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To Help Identify Risk of Heart Disease, Schools Test Children for Cholesterol

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Concerned that adult heart disease may have its origins in high cholesterol levels developed early in life, educators and medical experts are beginning to test school-age children for cholesterol.

Childhood cholesterol testing, its supporters say, will help identify those children who are at higher risk of developing heart disease. Children who are found to have high levels, as well as those who have a family history of heart disease, can then be taught to modify their diet and life style early on and thus reduce their later risk, they argue.

For example, the Erie, Pa., school board this month voted to begin a free cholesterol-screening program for all students at a single high school. School officials there hope eventually to offer the screening to every student in the district.

"Heart disease doesn't start when you are 55 or 60 years old," said John Petrus, the president of the Erie school board. "It begins in youth."

A local hospital will conduct and cover the cost of the tests, which average about $1.60 to $2 per student, Mr. Petrus said. The school will also try to offer more low-cholesterol school lunches, he added.

Elsewhere, some 40,000 students who attend elementary schools that have participated in a national health-education program created by the American Health Foundation have had their cholesterol levels tested in school.

Kenneth Resnicow, director of school-health research for the New York-based nonprofit organization, said students in 15 states have been tested as part of the "Know Your Body" program over the past 10 years, the majority during the past three to four years.

In both Erie and under the ahf program, all students who receive their parents' permission can have their cholesterol level tested.

Some medical authorities, including the American Academy of Pediatrics, question the value of such universal screening efforts, however. They say that only those children thought to be at high risk for heart disease--those with a family history, who smoke, are obese, or have high blood pressure--should be tested.

No scientific consensus now exists on the issue, medical experts say, because the federal government has established cholesterol-testing guidelines only for adults age 20 and older; guidelines for younger people are expected to be released next spring.

The adult guidelines recommend that those with cholesterol levels in excess of 240 milligrams per deciliter of blood (mg/dl) be put on a restricted diet, and possibly medicat8ed. Men and high-risk women with cholesterol levels between 200 and 240 mg/dl are also advised to make dietary and life-style changes.

Under the ahf program, children with cholesterol levels that exceed 180 mg/dl are told to contact their doctors and to repeat the test. All children, regardless of their test outcome, are told to eat fewer foods that are high in saturated fat, which elevates cholesterol levels. Erie officials said they were likely to adopt the same 180 mg/dl standard for recommending that parents take further action.

While cholesterol levels tend to increase with age, some experts contend that there is not yet enough evidence to say that a child with a high cholesterol level will also have a high level as an adult.

Screening children can also be difficult, they say, since cholesterol levels tend to rise around the onset of puberty, only to decline and then level off during mid-adolescence.

"It's still a controversial issue, no doubt about it," said Ronald Kleinman, an associate professor of pediatrics at the Harvard Medical School and a member of of the panel drafting the federal guidelines for youths.

"There isn't enough information on the natural history of blood cholesterol in childhood to make clear-cut recommendations that everyone will agree with," he said.

Supporters of universal screening argue that children and parents often provide incomplete health histories, making it difficult to distinguish between the at-risk and low-risk groups. Also, said Mr. Resnicow, "a number of kids without heart disease in the family still have high cholesterol."

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