Efficacy and Safety of Lowering Dietary Intake of Fat and Cholesterol in Children With Elevated Low-Density Lipoprotein Cholesterol
The Dietary Intervention Study in Children (DISC)
- The Writing Group for the DISC Collaborative Research Group;
- Peter O. Kwiterovich, MD;
- Ginny Hartmuller, MS;
- Linda Van Horn, PhD;
- Katherine K. Christoffel, MD;
- Niki Gernhoffer, MS;
- Samuel Gidding, MD;
- John V. Lavigne, PhD;
- Ronald M. Lauer, MD;
- Linda Snetselaar, PhD;
- Patti Steinmuller, MS;
- Lynette Stickney;
- Norman L. Lasser, MD, PhD;
- Rhonda F. Greenberg, PsyD;
- Patricia Kennedy, MA;
- Vera I. Lasser, MA;
- Alan M. Robson, MD;
- Frank A. Franklin, MD, PhD;
- Kristian Von Almen, PhD;
- Victor J. Stevens, PhD;
- Shirley Craddick, MS;
- Merwyn R. Greenlick, PhD;
- Jacob A. Reiss, MD;
- Bruce A. Barton, PhD;
- Kathleen Brown, PhD;
- Paul L. Canner, PhD;
- Sue Y. S. Kimm, MD;
- Robert McMahon, PhD;
- Eva Obarzanek, PhD;
- Jeffrey A. Cutler, MD;
- Marguerite A. Evans, MS;
- Marilyn Farrand Zukel, MS;
- Sally A. Hunsberger, PhD;
- Edward Lakatos, PhD;
- Nancy C. Santanello, MD;
- Denise G. Simons-Morton, MD, PhD;
- Paul S. Bachorik, PhD;
- Elaine W. Gunter;
- I. Marilyn Buzzard, PhD
- The Johns Hopkins University School of Medicine, Baltimore, Md; Northwestern University Medical School, Chicago, Ill; University of Iowa School of Medicine, Iowa City; New Jersey Medical School, Newark; Children's Hospital, New Orleans, La; Kaiser Permanente Center for Health Research, Portland, Ore; Maryland Medical Research Institute, Baltimore; National Heart, Lung, and Blood Institute, Bethesda, Md; Central Lipid Laboratory, Lipid Research Atherosclerosis Unit, and Nonlipid Laboratory, The Johns Hopkins Hospital Clinical Laboratory, Baltimore, Md; Centers for Disease Control and Prevention; Nutrition Coordinating Center, University of Minnesota, Minneapolis
Abstract
Objective. —To assess the efficacy and safety of lowering dietary intake of total fat, saturated fat, and cholesterol to decrease low-density lipoprotein cholesterol (LDL-C) levels in children.
Design. —Six-center randomized controlled clinical trial.
Participants. —Prepubertal boys (n=362) and girls (n=301) aged 8 to 10 years with LDL-C levels greater than or equal to the 80th and less than the 98th percentiles for age and sex were randomized into an intervention group (n=334) and a usual care group (n=329).
Intervention. —Behavioral intervention to promote adherence to a diet providing 28% of energy from total fat, less than 8% from saturated fat, up to 9% from polyunsaturated fat, and less than 75 mg/4200 kJ (1000 kcal) per day of cholesterol (not to exceed 150 mg/d).
Main Outcome Measures. —The primary efficacy measure was the mean LDL-C level at 3 years. Primary safety measures were mean height and serum ferritin levels at 3 years. Secondary efficacy outcomes were mean LDL-C levels at 1 year and mean total cholesterol levels at 1 and 3 years. Secondary safety outcomes included red blood cell folate values; serum zinc, retinol, and albumin levels; serum high-density lipoprotein cholesterol (HDL-C) values, LDL-C:HDL-C ratio, and total triglyceride levels; sexual maturation; and psychosocial health.
Results. —At 3 years, dietary total fat, saturated fat, and cholesterol levels decreased significantly in the intervention group compared with the usual care group (all P<.001). Levels of LDL-C decreased in the intervention and usual care groups by 0.40 mmol/L (15.4 mg/dL) and 0.31 mmol/L (11.9 mg/dL), respectively. Adjusting for baseline level and sex and imputing values for missing data, the mean difference between the groups was —0.08 mmol/L (—3.23 mg/dL) (95% confidence interval [CI], —0.15 to —0.01 mmol/L [—5.6 to —0.5 mg/dL]), which was significant (P=.02). There were no significant differences between the groups in adjusted mean height or serum ferritin levels (P>.05) or other safety outcomes.
Conclusions. —The dietary intervention achieved modest lowering of LDL-C levels over 3 years while maintaining adequate growth, iron stores, nutritional adequacy, and psychological well-being during the critical growth period of adolescence.
(JAMA. 1995;273:1429-1435)
Footnotes
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On behalf of the DISC Collaborative Research Group, the following members comprised the writing group for this article: Ronald M. Lauer, MD (chairperson), Eva Obarzanek, PhD, Peter O. Kwiterovich, MD, Sue Y. S. Kimm, MD, Sally A. Hunsberger, PhD, Bruce A. Barton, PhD, Linda Van Horn, PhD, Victor J. Stevens, PhD, Norman L. Lasser, MD, PhD, Alan M. Robson, MD, Frank A. Franklin, MD, PhD, and Denise G. Simons-Morton, MD, PhD.
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Reprint requests to DISC Coordinating Center, Maryland Medical Research Institute, 600 Wyndhurst Ave, Baltimore, MD 21210.
