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May 10, 1995

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)

Author Affiliations

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

JAMA. 1995;273(18):1429-1435. doi:10.1001/jama.1995.03520420045036

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)