This study examined the effects of flaxseed supplementation on lipid levels in 32 children and adolescents with hypercholesterolemia. Participants consumed either muffins and bread containing ground flaxseed or placebo muffins and bread for 4 weeks. The study found that flaxseed supplementation resulted in a decrease in HDL cholesterol and an increase in triglyceride levels compared to the placebo. The use of flaxseed supplementation did not provide benefits and may adversely affect the lipid profile in children with hypercholesterolemia.

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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.

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• 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

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• 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

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• 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

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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).

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Results
Comparison of Baseline
Characteristicsa

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Results
Change in Outcomes

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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.

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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.

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• 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
(brian.mccrindle@sickkids.ca).
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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