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Sunday, July 6th, 2014
As a registered dietitian nutritionist, I always tout the perks of protein in the context of a nutritious diet. A satiating and satisfying nutrient, protein is found in a wide variety of animal and plant foods. Children need it because it provides their bodies with energy to support growth, development and maintenance of muscles, bones, organs and all body cells. But despite its many virtues, many children—and their parents—OD on protein.
The popularity of Atkins’ type diets coupled with concern over carbohydrate and added sugar intake have led many of us parents to consume more of our daily calories from protein. That has likely lead many kids to also eat more protein-rich foods. The emergence of more and more foods pumped up with protein—everything from granola bars to pasta, Cheerios with protein, high protein pretzels and even pancake mix made with extra protein as described in a recent segment on Good Morning America—is likely to make even more adults and children consume protein in amounts that can greatly exceed their daily needs.
For infants up to age 6 months, the adequate intake (AI) for protein is 9.1 grams daily. For older children, Recommended Dietary Allowances for protein range from 11 grams daily for 7- to 12-month-olds to 13 to 46 grams daily for 1- to 18-year-olds. To put these protein recommendations in perspective, the following foods and beverages each pack in about 8 grams of protein: 1 ounce roasted turkey, 1 ounce broiled sirloin, 1 cup milk, 1 ounce Swiss cheese, 4 ounces firm tofu; and ~1/2 cup chickpeas.
Although it’s a challenge to know just how much protein infants and older children consume, the most recent What We Eat in America report reveals that boys aged 2- to 5-years-old, 6- to 11-years-old, and 12- to 19-years-old consume an average of 56, 68 and 95 grams of protein, respectively, each day. The survey also shows that girls aged 2- to 5-years-old, 6- to 11-years-old, and 12- to 19-years-old consume an average of 56, 63, and 64 grams of protein, respectively, each day. grams. Essentially, the report suggests that children can easily consume 3 to 4 times the amount of protein recommended for them daily.
Although it’s not yet clear how excess protein affects children’s health over the long term, a recent review in Food & Nutrition Research concludes that a high intake of protein (15 to 20% of total calorie intake) in infancy and young childhood increases the risk of obesity later in life. The researchers recommend an average of 15% of total calorie intake for protein as the upper limit at 12 months of age. (However, current Dietary Guidelines for Americans recommend a range of 10- to 35% of total calories from protein for Americans aged 2 and older.) To reduce protein intake in an infants’ diet, the researchers recommend breastfeeding for the first year of life since breast milk has less protein than formula, and to avoid excessive intakes of protein-rich foods like cow’s milk.
Besides its link to weight gain, too much protein can strain kidneys and cause bones to excrete calcium. It can also lead to excess calorie and saturated fat intake—and increase the risk of unhealthy weight gain, cardiovascular disease, high blood cholesterol and high blood pressure. This is especially true if the protein foods children eat include big portions of fried, skinned chicken, fatty meats and full-fat dairy products.
While it’s much more important to focus on children’s overall diet and the foods they are offered and actually eat rather than specifically how much protein they consume, we parents can help them achieve more dietary balance. When it comes to protein, we need to provide—but not push—protein foods that are in their lowest fat forms and are prepared in healthful ways. Examples include low- and nonfat milk, yogurt and cheese; lean beef; skinless poultry; fish; eggs; beans and peas; and nuts and seeds. We need to offer these foods in amounts based on children’s unique needs (check out the Daily Food Planner based on MyPlate here).
Although few children are deficient in protein, those who for whatever reason consume fewer calories than they need for growth and those who follow vegetarian or vegan diets may fall short on protein. In such cases, it’s important to offer and encourage intake of protein-rich plant foods including soybeans and tofu (like animal proteins, these contain all the essential amino acids the body needs and cannot make itself) to meet calorie and energy needs. Adding such foods to other dishes your child already likes can help. And while foods touted as having extra protein can help some children meet their baseline protein needs, most can afford to bypass such foods and instead rely on foods that are naturally protein-rich.
Image of meat and dairy foods via shutterfly.
Do you pay attention to your child’s protein intake?
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Monday, June 30th, 2014
We all know that far too many kids weigh more than they should for optimal health and well being. But despite the dramatic surge in childhood obesity rates over the last three decades, there’s evidence that the levels of obesity as measured by body mass index (BMI) are starting to steady—and, in some cases, drop. In fact, national survey data shows that the rate of obesity in two- to five-year-olds decreased from an estimated 13.9% in 2003-2004 to 8.4% in 2011-2012.
Despite the glimmer of hope, a new article published in Pediatric Obesity suggests that BMI—a popular, easy to use screening tool based on height and weight—falls short in identifying children with higher than desirable body fat levels. Although the Centers for Disease Control and Prevention (CDC) describes BMI as “a reasonable indicator of body fatness for most children and teens,” a review of 37 studies of 53,521 four- to 18-year-olds found that 27% of children who were not classified (using BMI) as obese* had excess body fat levels.
According to Francisco Lopez-Jimenez, MD, Director of Preventive Cardiology at Mayo Clinic and senior author of the article, “BMI is based on body weight, not body composition (the amount of muscle and fat), and weight cannot discriminate muscle from fat.” He adds, “A child’s body weight can still be within “normal limits” even if he or she doesn’t have much muscle mass but has a high level of body fat.”
Although he considers BMI a good measure to capture population trends, David Katz, MD, Director, Yale University Prevention Research Center and Editor-in-Chief of the journal Childhood Obesity, says, “There are far more important metrics (than BMI) at the individual level—some requiring no technology other than our eyes.” While Katz acknowledges that we may not like to talk about the difference between ‘flab’ and muscle, he says we know it when we see it. “An excess of fat tissue, or flab, is potentially harmful even at lower BMIs.”
According to Lopez-Jimenez, an alternative to using BMI in children is to check waist and hip circumferences. He says, “If the waist it larger than the hip, the child likely has central obesity—unhealthy fat in the central portion of the body.” Lopez-Jimenez also notes an old teaching that may be useful: “If you cannot see the ribs of your child when he or she raises his or her arms, there’s probably a lot of fat under the skin.”
Although Katz says that BMI can be a useful (albeit imperfect) gauge of body weight, having good muscle tone and being fit can be protective even in children with a high BMI. Because health matters far more than body weight, Katz recommends that parents and clinicians assess children’s overall health with measures such as fitness, vitality, and energy level. While both Katz and Lopez-Jimenez recommend a nutritious diet and active lifestyle to help kids achieve and maintain a healthy body weight and optimize overall health, Lopez-Jimenez adds, “It is hard for a healthy child to become obese if he or she eats well and is constantly active.”
Check out four tips to help your kids eat less and better and 11 tips to nourish active kids.
*Obesity is defined as a BMI at or above the 95th percentile of the sex-specific CDC BMI-for-age growth charts.
Image of happy kids via shutterstock.
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Tuesday, June 17th, 2014
In an effort to “try to prevent thousands of deaths each year from heart disease and stroke,” the Associated Press (AP) reports that the U.S. Food and Drug Administration (FDA) will soon issue voluntary guidelines to encourage food companies and restaurants to lower sodium in their offerings.
Although current Dietary Guidelines for Americans set a daily cap of less than 2,300 milligrams for Americans over age two (and even less—1,500 milligrams—for adults aged 51 and over, African-Americans and those with high blood pressure, diabetes or chronic kidney disease), most children exceed these recommendations. National survey data reveals that while two to five year-olds meet the cap and average 2,307 milligrams of sodium daily (that’s about one teaspoon of salt), older children fare worse. Six- to 11-year-olds consume about 2969 milligrams of sodium daily, and 12- to 19-year-olds average a whopping 3,585 milligrams of sodium daily.
Typically, consuming more dietary sodium is linked with higher blood pressure. And for children, there’s moderate evidence that as sodium intake decreases, so does blood pressure. Helping children keep blood pressure in a normal range may also reduce the risk of cardiovascular disease, congestive heart failure, and kidney disease.
Despite evidence to the contrary, not everyone agrees sodium intake should be limited to garner blood pressure or other health benefits. In fact, a recent review published in the American Journal of Hypertension found that while both low sodium intakes and high sodium intakes were associated with increased mortality, average daily intakes of between 2,645–4,945 milligrams was associated with the most favorable health outcomes. According to the AP article, the food industry supports a 2013 Institute of Medicine report that suggests there’s no good evidence that eating sodium at levels below 2,300 milligrams daily offers benefits.
Whatever your thoughts about sodium, it’s important to know where it lurks so that you can be mindful when feeding even young children. A recent study published in Pediatric Obesity that examined the sodium and sugar content of packaged baby and toddler foods sold in America found that 58 percent of the products assessed either have a high level of sodium or at least 20 percent of calories from sugar. Researchers also found that 15 percent of toddler foods (especially entrees) exceeded the ‘moderate level’ recommended for sodium.
Other foods that kids typically eat that tend to be high in sodium—not to mention high in calories and less nutritious overall—include processed/packaged or restaurant foods including fried, breaded foods (like chicken nuggets and French fries), cheeseburgers, macaroni and cheese, sliced deli meats, condiments like catsup and processed meats like hot dogs. Still, otherwise nutritious foods like canned beans, vegetable-based soups, and whole grain breads can also pack in sodium which is why it helps to read labels to compare products. To put sodium in context, any item that contains 230 milligrams per serving is about 10 percent of the sodium recommended daily for kids.
Only time will tell if the FDA’s future voluntary sodium guidelines—if followed by the food industry—will help children lower their sodium intake and reap subsequent health benefits. Until then, it’s prudent to be aware of sodium in kids’ diets and to take steps to help them meet—and not exceed—current science-based sodium guidelines.
For more on sodium and tips to help your kids lower their intake, check out my recent Scoop on Food post, Kids and Sodium. You can also visit this CDC website.
What’s your take on kids and sodium? Do you think they should limit it in their diets?
Image of spilled salt and salt shaker via shutterstock.
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Monday, June 16th, 2014
If the new book The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet, featured in The New York Times, The Wall Street Journal, and Time has made you change your child’s plate and offer her fatty foods without abandon, I urge to you to think again. Although I recommend an all-foods-can-fit approach to eating and feeding my children—an approach that some registered dietitian nutrition colleagues support and others loathe—it makes little sense to disregard current science-based advice to limit saturated fatty acids.
A strong body of evidence suggests that higher intake of saturated fatty acids is linked with higher levels of both total and bad (LDL) cholesterol—risk factors for cardiovascular disease. Also, replacing some saturated fatty acids in the diet with monounsaturated and polyunsaturated fatty acids (unsaturated fats) is also linked with low blood cholesterol levels and a lower risk of cardiovascular disease. Because of these links, current Dietary Guidelines for Americans recommend consuming less than 10 percent of total calories as saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids; keeping trans fatty acid consumption as low as possible; and reducing intake of solid fats (like butter and lard).
According to the American Heart Association, lowering saturated fatty acid intake even more—to less than 7 percent of total daily calories—can confer even more benefits when it comes to heart health.
Even though foods that naturally contain saturated fatty acids like meat and dairy foods (milk, cheese and yogurt) contribute key nutrients, it’s wise to teach children to choose such foods and others high in saturated fatty acids (including grain-based desserts like cookies and cupcakes, and dairy-based desserts like ice cream) in lower fat forms while eating plenty of fruits, vegetables and whole grains. This can help minimize saturated fatty acid intake while maximizing overall nutrient intake. More importantly, it can also help children keep their total calorie intake at a level that meets (but doesn’t exceed) their needs. Because many foods that are rich in saturated fatty acids also tend to be high in calories (not to mention taste so good), they’re also relatively easy to over consume.
Excess intake of saturated fatty acids (and fat in general) that leads to an over consumption of total calories also can contribute to excess body fat levels. Because each gram of fat has more than double the calories found in a gram of either carbohydrate or protein, calories from foods high in fat content can add up really fast and cause children to take in more calories than they need. Also, even though excess calories from any nutrient—protein, fat or carbohydrate—can increase body fat levels, excess fat calories are more efficiently stored as body fat than excess carbohydrate or protein calories. So while it’s important to make sure children get enough calories from nutrient-rich foods to meet their needs, it’s also important to help them avoid excess calories from fat (especially saturated and trans fatty acids) to prevent unhealthy weight gain and obesity.
Although many variables including genes, excess total calorie intake, decreased physical activity, increased sedentary behavior and not enough sleep contribute to the development of obesity in children, helping children establish moderate and mindful eating habits can reduce the risk. Becoming obese not only burdens children both physically and emotionally, but it also puts them at increased risk for diet related diseases such as heart disease and type 2 diabetes. It also can increase the risk of nonalcoholic fatty liver disease (NAFLD). Highlighted recently in the New York Times, the prevalence of suspected NAFLD in adolescents has more than doubled over the last three decades and currently affects an estimated 1 in 10 children. Over time, NAFDL can lead to cirrhosis, liver failure, liver cancer and cardiovascular disease. A study published in the Journal of Pediatrics suggests that increased intake of monounsaturated and polyunsaturated fatty acids (especially omega-3 fatty acids) and reduced intake of added sugars (especially from soft drinks) may reduce the risk of or treat NAFLD.
When it comes to dietary fats, helping children choose leaner cuts of meat (like sirloin or flank steak and skinless poultry), low- or non-fat dairy products, eating more fish (especially those rich in omega-3 fatty acids), nuts and seeds, and limiting fried foods and other foods made with solid fats can help them better balance their fat intake (not to mention eat better). Still, focusing on manipulating a single nutrient in the diet—whether that nutrient is fat (or a particular fat, like saturated fat), sugar or something else—misses the boat, especially because most foods contain a mix of nutrients. And ODing on any single nutrient or food is never a good idea, especially because it then leaves less room for other nutrients and foods in the diet. So the next time you hear a story or read a headline that tells you it’s OK to eat more of this or that even though you’ve heard you shouldn’t, or to eliminate this or that (even though a little probably won’t kill you), be aware that these statements are likely too good to be true or. At best, they’re an oversimplification of the science of food and nutrition. I say it’s safer to let prudence rather than headlines be your guide when making food choices for yourself and your family.
The bottom line when it comes to dietary fat and children is to offer them a wide variety of nutrient-rich foods, to teach them how to balance their food choices and to learn what proper portions of all kinds of foods to meet individual needs for growth and development. And until we know more, I prefer a total diet rather than a single nutrient approach to eating and feeding, and recommend using current science-based Dietary Guidelines for Americans to guide your food choices. Although few children and adults fully follow the guidelines (they are admittedly idealistic and challenging to follow), simply moving in the direction of meeting the recommendations can help children eat better while reducing the risk of obesity and diet-related diseases. Staying active, getting adequate sleep and managing stress can also help.
(For more on my thoughts about dietary fat and kids, check out this recent Scoop on Food post.)
Image of fresh meat and dairy products via shutterstock.
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children, dietary fat, fat, health, obesity, saturated fat, saturated fatty acids | Categories:
Diet, Health, Must Read, Nutrition, Obesity
Tuesday, June 10th, 2014
If your kids, like most, fall short on fish intake, the U.S. Food and Drug Administration (FDA) and U.S. Environmental Protection Agency (EPA) want to change that. In an effort to update joint fish* consumption recommendations issued in 2004, the FDA and EPA just released draft updated advice for pregnant women, women who might become pregnant, women who breastfeed and young children.
Fish provides a vital source of nutrients needed by pregnant and breastfeeding women and children. Besides being a source of high quality protein, many types of fish—especially cold-water, oily fish, like salmon—are key food sources of two potent omega-3 fatty acids: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These essential polyunsaturated fatty acids (they’re essential because the body can’t make them and they need to be derived from the diet) are integral components of cell membranes and support critical functions in the brain, blood vessels and immune system. EPA creates compounds that help cells divide and grow and also plays a role in blood clotting, muscle activity and digestion, and DHA is critical for brain function. Although our bodies can make a little bit of EPA and DHA from plant foods, fish is a more reliable source of these vital nutrients. Studies also suggest that fish benefits heart health, may protect against depression and may even benefit skin health.
Depending on the type you choose, fish can also be a good or excellent source of nutrients including vitamin B12, niacin, selenium and phosphorus. Some are also excellent sources of vitamin D.
Although the draft recommendations encourage adults to consume 8 to 12 ounces weekly of a variety of fish that are lower in mercury (more on that below), it recommends that children consume amounts consistent with current Dietary Guidelines for Americans. Based on United States Department of Agriculture (USDA) Food Patterns, children ages 2 to 8 years who consume between 1,000 and 1,400 calories should aim for about 3 to 6 ounces of fish weekly. Older children who consume 1,600 or more calories (eg boys aged 10 and older, and girls aged 11 and older) can aim for at least 8 ounces of fish weekly. The draft recommendations also recommend feeding fish to children only after 6 months of age and to monitor for signs of an allergic reaction before feeding a second time since fish—especially shellfish—is recognized as a major allergen.
When it comes to fish options, the draft recommendations encourage low mercury fish options. While mercury, a heavy metal, occurs naturally in the environment, it also collects in the waters in which fish swim. There it becomes methylmercury, a neurotoxin. When fish feed, they absorb varying amounts of methylmercury, and nearly all fish contains at least traces of the heavy metal. Being exposed to too much methylmercury can harm the brain and nervous system, which is why it’s vital for women of childbearing age and children especially to make more mindful fish choices. The draft recommendations suggest avoiding higher mercury fish including tilefish from the Gulf of Mexico, shark, swordfish and king mackerel. They also recommend emphazsizing lower mercury fish options including salmon, shrimp, pollock, tuna (light canned), tilapia, catfish, and cod and limiting intake of white (albacore) tuna to 6 ounces a week since it contains an estimated three times the mercury found in light tuna.
If you’re still concerned about methylmercury or other harmful pollutants in fish, you can remove parts of the fish in which such substances tend to accumulate before cooking; these include the skin, belly fat, and internal organs.
To incorporate more fish in kids’ diets, you can serve it in small portions alongside or mixed with rice and vegetables, in fajitas or quesadillas, or bake it with breadcrumbs made from flaky whole grain cereal. Or make mini fish sticks! And if your kids won’t eat fish because they don’t like it, or because they follow a vegetarian or vegan diet, be sure to consult with a registered dietitian nutritionist to make sure they are meeting their basic nutrient needs.
Although it’s unclear when final FDA/EPA fish intake recommendations will be made, it’s prudent to follow the updated draft guidance—especially if your kids don’t eat much or any fish. And if you want to voice your opinion or make a comment about the draft advice, you can do so starting on June 11, 2014.
*includes fish and shellfish.
Image of grilled fish with BBQ vegetables via shutterstock.
Do you and your kids eat fish? If not, what’s stopping you? And if you do, what’s your favorite way to eat/prepare it?
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