A recent study in the Journal of the American Medical Association says cholesterol levels among kids ages 6 - 19 in the United States have improved from 1999 to 2016. While that's the good news, the bad news is that only half of the 26,000 kids in the study fall into that ideal range. Twenty-five percent of the kids in the study have cholesterol levels in the clinically high range.

HIGH CHOLESTEROL ... IN KIDS?

Yes. The biggest risk factor for children is being overweight. But eating a diet high in saturated and trans fats adds more risk. Like other health issues, a family history of high cholesterol weighs in, too. Left untreated, there are a lot of greater health problems that can occur if you ignore or are unaware of your child's cholesterol issue.

"Potential health risks associated with high cholesterol starting in childhood include coronary artery disease, heart attacks and strokes in adulthood, often with increased risk starting as early as 20s - 30s depending on the severity of elevation in cholesterol," says Jennifer C. Kelley, M.D., assistant professor of pediatrics in the Ian M. Burr Division of Pediatric Endocrinology and Diabetes at Vanderbilt University Medical Center.

The idea of "health" isn't necessarily a motivator for some kids to make changes, so it's important for parents to take the lead.

"Make it a family goal that's not focused on one child. It's important for everyone to eat healthy," says Jessica A. Bennett, a registered dietitian with the Monroe Carell Jr. Children's Hospital at Vanderbilt. "Sometimes I find parents talk about it too much. Actions speak louder than words. Start adding more fruit and veggies to plates, and start an afternoon family walk," she adds.

Bennett suggests parents simply start making changes in order to avoid a lot of frustration that often comes when overexplaining things.

WHAT ARE HEALTHY CHOLESTEROL LEVELS FOR KIDS?

Cholesterol — most overweight adults know — is that waxy, fat-based substance that travels from the liver through the blood attached to proteins called lipoproteins. There are good and bad types:

• Low-density lipoprotein (LDL) cholesterol: The "bad" cholesterol. 
• High-density lipoprotein (HDL) cholesterol: The "good" cholesterol.

"LDL cholesterol is known as the 'bad cholesterol,' says says Kelley. "When LDL levels are high for long periods, it can build up in the walls of arteries, particularly the arteries that supply the heart with blood," she adds.

The build-up, known as plaque, can cause narrowing, stiffening and/or blockage in the arteries over time, leading to heart disease with outcomes like strokes or heart attacks.

"HDL cholesterol is known as 'good cholesterol' and can improve heart health by removing cholesterol from the arteries and bringing it back to the liver," says Kelley.

Different types of foods fall into each of the LDL and HDL arenas.

"Foods that raise LDL include saturated and trans fats founds in sweets, fried foods, dairy products and red meats," says Bennett. "Foods promoting HDL include olive oil, fatty fish like salmon and tuna, flax seed, chia seeds, nuts (especially walnuts), whole grains and oats, avocados, products with plant sterols and stanols such as Benecol, Smart Balance products or Minute Maid heart-wise juice," she adds.

Kelley says the generally accepted cholesterol range for kids and teens looks like this:

Total cholesterol < 200 mg/dL

LDL cholesterol < 130 mg/dL

HDL cholesterol > 40 mg/dL

EAT TO LOWER CHOLESTEROL

"The healthiest diet to help lower cholesterol is a balanced Mediterranean-type diet that is high in green, leafy vegetables and fruits, whole grains and nuts, but is restricted in saturated fats, simple carbohydrates, processed foods and fast food," says MacRae F. Linton, M.D., director of the Vanderbilt Lipid Clinic & Laboratory and the Atherosclerosis Research Unit at Vanderbilt University Medical Center.

Kelley reminds parents to serve children foods that are high in fiber and low in saturated fat.

"Selecting lean meats, skim to 1-percent dairy products and using heart-healthy fats such as olive oil and avocado are good choices. Whole-grain items such as whole-wheat breads and cereals like Cheerios and oatmeal along with dried beans. are very helpful in lowering cholesterol," says Kelley. "Eating fruits and vegetables each day provides additional fiber which lowers cholesterol. Limiting your intake of fried high-fat meats, whole milk and cheese items along with sweets and desserts will decreases the amount of saturated fat consumed," she adds.

And what about eggs? Many families scramble them daily for breakfast, adding in cheese, sausage and more.

"Studies go back and forth, so the real verdict is still out with eggs, but I tell families to use them in moderation," says Bennett. "Watch the way you cook them. If you are adding bacon grease or butter, coconut oil or other fats, or adding cheese, you've just increased the cholesterol," she adds, noting that preparing them in the microwave or hard boiled cuts out the extra fat.

While whole eggs are a good source of protein and vitamin B, they are indeed rich in cholesterol.

"One egg contains about the recommended daily allowance of cholesterol in the diet," says Linton. "A problem with eggs is the company they keep — butter, bacon and sausage are high in saturated fat and tend to raise LDL levels in the blood. It is recommended that children eat 2 eggs or fewer a week," he adds.

BE ACTIVE

The American Academy of Pediatrics recommends all children and adolescents get at least one hour of physical activity every day.

"Regular exercise is crucial for maintaining metabolic health, and in particular it improves HDL (good) cholesterol levels," says Kelley.

Find an activity your child enjoys, and it's even better if the family does it together or your child's friends join in.

"They can also sign up to do a couch-to-5K program, or if they love dancing, take a class," says Bennett. "After dinner, the family can dance to five songs together or the starting place they feel they can commit to, then add onto it each week. Reward charts and calendars can be great motivation tools. Local community centers are another great place to start where they might have walking tracks, pools or group fitness classes aimed toward kids," she adds.

CAN KIDS TAKE MEDICATION?

Medications called statins are often prescribed to adults who struggle with cholesterol, and they are available to children as well.

"Statin therapy has been extensively studied in children and adolescents and has been shown to significantly improve cholesterol levels, specifically LDL cholesterol. It also reduces risk for heart disease and is safe and well-tolerated," says Kelley. "The FDA has approved statin therapy for use in children ages 8 years and older. The American Academy of Pediatrics and the American Heart Association recommend starting statin therapy for children and adolescents ages 8 and older in whom LDL cholesterol levels remain greater than 190 mg/dL even after trying dietary and lifestyle/activity changes," she adds.

If your child falls into the risk-factor realm for high cholesterol, or you're curious about your child's LDL and HDL levels, be sure to discuss checking cholesterol with your child's pediatrician. If your child does have elevated cholesterol, your pediatrician can refer him to a specialist to talk about evaluation and treatment.