原文: New Cholesterol Guidelines for Kids

On 7/7/08, the American Academy of Pediatrics issued new guidelines for monitoring and treating children with high blood cholesterol levels.* The stakes could hardly be higher. At issue is whether we pediatricians and parents can prevent long term cardiovascular disease in our children by detecting high cholesterol levels early on and by promptly intervening to lower those levels.

The problem is (as I will discuss), the scientific returns are not in as yet, so this is an open question about which you should keep current and discuss with your pediatrician. Because it's so important, I've read the guidelines very carefully. As your faithful cyber-pedi (or am I your pedi robo-cop?), I wanted to share my thoughts.


First, what do the guidelines recommend?

1. Most importantly, a healthy diet and increased physical activity for all children, including low-fat dairy products for all children over two years of age.
   
2. Low-fat dairy products for children 12 - 24 months who are overweight.
   
3. Screening (a fasting lipid profile) - starting at age 2 years and then every 3-5 years - for all children and adolescents with a family history of high cholesterol / high fat levels or early cardiovascular disease.
   
4. Screening for all children whose family history is unknown or who are overweight, have high blood pressure, or diabetes.
   
5. Weight management should be the primary treatment for overweight kids with high lipid levels.
   
6. For patients 8 years and older with an LDL concentration greater than 190 mg/dL (or 160 mg/dL with a family history of early heart disease or two additional risk factors present; or 130 mg/dL if diabetes is present), medications should be considered.

(LDL = low density lipoprotein = the bad guy cholesterol that appears to clog up the works, as opposed to HDL = high density lipoprotein = the good guy cholesterol that protects against atherosclerosis).

What I like about the guidelines:

• The prevention of adult diseases during childhood is one of our great challenges. These guidelines reinforce that vital pediatric mission.
  
• It makes sense to me to aggressively intervene with children who already show signs of disease (diabetes, metabolic syndrome) or who are at great risk by virtue of genetics.
  
• The emphasis on a low animal fat, high fiber diet will serve to improve the health of all humans (see my blogs on this favorite subject of mine: Overweight toddler, overweight teen? Dr. P's 8 steps to a healthier family ).
  
• I like being given the OK to put chubby one year-olds on low fat milk products.

My concerns about the guidelines:

• I wish they had put more emphasis on fitness, i.e., more exercise for our kids (see my blog: Your teen's physical fitness). Even an overweight child can and should be physically fit, just as even a skinny child can be an unrepentant couch potato.
  
• Since we know that artery clogging atherosclerosis begins in childhood, it makes sense to intervene early. But, in fact, we don't really know whether lowering cholesterol levels in childhood will, in any significant way, prevent long term cardiovascular disease. Since that is the case, our interventions should at least "do no harm".
  
• The potential short-term and long-term consequences of using cholesterol-lowering agents during childhood simply aren't known. Just because they appear to be safe in old fogies like me doesn't mean that they couldn't have some sort of unanticipated effect on the growing, changing child's body (especially since cholesterol and fatty acids are essential building blocka for many organs, including the brain).
  
• For that reason - and until long term studies are done and we know more - unless the risks seem especially high, I'm still not going to recommend medications for my healthy pediatric patients with high cholesterol levels.
  
• I worry about you all needlessly obsessing about a high cholesterol level in your otherwise healthy, happy, active child, especially since we don't really know what it will mean for your child over time.
  
• I worry (hey, I worry a lot!) about the loss of a carefree childhood. As I wrote in my old blog: What is lost from childhood when the glorious taste of a hot fudge sundae is confounded by the worry that it is causing blood vessel sludge?

Dr. P's bottom line: Unless your child has one of the risk factors listed above, don't worry about their cholesterol 'number'. Worry instead about their general fitness and nutritional well-being. Feed them a healthy, low animal fat, low junk food, high fiber diet, make sure they get plenty of exercise, and you'll be doing a superb job.

译文: 小孩子的新胆固醇摄入量指导方针

问题就是到目前为止还没有科学的方法（正如我将要谈论的一样），所以这是一个开放性的题目，你可以就你的观点和你的儿科医生探讨一下。指导方针如此重要，所以之前我已经很仔细地把它阅读过了。作为一位你们如此信任的儿科医生，我想和你们一起分享我的看法。

1，最重要的是，给孩子们提供健康的饮食和不断增强的体育活动，两岁以上的小孩还要注意吃低脂肪的奶制品。

2.12-24个月大的小孩如果体重超标，就要给他们吃低脂肪的奶制品。

3.给小孩子们和青少年建立一个“脂肪档案”，这些小孩的家族中有人是有高胆固醇或者是高脂肪病史的，或者是心血管疾病的病史---在两岁开始建立，接下来的每3-5年看一下这个档案。

4.筛选的所有儿童，他们的家族病史不明或他们的体重超重，或患有血压高，或患有糖尿病。

5.对于那些体重超标并且脂肪过高的儿童来说，控制体重是最基本的治疗方案。 6.8岁及8岁以上患者的低密度脂蛋白浓度大于190毫克/升（或160毫克/升与家族病史的早期心脏病或两个额外的风险因素有关; 或者是130毫克/升，如果是现在患有糖尿病的话），在使用药物时要谨慎。

（LDL就是低密度脂蛋白，它会阻碍胆固醇的正常运作，和LDL相反，HDL就是高密度脂蛋白，它可以帮助防止动脉粥样硬化）

 

我喜欢的指导方针：

 

•  在童年时代就预防成年疾病的发生是非常具有挑战性的。这个方针的颁布增强了小儿科医生的使命感。
•   我懂得了积极干预那些有疾病现象（糖尿病，代谢综合征）的小孩子，或者是那些会有极大可能因为基因遗传而患病的小孩。
• 强调低动物脂肪高纤维饮食 将会有助于提高全人类的健康(你可以在我的博客上看到我最喜欢讨论的主题之一: 超重的小孩，超重的青少年？P医生的拥有健康的家庭生活的8个步骤）。 
•  我认为给一岁的胖乎乎的小孩子吃低脂肪的奶制品是很不错的选择。

 

我对于指导方针的忧虑：

 

• 我希望他们更注重体型的合适行， 例如， 让孩子们多运动(看我的博客: 青少年的标准体型).  一个超重的小孩能够也应该身体健康，就像一个骨瘦如柴的孩子可以成为一个电视迷一样。
• 正如我们所知道的， 粥样动脉硬化  开始于童年时期，那么我们在早期就预防这种疾病的发生是很有必要的。但是，事实上，我们并不真正了解是否是童年时期的低胆固醇含量在很大程度上意味着可以预防以后的心血管疾病。既然这样，我们过早的预防至少对以后没有害处。
  
• 在童年时期服用降低胆固醇含量的药剂是否存在潜在的短期或长期的后果，我们一无所知。因为即使这些药用在像我一般年纪的人身上是安全的也并不表示他们不会对那些正在长身体的小孩产生副作用，（尤其是由于胆固醇和脂肪酸对人体的许多器官来说有重要作用，包括大脑）
  
• 由于以上的原因，除非我们能够了解更多，或者是除非患病的几率真的很高，不然我一般不会推荐我那些胆固醇过高的健康患者使用药物。
• 我担心你们总是想着你们健康，快乐并且充满活力的小孩可能会胆固醇过高，尤其是当我们不知道随着时间的推移，高胆固醇会给你的小孩带来什么后果的时候。
• 我担心（并且非常担心）无忧无虑的童年会消失。正如我在我以前的博客中所写的那样：当我们担心美味的软糖或圣代会引起血管堵塞时，童年将会缺少什么呢？
  
  

 

P医生的建议：除非你的小孩存在以上所列举的患病因素之一，否则你不用担心他们的胆固醇含量。你应该关心的是他们全面的身体和营养。给他们提供一个健康的饮食，低脂肪，非垃圾食品，高纤维的饮食，确保他们做足够的运动。