Jeannie McKenzie

Lower Fat Diets for Children Did Not Increase Food Costs

Abstract Food cost may be perceived as a barrier to the adoption of a low-fat diet. Therefore, the purpose of this investigation was to examine the food costs in diets of children who were adhering to a low-fat diet. These children were part of a larger study, The Childrens Health Project, examining the effectiveness of a nutrition education intervention in hyper-cholesterolemic children (4–10 years). Dietary intakes were evaluated from three 24-hour recalls collected by telephone at baseline and at 3 and 12 months following the intervention. Food costs were obtained using Nutritionist IV diet analysis software and were compared between two groups of children: a treatment group consisting of children considered at risk (elevated plasma total cholesterol) who received the nutrition education intervention and a control group consisting of children considered to be not at risk (nonelevated plasma total cholesterol) who received no intervention. There were no significant food cost differences between groups for all time periods, nor were there any differences within groups across time periods. These data suggest that among children adhering to a low-fat diet, there was no increase in food costs. Nutrition education programs may benefit by providing educational strategies to reduce or eliminate perceived food cost barriers.

The Dietary Intake of Children With IDDM

OBJECTIVE To assess the dietary intake of children with IDDM and to determine whether the intake meets the current nutritional recommendations for children with IDDM. RESEARCH DESIGN AND METHODS A total of 66 children with IDDM who were < 10 years of age were recruited from two suburban Pennsylvania hospitals. To collect dietary intake data, subjects were asked, via telephone interview, to complete three random-day 24-h dietary recalls. Data were analyzed for the content of nutrients and other food components by a computerized database program. Intakes were expressed as a 3-day average intake for each subject. RESULTS Overall mean intake of protein and cholesterol approximated the current recommendations. The mean intake of saturated fat exceeded recommendations, while fiber intake was < the recommended level. Many of the children consumed levels of saturated fat well above recommendations. Energy, vitamin, and mineral intakes were adequate for the overall sample. However, from 10 to 40% of the sample had an inadequate intake of vitamin D, vitamin E, and zinc. The percentage of those with inadequate intakes of these nutrients decreased with age. CONCLUSIONS These data suggest that, on average, among this sample of children with IDDM aged < 10 years, adherence to the current nutritional recommendations for children with IDDM was adequate, but some individual children had intakes that were not consistent with the recommendations for optimal management of IDDM.

Change in Nutrient Intakes, Number of Servings, and Contributions of Total Fat from Food Groups in 4- to 10-Year-Old Children Enrolled in a Nutrition Education Study

OBJECTIVE To determine change in nutrient intakes, number of servings, and contributions of total fat from food groups in children who lowered their dietary fat intake. DESIGN A research and demonstration study designed to lower plasma low-density lipoprotein cholesterol level. There were four study groups: two intervention and two control groups. All children had hypercholesterolemia except for those in one control group. There 24-hour dietary recalls were collected on randomly assigned days over a 2-week period at baseline and 3 months after the intervention. SUBJECTS Three hundred three 4-to 10-year old children from suburbs north of Philadelphia, Pa. INTERVENTIONS One intervention involved a home-based, parent-child autotutorial program (PCAT group) with audiotaped stories and print materials for the children and their families; the other intervention involved one face-to-face counseling session with a registered dietitian (counseling group). OUTCOME MEASURES Change in mean nutrient intakes compared with the Recommended Dietary Allowance (RDA); change in number of servings and mean grams of total fat contributed from 10 different food groups. STATISTICAL ANALYSES PERFORMED Analyses of variance and chi 3 analyses. RESULTS Children in every study group had mean intakes of all nutrients (except vitamin D) greater than 67% of the RDA 3 months after the baseline measurement. Several food groups (ie, meats, dairy products, fats/oils, and desserts) provided less total fat to the diets of children who reduced their dietary lipid intake after 3 months (i.e., PCAT and counseling groups). These children also reduced the mean number of servings selected from these food groups. Within these same food groups, some children consumed fewer servings of higher fat foods and more servings of lower fat foods. APPLICATIONS/CONCLUSIONS Children who lowered their dietary fat intake after intervention reported both quantitative and qualitative changes in food choices from several food groups. These choices did not significantly reduce their nutrient intakes.

Diet quality of young children who received nutrition education promoting lower dietary fat

OBJECTIVE : To evaluate the impact of nutrition education promoting lower dietary fat on the overall diet quality in children using a multidimensional index that measures nutrient and food intakes in relation to US dietary recommendations. DESIGN : Prospective cohort study with two intervention and two control groups. Children with elevated low density lipoprotein (LDL) cholesterol were randomized to one of two intervention groups or an at-risk control group. The intervention children received either the parent-child autotutorial (PCAT) programme, a 10-week home-based self-instruction nutrition education programme, or nutrition counselling from a registered dietitian. Children with non-elevated plasma cholesterol formed the not-at-risk control group. Dietary and blood data were collected at baseline and at 3 months. SETTING : Paediatric practices in suburbs north of Philadelphia, PA. SUBJECTS : Two hundred and twenty-seven 4-10-year-old children with elevated LDL cholesterol between the 80th and 98th percentiles, and 76 age- and gender-matched children with non-elevated plasma cholesterol, were studied. RESULTS : Children who received PCAT or counselling significantly improved their overall diet quality (-0.6 and -0.4 change in diet quality index (DQI) scores) compared with at-risk control children. Children who received either form of nutrition education were more likely to meet the recommendations for three components of the DQI (total fat, saturated fat, sodium) (OR >1.7), but did not improve their intakes of three components of the DQI (vegetables and fruits, complex carbohydrates, calcium) at 3 months. CONCLUSIONS : Nutrition education promoting lower dietary fat improved childrens overall diet quality. However, several dietary behaviours important for long-term health remained unchanged.

PEDIATRIC PREVENTIVE HEALTH SCREENING AND DIETARY INTAKE

Abstract As part of a program evaluating nutrition education for hypercholesterolemic children, a pediatric practice-based cholesterol screening program identified 261 3.9–9.9 year old children with elevated cholesterol levels (At-Risk). At baseline (before any intervention), the diets of these children were found to be relatively low in fat (29.7% calories as fat, and 11.2% as saturated fat). This is approaching recommended levels and is lower than has been reported for similar groups of children. To help evaluate potential influences upon the dietary intake of these At-Risk children, their diets were compared to the diets of children without elevated cholesterol levels (Not-At-Risk, n=81). The diets of the Not-At-Risk children were then compared to a group of children who had not completed cholesterol screening nor dietary intervention (not-screened, n=49). Three 24-hour dietary recalls were completed by telephone with each child at baseline and averaged. These recalls and subsequent comparisons showed that the only statistically significant differences between the groups were a lower caloric intake and fiber intake for the At-Risk group as compared to the Not-At Risk group. These results suggest that some groups of American children are consuming a diet with fat, saturated fat and cholesterol content closer to recommended levels than previously reported. In addition, participation in preventive health screening, such as a cholesterol screening program and being labelled as hypercholesterolemic, seemed to have little influence on the intake of fat, saturated fat or cholesterol.

THE GROWTH OF HYPERCHOLESTEROLEMIC CHILDREN DURING DIET INTERVENTION † 511

To evaluate the efficacy and safety of nutrition education for hyperchlesterolemic children, 261 3.9-9.9 year old children with elevated LDL-cholesterol (LDL-C) levels were randomly assigned to an innovative, home-based nutrition education program, standard nutrition counseling, or to an At-Risk Control group. A Not-At-Risk Control group of children with normal cholesterol levels was also recruited (n=81). Height, weight, skinfold measures and dietary intake were evaluated at baseline, 3, 6 and 12 months. At baseline the children were ingesting 29.2-29.9% and 11.1-11.7% calories as fat and saturated fat respectively. The intervention groups demonstrated significant decreases in fat and saturated fat intake after the interventions. At baseline, height z-score (ht-z) and weight z-score (wt-z) were associated with caloric intake, while weight-for-height median (WHM) was associated with fat intake. Wt-z, ht-z, WHM, and the sum of the four skinfolds (total skin) did not vary between the treatment groups over the year. No association between fat intake and wt-z, ht-z, WHM or total skin over time was observed. These results support the safety, with respect to sustaining comparable growth rates, of physician-initiated dietary intervention for hypercholesterolemic children.

ONE YEAR FOLLOW-UP OF NUTRITION EDUCATION FOR HYPERCHOLESTEROLEMIC CHILDREN† 581

The efficacy of an innovative home-based, physician-initiated parent-child autotutorial nutrition education program (PCAT) and of standard nutrition counseling for hypercholesterolemic children were evaluated. Two-hundred-sixty-one 3.9-9.9 year old children with elevated LDL cholesterol(LDL-C) levels were randomly assigned to one of the nutrition interventions, or to an At-Risk Control group. A Not-At-Risk Control group of children with normal cholesterol levels was also recruited (n=81). The change in knowledge of heart healthy foods, dietary intake, and (for the At-Risk groups only) blood lipid levels were evaluated at 3, 6 and 12 months post-baseline. The PCAT group exhibited a significant initial increase in knowledge of heart healthy foods, which was fully retained. The PCAT and Counseling groups lowered their total fat and saturated fat intake throughout the year. The PCAT groups decrease in LDL-C level at 3 months reached borderline significance, when compared to the At-Risk Control group. This trial demonstrated that knowledge and dietary change can be affected and retained via an innovative home-based nutrition intervention for children, though some form of ongoing intervention may be necessary to produce lasting decreases in LDL-C level.