Risk and benefit of low fat intake in childhood

The International Growth Standard for Children and Adolescents Project: Environmental Influences on Preadolescent and Adolescent Growth in Weight and Height

This review has two aims. The first is to identify important environmental influences on the growth of children aged 1 to 9 years and of adolescents, defined as those aged 10 to 19 years. The second is to identify possible environmentally based criteria for the selection of individuals and populations for data collection in the development of an international growth reference for these age ranges. There are many common environmental influences on the growth of children between the ages of 1 and 19 years; the examination and description of these forms the main body of this review. Subsequently, environmental factors influencing adolescent growth only are considered. In both cases, possible selection criteria are put forward. The most important inclusion criteria for both preadolescence and adolescence are good nutrition, lack of infection, and socioeconomic status that does not constrain growth. Additionally, low birthweight, catch-up growth, breastfeeding, and early adiposity rebound have impacts on growth and/or body composition into puberty. Exclusion of children born at low birth and/or experiencing catch-up growth could be most realistically operationalized if populations in which secular trends in growth were either completed or minimal were selected. Although an effect of hypoxia on child and adolescent growth, independent of nutrition, is small at most, many high-altitude populations have high prevalances of low birthweight and should be excluded on this basis. Since all populations are exposed to pollutants, contaminants, and toxicants in varying degrees, they cannot be realistically excluded from the sample frame. However, it may be desirable to exclude populations that are habitually exposed to extremely high levels of environmental pollution, including air pollution, and those living in close proximity to toxic waste. It is impossible to exclude populations and individuals on the basis of their exposure to aflatoxin contamination of food. However, exclusion on the basis of low socioeconomic status or poverty may well act as a proxy for this. There are a small number of populations that show extreme patterns of growth in body size and proportion in preadolescence and adolescence, and these should be excluded from the sample frame.

Dietary intakes and food sources of fat and fatty acids in Guatemalan schoolchildren: a cross-sectional study

BACKGROUND

Consumption of healthy diets that contribute with adequate amounts of fat and fatty acids is needed for children. Among Guatemalan children, there is little information about fat intakes. Therefore, the present study sought to assess intakes of dietary fats and examine food sources of those fats in Guatemalan children.

METHODS

The study subjects consisted of a convenience sample of 449 third- and fourth-grade schoolchildren (8-10 y), attending public or private schools in Quetzaltenango City, Guatemala. Dietary data was obtained by means of a single pictorial 24-h record.

RESULTS

The percentages of total energy (%E) from total fat, saturated fat (SFA) and monounsaturated fat (MUFA) reached 29%E for total fat and 10%E for each SFA and MUFA, without gender differences. %E from fats in high vs. low-socio economic status (SES) children were significantly higher for boys, but not for girls, for total fat (p = 0.002) and SFA (p < 0.001). Large proportions of the children had low levels of intakes of some fatty acids (FA), particularly for n-3 FA, with >97% of all groups consuming less than 1%E from this fats. Fried eggs, sweet rolls, whole milk and cheese were main sources of total fat and, SFA. Whole milk and sweet bread were important sources of n-3 FA for high- and low-SES boys and girls, respectively. Fried plantain was the main source of n-3 FA for girls in the high-SES group. Fried fish, seafood soup, and shrimp, consumed only by boys in low amounts, were sources of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, which may explain the low intakes of these nutrients.

CONCLUSIONS

alpha-linolenic acid, EPA and DHA were the most limiting fatty acids in diets of Guatemalan schoolchildren, which could be partially explained by the low consumption of sources of these nutrients, particularly fish and seafood (for EPA and DHA). This population will benefit from a higher consumption of culturally acceptable foods that are rich in these limiting nutrients.

Reproducibility and validity of a diet quality index for children assessed using a FFQ

The diet quality index (DQI) for preschool children is a new index developed to reflect compliance with four main food-based dietary guidelines for preschool children in Flanders. The present study investigates: (1) the validity of this index by comparing DQI scores for preschool children with nutrient intakes, both of which were derived from 3 d estimated diet records; (2) the reproducibility of the DQI for preschoolers based on a parentally reported forty-seven-item FFQ DQI, which was repeated after 5 weeks; (3) the relative validity of the FFQ DQI with 3 d record DQI scores as reference. The study sample included 510 and 58 preschoolers (2.5-6.5 years) for validity and reproducibility analyses, respectively. Increasing 3 d record DQI scores were associated with decreasing consumption of added sugars, and increasing intakes of fibre, water, Ca and many micronutrients. Mean FFQ DQI test-retest scores were not significantly different: 72 (sd 11) v. 71 (sd 10) (P = 0.218) out of a maximum of 100. Mean 3 d record DQI score (66 (sd 10)) was significantly lower than mean FFQ DQI (71 (sd 10); P < 0.001). The reproducibility correlation was 0.88. Pearsons correlation (adjusted for within-person variability) between FFQ and 3 d record DQI scores was 0.82. Cross-classification analysis of the FFQ and 3 d record DQI classified 60 % of the subjects in the same category and 3 % in extreme tertiles. Cross-classification of repeated administrations classified 62 % of the subjects in the same category and 3 % in extreme categories. The FFQ-based DQI approach compared well with the 3 d record approach, and it can be used to determine diet quality among preschoolers.

Rational approach to the treatment for heterozygous familial hypercholesterolemia in childhood and adolescence: a review

Atherosclerosis represents a disease that begins in childhood and in which LDL cholesterol plays a pivotal role for the development of the pathology. Children and adolescents with high cholesterol levels are more likely than their peers to present cholesterol elevation as adults. The identification of genetic dyslipidemias associated with premature cardiovascular disease is crucial during childhood to delay or prevent the atherosclerotic process. Guidelines for the diagnosis and treatment of hypercholesterolemia during pediatric age are available from the National Cholesterol Education Program. A heart-healthy diet should begin at the age of 2 yr and a large number of studies have demonstrated no adverse effects on nutritional status, growth, pubertal development, and psychological aspects in children and adolescents limiting total and saturated fat intake. Pharmacotherapy should be considered in children over 10 yr of age when LDL cholesterol concentrations remain very high despite severe dietary therapy, especially when multiple risk factors are present. The only lipid-lowering drugs recommended up to now for childhood and adolescence are resins reported to be effective and well tolerated, although compliance is very poor because of unpalatability. The use of statins is increasing and seems to be effective and safe in children, even if studies enrolled a small number of patients and evaluated efficacy and safety for short-term periods. Recently, an interesting drug represented by ezetimibe has been found that may provide cholesterol-lowering additive to that reached with statin treatment. This review provides an update on recent advances in the diagnosis, therapy, and follow-up of familial hypercholesterolemia during pediatric age and adolescence.

Calcium intake trends and health consequences from childhood through adulthood

Issues involving low calcium intake and dairy product consumption are currently the focus of much debate and discussion at both the scientific and lay community levels. In this review, we examine the following major areas of interest: (1). the role of calcium intake and dairy product consumption in chronic diseases, (2). nutritional qualities of milk and other dairy products, (3). trends in calcium intake and dairy product consumption, (4). current status of calcium intakes and dairy product consumption in children, (5). tracking of calcium intake and diary product consumption, (6). the impact of school meal participation on calcium intake and dairy product consumption, (7). concerns related to calcium-fortified foods and beverages and (8). factors influencing children's milk consumption. To date, the findings indicate that calcium intake and dairy product consumption have beneficial roles in a variety of chronic diseases; dairy products provide an abundant source of vitamins and minerals; calcium intakes of children have increased over time, yet intakes are not meeting the current adequate intake (AI) calcium recommendations; dairy consumption has decreased, and soft drink consumption and, possibly, consumption of calcium-fortified products have increased; consumption of dairy products have a positive nutritional impact on diets of children, particularly from school meals, and there are many factors which influence children's milk consumption, all of which need to be considered in our efforts to promote adequate calcium intakes by children. Based on this review, areas that need immediate attention and future research imperatives are summarized in an effort to further our understanding on what we already know and what we need to know to promote healthier eating habits early in life.

Diet quality, nutrient intake, weight status, and feeding environments of girls meeting or exceeding recommendations for total dietary fat of the American Academy of Pediatrics

OBJECTIVES

To compare the diet quality and weight status of girls consuming diets meeting the recommendation of the American Academy of Pediatrics for dietary fat with those of girls consuming >30% of energy from fat and to examine relationships between girls' dietary fat intake, mothers' nutrient intakes, and mothers' child-feeding practices.

DESIGN

Participants were 192 white girls and their mothers, who were divided into 2 groups: >30% of energy from fat (high fat [HF]) or </=30% of energy from fat (low fat [LF]), based on girls' 3-day dietary recalls. Girls' food group and nutrient intakes, Healthy Eating Index, body mass index, and mothers' nutrient intakes and child-feeding practices were compared.

RESULTS

Girls with HF diets consumed fewer fruits, more meat, and more fats and sweets and had lower Healthy Eating Index scores than did the girls in the LF group. Mothers of girls in the HF group had higher fat intakes than did those in the LF group. Girls and mothers in the HF group had lower intakes of fiber and vitamins A, C, B6, folate, and riboflavin. Mothers in the HF group reported using more restriction and pressure to eat in feeding their daughters. Girls in the HF group showed greater increase in body mass index and skinfold thickness from age 5 to 7 years.

CONCLUSION

These findings provide additional support for the recommendation of the American Academy of Pediatrics to limit total dietary fat. Findings reveal that mothers' use of controlling feeding practices are not effective in fostering healthier diets among girls and that mothers' own eating may be more influential than their attempts to control the intake of their daughters. dietary fat, dietary quality, nutrient intake, overweight, feeding practices, children.

The role of dietary calcium and other nutrients in moderating body fat in preschool children

OBJECTIVE

To assess preschool children's food consumption (24-60 months) and relate these findings to body composition at 70+/-2 months.

DESIGN

A longitudinal study of children's dietary intakes for selected nutrients and servings of dairy products.

SUBJECTS

Fifty-three white children participating in a longitudinal study (2-96 months) of children's food practices and growth.

MEASUREMENTS

Using in-home interviews and trained interviewers, 18 days of dietary data and measured height and weight of each child at 6 month intervals were collected. Body composition was determined by dual energy X-ray absorptiometry.

RESULTS

Dietary fat was 30-33% of energy with saturated and monounsaturated fat intakes>10% and polyunsaturated<10%. Adjusting for body mass index (BMI), GLM models to predict percent body fat (%BF) or grams of total fat (gTF) with mean longitudinal calcium intake (%BF: R2=0.51, F=7.88, P<0.0001; gTF: R2=0.51, F=9.84, P=0.0001) or total servings of dairy products (%BF: R2=0.47, F=6.93, P<0.0001; gTF: R2=0.47, F=8.31, P<0.0001) as independent variables gave significant results. Higher mean longitudinal calcium (mg/day) intakes and more servings/day of dairy products were associated with lower body fat. Males had significantly less body fat (P=0.01) than females.

CONCLUSIONS

Higher longitudinal intakes of calcium, monounsaturated fat, and servings of dairy products were associated with lower body fat.

Fat intake of children in relation to energy requirements

The optimal fat intake for children is discussed in light of their energy requirements. Total energy requirements were estimated from doubly labeled water studies of total energy expenditure (TEE) and the energy cost of growth. Basal metabolic rates (BMRs) were calculated from weight by using the equations of Schofield et al or by indirect calorimetry. Activity energy expenditure and physical activity levels were calculated as TEE - BMR and TEE/BMR, respectively. Weight-specific energy requirements for maintenance and growth changed inversely to the increased energy needed for physical activity in healthy, active children. The total energy requirements of infants increased from 1.4 MJ/d at 1 mo to 4.0 MJ/d at 24 mo. The energy cost of growth decreased sharply from 37-38% to 2% of the total requirement during the first 24 mo of life. Energy requirements increased from 4 MJ/d at 2 y to 11 MJ/d at 18 y in girls and from 5 to 15 MJ/d in boys. The energy cost of growth varied between 1% and 4% of total energy requirements in childhood and adolescence. The current recommendation of 30% of energy from dietary fat for children aged >2 y is sufficient for adequate growth. Lower fat intakes may be associated with inadequate vitamin and mineral intakes and increased risk of poor growth. Diets higher in fat may lead to higher energy intakes and higher body fat, although available data for children are conflicting. Beyond infancy, children can meet their energy needs for maintenance, physical activity, and growth from a diet providing 30% of energy from fat.

Influence of dietary fat on the nutrient intake and growth of children from 1 to 5 y of age: the Special Turku Coronary Risk Factor Intervention Project

BACKGROUND

Excessive decreases in fat intake in young children have been linked with low intakes of energy and nutrients and possible growth failure.

OBJECTIVE

We evaluated nutrient intakes and growth of healthy children with different fat intakes during the first 5 y of life.

DESIGN

In the Special Turku Coronary Risk Factor Intervention Project (STRIP), 7-mo-old children were randomly assigned to an intervention aimed at reduced consumption of saturated fat and cholesterol (n = 540) or to a control group (n = 522). This analysis comprises data for children for whom > or = 6 of 8 possible 3-4-d food records were available (n = 730; 353 females). Children were divided according to fat intake pattern (percentage of energy) between the ages of 13 mo and 5 y into groups with continuously high fat intake (5% of children), increasing fat intake (5%), continuously low fat intake (5%), decreasing fat intake (5%), and average fat intake (80%). Children's energy and nutrient intakes and growth were then compared by analysis of variance.

RESULTS

Fat intake at 13 mo of age was particularly low (21% of energy) in the increasing fat intake group and in the continuously low fat intake group (22% of energy at 13 mo; 26% of energy at 5 y). Growth of children in all 5 fat intake groups, however, was not significantly different throughout the study period. Intakes of vitamins and minerals, except of vitamin D, met recommended dietary allowances in all fat intake groups.

CONCLUSION

Nutrient intakes and growth were not significantly different in children whose fat intake patterns differed between 13 mo and 5 y of age.

Perfil lipídico de dietas e sua relação com os níveis de colesterolemia em escolares de uma escola pública de Campinas, São Paulo, (Brasil)

Este estudo foi conduzido com 194 escolares com o objetivo de identificar o perfil lipídico de suas dietas, relacionando-os com o colesterol plasmático. Foi realizado um inquérito alimentar de 24 horas e a dosagem de colesterol e HDL-colesterol. Associação entre lipídios da dieta e do sangue foi analisada por correlação bivariada e regressão logística. A dieta consumida pelos escolares mostrou diferença significativa (teste t), entre os sexos, para a quantidade de carboidratos e de fibra alimentar. Os carboidratos contribuíram com 52,7% das calorias totais, as proteínas com 14,0%, os triglicérides com 33,3%, sendo que os ácidos graxos monoinsaturados com 12,0%, os poliinsaturados com 8,5% e os saturados com 12,5%. A quantidade de colesterol na dieta foi 176mg e de fibra alimentar 15g. O valor do colesterol plasmático foi 150mg/dl e do HDL-colesterol 36mg/dl. Observou-se associação direta entre colesterolemia e percentual de calorias proveniente de triglicerídeos, de ácidos graxos monoinsaturados e poliinsaturados. Encontrou-se associação positiva entre colesterolemia e porcentagem de calorias proveniente de ácidos graxos monoinsaturados. Concluiu-se que o método utilizado neste estudo não foi apropriado ao objetivo proposto devido à baixa prevalência de hipercolesterolemia (4,8%) entre os escolares estudados. Fatores de respostas individuais devem ser considerados no estudo de associação entre colesterol dietético e plasmático.

Dietary fat consumption and health

Dietary Guidelines have emerged over the past 30 years recommending that Americans limit their consumption of total fat and saturated fat as one way to reduce the risk of a range of chronic diseases. However, a low-fat diet is not a no-fat diet. Dietary fat clearly serves a number of essential functions. For example, maternal energy deficiency, possible exacerbated by very low-fat intakes (< 15% of energy), is one key determinant in the etiology of low birth weight. The debate continues over recommendations for limiting total fat and saturated fatty acid intake in children. Recent evidence indicates that diets with adequate energy providing less than 30% of energy from fat are sufficient to promote normal growth and normal sexual maturation. More attention needs to be devoted to the effect of dietary fat reduction on the nutrient density of children's diets. The association between dietary fat and CHD has been extensively studied. Diets high in saturated fatty acids and trans fatty acids increase LDL cholesterol levels, and in turn, the risk of heart disease. The relationship between high-carbohydrate/low-fat diets and CHD is more ambiguous because high-carbohydrate diets induce dyslipidemia in certain individuals. Obesity among adults and children is now of epidemic proportions in the United States. High-fat diets leading to excessive energy intakes are strongly linked to the increasing obesity in the United States. However, the prevalence of obesity has increased during the same time period that dietary fat intake (both in absolute terms and as a percentage of total dietary energy) has decreased. These trends suggest that a concomitant decrease in total dietary energy and modifications of other lifestyle factors, such as physical activity, also need to be emphasized. Obesity is also an independent risk factor for the development of diabetes. The current availability of fat-modified foods offers the potential for dietary fat reduction and treatment of the comorbidities associated with diabetes. However, to date, few studies have documented the effectiveness of fat-modified foods as part of a weight loss regimen or in reduction in CHD risks among individuals with diabetes mellitus. The association between total dietary fat and cancer is still under debate. While there is some evidence demonstrating associations between dietary fat intake and cancers of the breast, prostate, and colon, there are serious methodologic issues, including the difficulty in differentiating the effects of dietary fat independent of total energy intake. Reported total fat and saturated fatty acid intakes as a percentage of total energy have been declining over the past 30 years in the United States. Despite this encouraging trend, the majority of individuals--regardless of age--do not report consuming a diet that meets the levels of fat and saturated fatty acids recommended by the Dietary Guidelines for Americans. On a relative basis, saturated fat intake has gone down less than has total fat intake. Individuals of all ages who report consuming a diet with < or = 30% of energy from fat consistently have lower energy intakes. Given the increasing rates of obesity in the United States at an earlier and earlier age, dietary fat reduction may be an effective part of an overall strategy to balance energy consumption with energy needs. In each of the age/gender groups reporting consumption of < or = 30% of energy from fat and less than 10% of energy from saturated fatty acids, fat-modified foods play a more important role in their diets than for people who are consuming higher levels of fat and saturated fat. The data are clear than fat-modified foods make a more significant contribution to diets of consumers with low-fat intakes. While one cannot argue cause and effect from the results presented, the patterns of fat-modified foods/low-fat intakes are consistent. The focus on overall diet quality is often lost in the national obsession with lowering fat inta

Impact of adopting lower-fat food choices on nutrient intake of American children

OBJECTIVE

To compare the overall nutrient intake of American children (ages 2 to 19) who exclusively use skim milk instead of 1%, 2%, or whole milk; lean meats instead of higher-fat meats; or fat-modified products instead of full-fat products.

STUDY DESIGN

A unique sorting procedure was used to categorize respondents to the 1989-1991 Continuing Survey of Food Intake by Individuals according to reported use or nonuse of certain fat-reduction strategies. Differences in intake of 23 macronutrients and micronutrients, as well as energy, by exclusive users, mixed users, and nonusers of each strategy were statistically analyzed using analysis of variance with Scheffe's test. The number of fat-reduction strategies used by the children as well as demographic characteristics also were analyzed.

RESULTS

Only a small number of children qualified as exclusive users of skim milk (3%), lean meats (2%), and fat-modified products (1%). Energy intakes for all children were below 100% of the recommended dietary allowance. However, children (n = 85) who used skim milk exclusively in place of higher-fat milks closely approximated the current dietary recommendations (30% energy from fat, less than 10% from saturated fat, and less than 300 mg cholesterol) while maintaining adequate micronutrient intake and without significantly impacting energy. Children (n = 52) who used lean meats in place of higher-fat meats achieved the guideline for total fat; however, energy intake was 70% of the recommended dietary allowance and vitamin E was 63%. Children (n = 20) who use only fat-modified versions of cheese, salad dressing, cake, pudding, and yogurt made no significant impact on their energy, fat, or micronutrient intake. Of the 3299 children in the data set, only 3 qualified as users of two fat-reduction strategies and none qualified as users of all three strategies. Exclusive users of skim milk, lean meat, or fat-modified products were more likely to be female, white, and live in families with higher incomes. Those using skim milk or lean meat exclusively also were more likely to be older, whereas those exclusively using fat-modified products were younger. Furthermore, those using skim milk or fat-modified products exclusively were more likely to live in households where the head had more years of education, whereas those exclusively using lean meats were from households headed by those with slightly less years of education.

CONCLUSIONS

Despite the inherent limitations of population-based food surveys (including issues of underreporting, lack of biological markers and accurate anthropometric measures, and limited nutrient databases), these results provide insight into the rate of use of certain lower-fat food choices by children and suggest exclusive use can facilitate achievement of contemporary dietary recommendations. The impact of using these fat-reduction strategies on children's overall nutrient intake differs depending on the strategy used. Use of skim milk is an economical single-food strategy that facilitates achievement of contemporary dietary guidelines while maintaining nutrient adequacy. Professional guidance is recommended for children who exclusively use lean meats to assure adequate intake of energy and vitamin E. The impact of fat-modified products needs to be monitored closely as the number of such products increases in the marketplace. Results of this study can be used by health professionals working with children and their parents to highlight the overall efficacy of dietary recommendations while alerting them to potential pitfalls.

A rational approach to treating hypercholesterolaemia in children. Weighing the risks and benefits

Because atherosclerosis is a continuous process throughout life, expert panels have suggested guidelines to reduce the risk of cardiovascular disease, starting from childhood. The guidelines focus on population-based measures and on treating hypercholesterolaemia in individual children. Low-fat diets in children have been widely debated. There is little evidence that growth is stunted or that nutritional deficiencies arise if the energy that is lost by limiting fat intake is substituted with other nutrients. Dietary fibre, plant sterols and fish oils have been used to modify lipid levels in children; however, the efficacy of these dietary adjuncts is limited. Bile acid-binding resins are the only approved drugs to lower cholesterol levels in children and appear to be well tolerated. However, compliance with resins is low because of unpalatability, so low dosages are preferred and vitamin supplementation is prudent. Data on HMG CoA reductase inhibitors and fibrates are insufficient to recommend these drugs at present. Drug treatment should be restricted to children who are at exceptionally high risk of disease, usually those with genetic dyslipidaemias.

Estimation of obesity in schoolchildren by measuring skinfold thickness

To determine whether skinfold thickness is correlated with degree of overweight, serum levels of cholesterol, and blood pressure in children, 161 boys and 167 girls aged 9 and 10 y underwent physical examinations at three elementary schools in Japan. Triceps skinfold thickness was positively correlated with degree of overweight, atherosclerosis index, and systolic blood pressure, and was negatively correlated with levels of high-density lipoprotein (HDL) cholesterol. Among children who were highly overweight (> or = 30%), those with low triceps skinfold thickness (< 11.2 mm) have lower levels of HDL cholesterol, a higher atherosclerosis index, and higher systolic blood pressure than those with greater triceps skinfold thickness (> or = 11.2 mm). The ratio of degree of overweight to triceps skinfold thickness was significantly correlated with levels of HDL cholesterol in girls but not in boys. These results suggest that, in overweight schoolchildren, skinfold thickness may reflect the risk of future hypercholesterolemia and hypertension. Measurement of triceps skinfold thickness and determination of degree of overweight may be useful for the estimation of obesity in children.