| Blood Cholesterol |
| |
|
| |
|
>170 mg/dL
is borderline |
| |
|
>200 mg/dL
is elevated |
|
| |
|
LDL-C:
| |
|
>110 mg/dL
is borderline |
| |
|
>130 mg/dL
is elevated.
|
|
|
| |
|
Goals:
| |
|
LDL-C
|
| |
|
<160
mg/dL |
| |
|
(<130 mg/dL
is even better) |
|
| |
|
For patients
with diabetes,
|
|
| |
|
If LDL-C is
above goals, initiate additional therapeutic lifestyle changes, including diet
(<7% of calories from saturated fat; <200 mg cholesterol per day), in
conjunction with a trained dietitian. |
| |
|
Consider
LDL-lowering dietary options (increase soluble fiber by using age [in years]
plus 5 to 10 g up to age 15, when the total remains at 25 g per day) in
conjunction with a trained dietitian. |
| |
|
Emphasize
weight management and increased physical activity. |
| |
|
If LDL-C is
persistently above goals, evaluate for secondary causes (thyroid-stimulating
hormone, liver function tests, renal function tests, urinalysis).
|
| |
|
Consider
pharmacologic therapy for individuals with LDL >190 mg/dL with no other risk
factors for CVD or >160 mg/dL with other risk factors present (blood pressure
elevation, diabetes, obesity, strong family history of premature CVD).
|
| |
|
Pharmacologic
intervention for dyslipidemia should be accomplished in collaboration with a
physician experienced in treatment of disorders of cholesterol in pediatric
patients. |
|
| Other Lipids and Lipoprotein |
| |
|
Triglycerides:
| |
|
>150 mg/dL
HDL-C <40 mg/dL
|
|
|
| |
|
Goals:
| |
|
Fasting
TG |
| |
|
<150
mg/dL |
| |
|
HDL-C >40
mg/dL |
|
|
| |
|
Elevated
fasting TG and reduced HDL-C are often seen in the context of overweight with
insulin resistance. Therapeutic lifestyle change should include weight
management with appropriate energy intake and expenditure. Decrease intake of
simple sugars. |
| |
|
If fasting
TGs are persistently elevated, evaluate for secondary causes such as diabetes,
thyroid disease, renal disease, and alcohol abuse. |
| |
|
No
pharmacologic interventions are recommended in children for isolated elevation
of fasting TG unless this is very marked (treatment may be initiated at TG
>400 mg/dL to protect against postprandial TG of 1000 mg/dL or greater, which
may be associated with an increased risk of pancreatitis).
|
|
| Blood Pressure |
Systolic and diastolic pressure >95th percentile for age, sex
and height percentile. |
Goal:
| |
|
Systolic and
diastolic blood pressure <95th percentile for age, sex, and height
|
|
| |
|
Promote
achievement of appropriate weight. |
| |
|
Reduce sodium
in the diet. Emphasize increased consumption of fruits and vegetables.
|
| |
|
If BP is
persistently above the 95th percentile, consider possible secondary causes
(e.g., renal disease, coarctation of the aorta). |
| |
|
Consider
pharmacologic therapy for individuals above the 95th percentile if lifestyle
modification brings no improvement and there is evidence of target organ changes
(left ventricular hypertrophy, microalbuminuria, retinal vascular
abnormalities). Start blood pressure medication individualized to other
requirements and characteristics of the patient (i.e., age, race, need for drugs
with specific benefits). |
| |
|
Pharmacologic
management of hypertension should be accomplished in collaboration with a
physician experienced in pediatric hypertension.
|
|
| Weight |
| |
|
BMI:
| |
|
>85th
percentile is at risk of overweight |
| |
|
>90th
percentile is overweight
|
|
|
Goal:
| |
|
>Achieve and
maintain BMI <95th percentile for age and sex
|
|
| |
|
For children
who are at risk of overweight (>85th percentile) or obesity (>95th
percentile), a weight management program should be initiated with appropriate
energy balance achieved through changes in diet and physical activity.
|
| |
|
For children
of normal height, a secondary cause of obesity is unlikely. |
| |
|
Weight
management should be directed at all family members who are overweight, using a
family-centered, behavioral management approach. |
| |
|
Weight
management should be done in collaboration with a trained dietitian.
|
|
| Diabetes |
|
| |
|
Near-normal
fasting plasma glucose (<120 mg/dL) |
| |
|
Near-normal
HbA1c (<7%) (goals for fasting glucose and HbA1c should
take into consideration age and risk of hypoglycemia)
|
|
| |
|
Management of
type 1 and type 2 diabetes in children and adolescents should be accomplished in
collaboration with a pediatric endocrinologist. |
| |
|
For type 2
diabetes, the first step is weight management with improved diet and
exercise. |
| |
|
Because of
risk for accelerated vascular disease, other risk factors (e.g., blood pressure,
lipid abnormalities) should be treated more aggressively in patients with
diabetes. |
|
| Cigarette Smoking |
|
Complete cessation of smoking for children and parents who
smoke |
Advise every tobacco user (parents and children) to quit and be
prepared to provide assistance with this (counseling/referral to develop a plan
for quitting using available community resources to help with smoking
cessation). |