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Understanding Lab Values > Cholesterol


Cholesterol is found in the body from two sources: cholesterol we eat, and cholesterol our liver makes. Dietary cholesterol comes from meat, fish, poultry, and dairy products. Plants contain no cholesterol. Families with a history of high cholesterol often have a genetic predisposition to make more cholesterol, regardless of the diet and exercise habits of each person.

Cholesterol is a soft, fat-like, waxy substance found in the bloodstream and in all your body's cells. Not all cholesterol is bad, it actually serves very important functions in our bodies. It is used for producing cell membranes and some hormones, and serves other needed bodily functions. An unbalance of cholesterol in the blood, especially a high "bad cholesterol" is a major risk for coronary heart disease (which leads to heart attack) and stroke.

Cholesterol is transported to and from the cells by carriers called lipoproteins in the blood. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol. These two types of lipids plus triglycerides contribute to your total cholesterol count.

Puberty can affect cholesterol levels, so the optimal time to check this level as a routine screen is before puberty starts or after it is completed. The American Academy of Pediatrics (AAP) recommends all children between 9 and 11 years old be screened for high blood cholesterol levels. Guidelines do not advise routine screening between ages 12–16 unless the child has a strong family history of cardiovascular disease. Universal screening is again recommended between ages 17 and 21.

HDL (Good) Cholesterol - H = you want high levels

About 1/4 - 1/3 of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as “good” cholesterol because high levels of HDL seem to protect against heart attack. Low levels of HDL also increase the risk of heart disease. HDL takes cholesterol away from the arteries and back to the liver, where it's passed from the body. Some experts believe that HDL removes excess cholesterol from arterial plaque, thus slowing its buildup. With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol puts you at higher risk for heart disease. 

LDL (Bad) Cholesterol - L = you want low levels

When too much LDL cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances, it can form plaque: a thick, hard deposit that can narrow the arteries and make them less flexible. This is known atherosclerosis. If a clot forms and blocks a narrowed artery, heart attack or stroke can result. The lower your LDL cholesterol, the lower your risk of heart attack and stroke.


Triglyceride is a form of fat made in the body. High levels of triglycerides are most often be due to overweight/obesity, physical inactivity, cigarette smoking, excess alcohol consumption and a diet very high in carbohydrates (60% of total calories or more). Underlying diseases or genetic disorders can also be the cause. High triglyceride levels are associated with obesity, diabetes, and insulin resistance.

Total cholesterol

Total cholesterol that is reported by a lab includes LDL + HDL + VLDL (very low density lipoprotein), and IDL (intermediate density cholesterol).

Cholesterol level guidelines

The American Heart Association suggests the following cholesterol level guidelines in children and adolescents 2-19 years old:

Total cholesterol
  • Acceptable - less than 170
  • Borderline -170-199
  • High - 200 or greater

LDL cholesterol
  • Acceptable - less than 110
  • Borderline - 110-129
  • High - 130 or greater

Eating habits, exercise habits, cigarette smoke exposure, and genetics can each lead to risks of elevated cholesterol and heart disease. The atherosclerotic process (the buildup of plaques in the arteries) begins in childhood. High cholesterol can lead to early coronary heart disease if left untreated.

Treatment for high cholesterol

The primary treatment involves lowering LDL cholesterol by losing excess weight (if needed), exercising regularly, and following a diet low in saturated fat and cholesterol. If the elevated cholesterol is due to a genetic predisposition and not from poor diet and sedentary lifestyle, continuing healthy habits and monitoring levles until they reach a medically treated level is important.

The Child-1 Diet is recommended. Dr. Vincent Iannelli summarizes the CHILD-1 Diet well here.

If an elevated lipid level is associated with obesity or overweight status, weight loss can be very helpful. Weight loss should be monitored by a physician and/or dietitian closely in children. Growing children often should not lose weight, but maintain the same weight as they gain height. Working with a nutritionist or dietitian for caloric needs is especially beneficial in children, and although often not covered by insurance, working with a nutritionist can be well worth the cost. Consider the lifetime medical costs associated with obesity: diabetes, heart disease, joint problems, increased loss of work, and more. Not to mention the psychological impact of being overweight. For more information, read Weight Loss Tips for Teens.

Diets rich in omega-3 fatty acids have been shown to decrease levels of triglycerides.
  • Nuts (especially walnuts) are high in omega-3 fatty acids, as well as protein, fiber, healthy monounsaturated fats, vitamins, and antioxidants. One to one and a half ounces of nuts per day is recommended, unless there is a nut allergy. Too many nuts do increase the fat and calories in the diet, so should be avoided.
  • Fatty fish (salmon, tuna, trout, herring, sardines, and mackerel) are also high in omega-3 fatty acids. Two 4-ounce servings of fish per week are recommended, unless allergic to fish.
  • Flaxseed, canola oil, and omega-3 enriched eggs are other sources of omega-3 fatty acids.
  • For people who are not able to eat fish or nuts, fish oil supplements can be taken (unless allergy to fish is present). They are available in capsule form as well as gummy vitamins and liquid preparations. Health food stores will often allow children to sample a variety of flavors before purchasing.

If exercise and dietary changes fail to lower cholesterol, some children require medication. These medications are approved in children, but do have side effects, which should be discussed with your doctor if they are being considered. Medicine is sometimes seen as a "quick fix", but it must be used in conjunction with healthy habits.

There are familial forms of high cholesterol. These are also called genetic high cholesterol ... you have high cholesterol no matter how healthy you eat and how much you exercise. These often require medication beginning at an early age.

For more information on routine cholesterol screening, visit Dr Stuppy's blog on cholesterol.

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