Abstract
Combined dyslipidemia(CDL) [moderate to severe elevation in triglyceride (TG), decreased HDL-cholesterol (HDL), mild elevation in total (TC) and LDL-cholesterol (LDL)] is common in obese children. Primary treatment is lifestyle change. We reviewed the response to a standard staged approach in consecutive children with CDL referred to a pediatric cardiology prevention clinic who returned for follow-up(F/U). The clinical protocol uses the same physician/ registered dietitian team to prescribe a change in diet composition (fat free milk; no sugar-sweetened beverages; simple carbohydrates replaced with complex carbohydrates) and daily exercise (1/2 hr/d of moderate exercise beyond current activity). Patients return at 3 m intervals and are discharged when TG and LDL have normalized; calorie control and/or medication are not introduced until the primary approach has been unsuccessful at second F/U. Over the last 21 mos, 53 pts(52 % male) have been managed with this approach. At baseline (B/L), mean age was 12.9+3y with no significant difference between males(Ms) and females(Fs). In 94%, B/L BMI was > 95 th %ile. RESULTS (mean + SD): ALL F/U 1 F/U 2 MALE F/U 1 F/U 2 FEMALE F/U 1 F/U 2 B/L B/L B/L TC 213+38 194+42 190+41 208+33 187+39 186+40 220+42 202+44 195+42 TG 282+136 205+110 193+98 283+131 182+78 173+89 279+141 230+133 215+105 HDL 40+12 39+10 40+10 39+8 38+7 39+7 41+15 41+13 41+12 LDL 127+41 118+39 114+41 123+40 115+40 110+43 132+44 121+39 119+38 For all pts, there was a significant mean decrease in TC (p=.007) and TG (p=.001) at the first F/U visit, sustained at second F/U with no significant change in LDL or HDL. The mean decrease in TC was similar in Ms(p=.028) and Fs(p=.022) but decrease in TG was greater in Ms(39%)(p=.0003) than in Fs (23%)(p=.036) (p=.059 between Ms and Fs). At F/U 2, 50% of Ms vs 20% of Fs had normalized TC and TG levels (p=.043). Although there was no specific approach to weight loss, mean BMI decreased by 0.4 kg/m 2 , with no difference between Ms and Fs. CONCLUSIONS: (1) A simple lifestyle change focused on change in diet composition and daily exercise can significantly improve CDL in obese children on short term F/U, without weight loss; (2) Normalization of the lipid profile is significantly more common in Ms than Fs. If confirmed in a prospective trial, these are potentially important findings for this large and growing patient group.
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