Turku, Finland - Regularly counseling families about the importance of a healthy diet is an effective means of decreasing saturated fat and cholesterol intakes as well as reducing serum cholesterol levels in children until their early teenage years, a new study has shown [1]. The low-fat, low-cholesterol diet did not adversely affect physical development, report investigators, so fear that restricting saturated-fat intake influences growth or the onset of puberty is unwarranted.

These results, published online August 13, 2007 in Circulation by lead author Dr Harri Niinikoski (University of Turku, Finland) and colleagues, support the promotion of a healthy diet and lifestyle earlier in life. "The beneficial influences of the dietary counseling do not fade away during the years when the children start consuming more of their nutrients away from home," write the authors. "Furthermore, the lower saturated-fat intake in the intervention children was not associated with altered physical growth between seven months and 14 years of age."

The Finnish findings are from the Special Turku Coronary Risk Factor Intervention Project (STRIP), a community-based study in which 540 children were randomized to a low-saturated-fat, low-cholesterol diet, with dietary counseling emphasizing the importance of controlling environmental coronary heart disease risk factors. The researchers previously showed that early-onset counseling of a saturated-fat- and cholesterol-restricted diet significantly decreased serum cholesterol concentrations successfully until early school age with no adverse effects, compared with controls who did not receive dietary counseling.

The investigators note, however, that subjects older than seven years of age pose special challenges in nutrition counseling because school-age children and adolescents begin to consume more of their meals away from home, and peer pressure begins to influence food selections. In addition to this, serum lipid and lipoprotein levels in boys and girls are altered in puberty, making the effects of limiting fat and cholesterol unknown in these subjects.

In the STRIP study, families in the counseling group received individualized diet counseling at one- to three-month intervals until the child reached age two, and twice a year thereafter, whereas the control families were seen twice annually until the child was seven years old, and then annually. At age seven, the children were all counseled directly.

Niinikoski and colleagues say the emphasis of dietary counseling was not to reduce total fat calories but to shift food intake away from saturated fats and to reduce cholesterol intakes to less than 200 mg. Following the children until age 14 years, investigators report that those receiving dietary counseling had small but statistically significant lower median total- and LDL-cholesterol levels compared with those who did not receive dietary counseling. The difference in serum cholesterol levels between the diet group and the control group at 14 years was statistically significant for boys but not girls. The diets of the intervention children were lower in fat and saturated fat as well as higher in protein and carbohydrates. Boys tended to have lower total- and LDL-cholesterol levels than girls throughout childhood.

In terms of safety, the two treatment arms showed no difference in growth, body-mass index, pubertal development, or age of the first menstrual cycle for girls. "Our present data do not support the fear that saturated-fat restriction influences either growth or pubertal timing or tempo in healthy children," they write.

The researchers intend to follow the children in the STRIP study until they reach age 20, at which point they hope to determine whether the positive lipid effects of dietary counseling translate into significant reductions in atherosclerosis or subclinical disease.