Two programs that promote the role of pediatric practices in lowering LDL cholesterol levels in 4-10 year old hypercholesterolemic children through dietary modification will be evaluated. Pediatricians in five practices in Abington, PA will conduct a cholesterol screening program (capillary blood sample) for 4-10 year old children in their care. Children who test positive (total cholesterol >176 mg/dl) will be offered follow-up evaluations (two fasting venous blood samples) to confirm the positive initial test. Those with mean LDL cholesterol levels between the 80th and 98th percentiles for age/sex (107-164 mg/dl for boys and 112-164 mg/dl for girls) and who meet other entry criteria will be invited to join the study. Children with parental permission to participate will be randomized to one of three groups: two that receive dietary education, and a comparison group that receives no dietary education. One educational program will use face-to-face counseling with a registered dietitian and the other will use a home-based, parent-child autotutorial approach. In addition, a random sample of non-hypercholesterolemic children with total plasma cholesterol levels between the 40th and 60th percentiles for age/sex will be invited to join the study as a second comparison group. Prior to the education period (baseline) and three times thereafter (3, 6 and 12 months post-baseline), we will assess all four groups' consumption of total fat, saturated fat, and cholesterol, and their growth and pertinent cognitive psychosocial factors. Also, the plasma LDL cholesterol levels of the three hypercholesterolemic groups will be assessed at all four time points along with blood indicators of iron status at baseline and twelve months. To assess the educational programs' effectiveness we will compare changes in assessed variables of the hypercholesterolemic groups who did and did not receive dietary education. Also, we will ascertain how changes in diet, growth, and cognitive/psychosocial factors in these groups compare with those of the non-hypercholesterolemic group that had neither a positive diagnosis of elevated blood lipids nor dietary education. Additionally, we will evaluate the cost-effectiveness of the two dietary education programs. Outcomes of the study should provide valuable guidance for pediatricians who want to become more actively involved in identifying and treating children with elevated blood lipids.
| McHale, S M; Tershakovec, A M; Corneal, D A et al. (1998) Psychosocial factors in nutrition education for hypercholesterolemic children. Ann Behav Med 20:233-40 |
