Cholesterol: should we screen all children or change the diet of all children

Predicting Cholesterol, Progesterone, and Days to Ovulation Using Postpartum Metabolic and Endocrine Measures

The objective of this study was to examine relationships among metabolic and endocrine factors that may influence ovarian activity during early lactation. Holstein cows (n = 19) were bled twice each week to determine plasma concentrations of insulin (INS), glucose, cholesterol, insulin-like growth factor-1 (IGF-I), and progesterone (P4). Feed intake and milk production were recorded daily while body weights and milk composition were recorded weekly. Relationships among plasma cholesterol and P4, and days to first and second postpartum ovulation were modeled with energy balance (EB), dry matter intake, milk yield and composition, plasma metabolites, and hormones using the backward elimination technique of multivariate regression analysis. Variables that contributed the most to predicting plasma cholesterol concentrations were dry matter intake x SNF using model 1 (production variables) and the square of glucose (i.e., glucose2) using model 3 (plasma hormones and metabolites). For plasma P4 concentrations, EB (model 2, production variables) and IGF-I (model 3, plasma hormones and metabolites) were the major predictors. The production variables EB and percentage of milk lactose were the greatest contributors to the models predicting days to first and second postpartum ovulations, respectively. Of the plasma hormones and metabolites evaluated, IGF-I2 was the most significant predictor of days to first postpartum ovulation, whereas glucose2 and INS were the significant predictors of days to second postpartum ovulation. Plasma IGF-I, glucose, and INS have been implicated in ovarian functions and their significant contributions to these models are consistent with possible important roles in postpartum return to ovarian competence.

Sociodemographic inequalities in the diet of young children in the 1946 British birth cohort

OBJECTIVE

To evaluate whether there was food and nutrient equality across occupational social classes and geographical region for members of the 1946 British birth cohort at age 4 years.

DESIGN

Cross-sectional analysis of selected food groups, energy and nutrients from one-day recall diet records.

SETTING

England, Scotland and Wales in 1950.

SUBJECTS

Nationally representative sample of 4419 children aged 4 years in 1950 from the MRC National Survey of Health and Development (NSHD) (1946 Birth Cohort).

RESULTS

Significant food and nutrient inequalities occurred by region and occupational social class of the father. Disparity in fruit and vegetable consumption primarily led to the nutrient differences, especially with respect to lower vitamin C and carotene intakes in children from Scotland and from a manual social class background. Lower energy intake in Scottish children was attributable to inequality in the consumption of foods providing fat, and also to the retention of the traditional Scottish diet that included porridge and soups. Consumption of some rationed foods -- bacon, orange juice and tea -- was inequitably distributed by father's social class, but others, in particular meat and spreading fats, were consumed more uniformly. In contrast to fruits and vegetables, which showed marked sociodemographic disparities, other non-rationed foods such as bread and potatoes were consumed universally.

CONCLUSION

Local cultural norms may have played as strong a part in sociodemographic differences in the diet of children in the early 1950s as did the strict, post-war food rationing that prevailed. In consequence, nutritional equality was not achieved, and the relatively low intake of antioxidant vitamins during early childhood in certain population groups may have compromised health in the long term.

A rational approach to treating hypercholesterolaemia in children. Weighing the risks and benefits

Because atherosclerosis is a continuous process throughout life, expert panels have suggested guidelines to reduce the risk of cardiovascular disease, starting from childhood. The guidelines focus on population-based measures and on treating hypercholesterolaemia in individual children. Low-fat diets in children have been widely debated. There is little evidence that growth is stunted or that nutritional deficiencies arise if the energy that is lost by limiting fat intake is substituted with other nutrients. Dietary fibre, plant sterols and fish oils have been used to modify lipid levels in children; however, the efficacy of these dietary adjuncts is limited. Bile acid-binding resins are the only approved drugs to lower cholesterol levels in children and appear to be well tolerated. However, compliance with resins is low because of unpalatability, so low dosages are preferred and vitamin supplementation is prudent. Data on HMG CoA reductase inhibitors and fibrates are insufficient to recommend these drugs at present. Drug treatment should be restricted to children who are at exceptionally high risk of disease, usually those with genetic dyslipidaemias.

Relation of total homocysteine and lipid levels in children to premature cardiovascular death in male relatives

We assessed the relative importance of lipid, apo B, lipoprotein(a) [Lp(a)], and total homocysteine (tHcy) levels in children in relation to premature cardiovascular disease in family members. Parents of 381 girls and 375 boys age 8-12 y completed family history questionnaires. Nonfasting serum lipid and lipoproteins and plasma tHcy and cysteine levels were measured in the children. Serum folate and vitamin B12 levels were determined in a random subsample of 23% of the children, who participated in a food frequency interview. Children whose parents reported hypercholesterolemia had higher total and non-HDL cholesterol and apo B levels than the rest, but these levels were not associated with cardiovascular disease. tHcy levels were similar in girls and boys. tHcy was higher in children whose father, grandfather, or uncle died at age < or = 55 y of myocardial infarction or sudden cardiac arrest (n = 42) than in control children [5.92 mumol/L (95% confidence interval [CI] of 5.47-6.36) versus 5.25 mumol/L (95% CI, 5.16-5.34)], also after adjustment for socioeconomic group. Intake and serum levels of vitamin B12 and folate were within recommended or reference ranges. In a stepwise multiple regression analysis, serum folate (negative correlation), plasma creatinine, and sugar intake as percent of dietary energy (positive correlations) were significantly associated with tHcy (multiple r = 0.44, adjusted r2 = 18%; 95% CI, 5-30%). Our data show that a modest elevation in tHcy in children was related to premature cardiovascular death in their male relatives and may partly account for the contribution of family history to risk of cardiovascular disease. tHcy may be modifiable through the diet, even in children with apparently adequate vitamin nutriture.

Cholesterol screening and family history of vascular disease

Hypercholesterolaemia is a major risk factor for the development of coronary heart disease (CHD). Early detection and management of hypercholesterolaemia could retard the atherosclerotic process. Given that CHD and hypercholesterolaemia cluster within families, a screening strategy based on a family history of vascular disease has been advocated. Serum total cholesterol concentrations were measured in a random stratified sample of 1012 children aged from 12-15 years old participating in a coronary risk factor surveillance study in Northern Ireland. Information about vascular disease in close family members was obtained by means of a questionnaire. The study population was divided into two groups according to total cholesterol values: (i) normal, < 5.2 mmol/l (n = 822) and (ii) raised, > or = 5.2 mmol/l (n = 190). A family history identified 63 out of 190 individuals with hypercholesterolaemia yielding a sensitivity of 33.2% and specificity of 71.5%. Our data indicated that a strategy whereby only children from high risk families are screened for hypercholesterolaemia is ineffective. While primary prevention emphasising a healthy diet for all is essential, the role of universal screening deserves further appraisal.

Establishing reference total serum cholesterol values for Saudi children

Total serum cholesterol was measured in 1320 normal Saudi children aged 0-14 years. The result was 3.88 (0.83) mmol/L [mean (SD)] and there was no statistical difference between girls and boys. Results were lowest in the 0-4 year age group and highest in the 5-9 year age group. Percentile values were established for three age groups and compared with those published for American children; no statistical differences were observed. Unlike other developing countries Saudi children do not have lower serum cholesterol than their western counterparts. We believe that these findings reflect changing dietary habits and increasing affluence in Saudi Arabia.

Lipid-lowering therapy--implications for the prevention of atherosclerosis

Lipid-lowering therapy has been advocated as a means to decrease the incidence of cardiovascular disease. The basis for this are results of animal studies, epidemiologic surveys, and intervention studies in man. There have been recommendations by national and international advisory boards regarding the aims and means of such interventional strategies. These have not been unanimously accepted, however. The present article will review the evidence on which intervention strategies may be based and the current status of the scientific discussion. The implications for future strategies to prevent atherosclerosis are discussed.