FPA Guidlines

Pediatric Lipid Guidelines

Criteria for Lipid screening

Age 0-12 months: No routine lipid screening is recommended
Age 2-8 years: Measure fasting lipid profile only in high risk population

Positive Family history of premature cardiovascular disease
Parent with total cholesterol TC > 240 mg/dL or known dyslipidemia
If the parent had diabetes, hypertension, BMI>95 th percentil and/or smokes cigarettes

Age 9-11 years: Measure non-fasting lipid profile in all patients to look at non-HDL

Non-HDL=Total Cholesterol - HDL

Age 12-17 years: Measure fasting lipid profile in high risk populations (as above + BMI > 85th percentile)
Age 18-21 years: Measure non-fasting lipid profile in all patients to look at non-HDL

Definition of Abnormal Results and Recommendations for Initial Primary Care Management and Follow-up or Referral to COA Lipid Clinic

* please note that isolated total cholesterol may not represent cardiovascular risk, especially if HDL is >45 mg/dL. Therefore, our focus is LDL, non-HDL, and triglycerides.

LDL/non-HDL

Results	Intervention
LDL < 160mg/dL and/or Non-HDL < 160. Non-HDL=TC-HDL	Diet and exercise Exclude hypothyroidism by obtaining Free T4 and TSH Check Hemoglobin A1C and refer to Endocrine if > 6.5% Repeat fasting lipid profile in 6 months
LDL>160 mg/dL and/or Non-HDL>160 mg/dL	All of the above plus initiate referral to Lipid Clinic

Triglycerides

Results	Intervention
Fasting Triglycerides < 300 mg/dL	If non-fasting level is elevated, first repeat fasting lipid panel Initiate diet and exercise May try fish oil 1000g (1 capsule) PO BID in patients over 10 years. Check Hemoglobin A1C and refer to Endocrine if > 6.5%
Triglycerides>300 mg/dL	Initiate diet and exercise Check Hemoglobin A1C, Free T4 and TSH

Results

Intervention

Fasting Triglycerides < 300 mg/dL

If non-fasting level is elevated, first repeat fasting lipid panel

Initiate diet and exercise
May try fish oil 1000g (1 capsule) PO BID in patients over 10 years.
Check Hemoglobin A1C and refer to Endocrine if > 6.5%

Triglycerides>300 mg/dL

Initiate diet and exercise
Check Hemoglobin A1C, Free T4 and TSH

Lifestyle intervention should be taught for overweight patients

Consider consult with registered dietician or nutritionist
Increase activity level to a goal of 60 minutes/day; decrease sedentary time with TV/computer games; take TV out of the bedroom
Limit portion sizes, fried and fatty food diet
Elimiate All sweet drinks from diet (juices, sodas, Gatorade, Kool-Aid, sweet tea, etc) and choose sugar-free alternatives or water. Consider switching to 1% milk (or fat free) and limiitng consumption

Consider Metformin in patient over 10 years old who have markedly increased diabetes risk (morbid obesity, strong family history of diabetes, etc) or poor response to lifestyle interventions.

Adjust treatment with Metformin may be added to hlep decrease insulin resistance and potentially prevent/delay progression to over diabetes and cardiovascular morbidity. Regrettably, to date, evidence-based long-term studies regarding the efficacy of Metformin in pediatric prediabetes is lacking.
Starting dose - 500 mg PO BID. Can be titrated to 1000mg PO BID in older children.
Low starting dose (i.e. 250 mg PO BID, slowly titrated to final dose over 1-2 weeks) can decrease GI upset associated with initiation of therapy, but are not necessary.