Prospective randomised trial in 1062 infants of diet low in saturated fat and cholesterol

doi:10.1016/S0140-6736(95)90580-4

The Lancet

Volume 345, Issue 8948, 25 February 1995, Pages 471-476

https://doi.org/10.1016/S0140-6736(95)90580-4 Get rights and content

Abstract

Interventions to avoid atherosclerosis might be more successful if launched early in life when eating and life-style patterns are formed, but dietary interventions have been limited by fears of diet-induced growth failure. We investigated the effects of a diet low in saturated fat and cholesterol on serum lipid concentrations and growth in 1062 healthy 7-month-old infants in a randomised study. Every 1-3 months, families in the intervention group received dietary advice aimed at adequate energy supply, with low fat intake (30-35% energy, polyunsaturated/ monounsaturated/saturated fatty acid ratio 1/1/1, and cholesterol intake <200 mg daily). Infants in control families consumed an unrestricted diet. 3-day food records were collected at ages 8 and 13 months. Growth was carefully monitored. Between 7 and 13 months serum cholesterol and non-high-density-lipoprotein cholesterol concentrations did not change significantly in the intervention group (mean change -0·03 [SD 0·72] mmol/L and 0·01 [0·67] mmol/L) but increased substantially in the control group (0·24 [0·64] mmol/L and 0·23 [0·60] mmol/L; p for difference in mean changes between groups <0·001). Daily intakes of energy and saturated fat were lower in the intervention than in the control group at 13 months (4065 [796] vs 4370 [748] kJ, p=0·033, and 9·3 [3·5] vs 14·5 [4·8] g, p<0·001, respectively), and intake of polyunsaturated fat was higher (5·8 [2·2] vs 4·4 [1·4] g, p<0·001). Growth did not differ between the groups and was as expected for children at this age. Serum cholesterol concentrations fell significantly in parents of intervention-group infants. The increases in serum cholesterol and non-high-density-lipoprotein cholesterol concentration that occur in infants between the ages of 7 and 13 months can be avoided by individualised diets, with no effect on the children's growth.

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The aim was to study the impact of dietary intervention on the properties of paraffin-stimulated saliva, and on dental caries.
At 7 months of age 1062 infants (540 intervention; 522 controls) started in the prospective, randomized Special Turku Intervention Project (STRIP) aimed at restricting the child's saturated fat and cholesterol intake to prevent atherosclerosis of adult age (www.clinicaltrials.gov NCT 00223600). At 3 years of age, every fifth child was invited to an oral sub-study, and 148 (78 boys) children attended. At 6, 9, 12 and 16 years of age 135, 127, 114 and 88 children were restudied, respectively. Dietary intakes of carbohydrates, protein, saturated fat, calcium, phosphate, and fibre were regularly recorded using 4-day food records. Height and weight were regularly monitored. Paraffin-stimulated saliva samples were collected at 6, 9, 12 and 16 years of age, and analyzed for flow rate, buffer capacity, calcium, phosphate and proteins. Dental health was recorded and expressed as d₃mft/D₃MFT, and as time of caries onset.
Dietary intakes of calcium, phosphate and fibre, and salivary flow rate increased with time in both groups (p < 0.001, GLM for repeated measures). Fibre intake and salivary flow rate were higher in the intervention than in the control group (p = 0.042 and p = 0.0394, respectively, GLM for repeated measures). There were no correlations between dietary intakes and salivary concentrations of calcium or phosphate. Children who did not have caries experience (d₃mft/D₃MFT = 0) during the entire follow-up had higher salivary calcium than those who had caries already at 3 years of age. The association between salivary calcium and caries onset was significant up to 12 years of age. Toothbrushing frequency was statistically significantly associated with caries-onset at ages 6 (gamma statistic 0.457, p = 0.046) and 12 years (gamma statistic 0.473, p = 0.019).
The current long-term dietary intervention increased children's paraffin-stimulated salivary flow rate. The concentration of salivary calcium was directly correlated to dental health. Higher salivary flow rate in the intervention group is believed to be due to higher fibre intake in the intervention group.
Early nutrition patterns and diseases of adulthood: A plausible link?
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Citation Excerpt :
Aim of the above mentioned study was to investigate the effects of a diet low in saturated fat and cholesterol on serum lipid concentrations and growth. The study recruited more than 1000 healthy 7-month-old infants randomized to intervention or control groups [60]. Families in the intervention group received dietary advice to moderately restrict fat intake (25 to 30% of total energy supply) with adequate energy supply, to increase the unsaturated/saturated fat ratio and lower dietary cholesterol.
In the last decades several studies tested the hypothesis that at early development stages certain foods or nutrients, in specific amounts, fed during limited sensitive periods, may determine an endocrine metabolic asset leading to clinical alterations that take place decades later (early nutritional programming of long term health). Evidence is mounting for programming effects of infant feeding. Observational studies indicate that breast feeding, relative to formula feeding, reduces the risk for obesity at school age by about 20% even after adjustment for biological and sociodemographic confounders. Moreover, breastfeeding is constantly associated with increased neurodevelopmental scores up to early adulthood, while its outcome in terms of delayed decay of brain function is still unknown. Besides the environment surrounding breastfeeding, specific nutrients within human milk may play a direct role. With the introduction of solids the major changes in diet are represented by the sudden decrease of fat intake from 50 to 30% of total energy. A protein excess, commonly found throughout all European Countries, has been associated to a higher risk of adiposity in early childhood, as confirmed by first reports from a large European trial. The amount of fat does not seem to be associated with later adiposity, while its quality may affect blood lipoproteins, blood pressure and neurodevelopmental performance. Early intake of dietary fibers might also have beneficial effects. Epidemiologic data show that episodes of rapid growth (growth acceleration hypothesis), whichever the dietary habits, are associated with later unfavorable health conditions and should be prevented.
Role of fats in the first two years of life as related to later development of NCDs
2012, Nutrition, Metabolism and Cardiovascular Diseases
Compared to exclusive breastfeeding, the introduction of solids leads to a reduction of dietary fats. We explore the hypothesis that dietary fats consumed in the 6–24-month period might have later effects on non-communicable disorders and health.
We have considered studies on dietary fats as substrate for oxidation and energy production, effects on adiposity, blood lipoprotein levels and features of the metabolic syndrome, and the possible influences on brain development and function. Fat oxidation, despite a high initial dietary supply, is greatly suppressed and only gradually increases after birth. There is no evidence of any convincing association between fat intake during the 6–24-month period and later indices of adiposity. Fat quality may affect the blood lipoprotein picture at short-term through the first 12 months of life. In a large Finnish trial, a moderately restricted fat diet started at 7 months, with an increased unsaturated/saturated fat ratio, has shown favourable effects on serum cholesterol values, indices of insulin resistance and endothelial function especially in boys, and had no negative effects until the age of 18 years. The dietary supply of docosahexaenoic acid might affect brain development as well as some features of the metabolic syndrome.
In the 6–24-month period, the amount of fat intake does not show associations with later health conditions, and relatively high-fat diets do not seem to be harmful. Fat quality may have later effects on chronic-degenerative processes that need to be explored more in depth.
Time trends in dietary fat intake in a sample of German children and adolescents between 2000 and 2010: Not quantity, but quality is the issue
2014, British Journal of Nutrition

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Prospective randomised trial in 1062 infants of diet low in saturated fat and cholesterol

Abstract

Prevent Med

J Lipid Res

Am J Clin Nutr

Intimal thickening in the coronary arteries of infants and children as an indicator of risk factors for coronary heart disease

Eur Heart J

Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis: the Bogalusa Heart Study

N Engl J Med

Relationship of atherosclerosis in young men to serum lipoprotein concentrations and smoking: a preliminary report

JAMA

Serum cholesterol in young men and subsequent cardiovascular disease

N Engl J Med

Trends in coronary heart disease mortality and morbidity and related factors in Finland

Cardiology

Children should not be routinely screened for high blood cholesterol

Am J Dis Child

Highlights of the report of the expert panel on blood cholesterol levels in children and adolescents

Pediatrics

Individualized dietary counselling of the families: serum cholesterol concentration and growth of children aged 7 to 13 months

Acta Paediatr

Variation of growth in length and weight of children: I years 1 and 2

Acta Paediatr Scand