Effects of nutritional counseling on lipoprotein levels in a pediatric lipid clinic
M. Mietus-Snyder, A. L. Baker, E. J. Neufeld, C. Roberts, S. Dermarkarian, A. S. Beiser and J. W. Newburger
Department of Cardiology, Children's Hospital, Boston, MA 02115.
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.
