DIETARY ADHERENCE IN CHILDREN WITH FAMILIAL HYPERCHOLESTEROLEMIA

We examined nutritional and psychosocial factors associated with adher ence to the recommended diet (less than or equal to 30% of energy from fat and < 10% from saturated fat) in children with familial hyperchol esterolemia. Ninety-eight boys and 74 girls aged 7-17 y treated for gr eater than or equal to 18 mo responded to a quantitative food-frequenc y questionnaire that was self- (ages 13-17 y) or dietitian(ages 7-12 y ) administered. One hundred nine subjects also completed a weighed foo d record. Psychosocial assessments included the Child Behavior Checkli st, Youth Self Report, and Children's Global Assessment Scale. The wei ghed record showed better adherence to dietary guidelines than the foo d-frequency questionnaire, but energy intake was underestimated. Low e nergy reporters had a healthier diet than the rest with the weighed re cord. According to the questionnaire, energy intake was underreported in only 9% of subjects and was not associated with a healthier diet, t hus, further analyses were based on the questionnaire. Intakes of vita min C (P = 0.0001), folate (P = 0.0001), riboflavin (P = 0.03), thiami ne (P = 0.0001), and magnesium (P = 0.0001) per megajoule increased as quartile of total fat intake (as a % of total energy) decreased, refl ecting increased intakes of cereals (P = 0.002), pasta (P = 0.01), fru it (P = 0.0001), pure meat (not minced or meat products; P = 0.047), s kim milk (P = 0.0001), and skim cheese (P = 0.005). Energy and sugar ( % of total energy) intakes were not significantly different across all fat intakes; energy density decreased with decreasing fat quartile. O verall psychosocial function score and parental educational level were associated with lower fat intake in multivariate analysis, explaining 11% of the variance in fat intake. We conclude that adherence to fat restriction among children treated for familial hypercholesterolemia i s associated with increased micronutrient density, decreased energy de nsity, and psychosocial factors that facilitate adherence.