PEDIATRICS Vol. 89 No. 3 March 1992, pp. 555-584
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IV. The Individualized Approach: Treatment

DIET THERAPY

The general aim of diet therapy is to reduce elevated blood cholesterol levels while maintaining a nutritionally adequate eating pattern. The primary emphasis is on decreasing the level of saturated fatty acids (SFA), total fat, and cholesterol and on consuming only enough calories to achieve or maintain desirable body weight. Diet therapy is presented in two steps, the Step-One and Step-Two Diets, which are designed to reduce progressively intakes of SFA and dietary cholesterol.

Definition of Total and Low-Density Lipoprotein (LDL) Cholesterol Initiation Levels for Diet Therapy

The panel's recommended initiation levels (cutpoints) for dietary intervention in children and adolescents with a family history of cardiovascular disease (CVD) or parental hypercholesterolemia are shown in Table 4-1. Children and adolescents with total cholesterol levels <170 mg/dL or LDL cholesterol levels <110 mg/dL have acceptable levels. These young people should receive education on the recommended population eating pattern (see Section II, "The Population Approach: Nutrition Recommendations for Healthy Children and Adolescents") and risk factor reduction.

Therapeutic dietary instruction is indicated in all children and adolescents with a total cholesterol level gel70 mg/dL or an LDL cholesterol gell0 mg/dL. Those with borderline total blood cholesterol levels 170 to 199 mg/dL or borderline LDL cholesterol levels 110 to 129 mg/dL (about the 75th to 95th percentile) require advice that consists of instruction on the Step-One Diet and other risk factors by a physician, registered dietitian or other qualified nutrition professional, or other appropriately trained health professional, with reevaluation in 1 year (Fig 4-1).