Relationships of dietary fat consumption to serum total and low-density lipoprotein cholesterol in hispanic preschool children

Associations between Apolipoprotein E Gene Polymorphism, Diet and Dyslipidemia in a Yao Minority Area, China

OBJECTIVE

This study aimed to assess the effects of Apolipoprotein E (APOE) gene polymorphisms, dietary nutrient intake, and their interactions on the prevalence of dyslipidemia in a Yao minority area, China.

METHODS

rs429358, rs7412, rs7259620, and rs405509 of the APOE gene were genotyped in 1014 adults aged ≥30 years by using the MassArray system. Dietary nutrients intake data were ascertained from a 109-item food frequency questionnaire (FFQ).

RESULTS

Multifactorial logistics regression analysis showed that dyslipidemia was associated with rs7412-CT/TT genotype (OR: 0.540, Bonferroni correction confidence interval: 0.336-0.869), high fat intake (OR: 1.644, 95% CI: 1.128-2.395), high saturated fatty acid (SFA) intake (OR: 1.668, 95% CI: 1.146-2.428), medium carbohydrate intake (OR: 0.634, 95% CI: 0.461-0.873) and high carbohydrate intake (OR: 0.591, 95% CI: 0.406-0.858). The results of logistics regression multiplication model showed that medium carbohydrate intake in the carriers of the rs7412 minor alleles was associated with a low risk of dyslipidemia (OR: 0.433, Bonferroni correction confidence interval: 0.199-0.941).

CONCLUSIONS

Genetic variations at the rs7412, dietary fat, SFA, and carbohydrate intake and the interaction between APOE gene polymorphisms and carbohydrate intake are associated with dyslipidemia in Yao nationality people.

Childhood dietary trajectories and adolescent cardiovascular phenotypes: Australian community-based longitudinal study

OBJECTIVE

With the intention to inform future public health initiatives, we aimed to determine the extent to which typical childhood dietary trajectories predict adolescent cardiovascular phenotypes.

DESIGN

Longitudinal study. Exposure was determined by a 4 d food diary repeated over eight waves (ages 4-15 years), coded by Australian Dietary Guidelines and summed into a continuous diet score (0-14). Outcomes were adolescent (Wave 8, age 15 years) blood pressure, resting heart rate, pulse wave velocity, carotid intima-media thickness, retinal arteriole-to-venule ratio. Latent class analysis identified 'typical' dietary trajectories from childhood to adolescence. Adjusted linear regression models assessed relationships between trajectories and cardiovascular outcomes, adjusted for a priori potential confounders.

SETTING

Community sample, Melbourne, Australia.

SUBJECTS

Children (n 188) followed from age 4 to 15 years.

RESULTS

Four dietary trajectories were identified: unhealthy (8 %); moderately unhealthy (25 %); moderately healthy (46 %); healthy (21 %). There was little evidence that vascular phenotypes associated with the trajectories. However, resting heart rate (beats/min) increased (β; 95 % CI) across the healthy (reference), moderately healthy (4·1; -0·6, 8·9; P=0·08), moderately unhealthy (4·5; -0·7, 9·7; P=0·09) and unhealthy (10·5; 2·9, 18·0; P=0·01) trajectories.

CONCLUSIONS

Decade-long dietary trajectories did not appear to influence macro- or microvascular structure or stiffness by mid-adolescence, but were associated with resting heart rate, suggesting an early-life window for prevention. Larger studies are needed to confirm these findings, the threshold of diet quality associated with these physiological changes and whether functional changes in heart rate are followed by phenotypic change.

Validity and reproducibility of food frequency questionnaire in Japanese children aged 6 years

The aim of the present study was to evaluate the validity and reproducibility of a food frequency questionnaire (FFQ) for use among young Japanese children. Forty-seven mothers of children aged 6 y completed two 3-d diet records and two FFQs over a 6-mo period. The FFQ asked the mothers how often, on average, their children consumed each of the 162 food items listed and what the usual serving size of each item was during the 6 mo prior to the study. Intakes of macro- and micronutrients were estimated by multiplying the frequency by the serving size for each food item. The validity of the FFQ was assessed by comparison of the two 3-d diet records. The reproducibility of the FFQ was based on the first and second FFQ administrations. The validity correlation ranged from 0.05 for α-tocopherol to 0.59 for retinol. The median correlation was 0.40. The reproducibility correlation was higher than 0.50 for all nutrients. For most nutrients, FFQ had acceptable reproducibility, whereas validity showed low to moderate correlations. Our FFQ could reasonably rank individuals according to dietary intake for epidemiologic studies, although the validity of the questionnaire is limited to specific nutrients.

A cross-sectional study of dietary habits and lipid profiles. The Rivas-Vaciamadrid study

The relations between dietary habits and serum lipids have been firmly established in adults. In children, this relation has been less extensively studied. We have assessed the relations between dietary components, including the different types of fatty acids (saturated, polyunsaturated and monounsaturated) and serum lipids and apolipoproteins in a group of 673 6-year-old children of the town of Rivas-Vaciamadrid, Spain. Children in the highest tertile of total fat consumption, when compared with children in the lowest tertile, had higher mean levels of total cholesterol (188.3 mg/dl vs. 146.8 mg/dl), triglycerides (56.7 mg/dl vs. 51.3 mg/dl), LDL cholesterol (120.7 mg/dl vs. 92.6 mg/dl), HDL cholesterol (56.2 mg/dl vs. 54.5 mg/dl) and apolipoprotein B (86.8 mg/dl vs. 62.9 mg/dl). When compared with children in the lowest tertile, children in the highest tertile of saturated fat consumption had significantly higher mean levels of total cholesterol (206.3 mg/dl vs. 151.8 mg/dl), LDL cholesterol (140.6 mg/dl vs. 95.1 mg/dl) and apolipoprotein B (99.2 mg/dl vs. 64.3 mg/dl) and lower mean levels of HDL cholesterol (53.5 mg/dl vs. 57.5 mg/dl), whereas children in the highest tertile of monounsaturated fat consumption had significantly higher mean levels of HDL cholesterol (56.5 mg/dl vs. 51.8 mg/dl) and lower levels of total cholesterol (133.2 mg/dl vs. 201.6 mg/dl), LDL cholesterol (93.1 mg/dl vs. 137.5 mg/dl) and apolipoprotein B (68.6 mg/dl vs. 94.9 mg/dl) than children in the lowest tertile. No statistically significant relation between polyunsaturated fat and lipid levels was found. We have found a strong association between diet composition and lipid and apolipoprotein levels in 6-year-old children. Our findings strengthen the role of monounsaturated fatty acid consumption as a part of a healthy diet in childhood.

Energy and nutrient intakes by pre-school children in Flanders-Belgium

The objective of this cross-sectional study was to investigate energy and nutrient intakes in pre-school children in Flanders-Belgium, using multistage clustered sampling. Diets of 661 children (338 boys; 323 girls) between 2·5 and 6·5 years old were assessed, with parentally reported 3 d estimated diet records. Usual energy and nutrient intakes were compared with national and international recommendations. Statistical modelling was used to account for within-individual variation. Mean daily energy intakes (boys, 6543 kJ; girls, 5757 kJ) approached the estimated energy requirements (EER) (boys, 6040 kJ; girls, 5798 kJ) for children < 4 years old. For children at least 4 years old, mean energy intakes (boys, 6408 kJ; girls, 5914 kJ) were below the EER of 6995 and 6740 kJ/d, respectively. Mean energy percentage (en%) derived from saturated fatty acids (SFA) (13–14 en%) was above the acceptable macronutrient distribution range (AMDR) upper level of 12 en%. Mean percentages derived from MUFA (10–11 en%) and PUFA (4–5 en%) were below the AMDR lower levels of 12 and 8 en%, respectively. For fibre, iron and vitamin D intakes, < 15 % of the children reached the recommended dietary allowances. Everybody exceeded the tolerable upper intake levels for sodium. Although diets in Belgian children were adequate in most nutrients, the implications of low iron, vitamin D and fibre intakes should be investigated. Furthermore, this affluent diet, characterised by SFA, MUFA and PUFA intakes differing from the recommendations and excessive sodium intakes, might increase the risk for CVD in later life.

Cardiovascular Risk Reduction in Preschool Children: The “Healthy Start” Project

OBJECTIVE

To evaluate the impact of a multicomponent cardiovascular health intervention ("Healthy Start") which included a food service modification in a largely minority Head Start preschool population. The primary outcome measure was the change in serum cholesterol from the beginning to the end of the school year.

METHODS

Nine Head Start centers in Upstate N.Y. were assigned to either food service modification or control conditions. In addition, half of the centers assigned to the food service modification received supplemental nutrition education (FS/NU--food service modification/nutritional education), while the remaining centers were provided with supplemental safety education materials (FS--food service modification only). The control preschool centers (CON) also received supplemental safety educational curricula for children but their food services remained unchanged. Children had serum cholesterol, as well as height and weight measured at the beginning and end of the school year. A generalized linear univariate procedure was used with percent change in total serum cholesterol as the outcome variable and intervention group as the primary independent variable.

RESULTS

There was a significant decrease in total serum cholesterol among preschool children in food service intervention groups, (FS/NU and FS), compared to Controls (-6.0 versus -0.4 mg/dL). In addition to the significant difference in group means, children with elevated cholesterol at baseline were significantly more likely to have a cholesterol level in the normal range (<170 mg/dL) at follow-up if they attended a preschool in the food service modification group. There was a 30% reduction in risk of elevated cholesterol in the latter compared to controls. Participation in the dietary intervention did not affect short-term growth.

CONCLUSIONS

A preschool heart health intervention, "Healthy Start," designed to reduce the total and saturated fat content of snacks and meals to recommended levels was effective in reducing serum cholesterol in the study population as a whole and specifically children 'at risk'; i.e., those with initial elevated serum cholesterol.

The Interaction Model of Client Health Behavior as a Conceptual Guide in the Explanation of Children's Health Behaviors

This study used the Interaction Model of Client Health Behavior (IMCHB) as a conceptual guide to explain the correlates of children's diet and physical activity and explore the relationships of sex with their diet and physical activity of the school-aged child. A descriptive correlational study was conducted on 371 fifth-grade students and their parents. Information on the family's demographics, health experience, social influence, and environmental resources was collected, as well as data on the children's intrinsic motivation, cognitive appraisal, and affective response to food/physical activity. Children's self-reports on diet and physical activity were collected, as were parents' self-reports on health habits. Food preferences and diet self-efficacy explained the most variance in diet behavior for girls and boys. Girls scored healthier on food preferences and diet self-efficacy than did boys, but no difference was detected in their diet behavior. Girls participated in more low-intensity physical activity, but boys participated in more high-intensity physical activity than did girls. Findings provide strong support for the use of the IMCHB to explain children's diet but weak support for the explanation of children's physical activity. Further study of additional factors predictive of physical activity is indicated.

Established and recently identified coronary heart disease risk factors in young people: the influence of physical activity and physical fitness

Epidemiological studies have identified several risk factors for coronary heart disease (CHD), many of which are present in young people. [For the purpose of this review, the phrase "young people" embraces both children and adolescents.] One such risk factor is hypertension. In adults, exercise is thought to have a positive effect on blood pressure levels; however, findings are inconclusive for young people. Despite its association with CHD, obesity is on the increase in Western society's young population; prevention and intervention during early years is needed. An active lifestyle is considered to have a beneficial effect on body fatness. Lipoprotein profiles are directly associated with CHD status. In adults, there is some evidence that physical activity and/or fitness have a favourable effect on lipoprotein levels. Although information regarding the younger population is more ambiguous, it tends to concur with these findings. High levels of lipoprotein(a), are considered an independent risk factor for CHD. Relatively little has been written on young people, although some studies have postulated a favourable relationship with physical activity. An inverse relationship between aerobic fitness and CHD has been confirmed in adults; an association is not as easily verified for young people. Physical activity is similarly deemed to have a beneficial effect on health status. A high-fat diet has been linked to CHD in adults, and evidence to date reports similar findings for young people. Smoking increases the risk of CHD and even moderate smoking during youth could have damaging long-term consequences. There is some evidence that smoking is related to physical activity and fitness levels in young people. In adults, high levels of homocyst(e)ine have been associated with CHD. As yet, little has been written on the relationship between physical activity or physical fitness and homocysteine status in young people. High levels of plasma fibrinogen have been linked to CHD. Several studies have explored the relationship between plasma fibrinogen and physical activity and/or fitness in adults, but findings are inconclusive; for young people, the ambiguity is even greater. C-reactive protein is a molecular marker for CHD but, to date, little attention has been given to this aspect, especially amongst young people. The link between high levels of plasminogen activator inhibitor-1 and CHD has been confirmed, although the essence of this relationship is not established. There is a paucity of data on the younger population and the relevance of collating such information is questionable. For the younger population, most research is limited to the established CHD risk factors and further investigations of recently identified CHD risk factors are needed.

Fat content of the diet among preschool children in southwest Britain: II. relationship with growth, blood lipids, and iron status

OBJECTIVE

In most countries, it is recommended that adults restrict fat intake to 30% to 35% of energy to reduce the risk of coronary heart disease and certain cancers. However, the appropriate level of fat in the diet of children is hotly debated. It has been generally accepted that fat intake by children under 2 years of age should not be limited because of fears that nutrient intakes and thus growth and iron status might be compromised. However, there is very little longitudinal information on the relationship between fat intake and growth in representative populations of free-living children under 2 years old. The objective of this study was to investigate the relationship between fat intake as a percentage of energy, and nutrient adequacy, growth, blood lipids, and iron status in 18- and 43-month-old children.

DESIGN

This study forms part of the Avon Longitudinal Study of Parents and Children (ALSPAC)-a geographically-based cohort study in southwest England. A randomly selected subsample of the ALSPAC cohort attended research clinics approximately every 6 months from birth, at which a variety of anthropometric and other measurements were made. Dietary intakes at 18 and 43 months were assessed using a 3-day unweighed food record. A capillary blood sample was taken at 18 months for measurement of hemoglobin and ferritin levels. Nonfasting venous blood samples were taken at 31 and 43 months and analyzed for total and high-density lipoprotein cholesterol. The children were divided into quartiles of fat intake as a percentage of energy (QFI). QFI groups were compared for the number of children reaching recommended nutrient intakes, and for anthropometry, measures of iron status, and blood lipid levels.

PARTICIPANTS

Nine hundred fifty-one children at 18 months and 805 children at 43 months.

RESULTS

The mean (standard deviation) percentages of energy from fat in each quartile at 18 months were 31.2 (2.8), 36.1 (0.9), 39.1 (0.8), and 43.1 (2.2), corresponding to a fat intake in grams of 37.3 (8.1), 44.3 (8.1), 50.4 (10.2), and 55.4 (12.7). The number of children failing to reach recommended intake levels for zinc and vitamin A fell with increasing fat intake, while the number of children consuming less than the recommendations for iron and vitamin C rose at both ages. Despite this, there was no association between fat intake at 18 months and mean height or body mass index (BMI) at either 18 or 31 months. Fat intake at 43 months was also unassociated with concurrent or subsequent height or BMI. There was also no significant increase in the number of children falling below the tenth percentile for height or BMI as QFI fell. Mean ferritin levels at 18 months fell in both sexes as QFI increased. Total cholesterol levels at 31 months were significantly associated with QFI at 18 months, and rose from 3.99 mmol/l in the lowest QFI in boys, to 4.31 mmol/l in the highest QFI. QFI at 43 months was unassociated with cholesterol levels.

CONCLUSIONS

These data do not suggest that fat intakes are an important determinant of growth in these children, even before the age of 2 years, or that children at the bottom of the range of fat intakes are experiencing delayed growth. On the other hand, there is also no evidence in this study that children on higher fat intakes are at a greater risk of becoming obese. In contrast to a number of US studies, we have not found children on lower fat intakes to have lower iron intakes-indeed higher fat intakes were associated with a greater chance of consuming less than the recommended intake of iron and with lower ferritin levels. The association of higher fat intakes with higher total cholesterol levels among boys is of concern, as there is evidence that the process of atherosclerosis begins during the preschool years.

What Are Preschool Children Eating? A Review of Dietary Assessment

Accurate assessment of dietary intake among preschool-aged children is important for clinical care and research, for nutrition monitoring and evaluating nutrition interventions, and for epidemiologic research. We identified 25 studies published between January 1976 and August 2000 that evaluated the validity of food recalls (n = 12), food frequency questionnaires (n = 9), food records (n = 2), or other methods (n = 2). We identified four studies that evaluated the reproducibility of food frequency questionnaires. Validity studies varied in validation standard and study design, making comparisons between studies difficult. In general, food frequency questionnaires overestimated total energy intake and were better at ranking, than quantifying, nutrient intake. Compared with the validation standard, food recalls both overestimated and underestimated energy intake. When choosing a method to estimate diet, both purpose of the assessment and practicality of the method must be considered, in addition to the validity and reproducibility reported in the scientific literature.

Fitness, diet and coronary risk factors in a sample of southeastern U.S. children

The purpose of this study was to evaluate the relationship between physical fitness variables and nutrient intake to coronary risk factors (CRF) in a sample of children living in the Southeastern U.S. A total of 22 sixth-grade children of whom 10 were boys (mean age = 11.83 +/- 0.3) and 12 were girls (mean age 11.7 +/- 0.3) volunteered for this study. Results indicated that boys in comparison to girls weighed more (54.0 +/- 10.8 kg versus 42.1 +/- 8.0 kg; p < 0.05), had a higher body mass index (BMI) (23.6 +/- 2.7 versus 20.2 +/- 3.3; p < 0.05), a higher lean body mass (37.8 +/- 6.0 kg versus 30.7 +/- 3.8 kg; p < 0.01), and a higher systolic blood pressure (115.7 +/- 11.1 versus 106.4 +/- 8.1; p < .0001). There were, however, no significant gender differences in serum lipoproteins or nutrient intake. Stepwise multiple regression analyses indicated that physical fitness variables which included VO2max, one-mile run for time, grip strength, and leg strength could significantly predict resting diastolic blood pressure (DBP) (F = 3.06; p < 0.05) and percent body fat (F = 4.98; p < 0.01) in children. Analysis of food intake revealed that total and saturated fat, and carbohydrate intake could predict serum triglycerides (TG) (F = 5.18; p = 0.01) while total kilocalorie, fat, and carbohydrate intake could significantly predict percent body fat (F = 3.42; p < 0.03). These findings may be clinically relevant since both serum triglyceride levels and percent body fat were well above the 50th percentile according to U.S. norms. In summary, the present study showed that measurements of muscular strength in addition to aerobic fitness are associated with DBP and percent body fat in children. Furthermore, it is recommended that nutrient intake be used when evaluating CRF in children due to its ability to predict TG and percent body fat.

Lipid status in a population of Spanish schoolchildren

We assessed lipid status in a population of 181 schoolchildren and adolescents divided into three age groups: 6-7 years (n = 60), 10-12 years (n = 61) and 13-15 years (n = 60). All subjects were from the Mediterranean coastal area of Vélez-Málaga in southern Spain. Nutrient intakes and biochemical parameters related with lipid status [total cholesterol (TC), HDL-chol, LDL-chol, VLDL-chol and triglycerides (TG)] were measured. Boys and girls aged 6-7 years had the same plasma concentrations of TC and TG; these concentrations were slightly higher than the mean values for age and sex found in earlier studies in Spanish populations. The high TC values were due mainly to increased concentrations of LDL-chol. This age group also had the largest percentage of members (26.6% boys, 36.6% girls) with plasma TC above 200 mg/dl. Of the groups aged 10-12 years, more girls than boys had abnormally high plasma cholesterol (16.1 vs 10%), HDL-chol (6.5 vs 0%) and TG concentrations (6.5 vs 0%). However, more adolescent boys than adolescent girls (aged 13-15 years) had abnormally low plasma concentrations of HDL-chol (10 vs 3.3%).

The tracking of nutrient intake in young children: the Framingham Children's Study

OBJECTIVES

This study compared the nutrient intake of children at 3 through 4 years of age with that in subsequent years to determine whether nutrient intake tracked over time.

METHODS

Intakes of 10 nutrients were estimated by means of multiple days of food diaries collected over a span of up to 6 years of follow-up for 95 children in the Framingham Children's Study. All diaries collected during each of three age periods (age 3 through 4, age 5 through 6, and age 7 through 8) were averaged. Nutrient density intakes at each age period were compared.

RESULTS

Nutrient-specific correlations ranged from .37 to .63 between nutrient density intakes at age 3-4 and age 5-6. Correlations between intakes at age 3-4 and age 7-8 ranged from .35 to .62. Consistency of classification was strong; 35.7% to 57.1% of children in the highest quintile of intake at age 3-4 remained in that quintile at age 5-6, and 57.1% to 85.7% remained in the top two quintiles. At age 7-8, 40.0% to 66.7% of those with the highest intake at baseline were still in the top quintile, and 60.0% to 93.3% remained in the top two quintiles. Results were similar in the lowest quintile of intake. Extreme misclassification was rare.

CONCLUSIONS

This study suggests that tracking of nutrient intake begins as young as 3-4 years of age.

Relations between nutrient intake and serum lipid and apolipoprotein levels

OBJECTIVE

To study the relation between diet and serum lipid and apolipoprotein levels in a large, homogeneous group of Spanish children.

DESIGN

Survey.

SETTING

Eleven schools chosen at random in Madrid City and the surrounding area.

SUBJECTS AND METHODS

Subjects comprised 1682 children, 2 to 12 years of age. Dietary data were obtained with a 24-hour record performed by the child's main caregiver. For statistical analysis the sample was divided into tertiles on the basis of calorie-adjusted consumption of dietary components.

RESULTS

Children in the highest tertile of total fat consumption, compared with children in the lowest tertile, had significantly higher mean serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I (Apo A) and apolipoprotein B-100 (Apo B). When compared with children in the lowest tertile, children in the highest tertile of saturated fat consumption had significantly higher mean levels of TC, LDL-C, and Apo B, and lower mean levels of HDL-C and Apo A. Children in the highest tertile of monounsaturated fat consumption, compared with children in the lowest tertile, had significantly higher mean levels of HDL-C and Apo A, and lower mean levels of TC, LDL-C, and Apo B.

CONCLUSIONS

Our findings suggest that diet composition strongly influences lipid profile in children and point out the importance of monounsaturated fatty acids as modulators of serum lipid and apolipoprotein levels.

5-A-DAY: dietary behavior and the fruit and vegetable intake of Latino children

OBJECTIVES

The purpose of the study was to examine children's intake of fruits and vegetables in relation to the recent national "5-A-DAY" campaign.

METHODS

Four 24-hour dietary recalls per child collected from 205 mothers of 4- to 5-year-old urban Latino children were used to analyze average 5-A-DAY fruit and vegetable consumption and examine associations between 5-A-DAY consumption, nutrient intakes, and eating patterns.

RESULTS

The reported mean servings per day of fruits and vegetables, as defined by 5-A-DAY criteria, were 1.8 and 1.0, respectively, with only 6.8% (n = 14) of the children averaging five or more servings per day. Fruit juice accounted for 36% of 5-A-DAY servings. There were significant linear trends in intake of vitamins A and C, potassium, iron, cholesterol, protein, and fiber across quintiles of 5-A-DAY intake. There were no differences among quintiles in intake of saturated or total fat or in servings from most non-5-A-DAY food groups.

CONCLUSIONS

Latino children's intake of fruits and vegetables falls far short of current recommendations. Fruit juice accounted for a disproportionate amount of 5-A-DAY intake in this population. Sensible 5-A-DAY interventions should take into consideration the existing eating patterns of the target population.

The reproducibility of data from a Food Frequency Questionnaire among low-income Latina mothers and their children

We examined the 3-month and 1-year reproducibility of mothers' and children's dietary intakes of calories and 11 nutrients derived from oral administrations of a food frequency questionnaire to 166 Latina women. One-year correlations generally ranged from 0.40 to 0.55 for both mothers and children. For most nutrients, roughly half the children in the highest (lowest) quartile of intake at baseline were also in the highest (lowest) quartile 1 year later. The food frequency questionnaire has great potential for measuring typical nutrient intakes in these populations.

Food sources, dietary behavior, and the saturated fat intake of Latino children

BACKGROUND

Recent recommendations for Americans aged 2 and older call for a reduction in the average saturated fat intake to less than 10% of calories.

METHODS

Using 24-hour dietary recalls collected from mothers of 4- to 7-year-old urban Latino children, we identified foods and dietary behavior patterns that distinguish children with higher and lower mean daily percentages of calories from saturated fat.

RESULTS

Compared with children in the lowest quintile of intake, children in the highest quintile consumed more than twice as much saturated fat per day from high-fat milk products (18.5 g vs 7.8 g), mostly from whole milk. They did not consume different kinds of milk or different amounts of milk per eating occasion, but on average they consumed milk more frequently (2.8 vs 1.6 eating occasions per day). Even children in the lowest quintile, on average, exceeded the 10% of calories from saturated fat currently recommended. If low-fat (1% fat) milk had been substituted without other dietary changes, all but the highest two quintiles would have been within the recommended level.

CONCLUSIONS

The substitution of low-fat for whole milk appears to be a key strategy for preschool children for achieving recommended levels of saturated fat intake.