Efficacy and safety of lowering dietary intake of total fat, saturated fat, and cholesterol in children with elevated LDL cholesterol: the Dietary Intervention Study in Children.
Few studies have shown the efficacy and safety of lower-fat diets in children.



Our objective was to assess the efficacy and safety of lowering dietary intake of total fat, saturated fat, and cholesterol to decrease LDL-cholesterol concentrations in children.



A 6-center, randomized controlled clinical trial was carried out in 663 children aged 8-10 y with LDL-cholesterol concentrations greater than the 80th and less than the 98th percentiles for age and sex. The children were randomly assigned to either an intervention group or a usual care group. Behavioral intervention promoted adherence to a diet providing 28% of energy from total fat, <8% from saturated fat, </=9% from polyunsaturated fat, and <0.018 mg cholesterol*kJ(-)(1)*d(-)(1) (not to exceed 150 mg/d). The primary efficacy measure was mean LDL cholesterol and the safety measures were mean height and serum ferritin concentration at 3 y.



At 3 y, dietary total fat, saturated fat, and cholesterol were lower in the intervention group than in the usual care group (all P: < 0. 001). LDL cholesterol 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. With adjustment for baseline concentration, sex, and missing data, the mean difference between groups was -0.08 mmol/L (95% CI: -0.15, -0.01), or -3.23 mg/dL (95% CI: -5.6, -0.5) (P: = 0. 016). There were no significant differences between groups in adjusted mean height or serum ferritin.



Dietary changes are effective in achieving modest lowering of LDL cholesterol over 3 y while maintaining adequate growth, iron stores, nutritional adequacy, and psychological well-being during the critical growth period of adolescence.
Lauer
R M
RM
University of Iowa Hospitals and Clinics, Department of Pediatrics, Iowa City, IA 52242, USA. ronald-lauer@uiowa.edu
Obarzanek
E
E
Hunsberger
S A
SA
Van Horn
L
L
Hartmuller
V W
VW
Barton
B A
BA
Stevens
V J
VJ
Kwiterovich
P O
PO
Franklin
F A
FA
Kimm
S Y
SY
Lasser
N L
NL
Simons-Morton
D G
DG
D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002791:Cholesterol, Dietary / Q000008:administration & dosage; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D018752:Diet, Fat-Restricted / Q000009:adverse effects*; D004041:Dietary Fats / Q000008:administration & dosage*; D004042:Dietary Fats, Unsaturated / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000178:diet therapy* / Q000517:prevention & control*; D008297:Male; D012107:Research Design; D014280:Triglycerides / Q000097:blood; D014481:United States
D002791:Cholesterol, Dietary; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004041:Dietary Fats; D004042:Dietary Fats, Unsaturated; D014280:Triglycerides