Abstract
Background/Objectives:
There is convincing evidence that unsaturated fatty acids exert favourable effects on plasma cholesterol levels. However, it is not clear which type of oil has the most pronounced effect, especially not in paediatric patients. The aim was to compare two low-fat diet regimes enriched with either monounsaturated fatty acids by rapeseed oil (RO) or polyunsaturated fatty acids by sunflower oil (SO) in children affected with familial hypercholesterolaemia (FH).
Subjects/Methods:
Twenty-one children aged 6–18 years affected with FH were enrolled in this randomized and double-blind pilot trial. The subjects and their families were trained to adhere to a low-fat/low-cholesterol diet. All visible fats were to be replaced by either RO or SO (14–27 g/day) for 13 weeks. Dietary adherence was controlled by repeated 4-day dietary records; plasma lipids, lipoproteins and risk markers were assessed at baseline and post-intervention. Out of 21 subjects, 16 could be followed-up after 6 months.
Results:
Both fat-modified diets resulted in significant reduction in total cholesterol concentrations of 9.4% (RO P<0.005 vs SO P<0.05) and low-density lipoprotein (LDL) cholesterol concentrations of 12.7% (P<0.005) for RO and 11.3% (P<0.05) for SO. The reduction of the LDL/high-density lipoprotein (HDL) cholesterol ratio (RO 9% vs SO 3.5%) and high-sensitivity C-reactive protein (RO 16.8% vs SO 1.7%) were not statistically significant, respectively. In most participating families, a change in eating habits could be observed.
Conclusions:
A fat-modified diet enriched with RO seems to have very similar effects on cholesterol levels as with SO. However, our study suggests that RO has possibly more favourable effects concerning cardiovascular risk profile. Both diets appear to be feasible and were well accepted among our subjects. Although these results are promising, larger trials will be required to validate our findings.
This is a preview of subscription content, access via your institution
Relevant articles
Open Access articles citing this article.
-
Current Approach to the Diagnosis and Treatment of Heterozygote and Homozygous FH Children and Adolescents
Current Atherosclerosis Reports Open Access 08 May 2021
-
Non-ketogenic combination of nutritional strategies provides robust protection against seizures
Scientific Reports Open Access 14 July 2017
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout

References
Goldstein JL, Hobbs HH, Brown MS . Familial hypercholesterolemia. In: Scriver CR, Beaudet AL, Sly WS, Valle D (eds). The Metabolic and Molecular Bases of Inherited Disease. 8th edn McGraw-Hill: New York, NY, 2001, pp 2863–2913
Rader DJ, Cohen J, Hobbs HH . Monogenic hypercholesterolemia: new insights in pathogenesis and treatment. J Clin Invest 2003; 111: 1795–1803.
Wiegman A, de Groot E, Hutten BA, Rodenburg J, Gort J, Bakker HD et al. Arterial intima-media thickness in children heterozygous for familial hypercholesterolaemia. Lancet 2004; 363: 369–370.
Civeira F . International Panel on Management of Familial Hypercholesterolemia. Guidelines for the diagnosis and management of heterozygous familial hypercholesterolemia. Atherosclerosis 2004; 173: 55–68.
Hoffmann U, Dirisamer A, Heher S, Kostner K, Widhalm K, Neunteufl T . Relation of peripheral flow-mediated vasodilatation and coronary arterial calcium in young patients with heterozygous familial hypercholesterolemia. Am J Cardiol 2002; 90: 70–73.
Widhalm K, Brazda G, Schneider B, Kohl S . Effect of soy protein diet versus standard low fat, low cholesterol diet on lipid and lipoprotein levels in children with familial or polygenic hypercholesterolemia. J Pediatr 1993; 123: 30–34.
Poustie VJ, Rutherford P . Dietary treatment for familial hypercholesterolaemia. Cochrane Database Syst Rev 2001; 2: CD001918.
Daniels SR, Greer FR . Committee on Nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics 2008; 122: 198–208.
National Cholesterol Education Program (NCEP): highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 1992; 89: 495–501.
Schaefer EJ, Levy RI, Ernst ND, van Sant FD, Brewer HB . The effect of low cholesterol, high polyunsaturated fat and low fat diets on plasma lipid and lipoprotein cholesterol levels in normal and hypocholesterolemic subjects. Am J Clin Nutr 1981; 34: 1758–1763.
Mensink RP, Katan MB . Effect of a diet enriched with monounsaturated or polyunsaturated fatty acids on levels of low-density and high-density lipoprotein cholesterol in healthy women and men. N Engl J Med 1989; 321: 436–441.
Gustafsson IB, Vessby B, Ohrvall M, Nydahl M . A diet rich in monounsaturated RO reduces the lipoprotein cholesterol concentration and increases the relative content of n-3 fatty acids in serum in hyperlipidemic subjects. Am J Clin Nutr 1994; 59: 667–674.
Nydahl M, Gustafsson IB, Ohrvall M, Vessby B . Similar effects of RO (canola oil) and olive oil in a lipid-lowering diet for patients with hyperlipoproteinemia. J Am Coll Nutr 1995; 14: 643–651.
Mattson FH, Grundy SM . Comparison of effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on plasma lipids and lipoproteins in man. J Lipid Res 1985; 26: 194–202.
Valsta LM, Jauhiainen M, Aro A, Katan MB, Mutanen M . Effects of a monounsaturated rapeseed oi and a polyunsaturated sunflower oil diet on lipoprotein levels in humans. Arterioscler Thromb Vasc Biol 1992; 12: 50–57.
McDonald BE, Gerrard JM, Bruce VM, Corner EJ . Comparison of the effect of canola oil and SO on plasma lipids and lipoproteins and on in vivo thromboxane A2 and prostacyclin production in healthy young men. Am J Clin Nutr 1989; 50: 1382–1388.
Pedersen A, Baumstark MW, Marckmann P, Gylling H, Sandström B . An olive oil-rich diet results in higher concentrations of LDL cholesterol and a higher number of LDL subfraction particles than RO and SO diets. J Lipid Res 2000; 41: 1901–1911.
Hodson L, Skeaff CM, Chisholm WA . The effect of replacing dietary saturated fat with polyunsaturated or monounsaturated fat on plasma lipids in free-living young adults. Eur J Clin Nutr 2001; 55: 908–915.
American Academy of Pediatrics. National Cholesterol Education Program: Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 1992; 89: 525–584.
Anderson JW, Johnstone BM, Cook-Newell ME . Meta-analysis of the effects of soy protein intake on serum lipids. N Engl J Med 1995; 333: 276–282.
Demonty I, Lamarche B, Jones PJ . Role of isoflavones in the hypocholesterolemic effect of soy. Nutr Rev 2003; 61: 189–203.
Kromeyer-Hauschild K, Wabitsch M, Kunze D et al. Perzentile für den Body Mass Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben (Percentile for BMI for children and adolescents using a variety of German samples). Monatsschr Kinderheilkd 2001; 149: 807–818.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–576.
Hooper L, Summerbell CD, Higgins JP, Thompson RL, Clements G, Capps N et al. Reduced or modified dietary fat for prevention of cardiovascular disease. Cochrane Database Syst Rev 2000; 2: CD002137.
Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med 2011; 124: 841–851.
Deutsche Gesellschaft für Ernährung (DGE) D-A-CH-Referenzwerte für die Nährstoffzufuhr (D-A-CH reference values for nutrient intake) 1st edn. Umschau Buchverlag: Stuttgart, Germany, 2000.
Marcovina SM, Koschinsky ML, Albers JJ, Skarlatos S . Report of the National Heart, Lung, and Blood Institute Workshop on Lipoprotein(a) and Cardiovascular Disease: recent advances and future directions. Clin Chem 2003; 49: 1785–1796.
Rodríguez-Palmero M, Lopez-Sabater MC, Castellote-Bargallo AI, De la Torre-Boronat MC, Rivero-Urgell M . Comparison of two methods for the determination of fatty acid profiles in plasma and erythrocytes. J Chromatogr A 1997; 778: 435–439.
Welty FK, Lichtenstein AH, Barrett PH, Jenner JL, Dolnikowski GG, Schaefer EJ . Effects of ApoE genotype on ApoB-48 and ApoB-100 kinetics with stable isotopes in humans. Arterioscler Thromb Vasc Biol 2000; 20: 1807–1810.
Widhalm K, Heinrich K, Reithofer E . Therapie der familiären Hypercholesterinämie mit einfach ungesättigten Fettsäuren (Treatment of familial hypercholesterolemia with monounsaturated fatty acids). J Ernährungsmed 2001; 3: 21–23.
Gulesserian T, Widhalm K . Effect of a RO substituting diet on serum lipids and lipoproteins in children and adolescents with familial hypercholesterolemia. J Am Coll Nutr 2002; 21: 103–108.
Keys A, AndeROn JT, Grande F . Serum cholesterol responses to changes in the diet. III. Differences among individuals. Metabolism 1965; 14: 766–775.
Kwiterovich PO Jr, Barton BA, McMahon RP, Obarzanek E, Hunsberger S, Simons-Morton D et al. Effects of diet and sexual maturation on low-density lipoprotein cholesterol during puberty: the Dietary Intervention Study in Children (DISC). Circulation 1997; 96: 2526–2533.
Altwaijri YA, Day RS, Harrist RB, Dwyer JT, Ausman LM, Labarthe DR . Sexual maturation affects diet-blood total cholesterol association in children: Project HeartBeat!. Am J Prev Med 2009; 37: 65–70.
Gardner CD, Kraemer HC . Monounsaturated versus polyunsaturated dietary fat and serum lipids. A meta-analysis. Arterioscler Thromb Vasc Biol 1995; 15: 1917–1927.
Mata P, Alvarez-Sala LA, Rubio MJ, Nuño J, De Oya M . Effects of long-term monounsaturated- vs polyunsaturated-enriched diets on lipoproteins in healthy men and women. Am J Clin Nutr 1992; 55: 846–850.
Carmena R, Ascaso JF, Camejo G, Varela G, Hurt-Camejo E, Ordovas JM et al. Effect of olive and SOs on low density lipoprotein level, composition, size, oxidation and interaction with arterial proteoglycans. Atherosclerosis 1996; 125: 243–255.
Miettinen TA, Vanhanen H . Serum concentration and metabolism of cholesterol during rapeseed oil and squalene feeding. Am J Clin Nutr 1994; 59: 356–363.
Kris-Etherton PM, Pearson TA, Wan Y, Hargrove RL, Moriarty K, Fishell V et al. High-monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations. Am J Clin Nutr 1999; 70: 1009–1015.
Hooper L, Summerbell CD, Higgins JP, Thompson RL, Clements G, Capps N et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Rev 2011; 7: CD002137.
Södergren E, Gustafsson IB, Basu S, Nourooz-Zadeh J, Nälsén C, Turpeinen A et al. A diet containing RO-based fats does not increase lipid peroxidation in humans when compared to a diet rich in saturated fatty acids. Eur J Clin Nutr 2001; 55: 922–931.
Nikkari T, Luukkainen P, Pietinen P, Puska P . Fatty acid composition of serum lipid fractions in relation to gender and quality of dietary fat. Ann Med 1995; 27: 491–498.
Koletzko B, Kupke I, Wendel U . Treatment of hypercholesterolemia in children and adolescents. Acta Paediatr 1992; 81: 682–685.
Descamps OS, Tenoutasse S, Stephenne X, Gies I, Beauloye V, Lebrethon MC et al. Management of familial hypercholesterolemia in children and young adults: consensus paper developed by a panel of lipidologists, cardiologists, paediatricians, nutritionists, gastroenterologists, general practitioners and a patient organization. Atherosclerosis 2011; 218: 272–280.
Acknowledgements
The assistance in diet of G. Skacel and in medical tests of M. Fritsch is highly appreciated. This research was supported by a grant from the Foundation of VOG, Linz, Austria.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
DISCLAIMER
The sponsors were not involved in the conduct and writing of the manuscript. All authors directly participated in the planning, execution or analysis of the study.
Rights and permissions
About this article
Cite this article
Negele, L., Schneider, B., Ristl, R. et al. Effect of a low-fat diet enriched either with rapeseed oil or sunflower oil on plasma lipoproteins in children and adolescents with familial hypercholesterolaemia. Results of a pilot study. Eur J Clin Nutr 69, 337–343 (2015). https://doi.org/10.1038/ejcn.2014.234
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ejcn.2014.234
This article is cited by
-
Current Approach to the Diagnosis and Treatment of Heterozygote and Homozygous FH Children and Adolescents
Current Atherosclerosis Reports (2021)
-
Sesame oil and vitamin E co-administration may improve cardiometabolic risk factors in patients with metabolic syndrome: a randomized clinical trial
European Journal of Clinical Nutrition (2019)
-
Non-ketogenic combination of nutritional strategies provides robust protection against seizures
Scientific Reports (2017)