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Michele Mietus-Snyder, MD; Annette L. Baker, RN, MSN; Ellis J. Neufeld, MD, PhD; Connie Roberts, MS, RD; Susan Dermarkarian, RD; Alexa S. Beiser, PhD; Jane W. Newburger, MD, MPH

Am J Dis Child. 1993;147(4):378-381.

Abstract
• Objective.
—To determine the impact of nutritional counseling on lipoprotein profiles in dyslipoproteinemic children.

Design.
—Retrospective case review.

Setting.
—An academic hospital-based pediatric lipid clinic in Boston, Mass.

Participants.
—One hundred four newly referred children with primary dyslipoproteinemia.

Interventions.
—Nutritional recommendations were adapted from the National Cholesterol Education Program's step 2 diet. Three-day diet records were used to assess baseline and follow-up diets.

Results.
—Two thirds of the children continued to have excellent diets or improved their diets after counseling, but low-density lipoprotein cholesterol (LDL-c) values decreased by 15% or more in only 19% of children. The observed change in LDL-c was not significantly associated with nutritional counseling. However, a strong correlation was evident between dietary interventions and concentration of high-density lipoprotein cholesterol (HDL-c) values in serum. Marked fat restriction lowered HDL-c levels, while liberalization of use of fat, with emphasis on monounsaturates, in a subset of children following an excessively fat-restricted diet on presentation, appeared to improve HDL-c levels.

Conclusions.
—After nutritional counseling, LDL-c levels decreased by 15% or more in only 19% of dyslipoproteinemic children referred for treatment. There were no clear predictors of LDL-c responsiveness, but changes in dietary fat intake appeared to significantly influence HDL-c levels.

(AJDC. 1993;147:378-381)

Author Affiliations
From the Departments of Cardiology (Drs Mietus-Snyder and Newburger and Ms Baker) and Hematology (Dr Neufeld), Children's Hospital, Boston, Mass; the Department of Nutrition, Brigham and Women's Hospital, Harvard Medical School, Boston (Mss Roberts and Dermarkarian); and the Department of Epidemiology and Biostatistics, Boston University School of Public Health (Dr Beiser). Dr Mietus-Snyder is now with the Gladstone Institute for Cardiovascular Disease Research, San Francisco, Calif.

Footnotes
Accepted for publication October 23, 1992.

Reprint requests to Department of Cardiology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (Dr Newburger).

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