November 14, 2001
Question from Madbury, New Hampshire, USA:
My 12 year old daughter is 4 feet 8inches tall, weighs 69 pounds, is thin but muscular and seems healthy in most respects, except that her triglyceride levels have been high for two years and are climbing (now up to 178 mg/dl), and her HDL is low 32 mg/dl). She’s not a carbo-loader; we eat a very good balanced diet, with moderate protein, lots of fresh, whole foods, and not a lot of refined sugar. I’m frustrated because all I can get for advice is to reduce the carbs in her diet and have her exercise more. I feel there’s something wrong this is an active kid. Could she be on the verge of diabetes or some endocrine disorder? Her paternal grandmother had type�2 diabetes, was also thin, and had heart disease at an early age (50).
I was advised to put her on a high-protein diet, and I think that’s wrong, especially considering her age. She’s not overly concerned about her body image, and I don’t want her to start eating strange or restrictive diets. Also, she doesn’t eat eggs, or soy or many dairy products, and her choice of meats is limited (she does get protein about three times a day cheese, chicken, beans). Advice for diet resources for thin children with high triglycerides would be helpful since most of what I have found deals with overweight children. Advice for further testing or negotiations with doctors would also be appreciated.
I hope my response addresses your concerns. However, I am making my comments assuming that:
The triglyceride checks are done on a fasting sample. The cholesterol levels need not be done fasting, but the triglycerides do.
Other than her paternal grandmother, there is no other (known) family history of cardiovascular disease, such as heart attacks, strokes, or high blood pressure.
Your daughter was not a former low birth weight baby.
I am not too worried about an athletic, thin, healthy early teen with triglycerides of 178 mg/dl. Without a family history of early vascular disease, then her risk of future (especially near future) vascular disease is low, but she must not smoke. Future use of oral contraceptives may need to be considered with caution.
In and of itself, the information you describe is not a risk for diabetes, but if she were to develop diabetes, that would be an additional risk for vascular problems. Babies who were small in the womb (intrauterine growth retarded -IUGR) do seem to have some increased risk of insulin resistance which can lead to type�2 diabetes later in life.
Finally, the various medications that are used to treat increased lipids (triglycerides and cholesterol) have a rather small track record in children. While I have prescribed them, I would not place a child with a triglyceride level of only 178 mg/dL on them. Dietary measures are the way. Have you actually spoken with a dietitian?