Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Familial hypercholesterolemia · LDL cholesterol ·

Dietary treatment · Saturated fat · Plant sterols

Key Messages

• Children with severe hypercholesterolemia should
  be diagnosed and treated early to reduce the risk
  for premature cardiovascular morbidity and mor-
  tality


• Dietary modification can be initiated from the age
  of 2–3 years onwards


• Modifying dietary fat intake with limitation of satu-
  rated fats and their replacement by monounsatu-
  rated and polyunsaturated fats are the most impor-
  tant factors


• Preferential consumption of complex and slowly di-
  gested carbohydrates over sugars moderately re-
  duces plasma cholesterol levels but is often difficult
  to achieve in children


• Soluble (but not insoluble) dietary fiber may con-
  tribute to cholesterol lowering and may be recom-
  mended to selected, highly motivated families
  © 2015 S. Karger AG, Basel

Introduction

A large body of evidence from epidemiological

and intervention studies demonstrates that high

plasma concentrations of cholesterol and particu-

larly of LDL cholesterol are risk factors for the

early development of premature cardiovascular

diseases such as coronary heart disease and stroke,

and for the associated increased mortality [1, 2].

In children, high plasma concentrations of cho-

lesterol and LDL cholesterol lead to enhanced

early development of vascular damage in autopsy

studies, and clinical studies using ultrasound

techniques show increased lipid deposition in the

vascular intima and decreased vascular distensi-

bility. For the general population, including chil-

dren, healthy lifestyles and dietary habits that

promote cardiovascular health are advocated [3].

Children with markedly elevated cholesterol, for

example due to primary genetic disorders such as

familial hypercholesterolemia, should be diag-

nosed early and treated effectively. The basis of

intervention in children with hypercholesterol-

emia is dietary modification, which is described

here. In the subgroup of children with severe hy-

percholesterolemia who do not achieve a satisfac-

tory reduction of plasma cholesterol concentra-

tions with diet alone, the use of lipid-lowering

drugs in addition to diet should be considered.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 234–238
DOI: 10.1159/000375191

3.17 Hypercholesterolemia

Berthold Koletzko