In an effort to get a jump on preventing heart disease, health authorities in the United States recently recommended that all children have their cholesterol checked before puberty.

The National Heart, Lung and Blood Institute now suggests that children first get their cholesterol checked between the ages of 9 and 11, then have the test repeated between 19 and 21 years. The American Academy of Pediatrics has endorsed the guideline. This news comes as an amendment to a previous health guideline recommending cholesterol screenings for children with family histories of heart disease or who are at risk due to obesity or other health factors.

The reasons for this change are simple and unsurprising: although the effects of high cholesterol don't generally show up until adulthood, studies have found that curbing high cholesterol (and the habits that lead to it) early on can have a major impact in preventing the health issues associated with the condition later in life, such as heart attacks and stroke.

What Is Cholesterol?

The first thing to note is that not all cholesterol is bad for you. This waxy lipid is, in fact, naturally produced by the liver, and helps to maintain and repair cell walls. It also serves as the foundation for some hormones.

However, in order to move throughout the body, cholesterol must combine with protein. Together, these form what is known as lipoprotein, of which there are two types: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). These are more commonly known as "bad" and "good" cholesterol. This is because high levels of LDL in our bloodstream can lead to the build-up of cholesterol and plaque in our arteries, particularly those leading to the heart and brain. "This inhibits blood flow and increases our risk of developing cardiovascular disease, and suffering a heart attack, in particular," says Dr. Cameron McKay, a family physician at Beijing International SOS Clinic.

HDL, on the other hand, steers cholesterol away from the arteries, bringing it back to the liver where it can be processed and removed from the body. HDL can even help remove some of the plaque. Thus, the title "good cholesterol."

Causes of High Cholesterol

According to Dr. McKay, high cholesterol can be the result of a hereditary problem that causes individuals to make and/or absorb too much cholesterol. However, a more likely scenario is that it is the outcome of a combination of lifestyle factors, namely an unhealthy diet, being overweight and lack of exercise. An unhealthy diet, he says, could include high amounts of animal organs, prawns, squid, chicken or turkey skin, egg yolks, fried foods, potato crisps, heavy cream and high-fat cheeses. Children who limit their intake of the aforementioned food items, get plenty of exercise and don’t have a family medical history of high cholesterol or cardiovascular disease most likley won't have to worry too much about high cholesterol. However, those who exhibit one or a combination of these factors should get checked.

“If a close relative has had early onset cardiovascular disease or if a parent has high cholesterol, then testing those children should be considered and discussed with their doctors. This selective screening, if indicated, would begin at 2 years of age, though keep in mind that testing in children as young as this is seldom necessary,” says Dr. McKay.

Testing and Treatment

Thankfully, a simple blood test is all that is needed to check cholesterol levels. The hardest part, Dr. McKay cautions, may in fact be the 12 hours prior to the test, during which patients must abstain from consuming food and water. For this reason, he recommends scheduling the test for early in the morning.

When it comes to the results of the test, Dr. McKay says to focus on the amount of total cholesterol that is made up of LDL. At the same time, he reminds that checking cholesterol levels in children can be trickier than for adults, as “their levels tend to rise until puberty, then drop for a while before rising again. This can make it difficult to distinguish abnormal cholesterol levels,” explains Dr. McKay. Regardless of age, the first step in treating high cholesterol is following a healthy diet and doing more exercise. This means reducing or eliminating fatty foods, and replacing them with fiber-rich foods, fruits and vegetables. Something as simple as switching from cooking with animal fats to vegetable oils like olive or soybean will go a long way.

Dr. McKay also advises choosing fish, poultry (without the skin) and beans as healthier alternatives to red meat. "When you do serve/eat red meat, choose lean meat and trim the fat,” he adds. Of course, keep in mind that no radical dietary changes should be introduced without first consulting a doctor. If, for some reason, lifestyle changes have little to no effect on cholesterol levels, Dr. McKay says medication may be prescribed. However, this practice is quite rare among children.

The bottom line according to Dr. McKay: “Regular exercise and a healthy diet are the keys to preventing and treating high cholesterol, and this applies to the whole family—parents and kids.”