Childhood diet, overweight, and CVD risk factors: the Healthy Start project.

Cardiovascular disease (CVD) risk factors can be identified in children and tracked over time. We studied 519 children (mean age, 3.9 years) and reevaluated CVD risk factors 4 years later. Baseline and follow-up (FU) measures included height, weight, body mass index (BMI), blood pressure level, blood lipid values, and 24-hour dietary intake. Nutritional predictors of CVD risk factors (lipid levels and BMI) were identified using regression analysis at follow-up. Energy intake at baseline and FU, as well as increasing BMI over time, were directly associated with total cholesterol levels. Dietary intake of monounsaturated fat and dietary fiber were significant predictors of total cholesterol level at follow-up (inverse associations). Increasing BMI, waist circumference at FU, and intake of sucrose at FU were inversely associated with high-density lipoprotein cholesterol levels at FU. Waist circumference and BMI at FU were associated with higher triglyceride levels, while percent energy from monounsaturated fat was associated with lower values. This study provides further evidence that dietary intake influences CVD risk factors in childhood.

Weight control among obese adolescents: a pilot study.

OBJECTIVE: The present study evaluated weight loss and compliance outcomes for overweight adolescents assigned to one of two dietary interventions differing in the type of snacks allowed. METHODS: The study was a 12-week, controlled clinical trial, among otherwise healthy but overweight (body mass index >or=95th percentile) 11-year-old to 15-year-old girls who were randomly assigned to either a 1,500 kcal/day free-snack program or a 1,500 kcal/day restricted-snack program. All subjects were counseled to consume three servings of dairy products per day, and were provided with a 500 mg calcium supplement as well. Subjects in the free-snack group could choose any 150-calorie item as one of their two daily snacks, including regular soda if desired; however, subjects in the restricted-snack group were limited to diet soda. RESULTS: Thirty-two adolescent girls completed the 12-week intervention. Both diets were equally effective in achieving a modest amount of weight loss, and were equally acceptable to the subjects. Significant decreases in weight, body mass index, anthropometric measures, total cholesterol and triglycerides were observed. CONCLUSIONS: A 1,500 kcal/day diet allowing for a free snack of 150 calories was equally as effective as a more restricted snack policy in achieving a modest amount of weight loss among overweight 11-year-old to 15-year-old girls. In addition, results suggest that some soda may be included in a teen weight control diet, as long as caloric intake is maintained at recommended levels, and care is taken to achieve adequate intake of essential nutrients. Calcium intake among subjects was low at baseline, and, although it increased during the study (due to supplementation), further efforts to increase consumption of naturally calcium-rich and calcium-fortified foods and beverages are needed.

Cardiovascular risk reduction in preschool children: the "Healthy Start" project.

OBJECTIVE: To evaluate the impact of a multicomponent cardiovascular health intervention ("Healthy Start") which included a food service modification in a largely minority Head Start preschool population. The primary outcome measure was the change in serum cholesterol from the beginning to the end of the school year. METHODS: Nine Head Start centers in Upstate N.Y. were assigned to either food service modification or control conditions. In addition, half of the centers assigned to the food service modification received supplemental nutrition education (FS/NU--food service modification/nutritional education), while the remaining centers were provided with supplemental safety education materials (FS--food service modification only). The control preschool centers (CON) also received supplemental safety educational curricula for children but their food services remained unchanged. Children had serum cholesterol, as well as height and weight measured at the beginning and end of the school year. A generalized linear univariate procedure was used with percent change in total serum cholesterol as the outcome variable and intervention group as the primary independent variable. RESULTS: There was a significant decrease in total serum cholesterol among preschool children in food service intervention groups, (FS/NU and FS), compared to Controls (-6.0 versus -0.4 mg/dL). In addition to the significant difference in group means, children with elevated cholesterol at baseline were significantly more likely to have a cholesterol level in the normal range (<170 mg/dL) at follow-up if they attended a preschool in the food service modification group. There was a 30% reduction in risk of elevated cholesterol in the latter compared to controls. Participation in the dietary intervention did not affect short-term growth. CONCLUSIONS: A preschool heart health intervention, "Healthy Start," designed to reduce the total and saturated fat content of snacks and meals to recommended levels was effective in reducing serum cholesterol in the study population as a whole and specifically children 'at risk'; i.e., those with initial elevated serum cholesterol.

"Healthy-start": outcome of an intervention to promote a heart healthy diet in preschool children.

OBJECTIVE: We evaluated the effects of a preschool nutrition education and food service intervention "Healthy Start," on two-to-five-year-old children in nine Head Start Centers in upstate NY. The primary objective was to reduce the saturated fat (sat-fat) content of preschool meals to <10% daily energy (E) and to reduce consumption of sat-fat by preschoolers to <10% E. METHODS: Six centers were assigned to the food service intervention and three to control condition. Food service intervention included training workshops for cooks and monthly site visits to review progress towards goals. Child dietary intake at preschool was assessed by direct observation and plate waste measurement. Dietary intake at home was assessed by parental food record and telephone interviews. Dietary data were collected each Fall/Spring over two years, including five days of menus and recipes from each center. Dietary data were analyzed with the Minnesota NDS software. RESULTS: Consumption of saturated fat from school meals decreased significantly from 1.0%E to 10.4%E after one year of intervention and to 8.0%E after the second year, compared with an increase of 10.2% to 13.0% to 11.4%E, respectively, for control schools (p < 0.001). Total caloric intake was adequately maintained for both groups. Analysis of preschool menus and recipes over the two-year period of intervention showed a significant decrease in sat-fat content in intervention preschools (from 12.5 at baseline to 8.0%E compared with a change of 12.1%E to >11.6%E in control preschools (p < 0.001)). Total fat content of menus also decreased significantly in intervention schools (31.0% to >25.0%E) compared with controls (29.9% to >28.4%E). CONCLUSIONS: The Healthy Start food service intervention was effective in reducing the fat and saturated fat content of preschool meals and reducing children's consumption of saturated fat at preschool without compromising energy intake or intake of essential nutrients. These goals are consistent with current U.S Dietary Guidelines for children older than two years of age.