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OBJECTIVE: The aim of this study was to assess the safety and efficacy of lowering dietary intake of total fat, saturated fat, and cholesterol in growing children and adolescents with severe hyperlipidemia. STUDY DESIGN: This is a 3-year follow-up study conducted on a sample of convenience at three pediatric referral centers in New York City and its suburbs. Subjects were 138 children and adolescents 2 to 15 years of age (54% male), who had been referred with a diagnosis of hyperlipidemia. Those selected had total serum cholesterol values greater than the 95th percentile for age and had at least three visits over 3 years. They were placed on diets restricting total fat content to 30% of total calories and saturated fat to 10% of total calories (National Cholesterol Education Program Step I diet). Anthropometric measures, lipid profiles, and dietary assessment were obtained at each visit. Anthropometric data were analyzed by sex and age. Z scores for height and weight were calculated from NHANES II data and were compared by paired t tests (Hamill et al., 1979, Am J Clin Nutr 32:607-29). RESULTS: Total serum cholesterol dropped from 262 mg/dL at baseline to 249 mg/dL at 3-year follow-up (P = 0.003). There was no significant change in height or weight percentile, expressed as Z score, from baseline to 3-year follow up. CONCLUSIONS: In this population the supervised dietary interventions resulted in a sustained improvement of the lipid profile, with no demonstrable adverse effect on growth.

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OBJECTIVE: To compare compliance between directly observed preventive therapy and daily treatment for students with inactive (class II) tuberculosis. DESIGN: Cohort analytic study and cost-effectiveness analysis. Students found to be positive for purified protein derivative and having no abnormal chest x-ray films on mandated screening were advised to have prophylactic treatment with isoniazid. Treatment was either directly observed in the school health clinic or provided as daily therapy by the Department of Health. Treatment completion, age, sex, ethnicity, and recent immigration were compared between the 2 treatment groups. SETTING: A school-based clinic at an inner-city New York, NY, high school. RESULTS: In 1993, 864 students were screened. The positive purified protein derivative rate was 19.3%. All 161 students had negative findings on chest x-ray films. Of the students, 105 (65.2%) were enrolled in the school-based clinic directly observed preventive therapy program, 22 were referred to the Department of Health for daily therapy, and 34 excluded from the study before treatment. The 2 treatment groups did not differ in composition. Completion of therapy in the directly observed preventive therapy group (87.6%) was significantly greater than that in the daily therapy group (50%) (P = 0.001, X2 = 11.8) and that reported in the literature for programs other than directly observed preventive therapy (30%-70%). Directly observed preventive therapy was administered by existing personnel without additional expenditure. CONCLUSION: Directly observed preventive therapy is an effective strategy that should be used in the school clinic setting to increase compliance with prophylactic treatment for tuberculosis.

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OBJECTIVE: To assess the nutritional adequacy of low-fat, low-saturated fat, low-cholesterol-modified diets of children with hyperlipidemia. DESIGN: Case comparison study. SETTING: Tertiary care ambulatory pediatric atherosclerosis prevention center. PATIENTS AND OTHER PARTICIPANTS: White middle-class suburban children. Subjects were 54 consecutive children with hyperlipidemia (26 boys) with a mean (+/- SD) age of 10.8 +/- 3.4 years. Controls were 44 healthy children (19 boys) aged 10.8 +/- 0.9 years recruited from a local elementary school. INTERVENTION: The subjects received individual nutrition counseling on a National Cholesterol Education Program Step I Diet from a registered dietitian. MAIN OUTCOME MEASURE: The 3-day written food records were analyzed by a registered dietitian using the Minnesota Nutrient Data System. Outcome measures were intakes of energy, fat-soluble vitamins, and minerals as a percentage of the Recommended Dietary Allowance. The means between cases and controls were compared by Student's t test. RESULTS: There was no significant difference in consumption of energy, minerals, or vitamins D and E between the groups. The control group's diet contained significantly greater amounts of fat, saturated fat, and cholesterol. The children with hyperlipidemia consumed significantly more vitamin A (P < .005). CONCLUSION: The nutrient quality of fat- and cholesterol-modified diets of children who have received nutritional counseling compares favorably with the nutrient quality of controls on an unrestricted diet. Therefore, pediatricians can prescribe with confidence a Step I Diet for children with hyperlipidemia and adolescents when nutritional counseling is available.

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Dyslipoproteinemia, a risk factor for atherosclerosis, has been described in anorexia nervosa (AN). To assess whether dyslipoproteinemia is present in our AN population, and to investigate the effect of controlled refeeding, we prospectively examined lipid profiles in 16 hospitalized adolescents with anorexia nervosa on admission and at discharge with a body weight of 90% of ideal. Healthy high school females served as controls. Total cholesterol concentration was not different from controls at either time, and there was no change with weight restoration. Triglyceride levels decreased significantly with treatment, and at discharge, levels were significantly lower than controls. High-density lipoprotein-cholesterol (HDL-C) levels increased significantly with weight gain, and were significantly higher than controls at discharge. Apoprotein A1, the major structural protein of high-density lipoprotein, was also significantly higher among the AN patients after weight gain. Low-density lipoprotein-cholesterol (LDL-C) values did not change, but apoprotein B was significantly higher than controls at discharge. The dyslipoproteinemia demonstrated in our patients was characterized by elevated HDL-C and apoprotein A levels with normal LDL-C and low triglyceride concentrations. These changes were accentuated by restoring body weight.

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Atherosclerosis, the most common cause of death in the U.S., is a process that begins in childhood. Conditions and behaviors that have been associated with increased risk of atherosclerosis can be modified, with resulting decreases in risk. All children should be screened for risk factors, which include hypercholesterolemia, hypertension, smoking, obesity, and lack of exercise. Treatment for hypercholesterolemia includes reassurance, modification of the diet and, in rare instances, medication.

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