Dietary therapy for children with hypercholesterolemia

Accumulating evidence clearly shows that atherosclerosis begins in youth. T he National Cholesterol Education Program (NCEP) has recommended that child ren at high risk of developing coronary artery disease as adults be screene d so that those with elevated low-density lipoprotein (LDL) cholesterol lev els can be treated, primarily by modification of diet. The initial approach to these youthful patients is to use the NCEP step I diet. This diet provi des calories and nutrients that support normal growth and development, but limits saturated fat and total fat intake to no more than 10 and 30 percent of total calories, respectively, and cholesterol intake to no more than 10 0 mg per 1,000 kcal per day, to a maximum of 300 mg. If the goal of reducin g the LDL cholesterol level to below 130 mg per dL (3.35 mmol per L) is not achieved, the more restrictive step II diet should be initiated. However, the step II diet may not provide sufficient calories and nutrients to suppo rt normal growth and development; therefore, trained nutritionists may be r equired to effectively manage a child on this diet.