April 1993

Effects of Nutritional Counseling on Lipoprotein Levels in a Pediatric Lipid Clinic

Author Affiliations

From the Departments of Cardiology (Drs Mietus-Snyder and Newburger and Ms Baker) and Hematology (Dr Neufeld), Children's Hospital, Boston, Mass; the Department of Nutrition, Brigham and Women's Hospital, Harvard Medical School, Boston (Mss Roberts and Dermarkarian); and the Department of Epidemiology and Biostatistics, Boston University School of Public Health (Dr Beiser). Dr Mietus-Snyder is now with the Gladstone Institute for Cardiovascular Disease Research, San Francisco, Calif.

Am J Dis Child. 1993;147(4):378-381. doi:10.1001/archpedi.1993.02160280028012

• Objective.  —To determine the impact of nutritional counseling on lipoprotein profiles in dyslipoproteinemic children.

Design.  —Retrospective case review.

Setting.  —An academic hospital-based pediatric lipid clinic in Boston, Mass.

Participants.  —One hundred four newly referred children with primary dyslipoproteinemia.

Interventions.  —Nutritional recommendations were adapted from the National Cholesterol Education Program's step 2 diet. Three-day diet records were used to assess baseline and follow-up diets.

Results.  —Two thirds of the children continued to have excellent diets or improved their diets after counseling, but low-density lipoprotein cholesterol (LDL-c) values decreased by 15% or more in only 19% of children. The observed change in LDL-c was not significantly associated with nutritional counseling. However, a strong correlation was evident between dietary interventions and concentration of high-density lipoprotein cholesterol (HDL-c) values in serum. Marked fat restriction lowered HDL-c levels, while liberalization of use of fat, with emphasis on monounsaturates, in a subset of children following an excessively fat-restricted diet on presentation, appeared to improve HDL-c levels.

Conclusions.  —After nutritional counseling, LDL-c levels decreased by 15% or more in only 19% of dyslipoproteinemic children referred for treatment. There were no clear predictors of LDL-c responsiveness, but changes in dietary fat intake appeared to significantly influence HDL-c levels.(AJDC. 1993;147:378-381)