Flaxseed in Pediatric Hyperlipidemia

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JAMA Pediatrics Journal Club Slides: Flaxseed in Pediatric Hyperlipidemia

Wong H, Chahal N, Manlhiot C, Niedra E, McCrindle BW. Flaxseed in pediatric hyperlipidemia: a placebo-controlled, blinded, randomized clinical trial of dietary flaxseed supplementation for children and adolescents with hypercholesterolemia. JAMA Pediatr. Published online June 3, 2013. doi:10.1001/jamapediatrics.2013.1442.


• Background

– Elevated lipid profiles in youth are risk factors for early development of atherosclerotic lesions and cardiovascular disease.

– Pharmacologic interventions are used when lifestyle approaches fail to decrease low-density lipoprotein cholesterol within acceptable ranges.

– Dietary flaxseed may be a functional food that contains agents hypothesized to have hypolipidemic activity and/or other properties that may benefit cardiovascular health.

• Study Objective

– To determine the safety and efficacy of dietary flaxseed supplementation in the management of hypercholesterolemia in children.

Introduction


• Study Design

– Placebo-controlled, randomized clinical trial.

– Duration of intervention: 4 weeks.

• Setting

– Specialized dyslipidemia clinic at a tertiary pediatric care center.

• Patients

– 32 participants aged 8 to 18 years.

– Low-density lipoprotein cholesterol from 135 mg/dL (3.5 mmol/L) to less than 193 mg/dL (5.0 mmol/L).

Methods


• Patients

– The intervention group ate 2 muffins and 1 slice of bread daily containing ground flaxseed (30 g flaxseed total).

– The control group ate muffins and bread substituted with whole-wheat flour.

Nutritional Content per Serving of Muffins and Breads Used in the Study

Methods


Methods

• Outcomes– Primary: Attributable change in fasting lipid profile levels of high-density

lipoprotein cholesterol and triglycerides.– Secondary: Attributable change in fasting total cholesterol, low-density

lipoprotein cholesterol, body mass index z score, and total caloric intake.

• Limitations

– Flaxseed may lose nutritional value and thus effectiveness when ground for the consumption of muffins and bread by pediatric patients.

– Increases in body mass index and daily caloric intake were noted in both study groups during the trial.

– Compliance assessments were based on self-report from patient-completed intake logs and not through a direct biological measure.

– Small sample size (n = 32) and short duration of intervention (4 weeks).


Results

Comparison of Baseline Characteristicsa


Results

Change in Outcomes


Comment

• Dietary flaxseed supplementation was associated with no attributable benefit regarding lipid levels.

• Dietary flaxseed supplementation, while safe, was associated with adverse changes in the lipid profile of children with hypercholesterolemia:

– Significant decrease noted in high-density lipoprotein cholesterol level.

– Significant increase in triglyceride levels.

• The use of flaxseed supplementation in children with hypercholesterolemia may not be a viable option for lipid management.


Comment

• Nonpharmacologic management of hypercholesterolemia in children is challenging, with few available options.

• Flaxseed has been proposed as a possible alternative therapy for treating dyslipidemia.

• The predominant mechanism by which flaxseed influences lipid profiles remains unknown.

• Flaxseed supplementation remains an unverified strategy for the clinical management of cardiovascular risk factors in youths with hyperlipidemia and may adversely affect the lipid profile.


• If you have questions, please contact the corresponding author:– Brian W. McCrindle, MD, MPH, The Hospital for Sick Children,

555 University Ave, Toronto, ON M5G 1X8, Canada ([email protected]).

Funding/Support

• This study was supported by a research grant from the Labatt Family Innovation Fund.

Conflict of Interest Disclosures

• None reported.

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Flaxseed in Pediatric Hyperlipidemia