[Primary hyperlipidemia in children and adolescents: effects of dietary and pharmacological intervention]

A retrospective study was performed on children with hypercholesterolemia or hypertriglyceridemia referred to the Endocrine Clinic of the Niño Jesús University Hospital over a period of 5 years. One hundred twenty-seven children, from 2 to 16 years of age, were followed. The subjects were classified into the following groups: 90 with primary hyperlipidemia [55 polygenic hypercholesterolemia (PH), 23 familial hypercholesterolemia (FH) and 12 with familial combined hyperlipidemia (FCH)]; 2 with secondary hypercholesterolemia and 35 were found to have normal cholesterol and triglyceride values. All patients with primary hyperlipoproteinemia were instructed to carry out dietary intervention during a 6 month period, following the step I recommendations of the National Cholesterol Education Program (NCEP). The following results were obtained: In the group of children with PH and FH a decrease in total and LDL cholesterol was observed (p < 0.0001 for both groups). In the group of FH, a decrease in the LDL/HDL ratio was also observed (p < 0.01). In contrast, the group of children with FCH did not show any changes in the lipoprotein pattern after dietary intervention. In the three groups studied, no statistically significant differences were observed in the remaining parameters (HDL-C, VLDL, and apo A1) after dietary intervention. Lp(a) levels above 30 mg/dl were observed in 25%, 37% and 46% of the children with PH, FH and FCH, respectively. Nine patients with FH were treated with resins for 3 months. In these children a decrease in total and LDL cholesterol, apo B and in the LDL/HDL ratio was observed (p < 0.05). No changes in Lp(a) and HDL-C were observed in this group of children. In our experience, dietary intervention to reduce fat and cholesterol intake in children with primary hyperlipoproteinemia, a population at high risk of developing atherosclerosis, is safe and useful. The treatment with resins in children with FH improves their lipoprotein profile.