Providing food to treat adolescents at risk for cardiovascular disease

Abstract

Objective: Diet modification is recommended to treat childhood cardiovascular (CV) risk factors; however, the optimal dietary strategy is unknown.

Methods: In a randomized trial, the effect of a low-fat (LF) and a low-glycemic-load (LGL) reduced-calorie diet were examined in youth with overweight/obesity with CV risk factors. Using a novel intervention, we delivered LF or LGL meals and nutrition education to the home for 8 weeks (Intensive Phase), followed by 4 months Maintenance without food provision. Between-group differences in the change in insulin area under the curve (InsAUC) by oral glucose tolerance test and other risk factors were analyzed.

Results: Overall, participants (n = 27) showed substantial improvement during the Intensive Phase, including InsAUC (-59 ± 18.2 µU/ml × 120 min, P = 0.004), total cholesterol (-9.9 ± 3.6 mg/dl, P = 0.01), weight (-2.7 ± 0.5 kg, P < 0.001), waist circumference (-3.1 ± 0.8 cm, P < 0.001), HOMA-IR (-1.7 ± 0.4, P < 0.001), systolic blood pressure (-5 ± 1.4 mm Hg, P = 0.002), and CRP (-0.1 ± 0.1 mg/dl, P = 0.04). There were minimal between-group differences; the LF group showed greater declines in HDL (P = 0.005) and fasting glucose (P = 0.01) compared to the LGL group. Improvements waned during Maintenance.

Conclusions: Home delivery of LF or LGL diets resulted in rapid and clinically important improvements in CV risk factors that diminished without food delivery and did not differ based on dietary intervention. If scalable, food provision may represent an alternative nutrition treatment strategy.

Trial registration: ClinicalTrials.gov NCT01080339.

Figure 1

Enrollment Flow Diagram showing the number of participants assessed for eligibility, enrolled, randomized, followed and analyzed.

Figure 2

Results of the InsAUC measured by oral glucose tolerance test over 120 minutes are shown by dietary assignment at baseline and at 8 weeks. There was no difference between groups in the change in InsAUC from baseline (p=0.72). InsAUC – Insulin area under the curve; BL – baseline; LGL – low glycemic load; LF – low fat.