Abstract P182: Gender Difference in Response to Lifestyle Therapy in Obese Children with Combined Dyslipidemia
Combined dyslipidemia(CDL) [moderate to severe elevation in triglyceride (TG), decreased HDL-cholesterol (HDL), mild elevation in total (TC) and LDL-cholesterol (LDL)] is common in obese children. Primary treatment is lifestyle change. We reviewed the response to a standard staged approach in consecutive children with CDL referred to a pediatric cardiology prevention clinic who returned for follow-up(F/U). The clinical protocol uses the same physician/ registered dietitian team to prescribe a change in diet composition (fat free milk; no sugar-sweetened beverages; simple carbohydrates replaced with complex carbohydrates) and daily exercise (1/2 hr/d of moderate exercise beyond current activity). Patients return at 3 m intervals and are discharged when TG and LDL have normalized; calorie control and/or medication are not introduced until the primary approach has been unsuccessful at second F/U. Over the last 21 mos, 53 pts(52 % male) have been managed with this approach. At baseline (B/L), mean age was 12.9+3y with no significant difference between males(Ms) and females(Fs). In 94%, B/L BMI was > 95th%ile. RESULTS (mean + SD):
|ALL||F/U 1||F/U 2||MALE||F/U 1||F/U 2||FEMALE||F/U 1||F/U 2|
For all pts, there was a significant mean decrease in TC (p=.007) and TG (p=.001) at the first F/U visit, sustained at second F/U with no significant change in LDL or HDL. The mean decrease in TC was similar in Ms(p=.028) and Fs(p=.022) but decrease in TG was greater in Ms(39%)(p=.0003) than in Fs (23%)(p=.036) (p=.059 between Ms and Fs). At F/U 2, 50% of Ms vs 20% of Fs had normalized TC and TG levels (p=.043). Although there was no specific approach to weight loss, mean BMI decreased by 0.4 kg/m2, with no difference between Ms and Fs. CONCLUSIONS: (1) A simple lifestyle change focused on change in diet composition and daily exercise can significantly improve CDL in obese children on short term F/U, without weight loss; (2) Normalization of the lipid profile is significantly more common in Ms than Fs. If confirmed in a prospective trial, these are potentially important findings for this large and growing patient group.
- © 2012 by American Heart Association, Inc.