Healthy Eating Patterns Can Reduce Cardiovascular Risk in Children Considered Overweight or Obese

Michael Macknin, MD

New research from a trial conducted by investigators at the Cleveland Clinic is underscoring the impact of dietary choices and interventions in reducing cardiovascular risk factors among children with overweight or obesity.

An assessment of 3 specific eating patterns in children aged 9-18 years old with a BMI in the 95th percentile or greater, results of the study provide evidence suggesting adherence to either of the 3 diets examined in the trial could result in significant improvements in cardiovascular risk factors among this patient population.

“This study helps show the importance of starting healthy eating patterns as young as possible. We know that cardiovascular disease begins in childhood, and children's eating patterns are easier to mold than adolescents and adults,” said lead investigator Michael Macknin, MD, professor emeritus of pediatrics of Cleveland Clinic Lerner College of Medicine, in a statement from the Cleveland Clinic.

With an interest in further exploration of the impact of dietary choices on cardiovascular risk and risk factors among pediatric considered overweight or obese, Macknin and colleagues at the Cleveland Clinic designed the current study as a prospective randomized trial comparing the effects of the American Heart Association Diet, Mediterranean Diet, and a plant-based diet for 52 weeks from patients within the Cleveland Clinic’s Pediatric Obesity Registry. For inclusion in the trial, patients needed be 9-18 years of age, have a BMI for age and sex in the 95th percentile, and a total cholesterol greater than 169 mg/dL.

Ultimately, 96 child-caregiver dyads were identified for inclusion in the trial. Patients included in the study were asked to attend educational sessions to learn more about their assigned diets and receive support. Anthropometric measurements, including weight, BMI, blood pressure, and waist circumference, were recorded at weeks 0, 4, and 52. Investigators used fasting blood tests to assess biomarkers of risk including total cholesterol, LDL-C, HDL-C, and hsCRP.

Each of the 3 study arms contained 32 children and 32 parents or guardians. Of these 96 dyads, 83% attended the first study visit, 70% attended the 4-week visit, and 33% completed the 52-week visit. Investigators pointed out the small sample sizes resulted in inadequate power to detect significant differences in study results associated with participation in education sessions and study visits.

Upon analysis, results suggested significant improvements were observed in all groups at 4 weeks when examining weight, systolic and diastolic blood pressure, and myeloperoxidase. Additionally, similar statistically significant results were observed for total cholesterol and LDL-C. When assessing reasons for opting not to enroll in the study, time was identified as the only significant deterrent (P <.001).

“Because the process of heart disease begins in childhood, prevention should begin there as well,” said W.H. Wilson Tang, MD, study author and research director in the section of heart failure and cardiac transplantation medicine in the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic. “A large majority of heart disease is due to modifiable or controllable risk factors, so it’s important for children to understand that they are in large part responsible for their health.”

This study, “Three Healthy Eating Patterns and Cardiovascular Disease Risk Markers in 9 to 18 Year Olds With Body Mass Index >95%: A Randomized Trial,” was published in the Journal of Clinical Pediatrics.