TABLE 9-8

Evidence-Based Recommendations for Dietary Management of Elevated LDL Cholesterol, Non-HDL Cholesterol, and Triglyceride Levels

2 to 21 yElevated LDL cholesterol: CHILD-2–LDL
    Refer to a registered dietitian for family medical nutrition therapyGrade B Strongly recommend
        25%–30% of calories from fat, ≤7% from saturated fat, ∼10% from monounsaturated fat; <200 mg/d of cholesterol; avoid trans fats as much as possibleGrade A Recommend
    Supportive actions:
        Plant sterol esters and/or plant stanol estersa up to 2 g/d as replacement for usual fat sources can be used after 2 y of age in children with familial hypercholesterolemia
        Plant stanol esters as part of a regular diet are marketed directly to the public; short-term studies have found no harmful effects in healthy children
        The water-soluble fiber psyllium can be added to a low-fat, low-saturated-fat diet as cereal enriched with psyllium at a dose of 6 g/d for children 2–12 y of age and 12 g/d for those ≥12 y of age
        As for all children, 1 h/d of moderate-to-vigorous physical activity and <2 h/d of sedentary screen time are recommended.
Elevated triglycerides or non-HDL cholesterol: CHILD-2–TG
    Refer to a registered dietitian for family medical nutrition therapybGrade B Strongly recommend
        25%–30% of calories from fat, ≤7% from saturated fat, ∼10% from monounsaturated fat; <200 mg/d of cholesterol; avoid trans fats as much as possibleGrade A Recommend
        Decrease sugar intakeGrade B Recommend
            Replace simple with complex carbohydrates
            No sugar-sweetened beverages
        Increase dietary fish to increase ω-3 fatty acidscGrade D Recommend
  • Grades reflect the findings of the evidence review; recommendation levels reflect the consensus opinion of the expert panel; and supportive actions represent expert consensus suggestions from the expert panel provided to support implementation of the recommendations (they are not graded). Values given are in mg/dL. To convert to SI units, divide the results for TC, LDL cholesterol, HDL cholesterol, and non-HDL cholesterol by 38.6; for triglycerides, divide by 88.6.

  • a Can be found added to some foods, such as some margarines.

  • b If the child is obese, nutrition therapy should include calorie restriction, and increased activity (beyond that recommended for all children) should be prescribed. See “Overweight and Obesity” for additional age-specific recommendations.

  • c The FDA and the Environmental Protection Agency advise women of childbearing age who may become pregnant, pregnant women, nursing mothers, and young children to avoid some types of fish and shellfish and eat fish and shellfish that are low in mercury. For more information, call the FDA's food information line toll-free at 1-888-SAFEFOOD or visit www.cfsan.fda.gov/∼dms/admehg3.html.