Cholesterol levels in children

The NCEP/Expert Panel on Blood Cholesterol Levels in Children and Adoiescents and the American Academy of Pediatrics defined high cholesterol as concentrations more than the 95th percentile for total and LDL cholesterol in children and adolescents from families with hypercholesterolemia or premature vascular disease (see Table 26-18). Borderline total and LDL cholesterol concentrations are defined as values between the 75th and 95th percentiles. The NCEP panel referred to total and LDL cholesterol values below the 75th percentile as "desirable. Low HDL cholesterol was also defined as a concentration below 35 mg/dL. Children tend to have higher HDL cholesterol concentra-... 

Modified from National Cholesterol Education Program, Lipid Metabolism Branch, Division of Heart, Lung, and Blood Institute The Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Bethesda, MD National Institutes of Health, 1991. 

Figure 26-23 Model of steps in therapeutic life-style change. LDL, Low-density lipoprotein. (Mod/f/ed from Executive summary of the third report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents, National Cholesterol Education Program. Upid Metabolism Branch, Division of Heart, Lung, and Blood Institute. NIH Publication No. 01-3670. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. Bethesda MD National Institutes of Health, 2003.)...

The Total Plasma and LDL-Cholesterol Levels in Children and Adolescents from Families with Hypercholesterolemia or Premature Cardiovascular Disease ... 

Table 6. Effects of plant sterols and stanols on serum LDL cholesterol levels in children...

The proportions of delta 8-cholesterol and desmosterol in the serum rose while those of cholestanol, campesterol and sitosterol dropped, implying a decreased absorption of cholesterol and a compensatory increase in its synthesis. High basal precursor sterol proportions were predictive of a large decrement in titer of LDL cholesterol. It appeared that partial substitution of normal dietary lipid consumption with sitostanol was a safe and effective therapeutic measure for children with FH (Lees et al., 1977 Wang and Ng, 1999). The effect of a small amount of sitosterol, sitostanol and sitostanol esters dissolved in rapeseed oil on serum lipids and cholesterol metabolism in patients with primary hypercholesterolemia and various apolipoprotein E phenotypes on a rapeseed oil diet showed a diminution in TC and LDL-cholesterol levels in the serum (Gylling and Miettinen, 1994). 

Expert Panel. National Cholesterol Education Program. Reprot of the expert panel on blood chole.sterol levels in children and adolescents. Pediatrics 1992, 89 (Suppl. 2), 525 -584. 

Higher PFOA and PFOS serum levels in children were associated with higher total cholesterol and low-density lipoprotein (LDL). Higher PFOS was associated with higher high-density lipoprotein (HDL), but not with triglycerides. No consistent trend was observed for PFOA and HDL or triglycerides. 

The first description of the use of plant stanols to lower plasma cholesterol levels in humans was by Heinemann etal (1986) in a small uncontrolled study. They showed that the administration of capsules of sitostanol dispersed in monoacylglycerol and sunflower oil at a dose of 1.5g/day lowered LDL cholesterol levels by 15%. Similar concentrations of sitosterol and sitostanol infused directly into the small intestine decreased cholesterol absorption by 50% and 85%, respectively (Heinemaim et al, 1991). Becker et al (1993) obtained impressive results with low-dose sitostanol in an uncontrolled study with 9 children suffering from familial hypercholesterolemia. LDL cholesterol levels decreased by 33% when the children consumed 1.5 g sitostanol daily, and by 20% when they consumed 6 g sitosterol daily, suggesting that sitostanol is more effective than sitosterol at lowering LDL cholesterol levels. 

Liver toxicity is a rare side effect of CBZ therapy (Trimble, 1990), although a recent study reported that 9% of children on CBZ had mildly elevated aspartate aminotransferase (Camfield and Camfield, 1985). Higher mean serum total cholesterol (TC) levels, mean low-density lipoprotein level, and mean TC/high-density lipoprotein ratio have been reported in children with epilepsy treated with CBZ, compared with controls (Sozuer et ah, 1997). Conversely, an increase in serum high-density lipoproteins was reported in a smaller sample of patients treated with CBZ, and was therefore interpreted as a possible protective factor against atherosclerosis (Yalcin et ah, 1997). 

The use of plant sterols—(3-sitostcrol and sitostanol in consumer products to decrease cholesterol is supported by numerous clinical studies that document their efficacy in lowering mild hyperlipidemia (Jones et al., 1998 Hallikainen and Uusitupa, 1999). Although the normal diet contains plant sterols that range from 160 to 360 mg/day, a 5- to 10-fold increase is required to exert a cholesterol-lowering effect. Consumer products with increased amounts of phytosterols that exceed the content found in the diet have been made available to the consumer. In evaluating the efficacy of including sitostanol ester in margarine as a dietary supplement for children with familial hypercholesterolemia (FH), it was found that serum total cholesterol (TC), intermediate density lipoprotein-cholesterol and LDL-cholesterol levels fell while the HDL-cholesterol/LDL-cholesterol ratio was elevated. 

Resnicow K, Cross D. Are parents self-reported total cholesterol levels useful in identifying children with hyperlipidemia An examination of current guidelines. Pediatrics 1993 92 347-53. 

Vitamin D is a fat soluble vitamin related to cholesterol. In the skin, sunlight spontaneously oxidizes cholesterol to 7-dehydrocholesterol. 7-Dehydrocholesterol spontaneously isomerizes to cholecalciferol (vitamin D3), which is oxidized in the liver to 25-hydroxy cholecalciferol and, under the influence of PTH in the kidney, to 1,25-dihy-droxy cholecalciferol (calcitriol), the active form of vitamin D. Vitamin D induces the expression of calcium ion transport proteins (calbindins) in intestinal epithelium, osteoclasts, and osteoblasts. Calbindins and transient receptor potential channels (TRPV) are responsible for the uptake of calcium from the diet. In children, the absence of sunlight provokes a deficiency of vitamin D, causing an absence of calbindins and inadequate blood calcium levels. Osteoid tissue cannot calcify, causing skeletal deformities (rickets). In the elderly, there is a loss of intestinal TRPV receptors and decreased calbindin expression by vitamin D. In both cases, the resultant low blood calcium levels cause poor mineralization during bone remodeling (osteomalacia). Rickets is the childhood expression of osteomalacia. Osteoclast activity is normal but the bone does not properly mineralize. In osteoporosis, the bone is properly mineralized but osteoclasts are overly active. 

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