It might surprise you to learn that one in five children has high total cholesterol, low HDL cholesterol, or high LDL cholesterol. Approximately 7.8% of adolescents aged 12 to 19 have total cholesterol levels ≥200 mg/dL. Unfortunately, high cholesterol is a concern for children as well as adults. September is National Cholesterol Education Month, a good time to refresh your knowledge on this important topic.
The American Academy of Pediatrics recommends all children be screened for high cholesterol at least once between ages 9 and 11 and again between ages 17 and 21. This is a significant change from previous guidelines, which suggested screening only for children with a family history of heart disease or high cholesterol.
Atherosclerosis begins in childhood. Dietitians can help parents understand the implications and importance of controlling cholesterol levels in their children. Kathryn Riner, MS, RD, LD, a pediatric dietitian, suggests parents be proactive by providing a nutritious diet and supporting an active lifestyle to help their children reduce their risk of CVD later in life.
Recommendations for reducing cholesterol levels in children include the following:
- Choose more healthful fats. Choose foods low in total fat and saturated fat, and avoid trans fat altogether. Focus on lean cuts of meat, low-fat or nonfat dairy, and sources of monounsaturated fats. In particular, advise clients to select foods high in omega-3 fatty acids. While omega-3s don’t affect LDL cholesterol, they play a role in increasing HDL levels.
- Increase soluble fiber. Aim for high-fiber carbohydrates such as whole grains, vegetables, fruits, and legumes.
- Limit added sugars. Foods such as soda, juice, and sweets, and those low in fiber and high in less healthful fats should be limited to less than one serving/week.
- Increase activity levels. Physical activity should become part of the family’s lifestyle along with limited screen time. Let children pick their favorite family activity, from biking to walking and swimming.
Strategies for Success
Monique Richard, MS, RDN, LDN, RYT-200, a primary care dietitian, says that “often [parents] struggle with time management and getting kids to an activity or event, often going through drive-thrus or relying on prepackaged convenience foods.”
Handling day-to-day management of healthful eating when time is tight doesn’t need to be difficult. The following are some ideas to improve the quality of family meals:
1. Include children in meal planning. Make it a game or explore new recipes and foods as a family. Adina Pearson, RD, owner of Healthy Little Eaters, a nutrition counseling service that helps families make healthful meal choices, agrees: “There’s a lot of pressure on parents to try to overhaul everything in their diet and perhaps set some pretty high standards for a family meal—standards that might be difficult to reach day after day. I think it’s important for RDs to not contribute to these lofty goals.”
2. Embrace lifestyle changes for the entire family. Among Riner’s clients, overwhelmed parents who provide meals for their families are the biggest hurdle to children eating healthfully. “Often, they feel they need to restrict one child while letting [their] other children have a more diverse diet.” Making one meal for the whole family can solve this problem. Healthful eating benefits everyone.
3. Encourage gradual changes that are attainable. Pearson has seen that implementing structure rather than grazing can improve cholesterol without major food changes. Teach families to set meal times along with snack times and offer tips on how to stick to this schedule.
4. Advise parents on ways to help their children make more healthful food choices as they head into their preteen and teenage years. Riner says, “During the preteen and teenage years, parents continue to play a critical role in teaching their child about good nutrition. Planning meals in advance is a key strategy that helps families get healthful meals on the table consistently. With busy schedules, family members often eat in shifts, and if dinner is already made everyone can at least eat the same thing.” She adds, “Preteens and teenagers may also start to show an interest in cooking, and teaching them a few skills to make them comfortable in the kitchen can go a long way. Set the example, and your kids will follow your lead.”
Richard educates her clients on how to become role models for their children, as she believes it’s one of the most important and lasting ways to teach children about healthful dietary choices and lifestyle habits. “Prioritizing meals around responsibilities and activities and making foods available that are rich in color and easy to incorporate daily allows a habit to form over time, making it easier for it becoming the default. Even just having a family mealtime once a week may be helpful.” In addition, “including your child in meal- and snack-time decisions but also establishing boundaries of what the choices are will set them up for successful ways to think about taking care of their body.” Richard finds that “offering choices in a different way (eg, roasted cauliflower vs steamed) with positivity and never making it a forced event can be helpful and lasting” in that the child may want to try new foods and communicate preferences.
In the words of one parent whose child has high cholesterol, that diagnosis “has certainly made us aware that instead of saying we should eat better, we need to eat better!” She goes on to say, “We are slowly making changes. Grocery shopping is beginning to be planned better as well as meals incorporating healthier ingredients. As a family, we are not there yet, but all feel the importance of eating healthier.” The lasting lesson? This mother realized “it’s good for all of us to put more of an emphasis on the food we eat.”
About 30% of American adults have total cholesterol levels between 200 and 239 mg/dL, and more than 25% of the adult US population has blood cholesterol levels greater than 240 mg/dL, which is considered high risk. As nutrition professionals, we can take pride in helping decrease these numbers in years to come.
— Jodi Danen, RDN, is a family nutrition blogger at Create Kids Club. She’s creator of Lunch Bites lunch box note cards. Her passion and focus is on getting families back into the kitchen.