Effect of Diet on Lipid Levels in Children/Adolescents with Familial Hypercholesterolemia

Short Communication

Austin J Nutri Food Sci. 2022; 10(2): 1168.

Effect of Diet on Lipid Levels in Children/Adolescents with Familial Hypercholesterolemia

Widhalm K* and Fallmann K

Austrian Academic Institute for Clinical Nutrition and Medical University of Vienna, Austria

*Corresponding author: Widhalm K, Austrian Academic Institute for Clinical Nutrition and Medical University of Vienna, Austria

Received: October 26, 2022; Accepted: November 22, 2022; Published: November 29, 2022

Abstract

There is enough evidence, that children and adolescents with Familial Hypercholesterolemia (FH) should be treated in order to reduce elevated Total chol and LDL-c levels and therefore avoid the risk of early cardiovascular diseases. There are many papers published in the last years dealing with drug treatment, several publications describe guidelines for the therapy, however most without any data on the effect of recommended measures. The effect of diet on lipid levels in children with FH is not well documented. The goal of this paper was to search for data describing the effect of various dietary regimes in children and adolescents with FH. Surprisingly, there are only few papers studying the effect of various dietary regimes: in general, low fat-, fat substitutedor soy bean protein substituted diets are able to lower total chol and LDL-chol on average of 10–15 %. These effects should be documented and then used before starting drug treatment. Therefore, an effect of diet could reduce drug treatment or possibly postpone for some years. Anyhow, a carefully planned and performed diet for approx. 3 months should be the basis for the treatment of all children and adolescents with FH.

Keywords: Children/Adolescents; Familial Hypercholesterolemia; Diet; Drugs

Introduction

There is a body of evidence and general acceptance that children and adolescents affected with FH should be treated as soon as possible in order to lower elevated LDL-Chol levels. To achieve this goal, first dietary measures and secondary drug treatment is necessary [27,33]. Although there are several papers describing the effects of drug treatment, mainly for short periods, there is a paucity of studies describing the effect of dietary treatment in young subjects with FH. Principles of the diet are the reduction of saturated fats, substituted by mono- and polyunsaturated fatty acids, an increased intake of vegetables, fruits and legumes, and a low intake of simple carbohydrates. Surprisingly, there are many publications describing recommendations for the treatment of children and adolescents without any data.

Methods

In order to find out studies which describe dietary regimen and their effects in young subjects affected with FH we made a search on the scientific data banks and found only few publications in that field. Database searches were made on PubMed and Medline between December 2021 and May 2022. Searches were conducted with keywords as “Familial Hypercholesterolemia” and “Diet”.

Findings

The first paper judging the effect of diet on lipids in children with FH we found was published by Jakulj in 1974: They found a reduction of chol by 7, 5 and LDL-C by 9, 2% after a 4-week diet with daily 500ml low-fat yoghurt enriched with 2g stanols [1].

Laurin et al described a diet trial in 1991 in children with FH with a soy protein (35% of protein energy) compared with a low-milk protein drink. After some weeks the soy beverage reduced significantly triglycerides and low density lipoprotein (p < 0,05) whereas HDL-C increased significantly [2].

In 1993 our group in Vienna reported a dietary treatment in 23 children with FH or polygenic hypercholesterolemia using a soy protein substituted diet compared with a conventional diet for 8 weeks. In the soy group the lowering effect on LDL-C was significantly greater (p < 0, 05) than in the low fat, low cholesterol group [3].

Gylling and co-workers studied in 1995 the effect of sitostanol (3g/day) ester dissolved in rapeseed oil margarine in one homozygous and 14 heterozygous children with FH for 6 weeks within a doubleblind design. Sitostanol margarine diet reduced total cholesterol, HDL-C and LDL-C by 11, 26 and 15% and increased HDL/LDL ratio by 27%. They did not use a group with a usual low-fat diet [4].

The next study in this field has been published in 2002 by Amundsen at al from Oslo [5]. They conducted a study using plant sterol esters enriched spread in a randomized double blind crossover study for 8 weeks: They were able to show a decrease of LDL-C by 10,2% (p < 0,003) after this diet compared with the control group.

Again, our group in Vienna reported in 2002 a study on 10 children with FH the effect of a 5 months diet containing rapeseed oil compound with a classical low-fat/low-cholesterol diet. It could be shown, that the rapeseed diet lowered TG by 29% [6].

Another study carried out in Amsterdam on 41 children with FH has been published by de Jonghi at al in 2003: They also used a plant sterol spread (mainly sitosterol and campesterol) for 6 weeks and reported a decrease of total cholesterol by 11%, LDL-C by 14% as compared to placebo, but no effect on the endothelial function has been found. A reduction of total cholesterol by 10%, LDL-C by 7% compared to the classical low-fat diet an additional pronounced lowering effect of TG and HDL-C could be shown [7].

In 2008 our group in Vienna published a study of the effect of a standard diet compared to a soy substituted diet (0, 25-0,5g/kg body weight) in 23 children with FH during 3 months. After the standard diet chol and LDL-C decreased by 11, 8% and 11,8%, whereas during soy substituted diet an additional decrease of 7,7% and 7,6% could be shown [8].

In a trial comparing the effect of rapeseed oil with sunflower oil substituted low-fat diet our group was able to show that the cholesterol and LDL-C could be lowered by 10-12%, both significantly. The rapeseed diet showed more favorable effects in regard to the total cardiovascular risk profile [9].

Discussion

It is surprising that in contrast to adult studies only 10 diet studies on children with FH have been published during the last 30 years. From these studies it is evident that a strict dietary regime is able to lower total cholesterol and LDL-cholesterol in children with FH. This is important because lifestyle modification which includes not only diet but also physical activity and other factors that influence the behavior are essential factors in regard to prevent atherosclerotic processes in young age. From a psychological point of view, it seems fundamental for the whole family is motivated to adhere to a healthy lifestyle. Also unaffected family members could have a benefit from a healthy lifestyle and behavior.

In this regard it is very interesting, that between 2000 and 2020 at least 31 papers have been published describing recommendations and guidelines for the treatment of children and adolescents with FH without any data of the effect of diet [11-41) (Table 2).

Citation: Widhalm K and Fallmann K. Effect of Diet on Lipid Levels in Children/Adolescents with Familial Hypercholesterolemia. Austin J Nutri Food Sci. 2022; 10(2): 1168.