Pediatric Nutrition in Practice

Hypercholesterolemia 237

3

lipidemias ( table 3 ) are relatively common in chil-
dren and can often be influenced by treating the
underlying disorder or by elimination of causative
substances. Severe and lasting secondary hyperlip-
idemias may necessitate treatment similar to that
of primary genetic hyperlipidemias.

Dietary Treatment of Hypercholesterolemia

Treatment should achieve a lasting lowering of
cholesterol, thereby reducing the risk for prema-
ture cardiovascular morbidity and mortality while
supporting a good quality of life and enjoyment
of eating. At normal HDL cholesterol levels (>45
mg/dl), a targeted dietary modification is indicat-
ed at an LDL cholesterol concentration >130 mg/
dl ( table  2 ). Prerequisites for an effective dietary
change are good information and motivation of
the patient and family, which should be supported
by repeated counselling and practical training.
Dietary modification can be initiated from the
age of 2–3 years onwards. Modifying dietary fat
intake is the most important factor. Saturated fat-
ty acids with 12–16 carbon atoms (primarily ani-
mal fats and some tropical oils) and trans -isomer-
ic fatty acids (primarily from hydrogenated fats)
increase LDL cholesterol ( table 4 ) and should not

exceed 8–12% of the dietary energy intake. Di-

etary fat should preferentially comprise monoun-

saturated fatty acids (>10% of energy; e.g. rape-

seed and olive oils), which reduce LDL and in-

crease HDL cholesterol ( table  4 ), as well as

moderate amounts of polyunsaturated fatty acids

(7–10% of energy; e.g. corn and sunf lower seed

oils). Limiting the total fat intake to 30–35% of

energy intake contributes to the desired limitation

of saturated and trans -fatty acid intake. Dietary

cholesterol intake should not exceed 300 mg/day.

Preferential consumption of complex and

slowly d igested c a rbohyd rates over su ga rs (mono -

and disaccharides) moderately reduces plasma

cholesterol levels. Soluble dietary fiber (e.g. parts

of oat bran, psyllium) may also contribute to cho-

lesterol lowering, but not insoluble fiber (e.g.

wheat bran). However, diets with strictly limited

sugar and high fiber content are difficult to main-

tain for ma ny chi ldren a nd shou ld only be recom-

mended to selected, highly motivated families.

Patients and their family members require in-

tensive dietary counseling by a physician and a

dietician or nutritionist. Concomitant to dietary

treatment, normal weight and regular physical

activity are encouraged, and smoking is strongly

discouraged. Dietary records may indicate exist-

ing problems and help achieve improvements.

Ta b l e 4. Effects of dietary fats on plasma LDL and HDL cholesterol

Dietary fats Food sources Cholesterol

LDL HDL

Saturated fatty acid (12 – 16 carbons) Fatty milk products (butter, cream), fatty meats,
coconut oil

↑↑↑ ↑

Trans-fatty acids Hydrogenated fats (deep frying fats, hard margarine,
baked goods); ruminant fats (milk, beef, lamb)

↑↑ ↓

Monounsaturated fatty acids
(e.g. oleic acid)

Rapeseed and olive oil, avocado ↓↓ ↑

Polyunsaturated fatty acids
(e.g. linoleic acid)

Most vegetable oils (e.g. corn oil, sunflower seed oil),

soft margarine

↓↓ ↓ (at high

intakes)

Cholesterol Eggs, offal ↑ =

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