Reduction of Low-Density Lipoprotein Cholesterol by Dietary Intervention in Children at High Risk for Premature Coronary Artery Disease
The identification and treatment of children with elevated low-density lipoprotein (LDL) cholesterol levels is considered to be a high priority in any initiative to reduce the risk of premature coronary artery disease (CAD). Children who would benefit most from such treatment often have a strong family history of premature CAD. In the present study, 54 subjects in 35 families met the following criteria: they were identified through a parent with symptomatic atherosclerotic CAD and/or a strong family history of early CAD: they were between the ages of 2 and 19 years; they had fasting LDL cholesterol level above the normal range defined as greater than the 90th percentile for an age-matched control population (>120 mg/dl). At visit 1, they were counseled to follow a dietary regimen that would reduce dietary cholesterol intake to 200-250 mg/day, reduce fat intake to 30% of total calories, and increase the polyunsaturated : saturated fat ratio to 1 : 1. At visit 2, 1-12 months later (6.7 ±3.4 months), plasma lipid levels were again measured. There was a highly significant reduction in LDL cholesterol level in the group, from 170 ± 50 to 150 ± 49 mg/dl (paired t = 6.68, P < 0.001). Thirty-five children achieved a reduction of 10% or greater (10–34%): 17 achieved little or no change (± 10%); and two increased their LDL cholesterol (12–24%). The LDL cholesterol had fallen below the 90th percentile in 19 children; five of them fell below the 50th percentile. The change in LDL cholesterol level was not correlated with age, duration of nutritional therapy, or the initial LDL cholesterol level. The HDL cholesterol and total plasma triglycerides were unaffected by this dietary intervention. Among those with the highest LDL cholesterol levels (14 children > 200 mg/dl), the reduction in LDL cholesterol level, although similar to that for the rest of the group, was not sufficient to put them into the normal range. No significant reduction in the plasma apolipoprotein-B level was observed.
The results indicate that dietary management can significantly reduce LDL cholesterol levels in children who are at high risk for premature CAD because of a strong family history and an LDL cholesterol level above the 90th percentile.
KeywordsStrong Family History Plasma Lipid Level Early Coronary Artery Disease Bogalusa Heart Study Familial Combine Hyperlipidemia
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