Counseling On Diets Low In Saturated Fats Reduces Cholesterol Levels In Children

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American Heart Association rapid access journal report

DALLAS, Aug. 14 — Regularly counseling families and children about diets low in saturated fats effectively reduces blood cholesterol levels in children up to age 14 without affecting normal physical development, according to research reported in Circulation: Journal of the American Heart Association.

Finnish researchers compared 540 children assigned to a dietary counseling group to 522 who did not get special diet advice, starting from seven months of age. At age 14, the dietary group had a small but statistically significant lower median cholesterol level.

The finding could have important implications for efforts to reduce heart attacks and strokes by encouraging lifestyle changes, including healthier eating.

“In the long run, even a minor decrease in serum cholesterol concentrations in a large population can have a major influence on coronary heart disease,” said Harri Niinikoski, M.D., Ph.D., lead author of the study and a pediatric endocrinologist at the University of Turku in Finland.

Studies have shown that high blood levels of total cholesterol and low-density lipoprotein (LDL, or “bad” cholesterol) in childhood predisposes a person to early atherosclerotic changes in the large arteries, which increases the risk of early heart attack and stroke.

“Such changes are not seen in the arteries of young children, but later in life,” Niinikoski said.

Researchers enrolled the families of 1,062 infants in the Special Turku Coronary Risk Factor Intervention Project (STRIP) between February 1990 and June 1992 at well-baby clinics in Turku. At seven months, the children were randomized to either counseling or a control group.

“We feel that lifetime habits form early in life and healthier lifestyles should be started earlier in life,” Niinikoski said. “We were trying to find out whether it is safe to start a lower-saturated-fat and lower-cholesterol diet early in life.”

Families in the counseling group received individualized diet counseling from a nutritionist at one- to three-month intervals until the child reached age 2, and twice a year thereafter. The control families were seen twice a year until the child’s seventh birthday and then once annually. They received the basic health education routinely given at Finnish well-baby clinics and school healthcare. At age 7, the children were counseled directly.

The aim of diet counseling was not to reduce the total number of fat calories in the diet, but to shift the child’s intake from saturated toward unsaturated fats and have cholesterol intakes of less than 200 mg — e.g., more vegetable oils than animal fats and butter.

“We want to emphasize that this diet is not vegetarian or even close to it,” Niinikoski said. “Our aim was not to reduce intake of cholesterol and total fat in infancy. The children were advised to use meat and fish, etc., but to choose meat and milk products lower in saturated fat.”

Four years ago, the research team reported in Circulation that counseling had resulted in decreased serum cholesterol in the diet group at age 7.

The STRIP findings reported in the current study demonstrated that the benefits of diet counseling persisted up to age 14. Key results included:

* The counseled children had diets constantly lower in fat and saturated fat, and higher in protein and carbohydrates than those who received no dietary advice.
* Total fat intake did not differ between the genders.
* The children’s average serum cholesterol level peaked at age 7 to 9 in both genders, and by age 14, cholesterol in the blood had decreased to the same levels as when the children entered the study.
* Boys generally had lower total and LDL cholesterol levels than girls throughout childhood.
* The difference in serum cholesterol levels between the diet group and the control group at 14 years was statistically significant for boys but not for girls.
* The counseled group had lower cholesterol readings. “Overall, the difference between the mean serum cholesterol values of the intervention and control children is quite small — about 5 percent in boys and 2–4 percent in girls depending on age — significant for boys but not for girls,” Niinikoski said.
* A detailed examination of changes in the various forms of cholesterol between ages 10 and 14 years showed that puberty markedly influenced serum cholesterol changes.
* Serum triglycerides were lower in boys than girls but dietary counseling only affected the levels in boys.
* At age 14, no significant differences existed between the two groups in height, weight, body mass index (BMI), puberty changes, and age of first menstrual period for girls. “In detailed cognitive tests at 5 years of age, the counseled children performed as well as the controls,” Niinikoski said.
* Even though the intervention children consumed a lower cholesterol diet, “there were no influences on pubertal development in either gender,” Niinikoski said. “All of the children continued breastfeeding or drank formula up to 12 months of age. Fat-reduced milks should never be started during the first year of life.”

“These finding are significant because they were achieved in healthy, normal children, and they persisted up to at least 14 years of age,” Niinikoski said.

The researchers intend to follow the children in the STRIP study, who are now between 15 and 17 years old, until they reach age 20. The researchers expect to find whether dietary counseling can reduce the build-up of fatty materials in artery walls that can cause cardiovascular events.

Co-authors are Hanna Lagström, Ph.D.; Eero Jokinen, M.D., Ph.D.; Marja Siltala, Stud. Soc. Sc.; Tapani Rönnemaa, M.D., Ph.D.; Jorma Viikari, M.D., Ph.D.; Olli T. Raitakari, M.D., Ph.D.; Antti Jula, M.D., Ph.D.; Jukka Marniemi, Ph.D.; Kirsti Näntö-Salonen, M.D., Ph.D. and Olli Simell, M.D., Ph.D.

Source: American Heart Association