What dietary education is recommended for an 8-year-old with elevated triglycerides (hypertriglyceridemia) and low High-Density Lipoprotein (HDL) cholesterol (hypoalphalipoproteinemia)?

From the Guidelines

For an 8-year-old with triglycerides of 189 mg/dL and HDL of 39 mg/dL, dietary changes are recommended to improve these values, focusing on reducing added sugars and emphasizing whole foods, healthy fats, and regular physical activity, as supported by the 2021 ACC expert consensus decision pathway 1. To improve the lipid profile, it is essential to:

• Reduce added sugars, especially in beverages like soda and juice, and limit processed foods containing high fructose corn syrup
• Encourage whole foods including fruits, vegetables, whole grains, and lean proteins like chicken, fish, and beans
• Replace unhealthy fats with healthier options such as olive oil, avocados, and nuts while limiting fried foods and processed snacks
• Emphasize fiber-rich whole grains, legumes, and nuts, as recommended in the 2021 ACC expert consensus decision pathway 1
• Limit saturated fat intake to less than 10% of calories per day, as suggested by the American Heart Association guidelines 1
• Encourage at least 60 minutes of physical activity daily through activities the child enjoys, as recommended by the American Heart Association guidelines 1 These recommendations work because excess sugar consumption directly increases triglyceride levels, while regular physical activity and healthier fats can help raise HDL cholesterol, as supported by the expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents 1. Consistency is key, as these changes need to become lifestyle habits rather than temporary fixes. Some key points to consider:
• The 2021 ACC expert consensus decision pathway 1 provides the most recent and highest-quality guidance on managing hypertriglyceridemia, emphasizing the importance of dietary changes and lifestyle modifications
• The American Heart Association guidelines 1 provide a comprehensive framework for promoting cardiovascular health in children and adolescents, including dietary recommendations and physical activity guidelines
• The expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents 1 provides additional guidance on dietary management of dyslipidemia, including the use of plant sterol or stanol esters as dietary adjuncts.

From the Research

Dietary Recommendations for an 8-Year-Old with Triglycerides 189 and HDL 39

To address the dietary needs of an 8-year-old with triglycerides at 189 and HDL at 39, it's essential to consider the impact of different types of fatty acids on lipid profiles.

• The intake of saturated fatty acids, except for stearic acid, can raise low-density lipoprotein (LDL) cholesterol levels 2.
• Trans-monounsaturated fatty acids can raise LDL cholesterol and lower high-density lipoprotein (HDL) cholesterol 2.
• Polyunsaturated fatty acids can lower LDL cholesterol, and omega-3 fatty acids from fish can lower triglyceride levels 2, 3.
• A diet high in saturated fatty acids is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) 4, 5.
• Replacing saturated fats with unsaturated fats, particularly polyunsaturated fatty acids, may reduce ASCVD risk 4.

Specific Dietary Advice

• Minimize saturated fats and refined carbohydrates, and eliminate trans-fats 3.
• Increase consumption of fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids 3.
• Adhering to a Mediterranean diet is strongly recommended due to its benefits in lowering cardiovascular disease and total mortality 3.
• High-dose omega-3 fatty acids can lower triglycerides, reduce cardiovascular disease, and prevent coronary plaque progression 3.

Key Considerations for Lipoprotein Metabolism

• Dietary fatty acid composition regulates lipids and lipoprotein metabolism and may confer cardiovascular disease benefit 6.
• High dietary fish-derived n-3 polyunsaturated fatty acid consumption can diminish hepatic triglyceride-rich lipoprotein secretion and enhance conversion to LDL 6.
• Intake of saturated fatty acids with increased palmitic acid at the sn-2 position may decrease postprandial lipemia 6.