Chapter 8

Topic 4
Minawati
Nuriyatul Millah
Shinta Putri Sumanda

Lowering Cholersterol In The

Population
In The Report of the Expert Panel on
Population Strategies for Bbbblood Cholesterol
Reduction, similar CHD risk factors are
identified as in the ATP III report and similar
total cholesterol and LDL-C cuttof points are
use in classifying persons.

 This fact, along with a decrease in cigarette

smoking and a possible increase in leaisuretime physical activity have no doubt
contributed to the nearly 60% declined in
heart disease mortality between 1950 and
2000.
Several studies have shown that cholesterol
lowering can slow the progression of and even
reverse arthelosclerotic narrowing.

 The conclusion now seems inescapable that

definite regression can be expected in 16% to
47% of patients, provided that large decrease
in LDL-Cholesterol ( of the order 34% to 48% )
are induced for period of 2 to 5 years.

Coronary Heart Disease in Children

and Adolescents
Data from a number of researchers
studying the development and
progression of coronary artery lesions in
infants and children support the view
that atherosclerosis begins in childhood
and progresses slowly into adulthood.

 Evidence from the Pathobiological

Determinants of atherosclerosis in Youth
( PDAY ) study, for example, indicates that
early atherosclerosis lesion in the
coronary arteries of adolescents and
young adults are associated with
smoking, high serum total cholesterol,
LDL-C and VLDL-C levels, and low HDL-C
levels.

 Other researchers has shown that

children in U.S. have higher cholesterol
levels than their counterparts in many
other country, this is probably because
they have a higher intake o saturated
fatty acids and dietary cholesterol.

Reducing The Cholesterol Levels

in Children and Adolescent

 Prevention of CHD needs to begin in

Childhood
The Report of the Expert Panel on Blood
Cholesterol Levels in Children and Adolescent
makes both patient-based and populationbased recommendations for reducing
cholesterol levels in these age group

Population-Based Recommendations
The goal: to lower average population levels of
blood cholesterol in children and adolescents
in order to reduce the incidence of adult CHD
and generally to improve health.
Nutritional adequacy be achieved by eating a
wide variety of foods
That energy be adequate to support growth
and development and to reach or maintain
desirable body weight

Patient Based Approach

The goal: to identify those children and
adolescent with elevated serum cholesterol level
or with other CHD risk factor that are likely to
increase their risk factor for CHD as adults
The Expert Panel did recommend, however,
serum cholesterol be measured in a spesific
subgroup of youth, those at greatest risk of
having blood cholesterol as adults and an
increased risk for CHD

The Expert Panel suggested that the folloeing

children and adolescent, be screened for elevated
cholesterol and other risk factor:
Those whose parents have coronary
arterosclerosis or had balloon angioplasty or
coronary artery baypass surgery
Those whose parents suffered documented
myocardial infarction, angina pactoris,
peripheral vascular deseae, etc
Those with parents having high serum
cholesterol
Those whose parental history is unknown

Rik Factor That May Contribute to

Early Onset of CHD

Family history of premature CHD

Cigarette Smoking
Elevated Blood Pressure
Low HDL
Overweight
Diabetes Melitus
Physical Inactivity

 The panel recommended that a childs total

cholesterol be measured when his or her
parent has high blood cholesterol
Once a borderline-high or high blood
cholesterol is established, then lipoprotein
analysis is recommended

Dietary Treatment in Coronary

Heart Deseae

Do lipoprotein analysis

Acceptable LDL
cholesterol < 110mg/dL

Borderline LDL
cholesterol 100-129
mg/dL

High LDL cholesterol

>=130 mg/dL

Provide education on
recommended eating
pattern and risk factor
reduction

Risk factor advice,

follow AHA dietary
guidelines, other risc
factor intervention

Do clinical evaluation,
screen all family
members, set goal LDL,
follow AHA diatary
guidelines

 Government agencies and private organization

have developed a variety of dietary and
lifestyle recommendations and promoting
healty levels of serum lipids and lipoprotein
and for reducing overall CHD risk.
Consistent features among these various
recommendations have been limiting
consumption of food rich in tolat fats,
saturated fatty acid, and dietary
cholesterol;maintaining a healty body weight
by balancing energy intake with energy
expenditure.

Saturated Fatty Acids

Saturated fatty acids (SFA) are the most
important dietary determinant of serum total
cholesterol and LDL-C levels. One exception to
this rule is stearic acid (18:0), an SFA that appears
to have a neutral effect on serum cholesterol and
lipoprotein levels. Moderation should still be
practiced in the consumption of fats high oin
stearic acid, such as beef fat and cocoa butter,
because these fats contain a subtantial amount of
the other SFAs that raise serum cholesterol.

During the past several decades, average

SFA intake among Americans has declined
from a high of nearly 20% of energy to the
current level of 11,4%. However, more
progress is needed in further reducing SFA
intake to meet the American Heart
Association's goals. This can be done by
identifying foods rich in saturated fat and
substituting foods containing less saturated
fat. Particular attention should be given to
monitoring the intake of these foods when
evaluating the diets of persons with elevated
serum levels of total cholesterol and LDL-C.

Trans Fatty Acids

Consumption of dietary trans unsaturated
fatty acid increases LDL-C and reduces HDL-C.
Although saturated fatty acids appear to increase
LDL-C to a somewhat greater extent than a equal
amount of dietary trans unsaturated fatty acids,
the detrimental effects of dietary trans
unsaturated fatty acids on serum lipid and
lipoprotein levels has led to recommendations to
limit intake of foods rich in trans unsaturated
fatty acids.

Trans fatty acids are unsaturated fatty acids

containing at least one double bond in the trans
configuration. However, unsaturated trans fatty
acids naturally occur at relatively low levels in
meat and dairy foods as by-products of
fermentation in ruminant animals. The richest
sources of trans fatty acids are partially
hydrogenated vegetable fats, such as vegetable
shortening and some margarines. With the
introduction of mandatory trans fat labelling on
January 1, 2006, it is easier for consumers to
identify and limit their consumption of trans fatty
acids.

Thank You!!!