September is Cholesterol Awareness Month, and there's a great deal we need to be aware of--and evidently are not.

Although more and more adults recognize the importance of monitoring their cholesterol levels and reducing them if necessary, most don't yet grasp how many children have high cholesterol too.

This much is certain. The level of blood cholesterol is a huge risk factor in coronary heart disease, which results in about 1.25 million heart attacks and claims the lives of almost 530,000 Americans each year. We're only now beginning to learn how early these problems develop and what can be done to prevent their occurrence.

"Up to one-third of children, from 2 years old through the teenage years, have high cholesterol," says Marc S. Jacobson, MD, a New York pediatrician and member of the American Academy of Pediatrics' Nutrition Committee. "A lot of these kids have never been tested because most people are unaware there's a potential problem."

There's mounting evidence, the American Heart Association reports, that heart disease or its precursors "begin in childhood" and that children's eating patterns "affect blood cholesterol levels and coronary heart disease risk."

The American Academy of Pediatrics (AAP) recommends cholesterol tests for children age 2 or older whose parents or grandparents experienced heart disease or vascular disease before the age of 55 or whose parents have cholesterol levels of 240 or up. About 90 percent of children with high cholesterol have at least one parent who also has elevated cholesterol levels.

Although heredity plays a significant role in childrens' cholesterol levels, so do controllable factors like regular aerobic exercise--or the lack thereof--and diet. To lower kids' cholesterol levels, the AAP recommends packing their lunches, cutting back on fried foods and limiting fast-food to no more than one or two meals per month. The American Heart Association proposes a diet "low in cholesterol and saturated fat and high in complex carbohydrates." Breakfasts should be high in fiber with cereals and whole-grain breads. Sandwiches should be made with whole-grain breads. Snacks can include fruits, vegetables, cereals, nonfat popcorn, rice cakes, carrots, sunflower and pumpkin seeds--not candy or cookies.

Finally: Grownups, watch what you eat around your children and how much time you spend on the couch, watching TV and eating junk food. "The best way to approach treatment is to make family-wide changes in diet and exercise," the Nemours Foundation recommends. "The child is not usually the only one at risk, so it's important to make this a family effort."

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