Dietary Intervention Study in Children (DISC)

Dietary Intervention Study in Children (DISC)

OVERVIEW

The intervention consists of promoting adherence to a specific diet in order to reduce consumption of fat, saturated fat, and cholesterol through frequent meetings and follow-up phone calls. During the first six months, meetings were weekly. In the second six months, there were four group sessions and two individual sessions. During the second and third years, group and individual maintenance sessions were held four to six times each year with monthly telephone contacts between sessions.

DISC was found to lower cholesterol for children with high levels of “bad” cholesterol, or LDL cholesterol, with no negative impact on development when the diet begins before the major pubertal growth spurt. The DISC group’s cholesterol levels were significantly lower than the control group’s and there were only two significant differences in development between the groups. The intervention group’s waist-to-hip ratio was lower than the control group at 1 year but not 3 years and the intervention group also scored lower on a depression scale at 3 years but not 1 year.

DESCRIPTION OF PROGRAM

Target population: Children, middle childhood

DISC is a family-oriented diet program designed to meet the recommended dietary allowances for age- and sex-specific groups.

The regimen requires the diet to provide 28% of calories from total fat, less than 8% from saturated fat, up to 9% from polyunsaturated fat, and less than 75 mg/4200 kJ (1000 kcal) per day of cholesterol (not to exceed 150 mg/d).

EVALUATION(S) OF PROGRAM

Writing Group for the DISC Collaborative Research Group (1995). "Efficacy and safety of lowering dietary intake of fat and cholesterol in children with elevated low-density lipoprotein cholesterol: The dietary intervention study in children (DISC)." Journal of the American Medical Association 273(18): 1429-1435.

Evaluated population: The DISC Collaborative Research Group looked at 362 prepubescent boys and 301 prepubescent girls ages 8 to 10 years old with LDL cholesterol levels greater than or equal to the 80^th but less than the 98^th percentiles for their age and sex. Children were randomly assigned to either an intervention group (N=334) or a control group (N=329).

The intervention group had a statistically significant, slightly higher proportion of children in families with household incomes less than $20,000 per year.

Approach: The intervention consisted of promoting adherence to a specific diet through frequent meetings and follow-up phone calls. The intervention consisted of several home visits and group session meetings. At the initial visit, the current eating pattern was assessed and a personal program developed for each participant. In the first six months there were six weekly and five biweekly group sessions augmented by two individual visits of children with their family members. In the second six months, parents and their children attended four group sessions and two individual sessions. During the second and third years, group and individual maintenance sessions were held four to six times each year with monthly telephone contacts between sessions.

The authors collected measurements from blood and measurements of development to see whether the diet had any physical impact on the growth of the children during their biggest growth spurt or any impact on their emotional development. Measurements were taken at baseline, one year, and at three years.

Blood was drawn for measurements of LDL cholesterol, total serum cholesterol, triglycerides, HDL cholesterol, and blood micronutrients (serum ferritin, zinc, retinol, and red blood cell folate). The children’s skinfold thicknesses, body circumferences, blood pressure, height, weight, BMI, and diet were assessed. The psychological assessments the children filled out were Achenbach’s Child Behavior Checklist, Spielberger’s State-Trait Anxiety Inventory for Children, reading and mathematics subsets of the Woodcock-Johnson Psycho-Educational Battery, Moos’ Family Environment Scale, Eyberg’s Child Behavior Inventory, and Sarason’s Life Experience Survey.

Results: The control and treatment group both experienced decreases in “bad” cholesterol (LDL) by years 1 (a small effect size of 0.25) and 3 (a small effect size of 0.18). The treatment group experienced a significantly greater decrease in LDL than the control group. Most measures of fat consumption were significantly lower for the treatment than the control group at one and three years (large effect sizes as high as 0.98).

The mean difference was not significant between the control and treatment groups in height, serum ferritin levels, weight, BMI, sum of skinfolds, blood pressure, hemoglobin levels, mean serum levels of zinc or albumin, red blood cell folate values, intakes of some vitamins (A, C or B₆, calcium or iron), sexual maturation, or most psychosocial assessments.

There were several impacts for the intervention group in their development. Waist-to-hip ratio was lower in the intervention group than in the usual care group at 1 year but was not different at 3 years. The one psychosocial assessment that differed between the control group and treatment group was Kovak’s Child Depression Inventory, showing a significantly lower score for the intervention at 3 years but not year 1.

SOURCES FOR MORE INFORMATION

Link to program curriculum:

http://www.feinberg.northwestern.edu/nutrition/tools-resources/research/disc.html

References

Program categorized in this guide according to the following:

Evaluated participant ages: 8-10

Program components: home-based, clinic-based

Measured outcomes: physical health, nutrition, LDL-C, total serum cholesterol, triglycerides, HDL-C, dietary assessment, skinfold thicknesses, body circumferences (at waist and hip), blood pressure, blood micronutrients (serum ferritin, zinc, retinol, red blood cell folate), height, weight, BMI, Achenbach’s Child Behavior Checklist, Spielberger’s State-Trait Anxiety Inventory for Children, reading and mathematics subsets of the Woodcock-Johnson Psycho-Educational Battery, Moos’ Family Environment Scale, Eyberg’s Child Behavior Inventory, and Sarason’s Life Experience Survey.

KEYWORDS: Children (3-11), Middle Childhood (6-11), Physical Health, Nutrition, Overweight, Obese, Home-Based, Clinic-Based, Home Visitation.

Program information last updated 5/19/09

		© Child Trends 2003