A Prospective Randomized Trial of Atherosclerosis Prevention in Childhood – The Strip Project
The Special Turku Coronary Risk Factor Intervention Project (STRIP) study is unique worldwide; no other study has started dietary intervention in infancy, and continued it for 20 years, and simultaneously, collected data with repeated measurements on a vast number of risk factors and subclinical markers for cardiovascular health.
The main purpose of the STRIP study is the prevention of atherosclerosis and coronary heart disease by a dietary intervention which began in infancy and has continued to early adulthood. The trial was launched in 1990 when 1062 seven-month-old children and their families were enrolled. Half of the families have received individualized dietary and other life-style counseling at least twice a year whereas the rest of the families have served as a control group. The STRIP study intervention continued until the participants reached the age of 20 years.
The main aim of the dietary counseling was the replacement of saturated fat with unsaturated fat in the child’s diet. In addition, the counseling promoted use of vegetables, fruits and whole-grain products and low intake of salt. Given dietary recommendations were based on the Nordic nutrition guidelines, and a fixed diet was never ordered. In addition to diet, child-oriented counseling aiming at primary prevention of smoking began at the child’s age of 8 years. During the first years, the counseling was given primarily to the parents. From the age of seven years, progressively more information was given directly to the child. For more detailed description of the cohort and intervention, please see
Simell et al. Int J Epidemiol 2009.
The main outcome measures comprise food consumption and nutrient intake data, serum lipid and lipoprotein concentrations, measures of somatic growth and development, blood pressure, and ultrasonic measures of arterial intima-media thickness, distensibility and endothelial function. The intervention has led to favorable changes in diet, as well as e.g. lower serum LDL cholesterol and blood pressure, improved insulin sensitivity, and diminished clustering of cardiometabolic risk factors. These changes have occurred without affecting growth or neurological development of the children. Additionally, several other aspects of cardiovascular health have also been examined, such as the associations between exposure to environmental tobacco smoke, physical activity and the arterial measures.
Results of the STRIP study have affected national and international dietary guidelines. For example, the results are highly recognized in the current U.S. guidelines for cardiovascular health and risk reduction in children and adolescents, please see
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents FULL REPORT
Additionally, American Heart Association has highlighted the results from the STRIP in its Presidential Advisory Statement on dietary fats and cardiovascular disease, please see
A Presidential Advisory From the American Heart Association
The first STRIP Follow-up Study began in spring 2015 when the participants were aged 26 years. This study phase continued the collection of the unique longitudinal data bank and also introducing novel aspects associated with cardiovascular health. These novel measures include e.g. the assessment of gut microbiota, cognitive function and retinal imaging. The data collection period was completed in January 2018. The results from this first post-intervention follow-up study revealed that the positive intervention effects had remained: the dietary fat quality was better and the targeted intake of dietary fibre and cholesterol were more often met in the intervention group. The participants in the intervention group also consumed more vegetables, fruits and berries compared to the control group. These beneficial effects were also reflected to better serum lipid profile and insulin sensitivity. Additionally, intervention was observed to have beneficial effects to retinal microvasculature.
The longitudinal design and extensive data collected since early childhood in the STRIP study enable multidisciplinary investigation of primordial prevention of cardiovascular diseases – central at the individual and societal level.
Collaborators