From the Guidelines
The Child 1 and Child 2 diets are effective dietary interventions for managing pediatric hypercholesterolemia, with substantial evidence supporting their use as first-line therapy, as recommended by the most recent guidelines 1.
Key Components of the Diets
The Child 1 diet is recommended for all children over 2 years of age with elevated cholesterol levels and focuses on consuming adequate calories for growth while limiting:
- Total fat to 25-30% of calories
- Saturated fat to less than 10% of calories
- Dietary cholesterol to less than 300 mg/day For children who don't achieve adequate cholesterol reduction with the Child 1 diet after 3-6 months, progression to the more restrictive Child 2 diet is recommended, which further reduces:
- Saturated fat to less than 7% of calories
- Dietary cholesterol to less than 200 mg/day
Evidence and Recommendations
These diets have been shown to reduce LDL cholesterol by 10-15% without negatively impacting growth or development when properly implemented, as supported by the expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents 1. Implementation should involve a registered dietitian to ensure nutritional adequacy, with particular attention to calcium, iron, zinc, and fat-soluble vitamin intake. The effectiveness of these diets stems from their reduction of saturated and trans fats, which decrease hepatic cholesterol production and increase LDL receptor activity, thereby enhancing cholesterol clearance from the bloodstream. Regular monitoring of lipid levels every 3-6 months is recommended to assess response to dietary therapy, as suggested by the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1.
Additional Considerations
In children with identified hypercholesterolemia and an elevated LDL cholesterol level, a more stringent diet with saturated fat at <7% of calories and dietary cholesterol limited to 200 mg/day has been shown to be safe and modestly effective in lowering the LDL cholesterol level, as reported by the expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents 1. The use of dietary adjuncts such as plant sterol or stanol esters up to 20 g/day can safely enhance LDL cholesterol–lowering effects short-term in children with familial hypercholesterolemia, as supported by the same expert panel 1.
From the Research
Dietary Therapy for Pediatric Hypercholesterolemia
The evidence for the Child 1 and Child 2 diets in managing pediatric hypercholesterolemia is not directly addressed in the provided studies. However, the studies discuss the importance of dietary therapy in managing hypercholesterolemia in children.
- The Child 1 diet is not mentioned in the studies, and its effectiveness in managing pediatric hypercholesterolemia is unclear.
- The Child 2 diet is also not mentioned, and its role in managing pediatric hypercholesterolemia is not supported by the provided evidence.
General Dietary Recommendations
General dietary recommendations for managing pediatric hypercholesterolemia include:
- A low-saturated fat and low-cholesterol diet 2
- Lifestyle guidance, including diet, for children diagnosed with familial hypercholesterolemia (FH) or probable FH 3
- A population-based approach to improve lifestyle and lipid levels in all children 4
Importance of Early Treatment
Early screening and treatment of children with familial hypercholesterolemia are crucial to reduce the risk of premature atherosclerotic cardiovascular disease (ASCVD) 5.