The goal of this demonstration and education study is to evaluate the efficacy of an inexpensive educational intervention to promote the substitution of low-fat for whole milk as a strategy for implementing the National Cholesterol Education Program (NCEP) dietary recommendation to reduce average daily intake of saturated fat. the intervention is directed at Hispanic preschool children and comprises a brief personal contact, low-literacy level print materials, and reinforcers. Hispanic families, which are increasing rapidly in the population, tend to have high prevalence of several cardiovascular disease risk factors, low levels of knowledge about cardiovascular disease prevention, and consume more saturated fat and less low-fat milk than non-Hispanic whites. Further, Hispanic preschool children have high prevalence rates of obesity, and tend to use whole milk exclusively. The proposed intervention strategy is a direct result of the NIH-sponsored Columbia University Study of Children's Activity and Nutrition, which indicated that virtually all the Hispanic preschool children in the sample consumed whole milk exclusively, that whole milk was the main source of dietary saturated fat, and that substitution of low-fat (1% fat) milk would reduce mean dietary saturated fat intake from over 30% above levels currently recommended by the NCEP to within recommended levels (< 10% of calories). The study design is a randomized controlled intervention trial with blinding, with the individual as the unit of sampling, assignment and analysis. A total of 600 low-income Hispanic families with preschool children will be sampled from a large urban network of pediatrics practices and randomized to intervention or control. The study endpoints are serum total and LDL cholesterol level and dietary saturated fat intake at 6 months post-intervention. Sample size determinations were based on alpha = 0.01, beta = 0.80, and delta (for total and LDL cholesterol) = 8.0 mg/dl and 7.1 mg/dl respectively. Measures of mothers' knowledge and beliefs and children's growth will also be collected. The intervention was designed in a practical way, so if efficacious and safe it can be disseminated, implemented and sustained in existing community programs in our target community and in others.
