Van Horn Linda, Obarzanek Eva, Friedman Lisa Aronson, Gernhofer Niki, Barton Bruce
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, 1102, Chicago, IL 60611-4402, USA.
Pediatrics. 2005 Jun;115(6):1723-33. doi: 10.1542/peds.2004-2392.
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.
通过饮食和生活方式改变预防心血管疾病在成年人中得到大力提倡，最好在儿童期就开始。儿童饮食干预研究（DISC）是一项针对663名低密度脂蛋白胆固醇升高的青春期前儿童（363名男孩和301名女孩）的多中心、协作、随机试验，旨在测试降低饱和脂肪和胆固醇摄入量同时倡导健康饮食模式的饮食干预的疗效和安全性。DISC的结果已被广泛发表。这项辅助研究报告了该队列中饮食模式变化的新数据。
我们着手比较儿童自我选择的饮食模式以及在DISC低脂饮食干预中实现依从性的方法与常规护理组儿童的情况。
进行了一项辅助研究以开发详细的食物分类系统，并报告关于对推荐饮食模式的饮食依从性的新分析。营养数据库中的每种食物根据其饱和脂肪和胆固醇含量进行排名，并在其相关食物组内分类为“可食用”（致动脉粥样硬化性较低）或“需注意”（致动脉粥样硬化性较高）食物。
在基线时，两组中可食用食物分别约占总能量摄入的57%和总脂肪能量摄入的12.4%至13.1%。3年后，干预组中可食用食物分别占总能量摄入和脂肪能量摄入的67.4%和13.7%，而常规护理组分别为56.8%和12.8%。两个治疗组在乳制品、甜点和脂肪/油类的消费量变化方面存在显著差异，干预组报告的可食用食物每天增加量比常规护理组多0.2至0.3份。干预组还报告，在面包/谷物、乳制品、脂肪/油类、肉类/鱼类/禽类、零食和蔬菜方面，“需注意”食物每天减少量比常规护理组多0.2至0.8份。总体而言，3岁时，零食、甜点和披萨在两组中均约占每日总能量摄入的三分之一。
与常规护理组儿童相比，干预组儿童报告每天食用更多份的可食用谷物、乳制品、肉类和蔬菜类食物，但两组的水果和蔬菜摄入量都较低。发现零食、甜点和披萨在这个年龄组的饮食中占比如此之大，即使是参与该干预的儿童也是如此，这为需要更积极、创新和现实的额外饮食咨询方法提供了有价值的见解。
