The controversy over treatment of high cholesterol in children

A perspectives piece published in the New England Journal of Medicine last week highlights the controversy in the USA over the treatment of children for high cholesterol levels.

In July this year, the American Academy of Pediatrics released revised recommendations for the treatment of high cholesterol in children. Recommendations included a reduction in the age at which drug therapy (i.e. statins) may be given from 10 years of age to 8 years of age. There was also a recommendation that nutrition therapy with reduced-fat milk should begin at one year of age for high-risk children.

According to the authors, “The recommendation to use statins in childhood seems to have hit a collective nerve, perhaps awakening us to the fuller implications of the obesity epidemic. It’s one thing to treat the rare child who has an inherited defect in cholesterol metabolism and quite another to extend treatment to children who are at risk for cardiovascular disease because of modifiable lifestyle factors.”

Kerry Andersen, a New Zealand Registered Dietitian working in Paediatrics at Hutt Valley Hospital, comments:

“Obesity is a significant issue in New Zealand children, with latest figures showing one in five children are overweight and a further one in twelve are obese. Obesity is associated with an increased risk of high-cholesterol levels.

It was interesting that in the USA they are recommending nutrition therapy with reduced-fat milk in children as young as one year of age. My opinion is that reduced fat (light blue) milk in high-risk one year olds may be appropriate in a few circumstances, but I am concerned that any child with obesity or high-cholesterol should be seen by a registered dietitian for a full assessment and appropriate dietary advice.

Whilst under the care of a dietitian, nutritional adequacy of the diet will be reviewed on a regular basis, and growth and development will be monitored closely. My big concern is that parents may hear about this guideline and may implement a low-fat diet for their own children who are not in fact at risk. Young children have high nutrient needs and require a nutrient-dense diet for optimal growth and development. I already see a number of children with growth faltering where parents are reluctant to add appropriate fat as they have concerns about heart disease and lack of understanding of fat requirements in children.

In terms of statin use, in New Zealand these are not currently recommended for children under 10 years of age.”

Reference: de Ferranti S, Ludwig DS. Storm over statins – the controversy surrounding pharmacological treatment of children. N Engl J Med, 2008; 359: 1309-1312.

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