Effect of Nutritional Intervention on Lipid Profile in a Cohort of Pediatric Subjects with Hypercholesterolemia

Background. It is well established that atherosclerosis leads to coronary heart disease (CHD) starting in the first decades of life, and hypercholesterolemia is one of its main determinants. Primitive hypercholesterolemia is present in 1 out of 250 subjects in the general population, it is already present, detectable and treatable in children and adolescents. According to the current guidelines, healthy-heart nutrition and lifestyle are first-line treatments. The aim of this study is to evaluate the effect of nutritional intervention on lipid profile in a cohort of paediatric patients with hypercholesterolemia referred to the Centre for Paediatric Dyslipidaemias, Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, Piacenza. Methods: Overall,75 paediatric subjects with moderate or severe primitive hypercholesterolemia (2–17 years), not on lipid lowering treatment, were included in the study; dietary habits were evaluated through a Food Frequency Questionnaire (FFQ) and Mediterranean Diet adherence evaluated through the KIDMED score and blood samples for lipid profile were collected at the enrollment (T0) and after six months (T1). Results: Lipid profile at T0 and T1, expressed as median (25th-75th percentile), was, respectively: total cholesterol 245 mg/dL (224-280) and 222 mg/dL (200-245) (Wilcoxon paired test on the difference between distributions yields p < 0.001), LDL-cholesterol 167 mg/dL (149-193) and 150 mg/dL (127-163) (p<0.001), HDL-C 55 mg/dL (48-66) and 56 mg/dL (48-64) (p=0.845), triglycerides 89 (70-114) and 80 (67-102) (p<0.001) and non-HDL-cholesterol 188 mg/dL (168-219) and 168 mg/dL (145-185) (p<0.001). Analysing weekly portions of main food items, we found that intake of meat, sausages, cheese, and junk food decreased (p< 0.01), whereas consumption of fruit and vegetables, fish, pulses, and whole foods improved (p < 001). KIDMED score at T0 and T1 (mean±standard deviation) was 5.5±2.1 and 7.5±1.8, with p<0.01. KIDMED score adherence class at T0 was optimal, medium, and low for n. 14 (18.7%), n.45 (60%), and n. 16 (21.3%) participants, respectively, while T1 it was optimal for 43 (57.3%), medium for 32 (42.7%) and low for 0 participants. Conclusions: The results of our study confirm that qualitative nutritional intervention is well accepted and implemented in our cohort and it resulted in positive outcomes in terms of nutritional habits and atherogenic lipid fraction reduction in children and adolescents with moderate or severe hypercholesterolemia.