Case Studies in Pediatric Lipid Disorders and Their Management

Abstract

Context Identification of modifiable risk factors, including genetic and acquired disorders of lipid and lipoprotein metabolism is increasingly recognized as an opportunity to prevent premature cardiovascular disease (CVD) in at-risk youth. Pediatric endocrinologists are at the forefront of this emerging public health concern and can be instrumental in beginning early interventions to prevent premature CVD-related events during adulthood. Aim In this article, we use informative case presentations to provide practical approaches to the management of pediatric dyslipidemia. Cases We present three scenarios which are commonly encountered in clinical practice: isolated elevation of low-density lipoprotein cholesterol (LDL-C), combined dyslipidemia, and severe hypertriglyceridemia. Treatment with statin is indicated when the LDL-C is ≥190 mg/dL (4.9 mmol/L) in children ≥10 years of age. For LDL-C levels between 130-189 mg/dL (3.4 – 4.89 mmol/L) despite dietary and lifestyle changes, the presence of additional risk factors and comorbid conditions would favor statin therapy. In the case of combined dyslipidemia, the primary treatment target is LDL-C ≤130 mg/dL (3.4 mmol/L) and the secondary target non-HDL-C <145 mg/dL(3.7 mmol/L). If the triglyceride is ≥400 mg/dL (4.5 mmol/L), prescription omega-3 fatty acids and fibrates are considered. In the case of triglyceride >1000 mg/dL (11.3mmol/L), dietary fat restriction remains the corner stone of therapy, even though the landscape of medications is changing. Conclusion Gene variants, acquired conditions or both are responsible for dyslipidemia during childhood. Extreme elevations of triglycerides can lead to pancreatitis. Early identification and management of dyslipidemia and cardiovascular risk factors is extremely important.

Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

“…To address triglycerides, decrease sugar intake and consumption of sugary beverages, and increase complex carbohydrate and fiber intake. LDL-C and non-HDL-C may be addressed by reducing saturated fat intake to <10% of total daily intake and increasing fiber intake [ 59 , [62] , [63] , [64] ]. Polyunsaturated or monounsaturated fats may be substituted [ 65 ].…”