BACKGROUND:
Lifestyle change is recommended by the 2011 NHLBI Expert Panel Integrated Guidelines as the cornerstone of pediatric lipid management. Using a Standardized Clinical Assessment and Management Plan (SCAMP)© (IRCDA Inc, Boston MA) as an implementation tool, we examined in a real-world setting the effect of making 3 lifestyle goals on lipid levels in youth referred to a pediatric Preventive Cardiology clinic.
METHODS:
Prospectively collected anthropometric, clinical, and laboratory data were analyzed on youth referred for lipid abnormalities between September 2010 and March 2014. Percent change in lipid fractions from baseline to last follow-up was calculated. Lifestyle recommendations given at initial visit were predictors of interest considered individually and as groups of 3. Multivariable adjusted linear regression was used to identify lifestyle combination trios that were associated with dyslipidemia change.
RESULTS:
Among 325 patients (55% female, median follow-up time 17 [IQR 10,28] months; mean age 13±4yrs], high LDL (>130 mg/dL) was present in 62%, high TG (> 150 mg/dL) in 35%, and low HDL (<40 mg/dL) in 28%. In those with the relevant lipid abnormality, LDL decreased by 11±17%, TG declined by 22±35% and HDL improved by 15±35%. Overall, BMI percentile declined by 2 points. The most common lifestyle goals given were ‘decrease saturated/trans fat’ (63%), ‘increase vegetables/fruit’ (61%), ‘increase exercise’ (55%), ‘continue exercise’ (35%), and ‘decrease glycemic index’ (30%). In those with HDL<40 adjusted for age and sex, ‘increase fish and nuts’ was associated with HDL improvement (6.52mg/dL[ 2.38,10.66];p=0.002) but, unexpectedly, ‘increase vegetables/fruit’ was associated with worse HDL (-3.87mg/dL[95%CI-6.75,-0.99]; p=0.01). In those with TG>150 as expected, ‘decrease fast food/eating out’ was associated with lower TG (37%[13,54]; p=0.006). After adjustment for age, sex, baseline lipid level, and BMI percentile change, the trio of ‘increasing vegetables/fruit’, ‘decreasing saturated/trans fat’, and ‘continue exercise’ was associated with lower LDL (-17.64mg/dL[-3.62,-31.56];p=0.01). Intriguingly, substituting ‘increase exercise’ instead of ‘continue exercise’ in this trio was not associated with lipid change.
CONCLUSIONS:
In a real-world cohort of dyslipidemic youth, providing lifestyle goals was associated with favorable lipid changes, with some combinations showing particular benefits. More data is warranted to explore the effect of specific lifestyle goal combinations in youth.
Promoting analysis of real-world data: Prospects for preventive cardiology in Japan