Programs could help teach children to eat healthier- study

06/06/05 A study of preadolescent children found that those who attended a behaviorally oriented nutrition education program and were taught to follow a diet low in saturated fat and dietary cholesterol adopted significantly better dietary habits over several years compared to their peers who received only general nutritional information.

The study showed that after three years, children in the intervention group consumed more than 67 percent of their total calories on average from heart-healthy foods, compared to less than 57 percent for children in the usual care group.

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.

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.

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.

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 has launched 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.