Societal aspects in the dietary management of childhood hyperlipidemia

Pediatric hyperlipidemias increasingly require dietary management of overweight and obesity for resolution. Dietary management of inappropriate weight gain may be outside of normal pediatric expertise. This review used scientific statements of expert professional groups, federal program documentation, and selected original articles or opinions to survey dietary techniques and highlight continuing controversies and therapeutic successes. At present, complex societal and environmental factors underlie the current epidemic in pediatric overweight, precluding definitive statements of best practices. Thus, although first-generation professional group recommendations are available, clinicians should expect recommendations to change. However, lack of standardized practices to assess the degree and quality of overweight (central versus peripheral adiposity) limit objective determination of therapeutic need and timely referral to nutrition professionals. Dietary management of insulin-resistant, overweight/obese children with dyslipidemias (metabolic syndrome) requires appropriate laboratory diagnostics to ensure that total fat and energy restrictions do not provoke or exacerbate hypertriglyceridemia or liver fat accumulation. Integrated treatment approaches that combine nutrition education, behavioral modification, and individualized diet instruction are showing success. Diet instructions that include practical translation of nutrition principles to daily eating habits are able to bring about substantial dietary change. The role of the school as a significant component of a child's lifestyle is described, as well as consideration of federally mandated feeding programs as a factor in designing effective dietary management strategies for those likely to be at high risk for overweight and dyslipidemias. The need for coordination among families, and health and school professionals to achieve success is emphasized.