OCP, seizure medications, isoretinoin, and alcohol
d. dietary history: eggs, dairy products, red meat, butter, oil
e. exercise and smoking
f. family history: due to an abnormality of the LDL receptor

Genetic Causes of Hyperchoresterolemia	Frequency	Levels
Heterozygous - most common	1 per 200-500	Twice normal
Homozygous Familial Hyperchlolesterolemia	1 per million	600 - 1200 mg/dL

Definition of High Cholesterol: Total cholesterol is calculated from LDL + HDL + Trigl/5.

General Approach: If abnormal result, confirm with fasting profile. Easily done in office lab.

NCEP	Total Choles	LDL Choles	Dr. Strong’s:	Total Choles
Acceptable	170 mg/dl	<110 mg/dl	Acceptable	<200 mg/dl
Borderline	170-199 mg/dl	110-130 mg/dl	Borderline	200-230 mg/dl
Elevated	>200 mg/dl	>130 mg/dl	Elevated	>230 mg/dl

Treatment of High Cholesterol:

1. Diet. Dietary treatment varies with the level of the LDL: Goal: reduce LDL by 10-15%:

a. Borderline LDL: Step 1 diet (fat <30% calories, saturated fat < 10% cals, chol: <300 mg/day). Reevaluate in 1 year.

b. High LDL: Rule out secondary causes: Step 1 diet, test other family members, start

Step 2 diet (sat fat < 7% of calories, cholesterol < 200 mg/day). Problems are that this restricts calories a lot in order to decrease the fat.

2. Medications: cholestyramine and colestipol (bile acid sequestrants); Goal in using medications: decrease cholesterol 10-25%. Indications for starting medications:

> 10 years of age and no improvement of cholesterol after 6-12 months of diet AND
LDL > 190 OR - LDL > 160 and positive family history.

Department of Pediatrics | Medical College of Georgia
Please email comments, suggestions or questions to:
John T. Benjamin M.D., jbenj@mcg.edu

February 27, 2004

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