Dietary modifications for managing familial hypercholesterolaemia

Familial hypercholesterolaemia is an inherited disorder characterised by a raised blood cholesterol, and premature ischaemic heart disease. Changing diet is an important management option to reduce low-density lipoprotein cholesterol (the bad cholesterol) levels. Recently, certain lipid-lowering drugs have shown to be safe and effective for the treatment of children with familial hypercholesterolaemia. However, dietary management remains important either on its own or combined with drug therapy. Several strategies are used to modify diet. This review aimed to compare cholesterol-lowering dietary interventions either in combination with each other or alone. These interventions included adding omega-3 fatty acids or plant sterols or plant stanols or soya proteins to diet. Eleven studies were included in the review. All the studies were short term and the majority were cross-over in design. For most of the comparisons there was no significant difference in the various intervention strategies when compared to cholesterol-lowering diet. However, for total cholesterol levels when plant sterols were compared with a cholesterol-lowering diet, a significant benefit was obtained with plant sterols. However, before drawing any conclusions, methodological problems with pooling results from cross-over studies should be considered. There is an imminent need for long-term trials with parallel group design to assess the potential benefits and harms of a cholesterol-lowering diet.