New studies are prompting some researchers to question the wisdom of a national cholesterol-lowering campaign, with the sharpest debate centering on the benefits for children.
On one hand are two major U.S. medical groups that have recommended a low-fat diet for all children over age 2. On the other, are some cholesterol experts who say the recommendations are extreme and potentially harmful.
Parents and doctors are left in between, not knowing whom to believe.
One of the concerned experts, Dr. Thomas B. Newman, a pediatrician and epidemiologist at the University of California, San Francisco, says the low-fat recommendations are "a national scandal" because they expose children to more risks than benefits.
"The evidence is mounting that it's a pretty bad idea for large numbers of people," Dr. Newman says. "Particularly children -- that's what bothers me the most."
Putting children who are not truly overweight on low-calorie, low-fat diets can backfire, retarding their growth and development, adds Dr. Trudy Bush, an epidemiologist at Johns Hopkins University. "I worry about lowering cholesterol in kids, particularly kids at the age of 2."
The guidelines that have Dr. Newman, Dr. Bush and other health experts concerned were issued by the National Cholesterol Education Program in the spring and endorsed by the American Academy of Pediatrics last month.
The recommendations say:
* All children over age 2 should stick to a low-fat diet (with fat comprising no more than 30 percent of total calories) to prevent obesity and to keep cholesterol levels low.
* Children should have their cholesterol levels tested if their parents have high cholesterol levels or heart disease.
* Children found to have borderline or high levels should be put on even stricter diets than the low-fat program recommended for the general population, or, if necessary, be given
Cholesterol levels in children and teen-agers, on average, are classified about 30 to 40 points lower than those for adults. Normal for a child or teen is below 170 milligrams of cholesterol per deciliter of blood (170 mg-dl); borderline high is between 170 and 199 mg-dl, and high is above 200 mg-dl.
Much of the new concern about lowering cholesterol levels too far, in adults and children, revolves around a major review of 19 studies from around the world published last month.
The review found a complex relationship of cholesterol with overall health:
* Death rates increased in men who had very low cholesterol levels almost as much as they did in those with very high cholesterol levels. In women, cholesterol appeared to have no influence at all on overall death.