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Cholesterol Keep It under Control



CHOLESTEROL

Keep It under Control

Walk by an elementary school classroom and you'll see a bustle of activity--and a roomful of apparently healthy kids. It's tough to believe that some of these kids may already be on their way to developing heart disease--also known as coronary artery disease.

There's growing evidence that coronary artery disease begins in childhood. Studies have shown that as many as 25 children out of 100 have borderline high levels of blood cholesterol, the goo that helps make artery-clogging plaque. Often, the cause of high cholesterol in kids is a high-fat diet coupled with a lack of exercise.

Until age two, children do need a diet that's higher in fat than the recommended diet for adults. And doctors say you shouldn't give low-fat milk or foods to an infant. Once your child is two, however, it's time to start watching the diet.

You may choose to have your child's cholesterol level checked. But whether or not you know cholesterol levels, experts agree that childhood is the time to begin patterns that will last a lifetime and--studies show--prolong life. If you encourage a healthy diet and lifestyle for your children, you will help prevent high cholesterol and future heart disease. Here's how.

Turn off the television. Excessive T V watching is linked to high cholesterol in children, points out Saundra MacD. Hunter, Ph.D., research professor at Tulane University School of Public Health in New Orleans. Researchers in California who studied 1,100 children found that kids who watched television more than two hours a day were twice as likely as non-T V viewers to have high cholesterol levels. To help limit viewing, give each child an allotment of a certain number of hours per week. Together, design a colorful chart where the child records her viewing. Or simply select specific programs the children can watch, and don't allow the television on at other times. You can also adopt this strategy for children who want to play video games for hours at a time.

Get the kids moving. 'Ideally, kids should do some form of aerobic exercise at least three times a week,' advises Peter Kwiterovich, Jr., M.D., professor of pediatrics and director of the Lipid Research Clinic at the Johns Hopkins University School of Medicine in Baltimore. To get the most benefit, children should exercise 20 minutes or longer--which shouldn't be at all difficult for active kids. 'Any sport where the arms and legs are constantly in motion is good--bicycling, running, walking, swimming,' he says.

Make low-fat dairy choices. Parents should limit the amount of fat in the diet of any child over the age of two, according to Matthew W. Gillman, M.D., assistant professor of medicine, pediatrics and public health at Boston University School of Medicine. You can help reduce your child's fat intake by limiting butter, margarine and high-fat dairy products such as whole milk, sour cream and ice cream. Whenever possible, use low-fat or nonfat substitutes. Many children like reduced-fat cottage cheese or yogurt, for instance.

Keep an eye on high-fat culprits. Instead of stocking up on chips and cheese curls, keep lower-fat pretzels, graham crackers or low-fat crackers in your cupboard, suggests Rebecca Pestle, R.D., a clinical nutritionist at Crawford Long Hospital of Emory University in Atlanta. For lunches avoid bologna, hamburgers and hot dogs that are usually high in fat. Your child will be better off with a lunch of low-fat cheese or fresh turkey or a chicken sandwich instead.

Switch gradually. Your family may rebel if you abruptly ditch whole milk, mayonnaise, ice cream, chips and fatty lunch meat and immediately switch to lower-fat products. Make changes gradually, suggests Pestle. 'Go from whole milk to 2 percent, for example, then to 1 percent and finally to skim,' she says. 'Or use skim milk and add dry milk to it to give it a richer taste without adding fat.' When you replace high-fat snacks and lunch meats with healthier choices, do it gradually rather than all at once.

Choose natural peanut butter. Peanut butter--like all foods made from plants--is cholesterol-free, but some types are healthier than others. The only fat in natural peanut butter--which contains only peanuts and sometimes salt--is peanut oil, which is a monounsaturated fat. Monounsaturated fats--when substituted for saturated fats--can help reduce the body's 'bad' cholesterol, says Pestle. But most brands of peanut butter that are creamy or smooth contain hydrogenated vegetable oil, a saturated fat that can increase blood cholesterol levels.

Supply plenty of produce. Serve plenty of fruits and vegetables, suggests Dr. Gillman. Aim at five servings of these foods a day. They're not only low in fat, but are considered important disease fighters as well.

Take your children shopping with you--one at a time to prevent bedlam--and let them help select the produce. 'Children are more likely to eat foods they've helped pick out,' says Pestle.

Increase fiber intake. Fiber is another cholesterol-fighter. 'Add oat bran and fruit to muffins or bread recipes,' suggests Pestle.

Also look for legumes, such as beans and lentils, and whole grain wheat and rice. All are good sources of fiber. Even finicky kids can be tempted by interesting menus. Your child may turn up her nose at lentil soup, for example, but will likely enjoy a bowl of chili or baked beans.

Monitor your meat. Realize that you don't need to serve meat at every meal or even daily. Fish is an excellent low-fat protein source, as are beans, lentils and split peas when you combine them with grains or foods made with grains, such as rice or bread, says Pestle. Even a peanut butter sandwich served with a glass of skim milk packs a lot of protein.

Prepare meat the low-fat way. When preparing chicken, remove the skin and any visible fat, says Pestle. Your lowest-fat meat choices are turkey and chicken breasts. But you can choose other meats that are relatively low in fat. When selecting beef, buy the leanest cuts, such as sirloin, tenderloin, round and flank, she says. 'Pork tenderloin and some hams are also very low in fat,' she says. A good choice is fresh, unprocessed ham. Another tip to help you choose low-fat meat: Look for the word 'loin' or 'round.'

A bout Cholesterol Screening

At what age should cholesterol levels be checked? This is a controversial topic, points out Matthew W. Gillman, M.D., assistant professor of medicine, pediatrics and public health at Boston University School of Medicine, 'Some experts recommend no screening whatsoever until adulthood.' At the other extreme, the American Health Foundation recommends that every child have his blood cholesterol screened after age two.

A middle-of-the-road approach is to consider having cholesterol checked after age two if you are aware of a family history of early heart disease or if either parent has a cholesterol problem, suggests Peter Kwiterovich, Jr., M.D., professor of pediatrics and director of the Lipid Research Clinic at the Johns Hopkins University School of Medicine in Baltimore.

The American Academy of Pediatrics and the National Cholesterol Education Program Expert Panel ( NCEP) recommend testing if any of the following risk factors are present.

* A grandparent, aunt, uncle or parent had a coronary artery bypass procedure or balloon angioplasty before age 55

* A grandparent, aunt, uncle or parent had a heart attack, stroke, angina or other cardiovascular disease before age 55

* Either parent has a cholesterol level above 240

* Your child has two or more risk factors for coronary heart disease, such as high blood pressure or obesity--or your child is exposed to cigarette smoke because someone in your household is a smoker

If you do have your child screened, realize that normal blood cholesterol levels are lower for children than adults. For children, the NCEP categorizes 170 milligrams per deciliter as acceptable, 170 to 199 as borderline and over 200 as definitely high. At borderline and high levels, your doctor will probably recommend further testing and perhaps a low-fat, low-cholesterol diet to ensure that it doesn't go any higher.

And when preparing any meat, bake or broil it instead of frying to decrease the amount of fat, suggests Dr. Gillman. Also trim fat off any meat.

Check out school lunches. Many school lunches are notoriously high in fat and salt. Visit your child's school or look at the menus for a couple of weeks to determine whether your child's school offers low-fat choices, says Dr. Kwiterovich. 'If your child's school lunches are too fatty, you should pack lunches,' he says. Good lunch box selections are fruit or dried fruit; carrot and celery sticks; graham crackers, bagels or low-fat muffins; yogurt; popcorn or pretzels; low-fat cookies, such as vanilla wafers, fig bars or ginger snaps, and low-fat cheese, lean ham, natural peanut butter or chicken or turkey sandwiches.

Make changes a family affair. You can't expect your kids to exercise and eat low-fat fare when you're lounging on the sofa eating hamburgers and fries. 'Children learn best by example,' says Pestle. 'If you set a good one, they're more likely to follow.' And the foods you keep in the house should only be the ones your kids are allowed to eat, he adds.

Don't go overboard. Don't go nuts when it comes to cutting fat out of your family's diet. Not only can this backfire--your kids may get rebellious and sneak off to spend their allowance money on snacks at the corner convenience store--but you can actually reduce the fat and calories in a child's diet too much for optimal health, says Dr. Kwiterovich. 'Moderation is the key,' he says.



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