Program

May 19, 2009

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 80th but less than the 98th
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.preventivemedicine.northwestern.edu/research/disc.html

References

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.

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

Program information last
updated 5/19/09

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