 Dietary Fats in Children: The American Perspective . . . page 2 Use of lipoprotein analysis in risk assessment and treatment Once a lipoprotein analysis is obtained, it should be repeated to determine the average LDL-cholesterol level and there by steps for risk assessment and treatment. Follow-up of the LDL-cholesterol determinations is as follows :
The Step - One diet calls for the same nutrient intake recommended for the population approach to lower cholesterol levels, i.e. no more than 30% of calories from total fat; less than 10% of total calories from saturated fat (including hydrogenated fat and sources of transfatty acids); up to 10% of calories from polyunsaturated fat; the remainder of fat as monounsaturates and no more than 300 mg/day of cholesterol. What makes the diet the rapeutic is the prescription in a medical setting together with monitoring and follow-up by a health professional. If careful adherence to this diet for at least three months does not result in a lowering of the LDL-cholesterol to acceptable levels, the Step - Two diet should be prescribed. Often children who have been identified to have high LDL-cholesterol levels have instituted a diet similar to the Step - One diet and require counseling to adopt the Step - Two diet. The Step - Two diet requires detailed assessment of current eating patterns and instruction by a physician, registered dietitian, nutritionist, registered nurse or other appropriately trained health professional. It aims to induce an eating pattern in which no more than 30% of calories are from total fat; less than 7% of total calories from saturated fat, up to 10% of calories from polyunsaturated fat, the remaining fat as monounsaturates and no more than 200 mg/day of cholesterol are consumed. The eating pattern requires careful planning to ensure adequacy of energy, vitamins and minerals and often requires assistance from a registered dietitians and periodic assessment of adherence. Drug therapy: Drug therapy should only be considered for children beyond 10 years of age and only after an adequate trial of diet therapy for 6-12 months in those whose LDL-cholesterol remains greater than 190 mg/dL (4.9 mmol/L) with a positive family history of premature cardiovascular disease or with two or more other risk factors which remain after vigorous attempts have been made to control them. The drugs that are currently recommended for the treatment of hypercholesterolemia and high LDL - cholesterol levels in children are the bile acid sequestrants cholestyramine and cholestipol, which act to bind bile acids in the intestinal lumen. They have prove n effects and apparent safety in children. Nicotinic acid, HMG Co A reductase inhibitors, probucol, gemfibrozil, D-thyroxine and para-aminosalicylic acid are not recommended for routine use in children and adolescents, because limited data about their safety in children exist. * It should be noted that the current position of the Canadian Paediatric Society (CPS) and Health Canada is that from the age of two until the end of linear growth, there should be a transition from the high fat diet of infancy to a diet that includes no more than 30% of energy as fat and no more than 10% of energy as saturated fat. (www.cps.ca) References:
|
