Paediatric guidelines for lipid reduction

Due to the fact that atherogenesis starts even in early childhood there is no doubt that the primary prevention of atherosclerotic diseases is a paediatric problem and therefore must start as early as possible in childhood. Thus, there is now indeed strong support for increasing efforts toward identifying those subjects with elevated total cholesterol or low density lipoprotein (LDL)-cholesterol levels and for providing appropriate treatment in order to achieve a substantial and pertinent reduction of those levels. Based on the data from the Lipid Research Clinics Program, the diagnosis of hypercholesterolaemia during infancy and childhood can easily be made, using the 95th percentiles for total cholesterol and for LDL-cholesterol. Today there is no doubt that elevated plasma cholesterol levels should be lowered first by dietary modification even in early childhood, beginning at the age of two years. Most authors report an average cholesterol reduction of about 10-15% by a low cholesterol-low fat diet. Our group had the opportunity to study 11 hypercholesterolaemic children consuming a type II diet containing 15-20 g soybean-protein, which resulted in a reduction of 32% in total cholesterol and 37% in LDL-cholesterol. In an individual patient who does not respond adequately to diet, drug treatment should be started. Bile acid-binding resins in a dose of 4-8 g are the drugs of choice at this time. A further 15-20% reduction of total plasma cholesterol can be achieved in most children. It is concluded that detection and adequate treatment of disorders of lipoproteins should be carried out early in childhood, in particular in families with a cardiovascular history.(ABSTRACT TRUNCATED AT 250 WORDS)