Large sections of the pediatric community, not to mention sporting clubs and the dietary supplements and functional foods industries, have expressed concern at an American Academy of Pediatrics (AAP) statement calling for obese children to be prescribed cholesterol-lowering statin drugs.
The move has stunned many pediatricians, one of whom stated the AAP should be embarrassed by its latest position.
They are critical of the AAP's seeming willingness to discount the potential of diet and lifestyle to combat obesity and ward off heart disease.
Those in the functional foods and dietary supplements industry offering products such as plant sterol and stanol foods and beverages that help maintain heart health and reduce cholesterol levels, will also be disappointed by the AAP missive.
Coca Cola director of communications, Ray Crockett, said its plant sterol-fortified version of orange juice, Minute Maid Heartwise, had potential to lower cholesterol levels among children.
But he noted the majority of consumers were adults.
Statins and kids
The AAP position has caused a stir with many health professionals questioning the science on which the position is based.
"What are the data that show this is helpful preventing heart attacks?" asked Dr. Darshak Sanghavi, a pediatric cardiologist and assistant professor at the University of Massachusetts Medical School, in the New York Times.
"How many heart attacks do we hope to prevent this way? There's no data regarding that."
The side effects of children as young as eight-years-old taking statins are as yet undetermined, especially when there are known side effects in certain sections of the adult population.
The AAP called for greater cholesterol screening among children, beginning at two years of age in some cases, with children of age deemed old enough to consume statins.
Children even younger than eight are currently prescribed statins but only if they suffer from conditions such as familial hypercholesterolaemia (FH).
It is the first time an association of the import of the AAP has called for widespread use among children of the world's number one blockbuster drug.
The medical professionals that sat on the AAP board that determined the guidelines agreed there was little data confirming the long-term effects of using statin drugs for 30-40 years, but pointed to safety data to back the recommendations.
"We extrapolate from the information we have in adults," panel member and assistant professor of pediatric epidemiology at the Children's Hospital of Philadelphia, Dr Nicolas Stettler, said.
"We know that in adults, decreasing cholesterol and giving some of those drugs decreases risk of heart disease or death. So there's really no reason to think that would be any different in children."
A statin called Pravachol is already approved by the Food and Drug Administration for use in children as young as eight.
The new guidelines state children as young as eight with LDL, or "bad" cholesterol of 190 milligrams per deciliter, or those with LDL of 160 and a family history of heart disease or two other risk factors, are eligible for statin use.
Among children with diabetes, drug treatment may begin when bad cholesterol reaches 130.
Cathy Ross, a cardiac nurse at the British Heart Foundation (BHF) noted statins were not able to be used in the UK by children under 10 except in the case of a definite diagnosis of familial hypercholesterolaemia.
"Anyone with a raised cholesterol should have their lifestyle examined and adjustments made that may reduce their cholesterol naturally such as increasing physical activity, reducing saturated fat in their diet, reaching and maintaining a healthy body weight and shape," she told NutraIngredients-usa.com.
"A child with a diagnosis of FH should be under the care of a specialist paediatric lipidologist/cardiologist."