title: 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).
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892-7936, USA.obarzane@nhlbi.nih.gov
authors.forename: E
authors.initials: E
authors.lastname: Obarzanek
authors.forename: S Y
authors.initials: SY
authors.lastname: Kimm
authors.forename: B A
authors.initials: BA
authors.lastname: Barton
authors.forename: L
authors.initials: L
authors.lastname: Van Horn L
authors.forename: P O
authors.initials: PO
authors.lastname: Kwiterovich
authors.forename: D G
authors.initials: DG
authors.lastname: Simons-Morton
authors.forename: S A
authors.initials: SA
authors.lastname: Hunsberger
authors.forename: N L
authors.initials: NL
authors.lastname: Lasser
authors.forename: A M
authors.initials: AM
authors.lastname: Robson
authors.forename: F A
authors.initials: FA
authors.lastname: Franklin
authors.forename: R M
authors.initials: RM
authors.lastname: Lauer
authors.forename: V J
authors.initials: VJ
authors.lastname: Stevens
authors.forename: L A
authors.initials: LA
authors.lastname: Friedman
authors.forename: J F
authors.initials: JF
authors.lastname: Dorgan
authors.forename: M R
authors.initials: MR
authors.lastname: Greenlick
mesh_terms: D000293:Adolescent; D001827:Body Height; D015992:Body Mass Index; D002648:Child; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D018752:Diet, Fat-Restricted / Q000009:adverse effects; D004041:Dietary Fats / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology; D008297:Male; D009752:Nutritional Status; D014280:Triglycerides / Q000097:blood
chemical_list: D008078:Cholesterol, LDL; D004041:Dietary Fats; D014280:Triglycerides; D005293:Ferritins; D002784:Cholesterol