Childhood Time Bomb : UC Irvine Study Finds High Levels of Cholesterol in Many 4th-Graders

What does the typical person look like who has a high level of serum cholesterol?

Is he a grossly overweight, late-middle-age couch potato who snacks on three-egg cheese omelets, wolfs down thickly marbled steaks with the fat left on, slathers everything with slabs of butter and washes it all down with several glasses of whole milk?

Or is he a 10-year-old who gets regular exercise and faithfully eats what his parents feed him?

According to Dr. Dennis Davidson, associate professor of cardiology at UC Irvine Medical School, both the adult and child stand a chance of suffering from dangerously high levels of the artery-clogging substance. Recent research in Orange County has shown that the buildup of cholesterol that figures in the death of an estimated 650,000 Americans each year may often begin in childhood.

After testing nearly 800 fourth-graders in the Westminster School District--one group of children in 1987 and another group this year--Davidson and other researchers from UCI’s Preventive Cardiology Division found that 10% of the children had total cholesterol readings of 200 or above.

That figure, said Davidson, is near the average reading for American adults. The average cholesterol level in fourth-graders nationwide is around 160.

A cholesterol reading near 200 in a 10-year-old child, Davidson said, may be a kind of time bomb that can explode in adulthood. Because high levels of cholesterol figure so prominently in the onset of coronary artery disease in adulthood--virtually all heart attacks are attributable to it--Davidson warned that bad eating habits in children, if not curtailed, can lead to a buildup of damaging plaque in coronary arteries when those children mature.

“All the evidence leads that way,” Davidson said. “And only one in three kids (who showed high readings) had a family history of heart disease at an early age. With the other two-thirds, we’re guessing it’s their environment or a combination of genetics and environment.”

The near-200 readings may be even more alarming when measured against the latest recommendations of the National Institutes of Health, which hold that, ideally, an adult’s cholesterol reading should be at or, preferably, well below 200.

The villains? Fast food. Ice cream. Cheese. Pizza. Hot dogs and hamburgers. French fries and potato chips. In other words, UCI dietitian Cindy Iftner said, all the edibles American kids hold dear.

“It has to do with a lot of inactivity and high-fat foods,” said Iftner. “Also a lot of vending machine food. But parents think that’s OK for kids, that it’s the all-American thing to have. And kids get used to these things and may not know any differently.”

And, she said, parents serve such foods to their children at home. Or worse, she said, some parents routinely rely on going out for fast food for many family meals. Also, she said, 40% to 60% of the calories obtained in most fast-food items come from fat. Ideally, those numbers should be halved, she said.

The health threat to children from the buildup of cholesterol is, in a historical context, relatively new, said Robert Kowalski, a Southern California medical writer and author of the recently released book “Cholesterol and Children.”

“We’re looking at a very peculiar situation in our society today,” he said. “We’re sitting on a time bomb. We’ve never had the risk factors develop for children like they’re developing now. There’s no question that heart disease begins in childhood.”

Although the Westminster study is relatively new and there has yet been no opportunity to track the buildup of cholesterol as the tested children mature, Kowalski pointed to a study in Bogalusa, La., begun 15 years ago, in which the town’s children were given free pediatric exams that included cholesterol testing. Over the years, autopsies were performed on the children who died as a result of accidents, disease or other causes, “and, sure enough, these kids were 10, 11, 12 years old and they had developed clogging of the arteries,” Kowalski said. The examiners “saw that they could directly correlate the clogging that already had begun with the level of cholesterol when the kids had been alive.”

Autopsies performed on young soldiers who were killed in the Vietnam War revealed similar results, he said.

That their children may have potentially dangerous levels of cholesterol often comes as a shock to parents, Kowalski said.

“Almost inevitably, people are surprised, if they think they’ve been eating a good diet,” he said. “In Orange County, let’s face it, we’re talking about a very family-oriented community, and parents are doing the best for their children. Here are these kids getting good, healthy diets and their cholesterol level is still elevated. People are buying certain products and assuming everything is OK.”

The “good, healthy diet,” however, can be deceiving. A daily diet that includes two eggs, bacon, buttered toast and a glass of whole milk for breakfast, a Big Mac with french fries and a glass of milk for lunch and grilled liver and onions, a glass of milk and carrot cake for dinner contains between 800 and 850 milligrams of cholesterol, depending on how the food is prepared. Medical researchers have said that a person’s daily cholesterol intake should be no higher than 300 milligrams.

If parents rely heavily on fast food, however, the numbers begin to skyrocket, Kowalski said.

“Before McDonald’s started in the late ‘50s,” he said, “there was no such thing as fast food.” Even after fast food became popular, “you’d go to McDonald’s occasionally for a treat. And that’s still perfectly fine. But today a child could start the day with an Egg McMuffin, eat at Burger King for lunch and Kentucky Fried Chicken for dinner and the next day have Shakey’s pizza--literally every meal coming from fast food.”

There is such a thing as low-cholesterol fast food, however, Iftner said.

“Salad bars are very good,” she said, “and Carl’s Jr. chicken sandwiches are our best recommendation for sandwiches.”

However, Iftner said, the best diet remains a balanced one, prepared at home, that contains moderate amounts of foods containing fat and cholesterol.

Diet as a prime determiner of cholesterol levels in children also seems to cut across national and ethnic boundaries, Kowalski said. In the Westminster sample, there was no noticeable difference among white, Latino or Asian children. Children growing up in Japan and Mexico tend to have low levels of cholesterol, Kowalski said, but when they are exposed to a typical American diet, the cholesterol levels rise.

“Ten years ago in Japan, the average cholesterol level was around 170,” Kowalski said. “Then they started importing fast food from us, and the young people have gone bonkers for it. Now the average cholesterol level in Japan has gone from 170 to 190, and the only visible difference is fast food.”

The solution need not be drastic, Kowalski said.

“Culture shock is not the thing to do in a family,” he said. “Families with high cholesterol shouldn’t think, ‘Oh, my God, we’re diseased.’ That’s absurd. The kids aren’t diseased, it’s a matter of education. You make gradual kinds of changes.”

Iftner said she asks parents to “buy sherbet instead of ice cream, fruit instead of chips. Make sandwich substitutions, like turkey instead of salami. A good time to start is when kids are about 5 or 6 and they start to be aware of food and making food choices.”

Testing children for cholesterol likely will become more widely promoted and available, Kowalski said. However, Davidson said that for a more widespread testing program to work in Orange County schools, more money and more school nurse time--”our biggest obstacle”--are needed.

“The ideal situation,” he said, “would be if the communities in the county would decide to routinely incorporate the testing into their school systems.”

That solution, Kowalski said, would serve not only to bring any cholesterol problems in children to light, but would in some cases be an indicator that one or both parents of a high-cholesterol child also may have a problem.

“It really serves two purposes to check children,” he said. “If a child is high in cholesterol, it’s likely the parents will be too, although they may not be genetically predisposed to it.

“As far as testing goes, I think we’re just beginning to see the tip of the iceberg. I think we’ll be seeing pediatricians routinely checking children for cholesterol and we’ll be seeing entrepreneurs coming into it. Companies are already being formed to do this. They work in shopping malls or at health fairs and administer the finger-prick test for about $5.”

(The finger-prick test involves extracting a small amount of blood from the fingertip and running it through a machine, which produces numeric total cholesterol readings in three minutes. The machine does not, however, produce separate readings for low- and high-density lipoproteins, the cholesterol types that are, respectively, harmful and beneficial. A more extensive laboratory blood test is needed to determine those readings.)

Two breakthroughs in the fight against cholesterol buildup have emerged in the past two years, partly as a result of research that led to Kowalski’s best-selling book of last year, “The 8-Week Cholesterol Cure.” In the book, Kowalski said medical researchers have found that eating oat bran as part of the daily diet tends to lower cholesterol levels. Also, for people with highly elevated cholesterol readings, niacin is also effective in lowering the level, sometimes drastically.

“Knowing what we know now,” he said, “we have a chance to end this problem with this generation. I don’t want my own son to have to deal with this when he gets older.”