Van Horn, L., Obarzanek, E., Friedman, L. A., Gernhofer, N., & Barton, B. (2005).Pediatrics, 115(6), 1723-1733.

Prevention of cardiovascular disease (CVD) optimally begins early in childhood with healthy lifestyle behaviors, including patterns of dietary intake and physical activity. For children with CVD risk factors, including dyslipidemia, the cornerstone of treatment is therapeutic lifestyle change with emphasis on dietary modification and physical activity. DISC was a multicenter randomized trial in 663 preadolescent children (55% males) with elevated low-density lipoprotein cholesterol (LDL-C), designed to test a dietary intervention to lower saturated fat and cholesterol intake while advocating a healthy eating pattern. This ancillary study was designed to compare children's self-selected eating patterns and approaches to achieving adherence to the DISC fat-reduced diet intervention. Foods in the nutrient database were ranked by saturated fat and cholesterol content and classified within its relevant food group as a "go" (less atherogenic) or "whoa" (more atherogenic) food. Results indicated that "go" foods contributed approximately 57% of total energy intake and 12.4% to 13.1% total fat energy intake in both groups. At the 3-year data point, "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 groups were significant for changes in consumption of dairy foods, desserts, and fats/oils. Snack foods, desserts, and pizza contributed approximately 1/3 of total daily energy intake in both groups at the 3-year data point. Dairy and desserts/snacks/pizza food groups had the greatest impact on children's body mass index (BMI) and their levels of atherogenic LDL-C. Girls and boys who consumed more dairy products were more likely to have a lower BMI, whereas boys who consumed more desserts, snacks, and pizza were more likely to have higher BMI and LDL-C levels. The collective results of DISC indicate that children can adapt to heart-healthy eating patterns; access to nutritious foods and family involvement is essential to this goal. The results also indicate the need for more innovative, realistic approaches for additional dietary counseling children and youths. Nurses interested in these topics should read this study in its entirety.

Comment by Laura L. Hayman