Healthy Hearts for Children : CHOLESTEROL & CHILDREN : A Parent’s Guide to Giving Children a Future Free of Heart Disease <i> by Robert E. Kowalski (Harper & Row: $16.95; 320 pp.) </i>
Coronary heart disease remains the leading killer of adults in industrialized countries. While there are many other pressing health concerns--AIDS, drug abuse, and injury-related deaths to name but a few--heart disease has no equal in its widespread and deadly impact.
Most of what is known about coronary disease falls under the rubric of secondary prevention, interventions aimed at slowing the progression of disease in individuals who already have symptoms. Unfortunately, about 25% of people having their first heart attack collapse and die before any therapy can help them. Much less is known for certain about primary prevention: keeping people from developing coronary disease in the first place.
Physicians routinely counsel adults to moderate the amount of fat in the diet, to control weight and blood pressure, to refrain from smoking, and to stay in shape, but there is still little agreement on what children should be doing to prevent coronary diseases 30, 40 or 50 years later in life.
Pediatricians have been reluctant to provide advice regarding control of weight, diet and blood pressure. Reluctance originally came from a lack of proof that problems in these areas “track” into adulthood--research now shows that to a large extent, they do--and from a concern that tampering with what seems natural in childhood could potentially do more harm than good. But as Robert Kowalski says in his new book, “Cholesterol & Children,” what is natural is not only culturally dependent but it is also likely to be unhealthy.
Kowalski, author of the best-selling “The 8-Week Cholesterol Cure,” now provides a practical guide to developing heart-prudent eating habits for children. In doing so, he addresses the two major objections usually offered to altering children’s diets: that overzealous parents will turn their children into macrobiotic dwarfs, or that food-conscious children will turn into anorexic or bulimic teens. He starts by reviewing the medical literature on cholesterol and heart disease, and moves on to some moderate, common sense suggestions that are the major strength of the book.
Kowalski echoes an increasingly mainstream message about childhood nutrition. First, don’t tamper with infant feeding. Breast-feeding is best, but standard formulas are a reasonable substitute. Then, once children are eating table foods and drinking cow’s milk, try to keep them on a balanced diet that contains a moderate but limited (30%) of its calories as fat, and check them, probably in the preschool years, for elevated levels of fat in their blood. In addition, make sure that dietary fat comes predominantly, but not exclusively, from mono- and polyunsaturated sources such as vegetables and fish. Wrap this up in a package of other healthy habits, and children stand a good chance of reducing their risk of coronary disease, while not endangering their normal growth.
Kowalski’s talent is in helping a parent see this as an approachable task. His book is full of charts and menus that make it a one-stop reference for the family starting to change its eating habits. Armed with this, the parent can move on to adapt other recipes and to develop more personalized solutions to the problem of excess fat and calories.
Kowalski is not as successful in reviewing the medical literature, or in talking about some of the other factors that along with diet contribute to the risk of heart disease. One problem is his frequent reference to physician Charles Glueck as “a leading authority on children and heart disease.” In the summer of 1987, when “Cholesterol and Children” was probably still in manuscript form, newspapers reported that Glueck had been censured by the National Institutes of Health for misrepresenting data on the safety of low-cholesterol diets for children. Although Glueck’s work is not central to Kowalski’s case for a prudent childhood diet, its inclusion demonstrates how hard it is for a science writer to stay abreast of all that is happening in a complex field.
Kowalski did, in fact, take on an enormous task. “Cholesterol & Children” does not confine itself to that subject, but along the way takes on the whole problem of the cardiac-prone life style, from watching too much television to Type A behavior. While it is important to stress that dietary changes alone may not alter the risk of heart disease, his coverage of the other topics is superficial and at times misleading.
For example, Kowalski says, “In later childhood the majority of parents give their children a vitamin supplement to be certain they get all the nutrients they need.” But as he also says repeatedly, the majority give their children all the unhealthy junk and fast food that they want. Certainly not every pediatrician would suggest vitamins for a child with reasonable eating habits. Why devote chapters to developing the scientific proof for some statements, only to fall back on “everyone does it” for other claims?
In another chapter, this one discussing Type A behavior, Kowalski warns parents that their college-age children are especially sensitive to stress and thus may increase their risk of heart disease. “Does the young man or woman prefer to work alone?,” he asks. “This may show a strong need to remain in total control over a situation.” Of course, it also may show the student’s normal, healthy progression from mass instruction grade-school style to the self-directed learning that most adults prefer. What’s more, the connection of Type A behavior with heart disease is a hotly debated topic, with many studies unable to reproduce the original and widely publicized findings.
It is unfortunate that Kowalski was not able to take the moderate, thoughtful approach to these additional topics that he applied to the question of diet. A better organized text might have made more room for them, or perhaps just noted their importance and referred the reader elsewhere.
