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PEDIATRICS Vol. 100 No. 1 July 1997, pp. 51-59

Safety of a Fat-reduced Diet: The Dietary Intervention Study in Children (DISC)

Received May 31, 1996; accepted Nov 27, 1996.

Eva Obarzanek*, Sally A. Hunsberger*, Linda Van HornDagger , Virginia V. Hartmuller§, Bruce A. Bartonparallel , Victor J. Stevens, Peter O. Kwiterovich#, Frank A. Franklin**, Sue Y. S. KimmDagger Dagger , Norman L. Lasser§§, Denise G. Simons-Morton*, and Ronald M. Lauer||

From the * National Heart, Lung, and Blood Institute, Division of Epidemiology and Clinical Applications, Bethesda, Maryland; Dagger  Northwestern University Medical School, Department of Preventive Medicine, Chicago, Illinois; § Johns Hopkins Hospital, School of Medicine, Department of Pediatrics, Baltimore, Maryland; parallel  Maryland Medical Research Institute, Baltimore, Maryland;  Kaiser Permanente Center for Health Research, Kaiser Foundation Hospitals, Portland, Oregon; # Johns Hopkins Hospital, Children's Medical and Surgical Center, Baltimore, Maryland; ** Children's Hospital of Alabama, Department of Gastrointestinal Nutrition, Birmingham, Alabama; Dagger Dagger  University of Pittsburgh School of Medicine, Department of Clinical Epidemiology and Preventive Medicine, Pittsburgh, Pennsylvania; §§ New Jersey Medical School, Preventive Cardiology Program, Newark, New Jersey; || University of Iowa Hospitals and Clinics, Department of Pediatrics, Iowa City, Iowa.

Objective.  To assess the relationship between energy intake from fat and anthropometric, biochemical, and dietary measures of nutritional adequacy and safety.

Design.  Three-year longitudinal study of children participating in a randomized controlled trial; intervention and usual care group data pooled to assess effects of self-reported fat intake; longitudinal regression analyses of measurements at baseline, year 1, and year 3.

Participants.  Six hundred sixty-three children (362 boys and 301 girls), 8 to 10 years of age at baseline, with elevated low-density lipoprotein cholesterol, who are participants of the Dietary Intervention Study in Children.

Measures.  Energy intake from fat assessed from three 24-hour recalls at each time point was the independent variable. Outcomes were anthropometric measures (height, weight, body mass index, and sum of skinfolds), nutritional biochemical determinations (serum ferritin, zinc, retinol, albumin, beta -carotene, and vitamin E, red blood cell folate, and hemoglobin), and dietary micronutrients (vitamins A, C, E, thiamin, riboflavin, niacin, vitamins B-6, B-12, folate, calcium, iron, zinc, magnesium, and phosphorus).

Results.  Lower fat intake was not related to anthropometric measures or serum zinc, retinol, albumin, beta -carotene, or vitamin E. Lower fat intake was related to: 1) higher levels of red blood cell folate and hemoglobin, with a trend toward higher serum ferritin; 2) higher intakes of folate, vitamin C, and vitamin A, with a trend toward higher iron intake; 3) lower intakes of calcium, zinc, magnesium, phosphorus, vitamin B-12, thiamin, niacin, and riboflavin; 4) increased risk of consuming less than two-thirds of the Recommended Dietary Allowances for calcium in girls at baseline, and zinc and vitamin E in boys and girls at all visits.

Conclusions.  Lower fat intakes during puberty are nutritionally adequate for growth and for maintenance of normal levels of nutritional biochemical measures, and are associated with beneficial effects on blood folate and hemoglobin. Although lower fat diets were related to lower self-reported intakes of several nutrients, no adverse effects were observed on blood biochemical measures of nutritional status. Current public health recommendations for moderately lower fat intakes in children during puberty may be followed safely.

Key words: children, fat intake, nutritional status, dietary safety, low-fat diet.




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