New Lipid Screening Guidelines for Children

Photo: Cholesterol in blood

Cholesterol is an organic chemical
substance classified as a waxy
steroid of fat;©
Alexandr Mitiu

Moreover, the recommendations are based on expert opinion, rather than solid evidence, the researchers said, which is especially problematic since the guidelines' authors disclosed extensive potential conflicts of interest.

The guidelines were written by a panel assembled by the National Heart, Lung and Blood Institute (NHLBI). They also were endorsed by the American Academy of Paediatrics. The guidelines call for universal screening of all 9 to 11-year-old children with a non-fasting lipid panel, and targeted screening of 30 to 40 per cent of 2 to 8-year-old and 12 to 16-year old children with two fasting lipid profiles. Previous recommendations called only for children considered at high risk of elevated levels to be screened with a simple non-fasting total cholesterol test.

The call for a dramatic increase in lipid screening has the potential to transform millions of healthy children into patients labelled with so-called dyslipidemia, or bad lipid levels in the blood, according to Doctor Thomas Newman, Doctor Mark Pletcher and Doctor Stephen Hulley.

"The panel made no attempt to estimate the magnitude of the health benefits or harms of attaching this diagnosis at this young age," said Newman. "They acknowledged that costs are important, but then went ahead and made their recommendations without estimating what the cost would be. And it could be billions of dollars."

Some of the push to do more screening comes from concern about the obesity epidemic in U.S. children. But this concern should not lead to more laboratory testing, said Newman.

"You do not need a blood test to tell who needs to lose weight. And recommending a healthier diet and exercise is something doctors can do for everybody, not just overweight kids," he said. The requirement of two fasting lipid panels in 30 to 40 per cent of all 2 to 8-year olds and 12 to 16-year- olds represents a particular burden to families, he said.

"Because these blood tests must be done while fasting, they cannot be done at the time of regularly scheduled 'well child' visits like vaccinations can," said Newman. "This requires getting hungry young children to the doctor's office to be poked with needles on two additional occasions, generally weekday mornings. Families are going to ask their doctors, 'Is this really necessary?' The guidelines provide no strong evidence that it is."; Source: University of California – San Francisco