U-M study finds that national cholesterol testing guidelines for
children may need to be revised
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(HealthNewsDigest.com) – ANN ARBOR, Mich. – With the epidemic of childhood obesity in the United States, there is concern that overweight and obese children need to be screened for chronic medical conditions, including high cholesterol levels.
However, body fat is not an effective indicator of high cholesterol in
children, according to new University of Michigan research.
Those are the findings of a U-M study led by U-M pediatricians Joyce
Lee, M.D., MPH, and Matthew Davis, M.D., MAPP, which will appear in the
August 3 edition of the Archives of Pediatric and Adolescent Medicine.
“We found, actually, that using body mass index to find kids with
high cholesterol does not work well. There were many overweight and
obese kids who had normal cholesterol, and there were a fair number of
healthy-weight kids who had high cholesterol,” says Lee, a member of
the Child Health Evaluation and Research (CHEAR) Unit in the U-M
Division of General Pediatrics, and assistant professor in the
Department of Pediatrics and Communicable Diseases at the U-M Medical
School.
The study was conducted after the American Academy of Pediatrics
revised its cholesterol screening guidelines in July 2008, advocating a
cholesterol check for kids who have increased risk of heart disease.
For the most part, that means all children who are overweight or obese,
which is about 30% of kids in the U.S.
“Our results indicate that the AAP guidelines for cholesterol
screening in kids may need to be revised,” says Lee. “Otherwise, we
may be missing high cholesterol in some kids and unnecessarily testing
others.”
The authors performed the study with national data from thousands of
children to see whether ‘body mass index’ (BMI), a measure of body fat
based on height and weight, can be used as a reliable way to find kids
with high cholesterol levels. They looked at the relationship between
BMI and two different cholesterol measures, including total cholesterol
and low density lipoprotein (LDL) cholesterol, i.e. “bad”
cholesterol.
For this study, children were classified as overweight if their BMI was
between the 85th and 95th percentiles, and defined as obese if their BMI
was greater than the 95th percentile for weight based on age and height.
Children had abnormal levels if they had a total cholesterol greater
than 200 mg/dl or LDL cholesterol level of greater than 130 mg/dl.
This study found that screening all overweight or obese children would
identify approximately 50% of children with abnormal cholesterol levels
but would also lead to unnecessary testing for up to 30% of children.
Other studies have looked at additional screening strategies for
abnormal cholesterol in children on the basis of having a family history
of early heart disease or high cholesterol. But as Lee notes, “A
positive family history also performs poorly for identifying children
with high cholesterol levels. Therefore, it may be more efficient for
the AAP to recommend a public health campaign to reduce cholesterol
among all children, rather than screening high-risk groups.”
In addition to Lee and Davis, co-authors include Achamyeleh
Gebremariam, MS, from the University of Michigan, and colleagues from
the Arkansas Center for Health Improvement, including Paula
Card-Higginson, BA, ELS, Jennifer L. Shaw, DrPH, MPH, MAP, and Joseph W.
Thompson, MD, MPH.
This work was funded by the Robert Wood Johnson Foundation. Dr. Lee was
also supported by NIH grant NIDDK K08DK082386 and the Clinical Sciences
Scholars Program at the University of Michigan.
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