Panel Issues Advice on Fat in Baby Diets

Children over the age of 2 should have diets moderately restricted in fat, but newborns and toddlers under 2 must continue to have high-fat diets, according to the American Academy of Pediatrics’ committee on nutrition.

Although the pediatricians stopped short of recommending any reduction for children under 2, they acknowledged that around a 30% fat content in the diet of children over 2 is probably prudent, in contrast to the 40% and higher levels typical of American children and families.

In a new policy statement released Tuesday at the academy’s annual meeting here, the pediatric nutrition group also warned families and physicians to stop a new and increasingly popular practice of having children tested for cholesterol levels, except in cases when children over 2 have family histories suggesting that they could be at high risk of heart disease later in life.

For example, the nutrition group said, children might be considered for testing if a close family member has had a history of hyperlitidemia (elevated blood-fat levels) or early heart attack (before age 50 in men, 60 in women).

Cholesterol-testing devices are widely available, not only in doctors offices but in some cities in department stores and sidewalk booths. Because there is no standardization of this equipment and the measurement of cholesterol is “fraught with difficulties,” including normal day-to-day and seasonal variations in many patients, the nutrition committee urged families to stay away from such tests, except when done in consultation with a physician--and then only in potentially high-risk cases.

The guidelines on testing are the first such statement the American Academy of Pediatrics has issued on the subject. However, the guidelines on diet essentially reaffirm the pediatric group’s longstanding contention that fat is a crucial element in children’s normal growth and development.

For years, the pediatricians group has been at odds with the American Heart Assn. and a number of other health advocate groups over the issue of fat content in the diets of children. The heart association has argued vociferously that healthy diets should never exceed 30% fat, if the risk of stroke and heart disease are to be reduced. And, assuming that heart disease begins early and builds over a lifetime, many heart specialists and internists have urged that such low-fat diets begin early in life.

Mother’s milk, considered the perfect food for babies, is about 40% fat, which gives some clue of the importance of fat in a baby’s diet, said Dr. Norman Kretchman, professor of nutritional sciences at UC Berkeley and a member of the Academy of Pediatrics’ nutrition committee.

Not only is fat needed for normal growth in children, it is also a key element in allowing the body to absorb a variety of essential vitamins and minerals, said Dr. Michael Gracey, a physician from Australia.

In children over 2, the physician said, diets should be balanced and watched for excess fat but should not be severely restricted.

Given peer pressure, there is a limit to how much a parent can restrict an older child’s diet anyway, Kretchman said.

And, fortunately, he said, children whose diets have been restricted in fat content normally catch up quickly once a normal diet is resumed.