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Children's adaptations to a fat-reduced diet: the Dietary Intervention Study in Children (DISC)
Linda Van Horn1, Eva Obarzanek, Lisa Aronson Friedman
1Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, 1102, Chicago, IL 60611-4402, USA. lvanhorn@northwetern.edu
Insights
Children in a dietary intervention study increased intake of healthy "go" foods and decreased unhealthy "whoa" foods. However, high consumption of snacks, desserts, and pizza persisted, indicating a need for improved dietary counseling strategies.
Area of Science:
- Pediatric Nutrition
- Cardiovascular Disease Prevention
- Dietary Interventions
Background:
- Cardiovascular disease prevention is crucial and should begin in childhood.
- The Dietary Intervention Study in Children (DISC) was a randomized trial for preadolescent children with high LDL cholesterol.
- This study analyzes eating pattern changes within the DISC cohort.
Purpose of the Study:
- To compare self-selected eating patterns in children adhering to a fat-reduced diet versus a usual-care group.
- To assess children's approaches to dietary adherence in a pediatric intervention.
Main Methods:
- Developed a "go" (less atherogenic) and "whoa" (more atherogenic) food classification system.
- Analyzed dietary adherence based on saturated fat and cholesterol content.
- Ranked and classified all foods in the nutrient database.
Main Results:
- The intervention group increased "go" food consumption (67.4% of energy) and decreased "whoa" food intake compared to the usual-care group.
- Significant changes in dairy, desserts, and fats/oils consumption were observed in the intervention group.
- Snacks, desserts, and pizza remained significant contributors to energy intake in both groups.
Conclusions:
- Children in the intervention consumed more "go" foods but fruit and vegetable intake remained low.
- High intake of snacks, desserts, and pizza highlights challenges in pediatric dietary interventions.
- More aggressive and innovative dietary counseling approaches are needed for children.
Background:
Prevention of cardiovascular disease through diet and lifestyle change is strongly advocated in adults and is initiated preferably during childhood. The Dietary Intervention Study in Children (DISC) was a multicenter, collaborative, randomized trial in 663 preadolescent children (363 boys and 301 girls) with elevated low-density lipoprotein cholesterol, designed to test the efficacy and safety of a dietary intervention to lower saturated-fat and cholesterol intake while also advocating a healthy eating pattern. DISC results have been published extensively. This ancillary study reports new data regarding changes in eating patterns among this cohort.
Objective:
We set out to compare children's self-selected eating patterns and approaches to achieving adherence to the DISC fat-reduced diet intervention with children in the usual-care group.
Methods:
An ancillary study was conducted to develop a detailed food-grouping system and report new analyses on dietary adherence to the recommended eating pattern. Every food in the nutrient database was ranked by its saturated-fat and cholesterol content and classified within its relevant food group as a "go" (less atherogenic) or "whoa" (more atherogenic) food.
Results:
At baseline, go foods contributed approximately 57% of total energy intake and 12.4% to 13.1% total fat energy intake in both groups. At 3 years, go foods contributed 67.4% and 13.7% of total and fat energy intake, respectively, in the intervention group versus 56.8% and 12.8% in the usual-care group. Differences between the 2 treatment groups were significant for changes in consumption of dairy foods, desserts, and fats/oils, with the intervention group reporting a 0.2- to 0.3-serving-per-day greater increase in go foods than the usual-care group. The intervention group also reported a 0.2- to 0.8-serving-per-day greater decrease in whoa foods than the usual-care group for breads/grains, dairy, fats/oils, meat/fish/poultry, snacks, and vegetables. Overall, snack foods, desserts, and pizza contributed approximately one third of total daily energy intake in both groups at 3 years.
Conclusions:
Children in the intervention group reported consuming more servings per day of go grains, dairy, meats, and vegetable foods compared with children in the usual-care group, but intake of fruits and vegetables was low in both groups. Discovering that snacks, desserts, and pizza actively contribute so heavily to the diets of this age group, even among children who were part of this intervention, offers valuable insights regarding the need for more aggressive, innovative, and realistic approaches for additional dietary counseling.
