Children's Adaptations to a Fat-Reduced Diet: The Dietary Intervention Study in Children (DISC)

Department of Preventive Medicine, Northwestern University, Evanston, Illinois, United States
PEDIATRICS (Impact Factor: 5.47). 07/2005; 115(6):1723-33. DOI: 10.1542/peds.2004-2392
Source: PubMed


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.
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.
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.
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.
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.

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    • "There is a growing body of research seeking to determine whether interventions aimed at weight loss can successfully change obese individuals' reactivity to food cues. Some studies have shown that behavioral interventions aimed at reducing fat intake can decrease individuals' motivation to consume high fat foods (Grieve and Vander Weg, 2003; Jansen et al., 2010; Ledikwe et al., 2007; Martin et al., 2011; Van Horn et al., 2005), raising the possibility of reduced reactivity to cues associated with such foods. Cross-sectional neuroimaging studies of successful dieters, or post-obese individuals, in comparison to normal-weight individuals, have yielded mixed results regarding responses of reward areas to visual or gustatory food cues (Cornier et al., 2009; Del Parigi et al., 2004). "
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    • "In obese children 8 yr or older, the Dietary Intervention Study in Children (DISC) intervention diet can be introduced without compromising growth, development and pubertal maturity73. This diet distributes 58 per cent of total calorie intake to carbohydrates, 28 per cent to fats and 14 per cent to protein. "
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    • "The dietary causes of obesity are complex and poorly understood. Although energy intake and eating patterns have been implicated in obesity (McDonald et al., 2009; van Horn et al., 2005), few attempts have been made to identify patterns of beverage consumption in this regard. Recently the energy intake from beverages, especially sweetened beverages has increased among children (French et al., 2003; Nielsen & Popkin, 2004; O'Connor et al., 2006). "
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