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WILL CHOLESTEROL SCREENING WORK IN CHILDREN?

The issue of cholesterol screening in children is highlighted in the American Journal of Diseases of Children.

Two articles report somewhat discouraging findings. The first study retrospectively examined the impact of dietary counseling on 104 children with primary dyslipoproteinemia. Although two-thirds of the children complied with dietary advice adapted from the National Cholesterol Education Program (NCEP), only 19 percent had a 15 percent or greater decrease in LDL cholesterol. However, 28 percent had a 15 percent or better increase in HDL cholesterol.

The second study highlights the problem of noncompliance. Questionnaires from parents of 1160 children in a prepaid health plan identified children at high risk for hypercholesterolemia. Although a free cholesterol test was offered, nearly a third of parents refused to have their child screened. Over a third of parents whose children had abnormal screening results refused a follow-up test, and only about a third of children with elevated LDL cholesterol enrolled in a nutrition program.

Cardiovascular disease begins in children, who have the most to gain from prevention. Here, it seems, is where agreement ends. The American Academy of Pediatrics and the NCEP guidelines recommend only screening children at high risk for hypercholesterolemia. One editorial supports the NCEP guidelines, but another argues for a more aggressive approach that would screen all children, lower the threshold for an abnormal test, and reduce the proportion of dietary fat below the current standard of 30 percent.

— RAD

Published in Journal Watch General Medicine April 30, 1993

Citation(s):

Einhorn PT; Rifkind BM. Cholesterol measurement in children. Am J Dis Child 1993 Apr 147 373-375.

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Berenson GS. Cholesterol: myth vs reality in pediatric practice. Am J Dis Child 1993 Apr 147 371-373.

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Bachman RP et al. Compliance with childhood cholesterol screening among members of a prepaid health plan. Am J Dis Child 1993 Apr 147 382-385.

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Mietus Snyder M et al. Effects of nutritional counseling on lipoprotein levels in a pediatric lipid clinic. Am J Dis Child 1993 Apr 147 378-381.

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