Rx Nutrition Resource Center

Rx Nutrition Resource Center

Disclosures: Macknin reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
October 01, 2021
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Healthy eating patterns improve CVD risk markers in children with overweight

Disclosures: Macknin reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Adhering to any of the healthy eating patterns from the 2015 U.S. dietary guidelines significantly improved CVD risk markers in children with overweight who have elevated cholesterol levels, researchers reported in Clinical Pediatrics.

“We initially undertook the study to try to compare the effectiveness of the three healthy eating patterns highlighted in the 2015-2020 Dietary Guidelines for Americans,” Michael Macknin, MD, pediatrics specialist at Cleveland Clinic Children’s and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, told Healio. “For unclear reasons, our patient population, selected using identical criteria to our pilot study, had lab values closer to normal and worse compliance than our pilot study patients. Therefore, our study was not sufficiently powered to detect between group differences, so we reported changes within the groups.”

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The 1-year prospective randomized pilot trial included 80 children (61% girls) aged 9 to 18 years with overweight for their age and sex and total cholesterol greater than 169 mg/dL and their parents/guardians from a large Midwestern hospital health system identified using the Pediatric Obesity Registry. Children were randomly assigned to one of the three healthy eating patterns: a plant-based diet (n = 25), a no-added-fat diet (n = 27) and the Mediterranean diet (n = 28).

Participants were recommended to attend 90-minute group educational sessions regarding their assigned diets at weeks 0, 1, 2, 3 and 4. Dietary intake was estimated through 24-hour dietary recall assessments collected by telephone 4 weeks before the study, between 2 and 4 weeks and between 48 and 52 weeks. Participants’ weight, BMI, BP and waist circumference were measured at weeks 0, 4 and 52, and participants completed diet acceptability questionnaires.

Attendance and compliance

In the first week, total attendance at the 90-minute educational sessions was 80%, with 70% attendance from those in the no-added fat diet and plant-based diet groups and 96% attendance from those in the Mediterranean diet group (P = .02). After the first week, total attendance ranged from 65% to 81%.

Researchers observed significantly greater child compliance to their assigned diet among those in the plant-based diet group (81%) compared with the no-fat added diet group (62%) or the Mediterranean diet group (56%; P < .001). At 52 weeks, the Healthy Eating Index-2010 and compliance were significantly lower among those in the no-fat added diet group.

Both children and their parents reported the Mediterranean diet as the most acceptable, the no-fat added diet as intermediately acceptable and the plant-based diet as the least acceptable. Children reported preferring the appearance and effort required to stay on the Mediterranean and no-fat added diets compared with the plant-based diet (P = .017 for appearance; P = .014 for effort).

Weight, cholesterol impact

There were significant improvements in weight, systolic and diastolic BP and myeloperoxidase in all children in all dietary groups at 4 weeks. Significant decreases in total cholesterol and LDL were observed among children in the no-fat added and plant-based diet groups. At 52 weeks, there were significant improvements in total cholesterol, LDL, fasting glucose, myeloperoxidase and waist circumference in all groups. However, only the no-fat-added and plant-based diet groups demonstrated significant improvements in systolic and diastolic BP at 52 weeks.

“We know cardiovascular disease begins in childhood. Future research should concentrate on initiatives to ease the time burden and increase implementation of established healthy eating principles,” Macknin said. “These efforts should include public health measures that can address diet-related diseases with a particular focus on children (many children eat one to two meals and snacks each day in school or day care, and those meals, when provided, should be healthy).”

For more information:

Michael Macknin, MD, can be reached at macknim@ccf.org.