Pediatric Nutrition in Practice

238 Koletzko^

The effect of treatment is assessed by repeated
measurements of LDL cholesterol (every ∼ 3–6
months). Dietary fat modification may reduce
LDL on average by 10–15% [4] , with marked inter-
individual variation partly predicted by the apo-
protein E genotype: individuals with the apopro-
tein E4 phenotype ( ∼ 10–15% of the European
population) with higher mean cholesterol and
lower triglyceride levels show a stronger response
of plasma cholesterol to dietary cholesterol intake.
In contrast, individuals with the apoprotein E3
phenotype ( ∼ 75–80% of the population) show a
lesser response to dietary cholesterol restriction.
The regular consumption of plant sterols or
plant stanols from enriched spreads or other en-
riched foods (also available as granulates) can
markedly reduce plasma LDL cholesterol by an
additional 10–15% and is encouraged [5 –7].
If dietary modification alone does not achieve
a satisfactory reduction in plasma LDL, addition-
al drug treatment with statins, ezetimibe or an-
ion exchange resins may be considered from the
age of 8–10 years onwards; however, the choles-
terol-lowering diet should be continued.

Conclusions

• At normal HDL cholesterol levels (>45 mg/
  dl), dietary modification should be considered
  for children with LDL cholesterol levels >130
  mg/dl


• Dietary saturated and trans -fats should be lim-
  ited to 8–12% of energy intake (E%), while
  monounsaturated fats should provide >10 E%
  and polyunsaturated fats 7–10 E%


• Limiting the total fat intake to 30–35% of en-
  ergy intake contributes to the desired limita-
  tion of saturated and trans -fatty acid intake


• Dietary cholesterol intake should be <300 mg/
  day


• This dietary fat modification may reduce LDL
  by 10–15%, with marked interindividual vari-
  ation


• Regular consumption of plant sterols/stanols
  from enriched foods can reduce plasma LDL
  cholesterol by an additional 10–15%


• Dietary treatment should be continued if
  drugs are used

non-users under free-living conditions.

Public Health Nutr 2011; 14: 1823–1832.

6 Malhotra A, Shafiq N, Arora A, Singh M,

Kumar R, Malhotra S: Dietary interven-

tions (plant sterols, stanols, omega–3 fatty

acids, soy protein and dietary fibers) for

familial hypercholesterolaemia. Cochrane

Database Syst Rev 2014; 6:CD001918.

7 Amir Shaghaghi M, Abumweis SS, Jones

PJ: Cholesterol-lowering efficacy of plant

sterols/stanols provided in capsule and

tablet formats: results of a systematic re-

view and meta-analysis. J Acad Nutr Diet

2013; 113: 1494–1503.

8 Braamskamp MJ, Wijburg FA, Wiegman

A: Drug therapy of hypercholesterolaemia

in children and adolescents. Drugs 2012;

72: 759–772.

9 Daniels SR, Greer FR; Committee on Nu-

trition: Lipid screening and cardiovascu-

lar health in childhood. Pediatrics 2008;

122: 198–208.

References

1 Expert Panel on Detection, Evaluation,
and Treatment of High Blood Cholesterol
in Adults: Executive Summary of the
Third Report of the National Cholesterol
Education Program (NCEP) Expert Panel
on Detection, Evaluation, and Treatment
of High Blood Cholesterol in Adults
(Adult Treatment Panel III). JAMA 2001;
285: 2486–2497.
2 Perk J, De Backer G, Gohlke H, Graham I,
Reiner Z, Verschuren WM, Albus C, Ben-
lian P, Boysen G, Cifkova R, Deaton C,
Ebrahim S, Fisher M, Germano G, Hobbs
R, Hoes A, Karadeniz S, Mezzani A,
Prescott E, Ryden L, Scherer M, Syvänne
M, Scholte Op Reimer WJ, Vrints C,
Wood D, Zamorano JL, Zannad F: Euro-
pean Guidelines on cardiovascular disease
prevention in clinical practice (version
2012): the Fifth Joint Task Force of the
European Society of Cardiology and Other
Societies on Cardiovascular Disease Pre-

vention in Clinical Practice (constituted

by representatives of nine societies and by

invited experts). Atherosclerosis 2012;

223: 1–68.

3 Expert Panel on Integrated Guidelines for

Cardiovascular Health and Risk Reduc-

tion in Children and Adolescents; Nation-

al Heart, Lung, and Blood Institute: Ex-

pert Panel on Integrated Guidelines for

Cardiovascular Health and Risk Reduc-

tion in Children and Adolescents: sum-

mary report. Pediatrics 2011; 128(suppl 5):

S213–S256.

4 Koletzko B, Kupke I, Wendel U: Treat-

ment of hypercholesterolemia in children

and adolescents. Acta Paediatr 1992; 81:

682–685.

5 Eussen SR, de Jong N, Rompelberg CJ,

Garssen J, Verschuren WM, Klungel OH:

Dose-dependent cholesterol-lowering

effects of phytosterol/phytostanol-en-

riched margarine in statin users and statin

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