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SOME KIDS HELPED BY CHOLESTEROL SCREENING

My pediatrician told me he was taking a blood sample to test the cholesterol level of my 7-year-old. I was surprised. Why would he give a 7-year-old a cholesterol test?

ANSWER - We don't know the reason, but your doctor may be aware of new criteria produced by the American Academy of Pediatrics Committee on Nutrition in cooperation with the National Education Program for children from 2 to 19 years of age. Those guidelines specify testing children with a family history of cardiovascular disease, or whose parents' cholesterol levels are 240 milligrams or higher per deciliter of blood. The same guidelines also recommend screening children whose family history is unknown or who have risk factors such as smoking.Evidence suggests that it makes sense to get an early start tracking cholesterol levels. Studies show a relationship between fatty streaks in the arteries of children and advanced disease later in life. In adolescents who have died, the extent of disease in the arteries early in life has been linked to levels both of total cholesterol and of the so-called "bad" or LDL-cholesterol. Furthermore, children who have familial, or inherited, hypocholesterolemia have very elevated cholesterol levels and a high incidence of coronary heart disease at a young age. Without screening, this problem - which is treatable - would be missed. Finally, studies that followed people over time indicate that adults with elevated cholesterol were more likely to have had high levels as children.

At present there is no way to compare the advantages of a prevention program begun early on to one instituted for people in their 20s or 30s. In children who are at some risk, however, it seems sensible to get a head start on the problem.

QUESTION - I'd like to know how long bread keeps safely after the "last date of purchase" on the package.

ANSWER - Because there's no all-inclusive answer to your question, the best policy is to take a look at the bread itself. If there are obvious signs of deterioration, especially mold, throw the bread away. Otherwise, changes in the taste and texture of the bread will tell you whether it has grown stale. Again, discard it if you think it tastes or feels funny.

Some people believe their bread will stay fresher if they store it in the refrigerator. In fact, it actuallykeeps better at room temperature, provided it is carefully sealed.

QUESTION - I've read that folate supplements taken during pregnancy might help prevent neural tube defect. Is this true?

ANSWER - Neural tube defect describes congenital abnormalities involving the brain and spinal cord, caused by the failure of the neural tube to close properly during embryonic development. A major new study conducted by the Medical Research Council of the United Kingdom at 29 sites in seven countries found that the use of very large doses of folate, 10 times the amount normally recommended during pregnancy, was beneficial.

Women in this study represented a special group, however. These women had already given birth to a child with neural tube defect or had a pregnancy terminated because the fetus had the problem.

In the study, the women were divided into four groups and given a supplement to be taken through the 12th week of pregnancy. One group was given the folate supplements, a second group received multivitamins with no folate, a third group, a combination of multivitamins and folate, and a fourth group, iron and calcium folate.

Among the women who received folate, the recurrence rate of neural tube defect was just 1 percent, compared to 3.5 percent in the other groups - a highly significant difference. The results of that trial were striking enough that the Centers for Disease Control issued recommendations for women who had had a pregnancy resulting in an infant or a fetus with neural tube defect. These women were advised to consult their physician as soon as they planned a pregnancy and unless advised otherwise, should take a 4 milligram supplement of folate, available in large doses only by prescription. Ideally, these women should begin taking the supplement four weeks before a pregnancy and should continue to do so for three months. They should also be monitored very closely.

While this study demonstrates a benefit in a population at high risk, it doesn't provide evidence to guide recommendations for the majority of women. And unfortunately, 95 percent of the cases occur in women with no history of having an infant with neural tube defect.

It remains to be answered whether such a large dose is safe. That amount may be considerably more than what is needed. Or some other intervention might have the same metabolic effect. Studies now under way may provide better answers.

1992, Washington Post Writers Group