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Cholesterol, LDL, HDL, and Triglycerides in Children and Teens

What is cholesterol?

Cholesterol is a fat-like, waxy substance. It can be found in all parts of your child's body. It helps make cell membranes, some hormones, and vitamin D. The cholesterol in blood comes from 2 sources. The first source is from the foods your child eats. The second source is from their liver. Your child's liver can make all of the cholesterol they need.

Cholesterol and other fats are carried through the blood. They are in the form of round blobs called lipoproteins. There are 2 main types of lipoproteins. One type is low-density lipoproteins (LDL). The other type is high-density lipoproteins (HDL).

What is LDL cholesterol?

What is HDL cholesterol?

LDL is often called bad cholesterol. But the body does need LDL. If your child's LDL level is high, it can cause plaque to form in the arteries. This is known as atherosclerosis. It is also known as hardening of the arteries. Atherosclerosis can lead to heart disease. It is a risk factor for heart attacks.

LDL should be low. To help lower LDL, your child should:

  • Not eat foods high in saturated fat or cholesterol

  • Not eat too many foods with sugar and refined carbohydrates

  • Not eat too many calories

  • Get more exercise

  • Keep a healthy weight

This type of cholesterol is known as good cholesterol. It helps remove LDL from the blood. It also helps prevent plaque in the blood vessels.

HDL should be as high as possible. To help raise HDL, your child should:

  • Exercise for at least 20 minutes, 3 times a week

  • Not eat foods with saturated fat

  • Lose excess weight

What are triglycerides?

Triglycerides are another type of fat found in the blood. Most of your teen's body fat is in the form of triglycerides.

High levels of triglycerides are linked with a higher risk of heart disease.

High triglyceride levels may be caused by any of these: 

  • Diabetes

  • Hypothyroidism

  • Kidney disease

  • Liver disease

  • Gene that causes high triglyceride levels in families (familial hypertriglyceridemia)

  • Obesity

  • Some medicines

  • Eating a lot of high-fat or sugary foods

  • Drinking a lot of alcohol

Should my child have a blood lipid test?

A lipid screening is a test to look at the levels of the fats in the blood. In the past, healthcare providers felt that children and teens were not at risk for high cholesterol levels. But we now know that children and teens are at risk. This is due to things such as:

  • Being inactive from too much screen time and not enough exercise

  • High-fat or high-sugar diets

  • Obesity

  • Family history of high cholesterol levels

Children and teens with high cholesterol are at higher risk for heart disease when they become adults. Keeping blood cholesterol levels in the normal range reduces this risk.

Lipid testing by age

Your child may need to fast before the blood test. This depends on the type of lipid test done. Fasting means your child should not eat food or drink anything but water before the test.

  • Under age 2. Lipid testing is not advised.

  • Ages 2 to 8. Testing is advised if your child has other risk factors for heart disease. These include diabetes, high blood pressure, obesity, exposure to cigarette smoke, or a family history of these. Other risk factors include family history of early coronary artery disease or lipid disorder, kidney disease, or other chronic inflammatory diseases.

  • Ages 9 to 11. Testing is advised. This can be done with either a fasting or non-fasting lipid profile.

  • Ages 12 to 16. Testing is not advised. This is because of changing lipid levels during puberty. But testing is advised if your child has risk factors as noted above.

  • Ages 17 to 21. Testing is advised. This is because lipid levels are more stable after puberty.

Understanding the test results

A full lipid profile can be an important part of your child’s health information. It shows the levels of each type of fat in the blood. These include LDL, HDL, triglycerides, and total cholesterol. Your child's healthcare provider can tell you what the results should be for your child. In general, healthy levels are:

  • LDL of less than 130 mg/dL

  • HDL of greater than 60 mg/dL (less than 35 mg/dL puts your teen at higher risk for heart disease)

Some children and teens (ages 2 to 19) have families with high cholesterol or early heart disease. In these cases, the National Heart Lung and Blood Institute advises these levels for cholesterol:

Total Cholesterol

LDL-Cholesterol

Acceptable

Less than 170 mg/dL

Less than 110 mg/dL

Borderline High

170 to 199 mg/dL

110 to 129 mg/dL

High

200 mg/dL or greater

130 mg/dL or greater

Treating high cholesterol in your child or teen

If the results of your child's lipid tests are abnormal, your child's healthcare provider will work with you to create a treatment plan. Most children and teens will not need medicine. A healthy diet, weight loss, and more physical activity may bring your child's blood lipid levels to normal. The provider will track lipid levels and help your child make lifestyle changes. Your child's provider will talk with you about medicine if needed.