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Neurological Development of 5-Year-Old Children Receiving a Low–Saturated Fat, Low-Cholesterol Diet Since Infancy
A Randomized Controlled Trial
Leena Rask-Nissilä, MD;
Eero Jokinen, MD, PhD;
Pirjo Terho, MD;
Anne Tammi, MD;
Helena Lapinleimu, MD, PhD;
Tapani Rönnemaa, MD, PhD;
Jorma Viikari, MD, PhD;
Ritva Seppänen, DSc;
Tapio Korhonen, PhD;
Juhani Tuominen, PhLic;
Ilkka Välimäki, MD, PhD;
Olli Simell, MD, PhD
JAMA. 2000;284:993-1000.
Context Early childhood introduction of nutritional habits aimed at atherosclerosis prevention is compatible with normal growth, but its effect on neurological development is unknown.
Objective To analyze how parental counseling aimed at keeping children's diets low in saturated fat and cholesterol influences neurodevelopment during the first 5 years of life.
Design Randomized controlled trial conducted between February 1990 and November 1996.
Setting Outpatient clinic of a university department in Turku, Finland.
Participants A total of 1062 seven-month-old infants and their parents, recruited at well-baby clinics between 1990 and 1992. At age 5 years, 496 children still living in the city of Turku were available to participate in neurodevelopmental testing.
Intervention Participants were randomly assigned to receive individualized counseling aimed at limiting the child's fat intake to 30% to 35% of daily energy, with a saturated:monounsaturated:polyunsaturated fatty acid ratio of 1:1:1 and a cholesterol intake of less than 200 mg/d (n = 540) or usual health education (control group, n = 522).
Main Outcome Measures Nutrient intake, serum lipid concentrations, and neurological development at 5 years, among children in the intervention vs control groups.
Results Absolute and relative intakes of fat, saturated fatty acids, and cholesterol among children in the intervention group were markedly less than the respective values of control children. Mean (SD) percentages of daily energy at age 5 years for the intervention vs control groups were as follows: for total fat, 30.6% (4.5%) vs 33.4% (4.4%) (P<.001); and for saturated fat, 11.7% (2.3%) vs 14.5% (2.4%) (P<.001). Mean intakes of cholesterol were 164.2 mg (60.1 mg) and 192.5 mg (71.9 mg) (P<.001) for the intervention and control groups, respectively. Serum cholesterol concentrations were continuously 3% to 5% lower in children in the intervention group than in children in the control group. At age 5 years, mean (SD) serum cholesterol concentration of the intervention group was 4.27 (0.63) mmol/L (165 [24] mg/dL) and of the control group, 4.41 (0.74) mmol/L (170 [29] mg/dL) (P = .04). Neurological development of children in the intervention group was at least as good as that of children in the control group. Relative risks for children in the intervention group to fail tests of speech and language skills, gross motor functioning plus perception, and visual motor skills were 0.95 (90% confidence interval [CI], 0.60-1.49), 0.95 (90% CI, 0.58-1.55), and 0.65 (90% CI, 0.39-1.08), respectively (P = .85, .86, and .16, respectively, vs control children).
Conclusion Our data indicate that repeated child-targeted dietary counseling of parents during the first 5 years of a child's life lessens age-associated increases in children's serum cholesterol and is compatible with normal neurological development.
Author Affiliations: Cardiorespiratory Research Unit (Drs Rask-Nissilä and Tammi), Departments of Pediatrics (Drs Lapinleimu, Välimäki, and Simell), Medicine (Drs Rönnemaa and Viikari), Biostatistics (Mr Tuominen), and Child Psychiatry and Psychology (Dr Korhonen), University of Turku, Research and Development Unit of Social Insurance Institution, (Dr Seppänen), and Department of Child and Adolescent Health Care (Dr Terho), City of Turku, and Hospital for Children and Adolescents, University of Helsinki, Helsinki (Dr Jokinen), Finland.
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