Children as young as two should be screened for bad cholesterol if they are overweight or have a parent or close family member with heart disease risk factors such as high blood pressure and high cholesterol, or premature heart disease (diagnosed before the age of 35 years). If diet changes don’t bring down artery-blocking bad cholesterol (low density lipoprotein or LDL) levels in these children, they should be prescribed cholesterol-lowering medicines called statins as early as the age of eight years.
These controversial new guidelines by the American Academy of Pediatrics (AAP) have triggered a worldwide debate on whether pills can replace the established benefits of diet modification and playground activity to prevent heart disease in the future.
Earlier, AAP recommendations said cholesterol drugs should be given only to those children over 10 years of age who failed to lose weight in a year despite making lifestyle changes. As obese and overweight children face a higher risk of heart disease, diabetes and high blood pressure as adults, the report also recommends a low-fat dairy diet for children as young as 12 months.
“Statin medications should be prescribed to only those high-risk children who do not respond to lifestyle changes such as limiting fat intake, increasing physical activity to an hour a day and cutting back on red meat,” said Dr R.R. Kasliwal, senior consultant cardiologist, Apollo Hospital.
A Delhi study in the Asia Pacific Journal of Clinical Nutrition (February, 2008) found that 24 per cent — one in four — of 3,493 students in the age group of 14-18 years were obese. “High bad cholesterol apart, Indians tend to accumulate fat around the stomach, have low levels of heart-protecting good cholesterol (high density lipoprotein or HDL), high blood pressure and elevated triglycerides (blood fats). This makes them more prone to heart disease, diabetes and stroke,” said Dr Anoop Misra, director of diabetes and metabolic disease, Fortis Group of Hospitals, who led the study.
In adults, the Body Mass Index (BMI) — calculated by weight in kilos divided by the square of the height in metres — of 30 or more is considered obese, but in youngsters the index depends on gender and age. “While many pediatricians track children’s height and weight, even general physicians need to keep obesity prevention in mind and give lifestyle modification advice based on height-to-weight ratio,” says Dr Kasliwal.