tissues outside the liver (extrahepatic) and other
parts of the body. A high LDL level may increase
chances of developing heart disease.Very low-density lipoprotein (VLDL). VLDLs carry
triglycerides from the intestine and liver to fatty (adi-
pose) and muscle tissues; they contain primarily tri-
glycerides. A high VLDL level can cause the buildup
of cholesterol in arteries and increase the risk of heart
disease and stroke.
Chylomicrons. Proteins that transport cholesterol
and triglycerides from the small intestine to tissues
after meals.
Generally speaking, LDL levels should be low,
because LDL deposits cholesterol in the arteries and
causes them to become clogged, and HDL levels should
be high, because HDL helps clean fat and cholesterol
from arteries, carrying it to the liver for removal from
the body. This is why HDL is often called the ‘‘good
cholesterol’’ and LDL the ‘‘bad cholesterol’’.
Precautions
The National Heart, Lung and Blood Institute
(NHLBI), through its National Cholesterol Education
Program (NCEP), recommends that adults begin cho-
lesterol screening at age 20 and repeat the screening
every five years. Persons who have one or more risk
factors for developing heart disease (for example dia-
betes, kidney disease, high blood pressure, vascular
disease, a history of elevated cholesterol levels) should
have their cholesterol levels checked more often.
Simple blood tests are done to check blood cho-
lesterol levels. A lipoprotein test, also called a fasting
lipid test, is commonly performed as part of a routine
medical examination. A cholesterol test measures lipid
levels and usually reports on four groups:
Total cholesterol (normal: 100–199 mg/dL)
LDL (normal: less than 100 mg/dL)
HDL (normal: 40–59 mg/dL)
Triglycerides (normal: less than 150 mg/dL)
Interactions
Dietaryfatsare known to interact with cholesterol
as follows:
monounsaturated fats (olives, olive oil, canola oil,
nuts, avocados) lower LDL, raise HDL
polyunsaturated fats (corn, soybean, safflower, cot-
tonseed oils, fish) lower LDL, raise HDL;
saturated fats (whole milk, butter, cheese, ice cream,
red meat; chocolate, coconuts) raise both LDL and
HDL;
trans fats (most margarines, vegetable shortening, par-
tially hydrogenated vegetable oil, deep- fried chips,
many fast foods, most commercial baked goods) raise
LDLAftercare
The American Heart Association (AHA) endorses
the following dietary recommendations for people
with high blood cholesterol:
total fat: 25% of total calories
saturated fat: less than 7% total calories
polyunsaturated fat: up to 10% total calories
monounsaturated fat: up to 20% total calories
carbohydrates: 50–60% total calories
protein: about 15% total calories
cholesterol: less than 200 mg/dL
plant sterols: 2g
soluble fiber such as psyllium: 10– 25g
Categories of appropriate foods include:
lean meat/fish: less than 5oz/day
eggs: less than 2 yolks per week (whites unlimited)
low-fat dairy products (<1% fat): 2–3 servings/day
grains, especially whole grains: 6–8 tsp/day
vegetables: less than 6 servings per day
fruits: 2–5 servings per dayComplicationsIf dietary cholesterol intake is excessive, it can
lead to an elevation of lipid levels in the bloodstream
(hyperlipidemia). These lipids include cholesterol,
phospholipids andtriglycerides(fats). Hypercholes-
terolemia is the term for high cholesterol levels, and
hypertriglyceridemiais the term for high triglyceride
levels. Because cholesterol-rich foods are also usually
high in saturated fat, hypercholesterolemia is often
combined to hypertriglyceridemia. Hyperlipidemias
have been shown to represent a major risk factor for
heart disease, the leading cause of death in the United
States.Parental concerns
Parents can make dietary choices that can prevent
cholesterol levels from being too high. For instance,
they can follow these guidelines:
Select only the leanest meats, poultry, fish and shell-
fish. Choose chicken and turkey without skin or
remove skin before eating. Some fish, like cod, have
less saturated fat than either chicken or meat.Dietary cholesterol