Main Text
Introduction
Familial Hypercholesterolaemia and atherosclerosis
Evidence on nutritional intervention in patients with FH
Lifestyle and nutrition to improve lipid profile: what do we know?
Lipids
Carbohydrates and fibres
Body weight reduction
Dietetic models
Mediterranean diet | Nordic diet | Dietary Approaches to Stop Hypertension (DASH) diet |
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Based on Greece and Southern Italy traditional diet. Refers to olive oil as principal dietary fat sources | Based on locally grown, seasonal food typical of the Nordic countries | Originally develop and used in the DASH trials to lower blood pressure |
High in fibre intake and mono saturated fatty acids, white low in saturated fat | Rich in dietary fibre, ow in sugar and sodium | Rich in dietary fibre, potassium, calcium, low in saturated fat, restricted in sodium |
• High intake of plant-based foods, such as fresh fruits, vegetables, legumes and nuts | • High intake of apple pears and berries, root, cabbages, cruciferous vegetables, potatoes, nuts and seeds | • Abundant amount of fruits and vegetables, pulses, nuts and seeds |
• Daily intake of cereals (especially whole grain) | • High intake of whole grain oats and rye bread | • Regular consumption of whole grain |
• Moderate consumption of fish (mainly blue fish) | • High intake of fish and seafood | • Fish intake |
• Moderate consumption of dairy products (yogurt and cheese) | • Prefer low fat dairy products | • Increase consumption of fat free or low fat dairy products, reduced full-fat dairy products |
• Low intake of red/processed meat; prefer chicken turkey. Sheep, goat | • Rarely red meats | • Prefer poultry to processed meat; limit high fat meat |
• Olive oil as main source of culinary fat | • Use of vegetable fat (margarine, rapeseed oil) | • Use vegetable oils; limits tropical oils |
• Low intake of sweets; wine allowed with meals, in moderation | • Avoid sugar-sweetened beverages or added sugar | Limits sweets and sugar sweetened foods and beverages |
Secondary hypercholesterolaemia
NUTRITIONAL MANAGEMENT OF CHILDREN/ADOLESCENTS WITH OVERWEIGHT AND/OR OBESITY |
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• Assessment of the child/adolescent’s and his/her family nutritional habits |
• Investigate on meal composition, portions, weekly food frequency, cooking methods, food presentation |
• Start with dietary avice |
DIETARY ADVICE FOR CHILDREN/ADOLESCENTS WITH OVERWEIGHT AND/OR OBESITY |
• Eat three meals and no more than two snacks per day |
• Consume adequate breakfast |
• Do not nibble between main meals |
• Avoid junk food |
• Increase daily amount of fruit, vegetables and fiber-rich cereals |
• Aged adequate portion |
Nutritional advice for children and adolescents with FH
General intervention
Children and adolescents with FH
STEP ONE DIET |
• Total fat ≤ 30% (no less than 20%) of total daily calories |
• Saturated fats < 10% of total daily calories |
• Polyunsaturated fats ≤ 10% of total daily calories |
• Cholesterol ≤ 300 mg/day |
STEP TWO DIET |
• Total fat ≤ 30% (no less than 20%) of total daily calories |
• Saturated fats < 7% of total daily calories |
• Polyunsaturated fats ≤ 10% of total daily calories |
• Cholesterol ≤ 200 mg/day |
Frequent mistakes and possible risks
Food restriction
Calcium intake
FOOD | CALCIUM (mg/100 g) |
---|---|
Cow’s milk | 1323 |
Parmesan cheese | 1165 |
«Crescenza» cheese | 557 |
«mozarella» cheese | 350 |
Rocket salad | 309 |
«Ricotta» cheese | 295 |
Almonds | 240 |
Dried figs | 186 |
Baked anchovies | 165 |
Chicory | 150 |
Beans | 135 |
Goat yogurt | 124 |
Semi skimmed cow milk yogurt | 120 |
Radish | 115 |
Artichoke | 86 |
Meal | Calcium rich food | Calcium (mg) |
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Breakfast | One greek yogurt (125 mg) | 188 |
Break | 20 almonds | 72 |
Lunch | Rocket salad 80 g | 247 |
200 ml of calcium-rich water | 80 | |
Break | 3 dried figs | 56 |
Dinner | Beans (100 g) | 135 |
Parmesan cheese on first course (10 g) | 116 |
Polyunsaturated fatty acids
Fish species | Anchovies | Sardine | Hake | Trout | Eel | Pangsius |
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Total pufa (g/100 g) | 45.96 | 36.32 | 40.70 | 31.24 | 17.40 | 15.55 |
Sum of (n-3) | 42.66 | 33.50 | 35.90 | 24.62 | 9.72 | 4.43 |
Sum of (n-6) | 3.30 | 2.82 | 4.80 | 6.61 | 7.66 | 11.11 |
(n-3) (n-6) | 12.9 | 11.9 | 7.3 | 3.72 | 1.26 | 0.40 |
Fish species | Bread sea bass | Wild sea bass | Bred daurade | Wild daurade | Bred salmon | Wild salamon |
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Total lipid content (g) | 9.36 | 2.15 | 11.13 | 7.37 | 12.3 | 6.3 |
Total PUFA (g/100 g) | 30.89 | 31.50 | 30.70 | 16.48 | 300.4 | 26.2 |
C 22: 6n-3 | 10.79 | 12.06 | 10.93 | 3.31 | 8.4 | 12.5 |
Sum of (n-3) | 22.70 | 23.66 | 24.07 | 12.06 | 21.2 | 24.4 |
Sum of (n-6) | 8.19 | 7.84 | 6.64 | 4.42 | 9.2 | 1.8 |
(n-3) (n-6) | 2.77 | 3.02 | 3.63 | 2.73 | 2.3 | 13.6 |
Type of nuts | Number of pieces per portion |
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Nuts | 8 |
Almond | 25 |
Hazelnut | 28 |
Pistachios | 50 |