Nutritional Management of Pediatric Dyslipidemia

Introduction:

One should avoid trans fat and saturated fats in an individual's diet. Milk is the primary source of saturated fat in young people, so fat-free unflavored milk is recommended. Nowadays, in the United States and many other countries, cardiovascular disease is the leading cause of mortality. Due to cardiovascular disease, one in three deaths occurs worldwide. It is known that atherosclerosis (deposition of fatty material on the inner walls of the arteries) begins in young people. The risk of premature adverse cardiovascular events and mortality rate is reduced when people recognize and treat dyslipidemia in children. Due to the rising rates of obesity in children, dyslipidemia is significantly more common in these age groups.

Dyslipidemia is known as a group of lipoprotein abnormalities that results in the following lipid abnormalities:

• Increase in triglycerides level (TG).

• Increase in non-high-density lipoprotein cholesterol (HDL-C).

• Increase in low-density lipoprotein cholesterol (LDL-C).

• Increase in total cholesterol (TC).

• Decrease in high-density lipoprotein cholesterol (HDL-C).

What Are the Causes of Pediatric Dyslipidemia?

The common occurrence of dyslipidemia in children 12 to 19 was approximately 20.3 percent, reported in the CDC (Center for Disease Control) morbidity and mortality weekly report. Usually, the causes of dyslipidemia are divided into primary and secondary causes.

Primary Dyslipidemia:

Typically in children, a group of disorders caused due to genetic defects in the synthesis, transport, or metabolism of lipoproteins is defined as primary dyslipidemia. Monogenic or polygenic defects are seen in these diseases. Given below are the few causes of primary dyslipidemia:

• Heterozygous familial hypercholesterolemia.

• Familial hypercholesterolemia.

• Familial combined hyperlipidemia.

• Familial chylomicronemia

• Sitosterolemia.

• Low HDL cholesterol.

• Familial hypobetalipoproteinemia.

• Familial hypertriglyceridemia.

• abetalipoproteinemia.

Secondary Dyslipidemia:

Obesity is the most common cause of dyslipidemia in the United States. There are multiple secondary causes for dyslipidemia are summarized and listed below:

• Endocrine or metabolic disorders.

• Exogenous.

• Drug therapy.

• Renal diseases.

• Infectious diseases.

• Hepatic conditions.

• Storage diseases.

• Inflammatory diseases.

• And other types of diseases are included.

What Is the Treatment for Pediatric Dyslipidemia?

For ten years, the treatment for pediatric dyslipidemia in children has been warranted because evidence shows that children with dyslipidemia show an increase in the risk of developing premature atherosclerotic cardiovascular disease, especially when there is a rise in LDL-C levels. Due to this, there is a decrease in the risk of cardiovascular events and mortality in adults. Given below are some of the treatment guidelines for pediatric dyslipidemia:

Risk Evaluation:

The American Heart Association has developed a risk stratification system for children to identify atherosclerotic risk in individuals. It is divided into three categories like

1. People at risk.

2. Moderate risk.

3. High risk.

Family History of Premature Cardiovascular Disease:

• Heart attack, treated angina, sudden cardiac death, or ischemic heart stroke in a first-degree relative before the age of 55 years in males. After the age of 65 in females, intervention for coronary artery diseases is generally defined as a family history of premature cardiovascular disease.

• Blood pressure, non-alcoholic fatty liver disease (NAFLD), polycystic ovarian syndrome (PCOS), cardiovascular disease (CVD), total cholesterol (TC), systemic lupus erythematosus (SLE), juvenile idiopathic arthritis (JIA), hypertrophic cardiomyopathy (HCM), transposition of the great arteries (TGA) are the other reasons of the family history of premature cardiovascular disease.

• In addition to statin therapy, people should try lifestyle changes like diet, physical activity, and weight loss for high-risk or moderate-risk conditions greater than two cardiovascular risk factors. One should follow the LDL goal of only 100 milligrams per decilitre.

• Dietary and lifestyle changes should be tried first by patients at risk or with less than two cardiovascular risk factors and moderate risk conditions. If this process is unsuccessful, the patients should keep an LDL goal of less than 130 mg/dl (milligrams per deciliter) and initiate statin therapy.

• If dietary and lifestyle changes are not successful for patients with no risk factors over the age of ten, then statin therapy initiated along with the LDL goal of less than 190 mg/dl should be tried by the patients.

• Patients should take at least two weeks with two fasting samples after confirming the lipid abnormalities. Only then should people start pharmacotherapy.

What Are the Steps in Dietary Management for Patients?

Patients with dyslipidemia should be counseled about dietary and lifestyle changes. Nutritionist consultation will be a valuable part of the treatment. Patients can lower their LDL levels with the help of the Cardiovascular Health Integrated Lifestyle Diet (CHILD). This process involves reducing cholesterol levels to under 300 milligrams per day. Restricting the saturated fat intake to under 10 percent of the daily calorie intake. According to age group, dietary recommendations for CHILD-1 are listed in the following sections.

From Birth to Six Months:

• Everyone should exclusively breastfeed all their babies up to six months of age.

• In case of contraindicating the mother's milk to the infant or unavailability of the mother’s milk, then one can give the donor’s breast milk or iron-fortified infant formula can be used to the infants.

• And also, infants are recommended for supplemental foods.

6 to 12 Months Infants:

• Breastfeeding can be continued for at least 12 months of age, along with gradually adding solids.

• One can change to iron-fortified infant formula until 12 months if maternal breast milk is contraindicated or unavailable to the kid.

• Encourage kids to drink water; they should not offer sweetened beverages and limit other beverages to 100 percent fruit juices.

• Unless under medical indication, people only need to restrict their fat intake, but others can follow the fat intake in their daily diet.

12 to 24 Months Kids:

• Based on the child’s growth, total fat intake, intake of other nutrient-dense foods, and family history of other cardiovascular diseases and obesity, one should add the fat intake to the child’s diet.

• In this period, a change to unflavored, reduced cow’s milk is added to their diet.

• Water should be encouraged by avoiding sweetened sugary beverages and limiting 100 percent fruit juices to 4 oz/day (ounces per day).

• Kids should be offered table foods that contain

  • Total fat 30 percent of daily kcal (kilocalories)intake.

  • Saturated fat is 8 to 10 percent of daily kcal intake.

  • Mono and polyunsaturated fat up to 20 percent daily kcal intake.

  • Cholesterol under 300 mg/day.

  • Trans-fat should be avoided.

  • Sodium intake should be limited.

2 to 10 Years Children:

• The first drink given to the child should be fat-free milk and an unflavored one.

• Children should avoid sugar-sweetened beverages and limit 100 percent fruit juices.

• Children should be encouraged to drink less than 4 ounces of water per day.

• Dietary fat intake by kids under this category includes:

  • 8 to 10 percent of saturated fat intake daily kcal.

  • Twenty percent of mono- and polyunsaturated fats daily kcal.

  • Cholesterol intake will be around 300 mg/day.

  • Total fat content should be around 25 to 30 percent of daily kcal.

  • And at last trans fat should be avoided.

• Healthy dietary fiber intake should be encouraged daily for the kids.

• For children over five years, at least one hour of moderate-to-vigorous physical activity should be encouraged daily.

11 to 21 Years Individuals:

• Fat-free, unflavored milk, and water are the first beverages that should be included in this age group of children.

• Sugar-sweetened beverages should be limited or avoided.

• One should limit 100 percent fruit juice to less than 4 oz/day.

• The dietary fat intake should consist of the following:

  • 8 to 10 percent of saturated fat daily kcal intake

  • Twenty percent of mono- and polyunsaturated fats daily kcal intake.

  • 25 to 30 percent of total fat daily kcal intake.

  • Children should consume 300 mg/day of cholesterol in their diet.

• High-dietary fiber intake should be encouraged for the kids. And daily moderate to vigorous physical activity should be encouraged for at least one hour.

• Healthy eating habits like eating meals as a family, limiting fast foods, and eating daily breakfast should be encouraged by the kids.

Conclusion:

One should change the diet plan to CHILD-2, which constitutes 7 percent of saturated fat less than the total calories, and cholesterol under 200 mg/day can be used only when the LDL cholesterol is more than or equal to 130 mg/dl after using 3 to 6 months daily. If the Patient follows the treatment for dyslipidemia, then one should eliminate the simple sugars from sweetened beverages and processed food, which will be very helpful to them.