Neurological development of 5-year-old children receiving a low-saturated fat, low-cholesterol diet since infancy - A randomized controlled trial

Context Early childhood introduction of nutritional habits aimed at atheros clerosis prevention is compatible with normal growth, but its effect on neu rological development is unknown. Objective To analyze how parental counseling aimed at keeping children's di ets low in saturated fat and cholesterol influences neurodevelopment during the first 5 years of life. Design Randomized controlled trial conducted between February 1990 and Nove mber 1996. Setting Outpatient clinic of a university department in Turku, Finland. Participants A total of 1062 seven-month-old infants and their parents, rec ruited at well-baby clinics between 1990 and 1992. At age 5 years, 496 chil dren still living in the city of Turku were available to participate in neu rodevelopmental testing. Intervention Participants were randomly assigned to receive individualized counseling aimed at limiting the child's fat intake to 30% to 35% of daily energy, with a saturated: monounsaturated:polyunsaturated fatty acid ratio of 1:1:1 and a cholesterol intake of less than 200 mg/d (n = 540) or usual health education (control group, n = 522). Main Outcome Measures Nutrient intake, serum lipid concentrations, and neur ological development at 5 years, among children in the intervention vs cont rol groups. Results Absolute and relative intakes of fat, saturated fatty acids, and ch olesterol among children in the intervention group were markedly less than the respective values of control children. Mean (SD) percentages of daily e nergy at age 5 years for the intervention vs control groups were as follows : for total fat, 30.6% (4.5%) vs 33.4% (4.4%) (P<.001); and for saturated f at, 11.7% (2.3%) vs 14.5% (2.4%) (P<.001). Mean intakes of cholesterol were 164.2 mg (60.1 mg) and 192.5 mg (71.9 mg) (P<.001) for the intervention an d control groups, respectively Serum cholesterol concentrations were contin uously 3% to 5% lower in children in the intervention group than in childre n in the control group. At age 5 years, mean (SD) serum cholesterol concent ration of the intervention group was 4.27 (0.63) mmol/L (165 [24] mg/dL) an d of the control group, 4.41 (0.74) mmol/L (170 [29] mg/dL) (P=.04). Neurol ogical development of children in the intervention group was at least as go od as that of children in the control group. Relative risks for children in the intervention group to fail tests of speech and language skills, gross motor functioning plus perception, and visual motor skills were 0.95 (90% c onfidence interval [CI], 0.60-1.49), 0.95 (90% CI, 0.58-1.55), and 0.65 (90 % CI, 0.39-1.08), respectively (P=.85, .86, and .16, respectively, vs contr ol children). Conclusion Our data indicate that repeated child-targeted dietary counselin g of parents during the first 5 years of a child's life lessens age-associa ted increases in children's serum cholesterol and is compatible with normal neurological development.