Journal of Nutrition LabDiet, Your World of Nutritional Answers

Home Help [Feedback] [For Subscribers] [Archive] [Search] [Contents]
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Groziak, S. M.
Right arrow Articles by Miller, G. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Groziak, S. M.
Right arrow Articles by Miller, G. D.

The Journal of Nutrition Vol. 128 No. 10 October 1998, pp. 1836-1838

Dietary Guidelines for Children: Where Are We Heading?

Susan M. Groziak and Gregory D. Miller1

National Dairy Council, Rosemont, IL 60018 

    INTRODUCTION
Introduction
References

The U.S. Dietary Guidelines for Americans were developed to provide dietary advice to the general healthy population about food choices that promote health and prevent disease. These guidelines serve as the cornerstone for federal nutrition programs in the United States, including the Food Stamp and National School Lunch Programs. To reflect current nutrition knowledge, the U.S. Department of Agriculture and the Department of Health and Human Services are required to revise the Dietary Guidelines every five years.

Historically, the Dietary Guidelines target individuals within a very large age range (i.e., Americans >= 2 y of age). However, nutrient needs and risk for developing chronic diseases differ significantly with age. For example, older adults exhibit a higher need for vitamin D than younger adults; children and teenagers exhibit high energy needs for growth and high calcium needs for building bone mass (Matkovic et al. 1994). Researchers have questioned the health benefits of a low fat diet for both children and older adults (Krumholz et al. 1994, Lifshitz and Tarim 1996, Muldoon et al. 1994).

In its report to the Secretary of Health and Human Services and the Secretary of Agriculture, the 1995 Dietary Guidelines for Americans Advisory Committee "strongly" recommended the development of dietary guidelines for children (Dietary Guidelines Advisory Committee 1995). The committee further advised that a working group be charged to "develop provisional guidelines for children and supporting peer-reviewed documentation that is essential for this process." In response, the U.S. Department of Agriculture and the Department of Health Human Services have contracted with the Life Sciences Research Office to review the scientific literature regarding this issue (Raiten, D. J., personal communication, 1998). To help identify the opinions of health professionals on the direction that dietary guidance targeting children should take, the National Dairy Council (NDC) as well as many other organizations have sponsored surveys, symposia and workshops on this topic. We would like to highlight some of the key recommendations/outcomes of these events and some of the implications to the revision of the Dietary Guidelines for the year 2000.

The next U.S. Dietary Guidelines Advisory Committee has recently been formed to provide suggested changes for the year 2000 edition of the guidelines to the U.S. Department of Agriculture and Department of Health and Human Services. As this process begins, it is useful for health professionals to review chronologically the direction that dietary guidance directed at children has taken during the past decade and the opinions of health professionals regarding this issue.

    POSITION STATEMENTS OF HEALTH PROFESSIONAL ORGANIZATIONS

1992.  The Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program recommended that, between 2 and 3 y of age, children make a transition to a diet that contains no more than 30% of energy from fat and <10% of energy from saturated fat (NCEP 1992). This expert panel also stated that it did not recommend universal blood cholesterol screening for U.S. children for reasons that include the following: 1) many children who exhibit high blood cholesterol during childhood do not exhibit high levels as adults and 2) "labeling" children with high blood cholesterol levels could provoke "unjustified anxiety in children and their parents."

The American Academy of Pediatrics Committee on Nutrition issued a position statement supporting the dietary goals of 30% of energy from total fat and <10% of energy from saturated fat for children >2 y. However, this statement cautioned that recommendations that call for <30% of energy from fat "may lead to the inappropriate use of more restrictive diets." The committee also emphasized that early childhood should be considered a transition period during which the fat content should gradually decrease to the recommended amounts (AAP-CON 1992).

1993.  After reviewing the existing research on dietary fat and children, the Joint Working Group of the Canadian Paediatric Society and Health Canada concluded that "there is no evidence that implementation of a diet providing 30% of energy as fat and 10% of energy as saturated fat in children would reduce illness in later life or provide benefit to children as children" (Health and Welfare Canada 1993). They also concluded that self-selected low fat diets may fail to provide adequate levels of energy and nutrients for optimal growth and development in children. The Joint Working Group of the Canadian Paediatric Society and Health Canada recommended that "there should be a transition from the high-fat diet of infancy to a diet that includes no more than 30% of energy as fat and no more than 10% of energy from saturated fat .  .  . from the age of two until the end of linear growth."

1995.  For the first time since their release in 1980, the 1995 Dietary Guidelines for Americans began to emphasize the unique dietary needs of children. Rather than recommend that children consume a low fat diet beginning at age 2 as the previous guidelines had advised, this report recommends that children at 2 y of age gradually adopt a diet that, by ~5 y of age, provides no more than 30% of energy from fat (Dietary Guidelines Advisory Committee 1995). The 1995 edition of the Dietary Guidelines also states that "major attempts to change a child's diet should be accompanied by monitoring of growth by a health professional at regular intervals" and children and teenagers should not drink alcohol at all.

The American Dietetic Association (ADA) issued a position statement supporting the exploration of specific dietary guidelines for healthy children (ADA 1995). This statement notes that the U.S. Dietary Guidelines for Americans require further clarification to meet the unique needs of children. Similar to the text in The Joint Working Group of the Canadian Paediatric Society and Health Canada report, the American Dietetic Association position statement emphasizes that food choices in children's diets should not be restricted because of the calorie, fat or sugar content of any one food.

1996.  The American Heart Association (AHA) revised its Dietary Guidelines for Healthy American Adults. These guidelines recommended that all individuals >2 y of age consume a diet containing <= 30% of energy from total fat and 8-10% of energy from saturated fat. However, the guidelines also state that "children between the ages of 2 and 5 can gradually adopt the diet habits of the family" (Krauss 1996). The guidelines also indicate that clinicians should be aware of the fact that genetics strongly influence an individual's response to a low fat diet and that the AHA's population guidelines must be applied individually.

1998.  The American Academy of Pediatrics (AAP) Committee on Nutrition updated its statement on Cholesterol in Children (AAP-CON 1998). This statement recommends that after 2 y of age, children gradually adopt a diet that, by ~5 y of age, contains no more than 30% of energy from total fat. However, because "concerns have been expressed that some parents and their children may overinterpret the need to restrict their fat intakes," the Committee on Nutrition established a lower limit of fat intake for children at 20% of energy.

    NATIONAL MEETINGS/WORKSHOPS ON DIETARY RECOMMENDATIONS FOR CHILDREN

1994.  The American Health Foundation and Kellogg's sponsored a symposium on dietary fiber and children. The participants in this symposium developed separate dietary fiber recommendations for children and adolescents (Williams et al. 1995). These recommendations advise that, between the ages of 2 and 20 y, individuals consume a daily level of dietary fiber in grams equal to their age plus 5.

1995.  The American Society for Nutritional Sciences (formerly the "American Institute of Nutrition") convened a symposium entitled "Dietary Guidelines for Children: a Focus on Fat" at the 1995 Experimental Biology Annual Meeting. Participants in this symposium noted the following:

1996.  The American College of Nutrition (ACN) held a Workshop on Dietary Guidelines for Children (ACN 1996). Conclusions generated at this workshop included the following:

1997.  The American Society for Nutritional Sciences (ASNS) convened a workshop on "The Role of Dietary Fat in Child Nutrition and Development" (ASNS 1997). Participants at this conference raised the following issues:

    SURVEYS

1995.  The American Dietetic Association, the International Food Information Council, and the President's Council on Physical Fitness and Sports released the results of the Food, Physical, Activity & Fun: What Kids Think Survey. This survey of 410 children between ages 9 and 15 y found that 81% of the children agreed with the statement "to eat healthy, you should avoid all high fat foods" (Gallup 1995).

In May of 1995, the National Dairy Council conducted a "Survey of Health Care Professionals regarding Dietary Guidelines and Children's Nutrition." Seventy-two percent of the 102 health professionals who responded to this survey agreed that separate dietary guidelines specific to children's needs would be useful (NDC 1995).

    CONCLUSIONS

The fact that psychologically, nutritionally and physiologically "kids are not little adults" has prompted many key organizations within the medical and health professional communities to support the development of separate dietary guidelines for children (ADA 1995, NDC 1996). The idea for separate dietary recommendations for children is not a new idea; many health professional organizations are already targeting dietary recommendations to children (AAP 1981, Skiba et al. 1997). As health professionals look to the future, the concept of separate dietary guidelines for children remains a critical issue to address. Any dietary guidelines targeted to children should be based on sound scientific evidence of safety and efficacy. Adult data should not be extrapolated to children. It is critical to be cautious when there is an ongoing debate of the health-promoting value of some dietary recommendations for adults (Oparil 1997, Ravnskov 1998). This is particularly important when the health benefits of applying the dietary recommendations are questionable or unproven. A lack of evidence of harm does not mean that such dietary recommendations are safe.

When any dietary guidelines are recommended, systems should be put into place to monitor the effect that following or implementing such recommendations by the general public may ultimately have on diet quality. The concern has been raised that following dietary recommendations to reduce the risk of some chronic diseases may inadvertently compromise nutrient intake and enhance the risk for other chronic diseases as a consequence (Miller 1996).

Health professionals must recognize that there is a low level of nutrition knowledge within the general public and that nutrition misinformation abounds. Thus, there is the potential for misapplication of broad dietary guidelines. For example, health professionals have observed inappropriate application of recommendations to reduce fat intake of children by adults (Lifshitz and Tarim 1996).

The safety of dietary guidance under controlled conditions supervised by a nutritionist/dietitian cannot be assumed for the general population. Most consumers do not have ready access to such a health professional. When consumers interpret and implement population-based dietary guidelines without professional guidance, guidelines must be carefully constructed to avoid adversely affecting nutritionally vulnerable age segments such as children and older adults.

Health professionals that are developing age-targeted dietary guidelines will have to consider individual taste and health needs. Healthful diets can taste good while allowing all foods in balance. What constitutes a healthful diet will depend upon an individual's genetic makeup. This means that population-based dietary guidelines will have to be applied individually.

The American Heart Association has begun to recognize the importance of such an approach in their recent medical/scientific statement on dietary guidelines. This document contends that "population-wide guidelines do not address the specific needs of all individuals" (Krauss et al. 1996). This statement suggests that clinicians should consider interindividual variation when making individual dietary recommendations. The best nutritional advice will be based on an understanding of the unique nutritional needs of individuals throughout various life stages.

Any new dietary guidelines developed for children should provide an emphasis on nutritional adequacy with an effort to consider future health. There should be a focus on a nutritious diet as part of a healthy lifestyle rather than a focus on dietary restrictions. The development of age-specific guidelines for children, as well as older adults, is an important consideration for the new Dietary Guidelines committee to explore in their efforts to develop effective dietary guidance for Americans in the year 2000 and beyond.

    FOOTNOTES
1   To whom correspondence should be addressed.

Manuscript received 9 July 1998..

    LITERATURE CITED
Introduction
References
0022-3166/98 $3.00 ©1998 American Society for Nutritional Sciences



This article has been cited by other articles:


Home page
 Am. J. Clin. Nutr.Home page
G. D Miller
Year 2000 dietary guidelines: new thoughts for a new millennium
Am. J. Clinical Nutrition, March 1, 2000; 71(3): 657 - 658.
[Full Text] [PDF]

Home page
 J. Am. Coll. Nutr.Home page
L. D. McBean and G. D. Miller
Enhancing the Nutrition of America's Youth
J. Am. Coll. Nutr., December 1, 1999; 18(6): 563 - 571.
[Abstract] [Full Text] [PDF]

Home page
 J. Nutr.Home page
J. A. Milner and R. G. Allison
The Role of Dietary Fat in Child Nutrition and Development: Summary of an ASNS Workshop
J. Nutr., November 1, 1999; 129(11): 2094 - 2105.
[Full Text]

This Article
Right arrow Full Text (PDF)
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Groziak, S. M.
Right arrow Articles by Miller, G. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Groziak, S. M.
Right arrow Articles by Miller, G. D.

Home Help [Feedback] [For Subscribers] [Archive] [Search] [Contents]
Copyright © 1998 by American Society for Nutrition