The Impact of Dietary Intervention on HDL and LDL Cholesterol Levels in a Pediatric Population

The diagnosis, implications and treatment of 'Hypercholesterolemia' dominated the pediatric literature in the 1980's. In recent years, the concept that major chronic disorders such as coronary heart disease and obesity may have their origins in childhood has attracted increasing attention. Suggestions that the atherosclerotic process leading to the development of adult coronary heart disease begins in early childhood, that blood cholesterol levels and lipoprotein levels track from childhood to adulthood and that diet and lifestyle factors contribute to elevated cholesterol levels have led to an interest in measures to prevent atherosclerosis through early intervention. Many aspects of the issue remain amorphous as the data are conflicting and controversial. In 1989, a panel of experts was convened by the National Cholesterol Education Program, to review all the existing literature and make recommendations to health practitioners. The experts identified many of the issues which remain unanswered and must be addressed before a rational public health policy can be formulated. The panel did not support universal screening of children for elevated cholesterol levels. Their position was supported by the American Academy of Pediatrics, Committee on Nutrition. The American Heart Foundation recommends the universal screening of children. While the debate continues, many pediatric practitioners have incorporated cholesterol screening as a part of their protocol for routine health care. The specific objectives of this study were to identify the percentage of children with elevated blood cholesterol levels (>75th percentile or 170 mg/di), and to record alterations in total cholesterol level as well as lipid fractions ([DLC, HDL-C, triglyceride and total cholesterol levels) after diagnosis and intervention. No attempt was made to attribute changes in lipid levels to any particular intervention since it was recognized that diagnosis itself, other untargeted interventions such as reading newspaper or magazine articles, watching television shows and reading grocery store handouts could bring about changes in dietary and lifestyle factors related to blood cholesterol levels. All children with diagnosed problems were informed of the importance of dietary change and were offered the opportunity to receive dietary advice. An attempt was also made to evaluate the degree of correlation between fingerstick (screening) method of cholesterol measurement and venipuncture (fasting) method of laboratory measurement. The sample consisted of 2504 children who were screened between July 3,1989, and April 30,1991. Of this group 709 children or 28% of the sample had elevated cholesterol levels. The mean cholesterol level of this group (n=709) was 190 mg/d1+19.42. The median was 185 mg/c11. Diagnosis and/or intervention resulted in increases in the levels of triglycerides and HDL-C and decreases in LDL-C and total cholesterol levels. The changes in total cholesterol levels, LDLC levels and TG levels between diagnosis and follow up were significant at the 0.05 level of significance using a two tail t-test. Seventy five children had laboratory measurement of lipids within 5 weeks of screening to confirm the diagnosis of hypercholesterolemia and get a more detailed profile of lipid fractions. Seventy percent of the children (n=75) had laboratory measures of total cholesterol that were within 10% of the initial measure by fingerstick screening. It was concluded from the study that diagnosis and intervention led to positive changes in the lipid profile. However data needs to be analyzed regarding the incidence of growth failure as a consequence of overzealous restriction of fat and cholesterol rich foods before definitive conclusions can be made regarding the safety and efficacy of cholesterol screening and intervention in early childhood.