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(Circulation. 1997;96:2526-2533.)
© 1997 American Heart Association, Inc.

Articles

Effects of Diet and Sexual Maturation on Low-Density Lipoprotein Cholesterol During Puberty

The Dietary Intervention Study in Children (DISC)

Peter O. Kwiterovich, Jr, MD; Bruce A. Barton, PhD; Robert P. McMahon, PhD; Eva Obarzanek, PhD; Sally Hunsberger, PhD; Denise Simons-Morton, MD, PhD; Sue Y. S. Kimm, MD; Lisa Aronson Friedman, ScM; Norman Lasser, MD, PhD; Alan Robson, MD; Ronald Lauer, MD; Victor Stevens, PhD; Linda Van Horn, PhD; Samuel Gidding, MD; Linda Snetselaar, PhD; Virginia W. Hartmuller, MS; Merwyn Greenlick, PhD; ; Frank Franklin, Jr, MD, PhD

From The Johns Hopkins University (P.O.K.), Baltimore, Md; Maryland Medical Research Institute (B.A.B., R.P.M., L.A.F.), Baltimore, MD; National Heart, Lung, and Blood Institute (E.O., S.H., D.S.-M.), National Institutes of Health, Bethesda, Md; University of Pittsburgh (S.Y.S.K.) (Pa); University of Medicine and Dentistry of New Jersey (N.L.) (Newark); Children's Hospital of New Orleans (A.R.) (La); University of Iowa (R.L., L.S.) (Iowa City); Kaiser-Permanente Center for Health Research (V.S., M.G.) Portland, Ore; Northwestern University (L.V.H.) Chicago, Ill; Children's Hospital of Chicago (S.G.) (Ill); National Cancer Institute (V.V.H.) Rockville, Md; and University of Alabama at Birmingham (F.F.)

Background The Dietary Intervention Study in Children (DISC) is a multicenter, randomized, controlled clinical trial designed to examine the efficacy and safety of a dietary intervention to reduce serum LDL cholesterol (LDL-C) in children with elevated LDL-C.

Methods and Results The effects of dietary intake of fat and cholesterol and of sexual maturation and body mass index (BMI) on LDL-C were examined in a 3-year longitudinal study of 663 boys and girls (age 8 to 10 years at baseline) with elevated LDL-C levels. Multiple linear regression was used to predict LDL-C at 3 years. For boys, LDL-C decreased by 0.018 mmol/L for each 10 mg/4.2 MJ decrease in dietary cholesterol (P<.05). For girls, no single nutrient was significant in the model, but a treatment group effect was evident (P<.05). In both sexes, BMI at 3 years and LDL-C at baseline were significant and positive predictors of LDL-C levels. In boys, the average LDL-C level was 0.603 mmol/L lower at Tanner stage 4+ than at Tanner stage 1 (P<.01). In girls, the average LDL-C level was 0.274 mmol/L lower at Tanner stage 4+ than at Tanner stage 1 (P<.05).

Conclusions In pubertal children, sexual maturation, BMI, dietary intervention (in girls), and dietary cholesterol (in boys) were significant in determining LDL-C. Sexual maturation was the factor associated with the greatest difference in LDL-C. Clinicians screening for dyslipidemia or following dyslipidemic children should be aware of the powerful effects of pubertal change on measurements of lipoproteins.

Key Words: coronary disease • pediatrics • diet • hyperlipoproteinemia • lipoproteins

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