title: Plant sterols-enriched diet decreases small, dense LDL-cholesterol levels in children with hypercholesterolemia: a prospective study.
abstract: BACKGROUND
  Small dense low density lipoprotein-cholesterol (sdLDL-C) molecules are more atherogenic compared with large buoyant ones. Phytosterols-enriched diets are effective in decreasing total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) concentrations in hyperlipidemic children without significant adverse effects. Limited data on the impact of such a diet on sdLDL-C levels is available in adults while there are no reports concerning children. The purpose of this study is to prospectively evaluate the effect of the daily consumption of 2 g of plant sterols on sdLDL-C levels in children with hypercholesterolemia.
  
  
  METHODS
  Fifty-nine children, 25 with LDL-C ≥ 3.4 mmol/l (130 mg/dl) and 34 with LDL-C < 3.4 mmol/l, aged 4.5-15.9 years, were included in the study. A yogurt-drink enriched with 2 g of plant sterols was added to the daily diet of hypercholesterolemic children and 6-12 months later lipid profiles were reassessed. Direct quantitative methods were used to measure LDL-C and sdLDL-C levels.
  
  
  RESULTS
  The consumption of plant sterols reduced sdLDL-C significantly (p < 0.001), but levels remained higher compared with controls (p < 0.001). TC, LDL-C, non high density lipoprotein-cholesterol (NonHDL-C) and apolipoprotein B (ApoB) levels also decreased significantly (p < 0.05). The median reduction of sdLDL-C and LDL-C was 16.6% and 13%, respectively. These variables decreased >10% in sixteen children (64%), independently from baseline levels, sex, age and body mass index (BMI). High density lipoprotein-cholesterol (HDL-C), lipoprotein a [Lp(a)], and triglycerides (TGs) levels remained unaffected.
  
  
  CONCLUSIONS
  Plant sterols decrease sdLDL-C significantly and may be beneficial for children with hypercholesterolemia.
authors.affiliation: Lipid Outpatient Clinic, Second Department of Pediatrics, Athens University, Athens, Greece. garoufi@yahoo.gr.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Garoufi
authors.forename: Styliani
authors.initials: S
authors.lastname: Vorre
authors.forename: Alexandra
authors.initials: A
authors.lastname: Soldatou
authors.forename: Charalampos
authors.initials: C
authors.lastname: Tsentidis
authors.forename: Lydia
authors.initials: L
authors.lastname: Kossiva
authors.forename: Antonios
authors.initials: A
authors.lastname: Drakatos
authors.forename: Antonios
authors.initials: A
authors.lastname: Marmarinos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Gourgiotis
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects; D004032:Diet / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000178:diet therapy*; D008297:Male; D009391:Nephelometry and Turbidimetry; D010840:Phytosterols / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D010840:Phytosterols