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Alieva A, Di Costanzo A, Gazzotti M, Reutova O, Usova E, Bakaleiko V, Arca M, D'Erasmo L, Pellegatta F, Galimberti F, Olmastroni E, Catapano AL, Casula M. Genetic heterogeneity of familial hypercholesterolaemia in two populations from two different countries. Eur J Intern Med 2024; 123:65-71. [PMID: 38245461 DOI: 10.1016/j.ejim.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a genetically determined monogenic disorder of predominantly autosomal dominant inheritance. A number of studies on differences in the genetic profile of patients with FH have demonstrated the importance of a more substantive evaluation of genetic features. The aim of this study was to evaluate the genetic profile of patients with clinical FH among Italian and Russian patients. METHODS We included 144 Italian and 79 Russian FH patients; clinical diagnosis was based on the same criteria. Patients were divided in: positive to genetic test (one causative variant), inconclusive (only variants of uncertain clinical significance [VUS]), and negative (with likely benign/benign variants, heterozygous variants in LDLRAP1 gene, or without causative variants). RESULTS The genetic test was positive in 76.4 % of the Italian patients and in 49.4 % of the Russian patients. The presence of VUS alone was detected in 7.6 % and in 19.0 % (p < 0.001), respectively. Among patients with positive genetic diagnosis, pre-treatment LDL-C levels were higher in the Russian cohort (353.5 ± 111.3 vs. 302.7 ± 52.1 mg/dL, p = 0.009), as well as the percentage of treated patients (53.8 % vs. 14.5 %, p < 0.001) and the prevalence of premature coronary heart disease (12.8 % vs. 3.6 %, p = 0.039). Among patients carrying only VUS, mean pre-treatment LDL-C levels were similar between the cohorts (299.5 ± 68.1 vs. 295.3 ± 46.8 mg/dL, p = 0.863). Among pathogenic/likely pathogenic variants and VUS, only 5 % and 4 % was shared between the two cohorts, respectively. CONCLUSION The genetic background of patients clinically diagnosed with FH in two different countries is characterized by high variability.
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Affiliation(s)
- Asiiat Alieva
- Almazov National Medical Research Centre, Saint Petersburg, Russia.
| | - Alessia Di Costanzo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Olga Reutova
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Elena Usova
- Almazov National Medical Research Centre, Saint Petersburg, Russia
| | | | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura D'Erasmo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Elena Olmastroni
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences (DisFeB), University of Milan, Milan, Italy
| | - Alberico L Catapano
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences (DisFeB), University of Milan, Milan, Italy
| | - Manuela Casula
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences (DisFeB), University of Milan, Milan, Italy
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Cardiero G, Ferrandino M, Calcaterra IL, Iannuzzo G, Di Minno MND, Buganza R, Guardamagna O, Auricchio R, Di Taranto MD, Fortunato G. Impact of 12-SNP and 6-SNP Polygenic Scores on Predisposition to High LDL-Cholesterol Levels in Patients with Familial Hypercholesterolemia. Genes (Basel) 2024; 15:462. [PMID: 38674396 PMCID: PMC11050365 DOI: 10.3390/genes15040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) comprises high LDL-cholesterol (LDL-c) levels and high cardiovascular disease risk. In the absence of pathogenic variants in causative genes, a polygenic basis was hypothesized. METHODS In a population of 418 patients (excluding homozygotes) with clinical suspicion of FH, the FH-causative genes and the regions of single nucleotide polymorphisms (SNPs) included in 12-SNP and 6-SNP scores were sequenced by next-generation sequencing, allowing for the detection of pathogenic variants (V+) in 220 patients. To make a comparison, only patients without uncertain significance variants (V-/USV-) were considered (n = 162). RESULTS Higher values of both scores were observed in V+ than in V-. Considering a cut-off leading to 80% of V-/USV- as score-positive, a lower prevalence of patients positive for both 12-SNP and 6-SNP scores was observed in V+ (p = 0.010 and 0.033, respectively). Mainly for the 12-SNP score, among V+ patients, higher LDL-c levels were observed in score-positive (223 mg/dL -IQR 187-279) than in negative patients (212 mg/dL -IQR 162-240; p = 0.006). Multivariate analysis confirmed the association of scores and LDL-c levels independently of age, sex, and presence of pathogenic variants and revealed a greater association in children. CONCLUSIONS The 12-SNP and 6-SNP polygenic scores could explain hypercholesterolemia in patients without pathogenic variants as well as the variability of LDL-c levels among patients with FH-causative variants.
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Affiliation(s)
- Giovanna Cardiero
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (G.C.); (M.F.); (G.F.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, 80145 Naples, Italy
| | - Martina Ferrandino
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (G.C.); (M.F.); (G.F.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, 80145 Naples, Italy
| | - Ilenia Lorenza Calcaterra
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (I.L.C.); (G.I.); (M.N.D.D.M.)
| | - Gabriella Iannuzzo
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (I.L.C.); (G.I.); (M.N.D.D.M.)
| | - Matteo Nicola Dario Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (I.L.C.); (G.I.); (M.N.D.D.M.)
| | - Raffaele Buganza
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università di Torino, 10126 Turin, Italy; (R.B.); (O.G.)
| | - Ornella Guardamagna
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università di Torino, 10126 Turin, Italy; (R.B.); (O.G.)
| | - Renata Auricchio
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80131 Naples, Italy;
| | - Maria Donata Di Taranto
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (G.C.); (M.F.); (G.F.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, 80145 Naples, Italy
| | - Giuliana Fortunato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (G.C.); (M.F.); (G.F.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, 80145 Naples, Italy
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Casula M, Gazzotti M, Capra ME, Olmastroni E, Galimberti F, Catapano AL, Pederiva C. Refinement of the diagnostic approach for the identification of children and adolescents affected by familial hypercholesterolemia: Evidence from the LIPIGEN study. Atherosclerosis 2023; 385:117231. [PMID: 37648636 DOI: 10.1016/j.atherosclerosis.2023.117231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND AIMS We aimed to describe the limitations of familiar hypercholesterolemia (FH) diagnosis in childhood based on the presence of the typical features of FH, such as physical sings of cholesterol accumulation and personal or family history of premature cardiovascular disease or hypercholesterolemia, comparing their prevalence in the adult and paediatric FH population, and to illustrate how additional information can lead to a more effective diagnosis of FH at a younger age. METHODS From the Italian LIPIGEN cohort, we selected 1188 (≥18 years) and 708 (<18 years) genetically-confirmed heterozygous FH, with no missing personal FH features. The prevalence of personal and familial FH features was compared between the two groups. For a sub-group of the paediatric cohort (N = 374), data about premature coronary heart disease (CHD) in second-degree family members were also included in the evaluation. RESULTS The lower prevalence of typical FH features in children/adolescents vs adults was confirmed: the prevalence of tendon xanthoma was 2.1% vs 13.1%, and arcus cornealis was present in 1.6% vs 11.2% of the cohorts, respectively. No children presented clinical history of premature CHD or cerebral/peripheral vascular disease compared to 8.8% and 5.6% of adults, respectively. The prevalence of premature CHD in first-degree relatives was significantly higher in adults compared to children/adolescents (38.9% vs 19.7%). In the sub-cohort analysis, a premature CHD event in parents was reported in 63 out of 374 subjects (16.8%), but the percentage increased to 54.0% extending the evaluation also to second-degree relatives. CONCLUSIONS In children, the typical FH features are clearly less informative than in adults. A more thorough data collection, adding information about second-degree relatives, could improve the diagnosis of FH at younger age.
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Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, 20133, Italy; IRCCS MultiMedica, Sesto San Giovanni, Milan, 20099, Italy.
| | - Marta Gazzotti
- Fondazione SISA (Società Italiana per lo Studio dell'Aterosclerosi), 20133, Milano, Italy
| | - Maria Elena Capra
- Centre for Paediatric Dyslipidaemias, Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121, Piacenza, Italy
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, 20133, Italy; IRCCS MultiMedica, Sesto San Giovanni, Milan, 20099, Italy
| | | | | | - Cristina Pederiva
- Clinical Service for Dyslipidaemias, Study and Prevention of Atherosclerosis in Childhood, Paediatrics Unit, ASST-Santi Paolo e Carlo, 20142, Milan, Italy
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Pederiva C, Gazzotti M, Arca M, Averna M, Banderali G, Biasucci G, Brambilla M, Buonuomo PS, Calabrò P, Cipollone F, Citroni N, D’Addato S, Del Ben M, Genovesi S, Guardamagna O, Iannuzzo G, Iughetti L, Mandraffino G, Maroni L, Mombelli G, Muntoni S, Nascimbeni F, Passaro A, Pellegatta F, Pirro M, Pisciotta L, Pujia R, Sarzani R, Scicali R, Suppressa P, Zambon S, Zenti MG, Calandra S, Catapano AL, Tarugi P, Galimberti F, Casula M, Capra ME. Clinical Approach in the Management of Paediatric Patients with Familial Hypercholesterolemia: A National Survey Conducted by the LIPIGEN Paediatric Group. Nutrients 2023; 15:3468. [PMID: 37571405 PMCID: PMC10420921 DOI: 10.3390/nu15153468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/18/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Detection and treatment of patients with familial hypercholesterolemia (FH) starting from childhood is fundamental to reduce morbidity and mortality. The activity of National realities such as the LIPIGEN (LIpid transPort disorders Italian GEnetic Network) Paediatric Group, founded in 2018, is a milestone in this context. The aim of this exploratory survey, conducted in October 2021 among Italian lipid clinics included in the LIPIGEN Paediatric Group, was to investigate the current clinical approach in the management and treatment of paediatric patients with suspected FH. A digital questionnaire composed of 20 questions investigating nutritional treatment and nutraceutical and pharmacological therapy for children and adolescents with FH was proposed to the principal investigators of 30 LIPIGEN centres. Twenty-four centres responded to the section referring to children aged < 10 years and 30 to that referring to adolescents. Overall, 66.7% of children and 73.3% of adolescents were given lipid-lowering nutritional treatment as the first intervention level for at least 3-4 months (29.2% and 23.3%) or 6-12 months (58.3% and 53.3%). Nutraceuticals were considered in 41.7% (regarding children) and 50.0% (regarding adolescents) of the centres as a supplementary approach to diet. Lipid-lowering drug therapy initiation was mainly recommended (91.7% and 80.0%). In 83.3% of children and 96.7% of adolescents, statins were the most frequently prescribed drug. We highlighted several differences in the treatment of paediatric patients with suspected FH among Italian centres; however, the overall approach is in line with the European Atherosclerosis Society (EAS) recommendations for FH children and adolescents. We consider this survey as a starting point to reinforce collaboration between LIPIGEN centres and to elaborate in the near future a consensus document on the management of paediatric patients with suspected FH so as to improve and uniform detection, management, and treatment of these patients in our country.
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Affiliation(s)
- Cristina Pederiva
- Clinical Service for Dyslipidaemias, Study and Prevention of Atherosclerosis in Childhood, Paediatrics Unit, ASST-Santi Paolo e Carlo, 20142 Milan, Italy
| | - Marta Gazzotti
- Fondazione SISA (Società Italiana per lo Studio dell’Aterosclerosi), 20133 Milan, Italy
| | - Marcello Arca
- Dipartimento di Medicina Traslazionale e di Precisione, Università La Sapienza di Roma, 00185 Rome, Italy
- AO Policlinico Umberto I, 00161 Rome, Italy
| | - Maurizio Averna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
- Istituto di Biofisica, Consiglio Nazionale Delle Ricerche, 90146 Palermo, Italy
| | - Giuseppe Banderali
- Clinical Service for Dyslipidaemias, Study and Prevention of Atherosclerosis in Childhood, Paediatrics Unit, ASST-Santi Paolo e Carlo, 20142 Milan, Italy
| | - Giacomo Biasucci
- Centre for Paediatric Dyslipidaemias, Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Marta Brambilla
- Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Paola Sabrina Buonuomo
- Rare Diseases and Medical Genetic Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, 00163 Rome, Italy
| | - Paolo Calabrò
- UOC Cardiologia Clinica a Direzione Universitaria e UTIC, AORN “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy;
- Dipartimento di Scienze Mediche Traslazionali, Università Degli Studi Della Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Francesco Cipollone
- Clinica Medica, Centro di Alta Specializzazione per la Prevenzione dell’Aterosclerosi, Centro di Eccellenza ESH per L’ipertensione Arteriosa, Centro di Riferimento Regionale per le Dislipidemie, Ospedale Policlinico SS Annunziata, 66100 Chieti, Italy
| | - Nadia Citroni
- Centro Dislipidemie e Aterosclerosi, Ospedale di Trento, APSS-Trento, 38122 Trento, Italy
| | - Sergio D’Addato
- UO di Medicina Interna Cardiovascolare, Ambulatorio Dislipidemie, Università di Bologna, 40138 Bologna, Italy
- IRCCS S Orsola, 40138 Bologna, Italy
| | - Maria Del Ben
- AO Policlinico Umberto I, 00161 Rome, Italy
- Dipartimento Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Università La Sapenza di Roma, 00161 Rome, Italy
| | - Simonetta Genovesi
- Istituto Auxologico Italiano, 20149 Milan, Italy
- Dipartimento di Medicina e Chirurgia, Università di Milano-Bicocca, 20126 Milan, Italy
| | - Ornella Guardamagna
- Department of Public Health and Paediatric Sciences, Turin University, 10126 Turin, Italy
| | - Gabriella Iannuzzo
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Lorenzo Iughetti
- U.O.C. Pediatria, Azienda Ospedaliero Universitaria di Modena, 41124 Modena, Italy
| | - Giuseppe Mandraffino
- Department of Clinical and Experimental Medicine, Lipid Centre, University Hospital G Martino, 98100 Messina, Italy
| | - Lorenzo Maroni
- Ambulatorio Ipertensione Dislipidemie, UO Medicina Generale, ASST Valle Olona, Ospedale di Gallarate, 21013 Gallarate, Italy
| | - Giuliana Mombelli
- Centro Dislipidemie ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Sandro Muntoni
- Dipartimento di Scienze Biomediche, Università Degli Studi di Cagliari, 09124 Cagliari, Italy
- Centro per le Malattie Dismetaboliche e l’Arteriosclerosi, Associazione ME DI CO Onlus Cagliari, 09123 Cagliari, Italy
| | - Fabio Nascimbeni
- UO Medicina Interna Metabolica, Lipidology Centre, Baggiovara Hospital, AOU of Modena, 41126 Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Angelina Passaro
- Centro per lo Studio e il Trattamento Delle Malattie del Metabolismo, Aterosclerosi e Nutrizione Clinica, Azienda Ospedaliera-Universitaria S Anna di Ferrara, 44124 Ferrara, Italy
- Dipartimento di Medicina Traslazionale e per la Romagna, Università degli Studi di Ferrara, 44122 Ferrara, Italy
| | - Fabio Pellegatta
- IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
- Centro per lo Studio dell’Aterosclerosi, Ospedale E Bassini, 20092 Cinisello Balsamo, Italy
| | - Matteo Pirro
- Sezione Medicina Interna, Angiologia e Malattie da Arteriosclerosi, Dipartimento di Medicina e Chirurgia, Università Degli Studi di Perugia, 06132 Perugia, Italy
| | - Livia Pisciotta
- IRCCS Ospedale Policlinico San Martino UOSD Dietetica e Nutrizione Clinica, Dipartimento di Medicina Interna, Università di Genova, 16132 Genoa, Italy
| | - Roberta Pujia
- Dipartimento Scienze Mediche Chirurgiche, Università Degli Studi Magna Graecia, 88100 Catanzaro, Italy
| | - Riccardo Sarzani
- Clinica Medica e Geriatrica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica Delle Marche, 60126 Ancona, Italy
- IRCCS-INRCA, 60124 Ancona, Italy
| | - Roberto Scicali
- Department of Clinical and Experimental Medicine, University of Catania, Ospedale Garibaldi, 95122 Catania, Italy
| | - Patrizia Suppressa
- Department of Internal Medicine and Rare Diseases Centre “C. Frugoni”, University Hospital of Bari, 70124 Bari, Italy;
| | - Sabina Zambon
- Dipartimento di Medicina, Università di Padova, 35128 Padua, Italy
| | - Maria Grazia Zenti
- Servizio di Diabetologia e Malattie Metaboliche “Ospedale P. Pederzoli”, Casa di Cura Privata, 37019 Peschiera del Garda, Italy
| | - Sebastiano Calandra
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | | | - Patrizia Tarugi
- Department of Life Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | | | - Manuela Casula
- IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy
| | - Maria Elena Capra
- Centre for Paediatric Dyslipidaemias, Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
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Capra ME, Biasucci G, Crivellaro E, Banderali G, Pederiva C. Dietary intervention for children and adolescents with familial hypercholesterolaemia. Ital J Pediatr 2023; 49:77. [PMID: 37349839 DOI: 10.1186/s13052-023-01479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/25/2023] [Indexed: 06/24/2023] Open
Abstract
Familial hypercholesterolaemia (FH) is a frequent genetic disorder characterised by high plasma levels of total and LDL-cholesterol and premature atherosclerosis. If left untreated, affected subjects have a high risk of cardiovascular disease, as they are exposed to very high levels of LDL-cholesterol from birth. Healthy dietary habits and lifestyle are the first treatment option and, if started from childhood, represent a milestone in the prevention of atherosclerotic disease, both as a starting point and in combination with drug therapy. In this work, based on the main consensus documents available so far, we have evaluated the most up-to-date indications of the dietetic-nutritional intervention for the treatment of FH, delving into the peculiar aspects of the diet of the child/adolescent affected by FH. After an analysis of the macro- and micronutrients and the most common dietary patterns currently recommended, we highlighted some practical aspects, some frequent errors and some risks we could fall into when dealing with paediatric nutritional treatment. In conclusion, the dietary intervention for the child/adolescent with FH is a complex task, that should be individualised and tailored taking into account, first of all, the nutritional adequacy for growth and development, but also the multiple aspects linked to the child/adolescent's age, tastes and preferences, the family they belong to, the socio-economic context and the Country they live in.
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Affiliation(s)
- Maria Elena Capra
- Centre for Paediatric DyslipidaemiasPaediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, University of Parma, 29121, Piacenza, Italy
- Department of Translational Medical and Surgical Sciences, University of Parma, 43126, Parma, Italy
- Società Italiana Di Nutrizione Pediatrica (SINUPE), 20126, Milan, Italy
| | - Giacomo Biasucci
- Centre for Paediatric DyslipidaemiasPaediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, University of Parma, 29121, Piacenza, Italy.
- Società Italiana Di Nutrizione Pediatrica (SINUPE), 20126, Milan, Italy.
| | | | - Giuseppe Banderali
- Società Italiana Di Nutrizione Pediatrica (SINUPE), 20126, Milan, Italy
- Clinical Service for DyslipidaemiasStudy and Prevention of Atherosclerosis in ChildhoodPediatrics Unit, ASST-Santi Paolo E Carlo, 20142, Milan, Italy
| | - Cristina Pederiva
- Società Italiana Di Nutrizione Pediatrica (SINUPE), 20126, Milan, Italy
- Clinical Service for DyslipidaemiasStudy and Prevention of Atherosclerosis in ChildhoodPediatrics Unit, ASST-Santi Paolo E Carlo, 20142, Milan, Italy
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