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      Children and young adults with familial hypercholesterolaemia (FH) have healthier food choices particularly with respect to dietary fat sources compared with non-FH children

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          Abstract

          Familial hypercholesterolaemia (FH) leads to elevated plasma levels of LDL-cholesterol and increased risk of premature atherosclerosis. Dietary treatment is recommended to all patients with FH in combination with lipid-lowering drug therapy. Little is known about how children with FH and their parents respond to dietary advice. The aim of the present study was to characterise the dietary habits in children with FH. A total of 112 children and young adults with FH and a non-FH group of children ( n 36) were included. The children with FH had previously received dietary counselling. The FH subjects were grouped as: 12–14 years (FH (12–14)) and 18–28 years (FH (18–28)). Dietary data were collected by SmartDiet, a short self-instructing questionnaire on diet and lifestyle where the total score forms the basis for an overall assessment of the diet. Clinical and biochemical data were retrieved from medical records. The SmartDiet scores were significantly improved in the FH (12–14) subjects compared with the non-FH subjects (SmartDiet score of 31 v. 28, respectively). More FH (12–14) subjects compared with non-FH children consumed low-fat milk (64 v. 18 %, respectively), low-fat cheese (29 v. 3%, respectively), used margarine with highly unsaturated fat (74 v. 14 %, respectively). In all, 68 % of the FH (12–14) subjects and 55 % of the non-FH children had fish for dinner twice or more per week. The FH (18–28) subjects showed the same pattern in dietary choices as the FH (12–14) children. In contrast to the choices of low-fat dietary items, 50 % of the FH (12–14) subjects consumed sweet spreads or sweet drinks twice or more per week compared with only 21 % in the non-FH group. In conclusion, ordinary out-patient dietary counselling of children with FH seems to have a long-lasting effect, as the diet of children and young adults with FH consisted of more products that are favourable with regard to the fatty acid composition of the diet.

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          Consistent dietary patterns identified from childhood to adulthood: the cardiovascular risk in Young Finns Study.

          Dietary patterns are useful in nutritional epidemiology, providing a comprehensive alternative to the traditional approach based on single nutrients. The Cardiovascular Risk in Young Finns Study is a prospective cohort study with a 21-year follow-up. At baseline, detailed quantitative information on subjects' food consumption was obtained using a 48 h dietary recall method (n 1768, aged 3-18 years). The interviews were repeated after 6 and 21 years (n 1200 and n 1037, respectively). We conducted a principal component analysis to identify major dietary patterns at each study point. A set of two similar patterns was recognised throughout the study. Pattern 1 was positively correlated with consumption of traditional Finnish foods, such as rye, potatoes, milk, butter, sausages and coffee, and negatively correlated with fruit, berries and dairy products other than milk. Pattern 1 type of diet was more common among male subjects, smokers and those living in rural areas. Pattern 2, predominant among female subjects, non-smokers and in urban areas, was characterised by more health-conscious food choices such as vegetables, legumes and nuts, tea, rye, cheese and other dairy products, and also by consumption of alcoholic beverages. Tracking of the pattern scores was observed, particularly among subjects who were adolescents at baseline. Of those originally belonging to the uppermost quintile of pattern 1 and 2 scores, 41 and 38 % respectively, persisted in the same quintile 21 years later. Our results suggest that food behaviour and concrete food choices are established already in childhood or adolescence and may significantly track into adulthood.
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            Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein.

            To enhance the effectiveness of diet in lowering cholesterol, recommendations of the Adult Treatment Panel III of the National Cholesterol Education Program emphasize diets low in saturated fat together with plant sterols and viscous fibers, and the American Heart Association supports the use of soy protein and nuts. To determine whether a diet containing all of these recommended food components leads to cholesterol reduction comparable with that of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins). Randomized controlled trial conducted between October and December 2002. Forty-six healthy, hyperlipidemic adults (25 men and 21 postmenopausal women) with a mean (SE) age of 59 (1) years and body mass index of 27.6 (0.5), recruited from a Canadian hospital-affiliated nutrition research center and the community. Participants were randomly assigned to undergo 1 of 3 interventions on an outpatient basis for 1 month: a diet very low in saturated fat, based on milled whole-wheat cereals and low-fat dairy foods (n = 16; control); the same diet plus lovastatin, 20 mg/d (n = 14); or a diet high in plant sterols (1.0 g/1000 kcal), soy protein (21.4 g/1000 kcal), viscous fibers (9.8 g/1000 kcal), and almonds (14 g/1000 kcal) (n = 16; dietary portfolio). Lipid and C-reactive protein levels, obtained from fasting blood samples; blood pressure; and body weight; measured at weeks 0, 2, and 4 and compared among the 3 treatment groups. The control, statin, and dietary portfolio groups had mean (SE) decreases in low-density lipoprotein cholesterol of 8.0% (2.1%) (P =.002), 30.9% (3.6%) (P<.001), and 28.6% (3.2%) (P<.001), respectively. Respective reductions in C-reactive protein were 10.0% (8.6%) (P =.27), 33.3% (8.3%) (P =.002), and 28.2% (10.8%) (P =.02). The significant reductions in the statin and dietary portfolio groups were all significantly different from changes in the control group. There were no significant differences in efficacy between the statin and dietary portfolio treatments. In this study, diversifying cholesterol-lowering components in the same dietary portfolio increased the effectiveness of diet as a treatment of hypercholesterolemia.
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              Familial hypercholesterolemia: screening, diagnosis and management of pediatric and adult patients: clinical guidance from the National Lipid Association Expert Panel on Familial Hypercholesterolemia.

              The familial hypercholesterolemias (FH) are a group of genetic defects resulting in severe elevations of blood cholesterol levels and increased risk of premature coronary heart disease. FH is among the most commonly occurring congenital metabolic disorders. FH is a treatable disease. Aggressive lipid lowering is necessary to achieve the target LDL cholesterol reduction of at least 50% or more. Even greater target LDL cholesterol reductions may be necessary for FH patients who have other CHD risk factors. Despite the prevalence of this disease and the availability of effective treatment options, FH is both underdiagnosed and undertreated, particularly among children. Deficiencies in the diagnosis and treatment of FH indicate the need for greatly increased awareness and understanding of this disease, both on the part of the public and of healthcare practitioners. This document provides recommendations for the screening, diagnosis and treatment of FH in pediatric and adult patients developed by the National Lipid Association Expert Panel on Familial Hypercholesterolemia. This report goes beyond previously published guidelines by providing specific clinical guidance for the primary care clinician and lipid specialist with the goal of improving care of patients with FH and reducing their elevated risk for CHD. Copyright © 2011 National Lipid Association. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                J Nutr Sci
                J Nutr Sci
                JNS
                Journal of Nutritional Science
                Cambridge University Press (Cambridge, UK )
                2048-6790
                2013
                11 October 2013
                : 2
                : e32
                Affiliations
                [1 ]Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo , Oslo, Norway
                [2 ]The Lipid Clinic, Oslo University Hospital , Oslo, Norway
                [3 ]Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo , Oslo, Norway
                [4 ]Department of Health, Nutrition and Management, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences , Oslo, Norway
                Author notes
                [* ]Corresponding author:, Dr Kirsten B Holven, fax +47 22851361, email kirsten.holven@ 123456medisin.uio.no
                Article
                S204867901300027X 00027
                10.1017/jns.2013.27
                4153102
                37fc3433-0a46-4729-8a70-3859b94bc0a2
                © The Author(s) 2013

                The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution license < http://creativecommons.org/licenses/by/3.0/.

                History
                : 19 December 2012
                : 02 August 2013
                : 07 August 2013
                Page count
                Figures: 1, Tables: 4, References: 16, Pages: 8
                Categories
                Human and Clinical Nutrition

                familial hypercholesterolaemia,children,diet,dietary fat sources,fh, familial hypercholesterolaemia,fh (12–14), fh subjects aged 12 to 14 years,fh (18–28), fh subjects aged 18 to 28 years

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