Combined dyslipidemia in obese children: Response to a focused lifestyle approach

► Combined dyslipidemia is seen in children with obesity, insulin resistance, and type 2 diabetes.
► Prior management focuses on weight loss and low-density lipoprotein cholesterol.
► Practical management protocol for diet composition change and increased activity.
► Protocol with no initial focus placed on weight loss.
► Practical lifestyle approach improves lipid profile and decreases BMI in obese children.

BackgroundCombined dyslipidemia (elevated triglyceride [TG] ± non–high-density lipoprotein cholesterol [non-HDL-C] ± total cholesterol [TC] ± low-density lipoprotein cholesterol [LDL-C] ± reduced high-density lipoprotein cholesterol [HDL-C]) is seen in >40% of obese children. Primary recommended treatment is weight loss with limited reports of any other approach.ObjectiveIn children with combined dyslipidemia, evaluate the response to a clinical protocol focused on diet composition change and increased activity with no direct weight loss approach.MethodsRetrospective review of lipid profile and growth parameter changes in patients 6 to 18 years of age with diagnosis of combined dyslipidemia seen between December 31, 2009, and December 31, 2011, managed with this protocol through 2 follow-up visits. Combined dyslipidemia diagnosed when ≥2 lipid values exceed the upper limit of normal for TC, TG, non-HDL-C, or LDL-C ± HDL-C below the lower limit of normal.ResultsFifty-three patients were identified, 55% male, 92% obese, mean age 12.1 ± 3.4 years with mean follow-up 9.2 months. Lipid parameters (mean ± SD, mg/dL) improved significantly (P < .001): TC 209 ± 39 to 181 ± 32; TG 255 ± 119 to168 ± 99; non-HDL-C 167 ± 35 to 138 ± 30 and LDL-C 121 ± 43 to 106 ± 30. HDL-C was unchanged. Body mass index decreased in 58% and mean body mass index decreased 0.67 kg/m2 (P < .05).ConclusionsFocused lifestyle changes significantly improved combined dyslipidemia in obese children. With no direct weight loss approach, body mass index decreased in 58%.