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ASTHMA

Population

  • Children.

Recommendations

Global Initiative for Asthma (GINA) 2017

  • Advise pregnant women and parents of young children not to smoke.

  • Encourage vaginal delivery.

  • Minimize use of acetaminophen and broad-spectrum antibiotics during first year of life.

  • Avoid maternal obesity and excessive prepartum weight gain.

Source

  • Global Initiative for Asthma. 2017.

Comments

  1. Environmental exposures such as automobile exhaust and dust mites are associated with higher rates of asthma, while others (household pets and farm animals) may be protective. Avoiding tobacco smoke and air pollution is protective, but allergen avoidance measures have not been shown to be effective primary prevention.

  2. Public health interventions to reduce childhood obesity, increase fruit and vegetable intake, improve maternal-fetal health, and reduce socioeconomic inequality would address major risk factors. (Lancet. 2015;386:1075-1085)

  3. Maternal intake of allergenic food likely decreases the risk of allergy and asthma in offspring.

  4. Breast-feeding is generally advisable, but not for the specific purpose of preventing allergies and asthma.

ATHEROSCLEROTIC CARDIOVASCULAR DISEASE

Population

  • Children and adolescents.

Recommendations

NIH/NHLBI 2012

  • Screen all children for cholesterol once between age 9 and 11 y and once between age 17 and 21 y.

  • Use nonfasting total cholesterol and HDL cholesterol as the screening tests.

  • Clinicians may recommend low-fat or nonfat dairy at age 1 y for high-risk patients.

  • If lifestyle changes are not effective, consider a lipid-lowering agent at age 10 y.

Lifestyle Therapies

  • If LDL elevated, refer to a registered dietitian for family medical nutrition therapy:

    • 25%–30% of calories from fat,a ≤7% from saturated fat, approximately 10% from monounsaturated fat; <200 mg/d of cholesterol; avoid trans fats as much as possible.

  • Plant sterol esters and/or plant stanol estersb up to 2 g/d as replacement for usual fat sources can be used after age 2 y in children with familial hypercholesterolemia.

  • Plant stanol esters as part of a regular diet are marketed directly to the public. Short-term studies show no harmful effects in healthy children.

  • The water-soluble fiber psyllium can be added to a low-fat, low-saturated-fat diet as cereal enriched with psyllium at a dose of 6 g/d for children 2–12 y, and 12 g/d for those ≥12 y.

  • If TG elevated, refer to a registered dietitian for family medical nutrition therapy:

    • 25%–30% of calories from fat, ≤7% from saturated fat, ∼10% from monounsaturated fat; <200 mg/d of cholesterol; avoid trans fats as much as possible.

  • Decrease sugar intake by replacing simple with complex carbohydrates and eliminating sugar sweetened beverages.

  • Increase dietary fish to increase omega-3 fatty acids.c

  • As in all children, recommend physical activity. Age 5–10, 1 h/d of moderate-to-vigorous physical activity and <2 h/d of sedentary screen ...

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