PEDIATRICS Vol. 96 No. 5 November 1995, pp. 1005-1009
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The Role of Fiber in the Treatment of Hypercholesterolemia in Children and Adolescents

Peter O. Kwiterovich Jr MD1

1 Lipid Research Atherosclerosis Unit, Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, MD

The effect of adding water-soluble fiber to a diet low in total fat, saturated fat, and cholesterol to treat hypercholesterolemic children and adolescents with elevated plasma low-density lipoprotein (LDL) cholesterol levels was assessed. In more than a half-dozen studies, the effect of water-soluble fiber on the LDL cholesterol level ranged from no change to as high as a 23% decrease using oat bran, psyllium, or locust bean gum. The wide range of effects in these studies may be related to the quality of the dietary intervention or to different methods of randomization, blinding, dietary assessment, and laboratory measurement. For example, the addition of supplemented soluble fiber (psyllium) to a step 1 diet may provide additional lowering of LDL cholesterol of 10% to 15%. However, in children consuming the more stringent step 2 diet, the addition of water-soluble fiber may have less additional effects on LDL cholesterol. As recommended by the National Cholesterol Education Program Expert Panel on Blood Cholesterol Levels in Children and Adolescents, dietary therapy, that is, a diet low in total fat, saturated fat, and cholesterol, remains the cornerstone of treatment for children and adolescents with elevated LDL cholesterol levels. The use of foods high in water-soluble fiber that contain no cholesterol and are low in saturated fat remains a good choice in children following a step 1 or step 2 diet. Additional clinical trials in larger numbers of well-defined subjects will be needed to assess further the utility of adding water-soluble fiber supplements to the National Cholesterol Education Program step 1 or step 2 diets. The addition of drug therapy in children with elevated LDL cholesterol levels should be undertaken only in those with more marked elevations in the LDL cholesterol levels, particularly in those with positive family histories of premature coronary artery disease and the presence of two or more other coronary artery disease risk factors.




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[Abstract] [Full Text] [PDF]