PEDIATRICS Vol. 107 No. 2 February 2001, pp. 256-264
Long-Term Safety and Efficacy of a Cholesterol-Lowering Diet in Children With Elevated Low-Density Lipoprotein Cholesterol: Seven-Year Results of the Dietary Intervention Study in Children (DISC)
Received Nov 24, 1999; accepted Jun 30, 2000.
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From the * Division of Epidemiology and Clinical Applications,
National Heart, Lung, and Blood Institute, Bethesda, Maryland;
Department of Family Medicine and Clinical Epidemiology, University
of Pittsburgh, Pittsburgh, Pennsylvania; § Maryland Medical Research
Institute, Baltimore, Maryland; Department of Preventive Medicine,
Northwestern University Medical School, Chicago, Illinois; ¶ Division
of Lipid Research/Atherosclerosis, Johns Hopkins University Hospital
School of Medicine, Baltimore, Maryland; # Department of Medicine, New
Jersey Medical School, Newark, New Jersey; ** Children's Hospital, New
Orleans, New Orleans, Louisiana; G/I Nutrition, Children's
Hospital of Alabama, Birmingham, Alabama; §§ Division of Pediatric
Cardiology, University of Iowa, Iowa City, Iowa; || Kaiser
Permanente Center for Health Research, Portland, Oregon; ¶¶ Division
of Cancer Epidemiology and Genetics, National Cancer Institute,
Rockville, Maryland; and the ## Kaiser Foundation Hospitals, Portland,
Oregon.
Objective. Diets reduced in fat and cholesterol are recommended for children over 2 years of age, yet long-term safety and efficacy are unknown. This study tests the long-term efficacy and safety of a cholesterol-lowering dietary intervention in children.
Methods. Six hundred sixty-three children 8 to 10 years of age with elevated low-density lipoprotein cholesterol (LDL-C) were randomized to a dietary intervention or usual care group, with a mean of 7.4 years' follow-up. The dietary behavioral intervention promoted adherence to a diet with 28% of energy from total fat, <8% from saturated fat, up to 9% from polyunsaturated fat, and <75 mg/1000 kcal cholesterol per day. Serum LDL-C, height, and serum ferritin were primary efficacy and safety outcomes.
Results. Reductions in dietary total fat, saturated fat, and cholesterol were greater in the intervention than in the usual care group throughout the intervention period. At 1 year, 3 years, and at the last visit, the intervention compared with the usual care group had 4.8 mg/dL (.13 mmol/L), 3.3 mg/dL (.09 mmol/L), and 2.0 mg/dL (.05 mmol/L) lower LDL-C, respectively. There were no differences at any data collection point in height or serum ferritin or any differences in an adverse direction in red blood cell folate, serum retinol and zinc, sexual maturation, or body mass index.
Conclusion. Dietary fat modification can be achieved and safely sustained in actively growing children with elevated LDL-C, and elevated LDL-C levels can be improved significantly up to 3 years. Changes in the usual care group's diet suggest that pediatric practices and societal and environmental forces are having positive public health effects on dietary behavior during adolescence. Key words: children, fat intake, serum cholesterol, saturated fat.
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