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Abha Kaistha, MD; Richard J. Deckelbaum, MD; Thomas J. Starc, MD; Sarah C. Couch, PhD, RD

Arch Pediatr Adolesc Med. 2001;155:1225-1230.

Objective  To assess the nutritional adequacy of the diets of children with hyperlipidemia following medically unsupervised low-fat diets compared with children receiving unrestricted diets.

Design  Case comparison study.

Patients and Other Participants  Forty-six children were referred to the Children's Cardiovascular Health Center, Columbia–Presbyterian Medical Center, New York, NY, for treatment of hyperlipidemia who had achieved the Step I diet recommendations for total fat before formal nutritional counseling (mean age ± SE, 9.7 ± 0.3 years; sex distribution, 24 boys [53%]; ethnicity, 26 Latinos [57%] and 20 whites [43 %]; body mass index ± SE, 22.4 ± 0.7 kg/m²), and 34 healthy children participating in well-child visits at a local pediatric practice (mean age ± SE, 10.2 ± 0.4 years; sex distribution, 18 boys [54%]; ethnicity, 19 Latinos [57%] and 15 whites [43%]; body mass index ± SE, 22.5 ± 1.1 kg/m²).

Main Outcome Measures  Three-day food records were analyzed by a registered dietitian using the Minnesota Nutrient Data System. Outcome measures were intakes of calories, total and saturated fats, carbohydrate, protein, essential fatty acids, fat-soluble vitamins, folate, vitamin C, calcium, iron, and zinc.

Results  The percentage of calories from fat and saturated fat was significantly lower in the hyperlipidemic population (mean ± SE, hyperlipidemic vs control subjects: total fat, 22.7% ± 0.7% vs 34.5% ± 0.6%, P<.001; saturated fat, 7.9% ± 0.3% vs 12.9% ± 0.4%, P<.001). The caloric intake in controls was 17% higher than in patients with hyperlipidemia. Ninety percent of the decrease in calories in the hyperlipidemic group could be accounted for by the decrease in total fat intake. After adjusting for calories, no significant difference was noted between the groups for any of the vitamins and minerals mentioned earlier.

Conclusion  Our findings suggest that before formal nutritional counseling, overzealous dietary fat restriction can occur in children with hypercholesterolemia.

From the Department of Pediatrics (Drs Kaistha, Deckelbaum, Starc, and Couch) and the Institute of Human Nutrition (Drs Deckelbaum, Starc, and Couch), Columbia–Presbyterian Medical Center, New York, NY. Dr Couch is now with the Department of Health Sciences, Program in Dietetics and Nutrition Science, University of Cincinnati Medical Center, Cincinnati, Ohio.

Corresponding author: Sarah C. Couch, PhD, RD, Department of Health Sciences, Program in Dietetics and Nutrition Science, University of Cincinnati Medical Center, 364 French Bldg E, Cincinnati, OH 45221-0394 (e-mail: couchsc{at}email.uc.edu). Reprints: Richard J. Deckelbaum, MD, Institute of Human Nutrition, Columbia–Presbyterian Medical Center, PH 15E, 630 W 168th St, New York, NY 10032.

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