Summary

The results, published in the June issue of Pediatrics, are from a new ancillary study of the Dietary Intervention Study in Children ( DISC ). Scientists reviewed dietary recalls from 595 children who were ages 8 to 10 and who had high blood cholesterol levels at the start of the study. The researchers analyzed dietary information by food groups and measured adherence to recommended food patterns and changes over time.

"These new findings offer valuable lessons for finding effective ways to help children develop healthier eating habits - a critical need in light of the rising rates of obesity and related conditions among children," said Elizabeth G. Nabel, MD, director of the National Heart, Lung, and Blood Institute ( NHLBI ), which sponsored the study. NHLBI is part of the National Institutes of Health ( NIH ).

The study provides glimpses of real-world eating behavior and reveals the challenges of trying to eat a healthy diet in a fast-paced world. For example, the study documents a long-suspected phenomenon of modern society: approximately one-third of the total daily calories consumed by the children in both groups came from snack foods, desserts, and pizza.

The main DISC trial is the first long-term clinical trial of the effects of a fat-reduced dietary intervention on growing children. Over the seven years of the original study, children who adopted a low-fat, low-cholesterol diet decreased their intake of total fat, saturated fat and cholesterol within the first year of the study and maintained lower levels for several more years. Those selected for the intervention group participated in a nutrition education program which included a behavioral component to promote healthier eating. Parents of the children in the intervention group participated in a similar program. Researchers previously reported that the dietary changes made by children in the intervention group did not adversely affect the children's nutritional status, growth, or development.

In the latest analysis, researchers analyzed the dietary recalls collected over three days at the beginning of the study and again after three years. They found that the dairy food group and the desserts/snacks/pizza group had the greatest impact on the children's body mass index ( BMI ) and their levels of LDL, or "bad," cholesterol. Girls and boys who consumed more dairy products were more likely to have a lower BMI. In addition, boys who consumed more desserts, snacks, and pizza were more likely to have higher BMI and LDL levels.

Specific foods within each food group were also classified based on the ingredients or preparation methods as either "Whoa" foods - those that were high in saturated fat and dietary cholesterol - or heart-healthy "Go" foods - those that were low in saturated fat and dietary cholesterol.

Compared to baseline, after three years, children in the intervention group consumed more of the "Go" food choices in all of the food groups except fruit, and they consumed fewer of the "Whoa" food choices with one exception: pizza. They also consumed on average slightly fewer snacks and desserts after three years compared to the usual care group. In addition, children in the intervention group chose more "Go" versions of desserts ( such as lowfat frozen yogurt, gelatin or angel food cake ) and more "Go" versions of pizza ( such as those made with lowfat cheese ) compared to those in the usual care group. However, the authors note, children in both groups ate fewer than recommended servings of fruits and vegetables.

The intervention group's greater consumption of total daily calories from "Go" foods shows that children and their families can be taught to improve children's diets, according to Linda Van Horn, PhD, RD, professor of preventive medicine at Northwestern University, lead author of the study.

"You can raise a child to enjoy healthy eating and to be selective about food choices. Habits developed in childhood will hopefully last throughout their lives," said Van Horn. "With the right guidance and nutrition education, children learn to prefer healthy foods such as carrots and raisins or cereal as snacks, for example. We could really help improve both the nutritional quality and energy balance of our children's diets by teaching them to make healthy food choices at an early age."

Eva Obarzanek, PhD, RD, NHLBI nutritionist and DISC project officer, agrees that most children could benefit from healthier eating patterns like those followed by DISC participants. "DISC has shown that following a diet low in saturated fat and cholesterol is safe for children in this age group - and a heart-healthy diet can lower blood cholesterol levels," she noted.

Lower levels of LDL cholesterol are known to reduce the risk for heart disease. Obarzanek added, "It's never too early to start protecting your heart - or your child's heart."

Studies have shown that atherosclerosis, or hardening of the arteries - the leading cause of heart disease -- begins in childhood. The National Cholesterol Education Program recommends that children over the age of about 2 years, as well as all adults, adopt a heart-healthy eating pattern to reduce their risk of developing heart disease as adults. Children and adults can also lower their risk by maintaining a healthy weight and by being physically active.

Parents and others play an important role in shaping their children's dietary habits. "In addition to being strong advocates for their children by helping them learn to make good food choices, parents and other adults need to take responsibility for ensuring that children have access to healthy foods at home, at school, and at sporting or recreational events," Van Horn added. "For example, when it's your turn to bring the snack for the kids on the soccer team, instead of chips or candy, how about having orange slices and strawberries instead? Children can learn to say 'no thanks' to a sugar-sweetened soda and to request water or skim milk instead, but those foods have to be available to them."

The six DISC clinical center sites were Kaiser Foundation Research Institute, Johns Hopkins University, Louisiana State University, New Jersey Medical College, Northwestern University, and the University of Iowa. The coordinating center was the Maryland Medical Research Institute.

To help families adopt healthier lifestyles, NIH launched today a new national public education program targeting parents and caregivers of children ages 8 to 13. Developed by NHLBI and promoted in collaboration with several other NIH institutes, national health and youth organizations, and community-based groups, We Can! ( Ways to Enhance Children's Activity & Nutrition! ) provides resources to encourage healthy eating, increase physical activity, and reduce sedentary time. The program offers a parents' handbook in Spanish and English as well as a new six-lesson curriculum for parents and tested curricula for children through community-based sites. A new online resource provides parents, caregivers, communities, national partners, and media up-to-date health information and tips on maintaining a healthy weight for families. For more information, visit http://wecan.nhlbi.nih.gov or call toll-free 866-35-WE CAN ( 866-359-3226 ).

To interview an NHLBI expert, please contact the NHLBI Communications Office at ( 301 ) 496-4236 or nhlbi_news@nhlbi.nih.gov. To interview Dr. Van Horn, please contact Elizabeth Crown, 312-503-8928 or e-crown@northwestern.edu.

NHLBI is part of the National Institutes of Health ( NIH ), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services. Additional information about cardiovascular disease and other NHLBI-supported research and educational programs are available online at the NHLBI Website, http://www.nhlbi.nih.gov.

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• Programs can teach children to eat healthier, NHLBI-sponsored study (press release)

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