Dissertação de Mestrado Nutrição Humana e Metabolismo 2023 Faculdade de Ciências Médicas, Universidade NOVA de Lisboa

Introduction: The COVID-19 pandemic lockdowns have led to a surge in childhood obesity due to changes in eating habits and physical activity levels of children and adolescents. The high cardiovascular risk in paediatric patients with familial hypercholesterolemia (FH) makes them particularly vulnerable to the effects of lockdowns. While limited evidence exists on lipid profile deterioration in adults with FH during lockdowns, data is lacking in paediatric ages. Our aim was to investigate the impact of lockdowns on lipid and anthropometric profiles of paediatric patients with FH in an exploratory analysis. Methodology: This was a retrospective, single centre study. Participants were paediatric patients with FH from the Reference Centre of Inherited Metabolic Diseases of Centro Hospitalar Universitário de Lisboa Central. Pre-pandemic (baseline) biochemical and anthropometric measurements were compared to those from September 2021 – April 2022 (post-pandemic). Primary outcomes were changes in LDL-C concentrations and body mass index (BMI) z-scores between the pre- and post-pandemic periods. Changes in the remaining biochemical and anthropometric parameters, as well as other clinical variables were secondary outcomes. Results: The study included 30 participants (57% female) aged 1 to 16 years, with a median of 11 years at baseline. No significant changes were found in lipid profiles from baseline to post-pandemic. The median [P25-P75] blood LDL-C concentration was 125 [112-150] mg/dL pre-pandemic vs. 125 [100-147] mg/dL post-pandemic (p=0.89); HDL-C was 58 [52, 65] mg/dL vs. 56 [51, 61] mg/dL (p=0.11); triglycerides were 64 [44, 86] mg/dL vs. 59 [42, 86] mg/dL (p=0.18); and total cholesterol (available in 10 participants) was 197 [178, 228] mg/dL vs. 211 [157, 244] mg/dL (p=0.92). Change in BMI z-score was not significant (0.19 [-0.58, 0.89] pre-pandemic vs. 0.30 [-0.48, 1.10] post-pandemic, p=0.52). At baseline, 8 participants were on lipid-lowering drugs vs. 9 post-pandemic. Half of the participants had none or a single consultation with a paediatrician at the Reference Centre from March 2020 to August 2021. Conclusion: Non-deterioration of lipid and anthropometric profiles during the COVID-19 pandemic may be interpreted as a positive outcome since some worsening was expected. We speculate that the Reference Centre clinical team was successful in educating patients and families on the health risks of FH, making them more prone to uphold healthy habits during lockdowns. However, these findings must be interpreted with caution given the small and heterogeneous study sample. Further research using a multicentric approach would be crucial to gain a better understanding of the impact of lockdowns in this population