title: 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.
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.
  
  
  METHODS
  Six-center randomized controlled clinical trial.
  
  
  METHODS
  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).
  
  
  METHODS
  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).
  
  
  METHODS
  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 imputting 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.
mesh_terms: D000704:Analysis of Variance; D001774:Blood Chemical Analysis; D001827:Body Height; D002648:Child; D002791:Cholesterol, Dietary / Q000008:administration & dosage* / Q000378:metabolism; D008078:Cholesterol, LDL / Q000097:blood*; D004041:Dietary Fats / Q000008:administration & dosage* / Q000378:metabolism; D002149:Energy Intake; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000178:diet therapy*; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D015596:Nutrition Assessment
chemical_list: D002791:Cholesterol, Dietary; D008078:Cholesterol, LDL; D004041:Dietary Fats; D005293:Ferritins