Growth vs. Cholesterol : Doctors Split on Need for Low-Calorie Diet for Kids
Should kids catch cholesterol phobia?
Certainly it’s going around. For lots of grown-ups, sausage is sin. Bacon is verboten. A juicy steak is dietary blasphemy.
Americans are concerned--not to say obsessed--over what they eat. And the belief has taken root that youngsters should watch their diets, too.
It makes sense: Heart disease starts early. The man who dies of a heart attack at 65 is the victim of an illness that probably began in nursery school.
Many doctors believe they can forestall this insidious destruction by starting people on healthy diets in childhood. While they caution that infants need lots of fat to grow quickly, these experts argue that after age 2, everybody should follow a “prudent” diet.
Definitions vary, but in general this means that 30% or less of the day’s calories should come from fat, and only a third of the fat should be the saturated variety.
Can Improve Chances
People get heart disease because they inherit the wrong genes. They can improve their chances of surviving, and perhaps avoid the disease completely, if they eat right. Too much saturated fat in the diet dangerously raises their cholesterol levels. Over a lifetime, this clogs the heart’s plumbing and eventually stops it up entirely.
Almost everyone agrees that a prudent diet is good, or at least harmless, for adults. Even if people have good heart genes, it will help them keep off weight and maybe give them an edge against some kinds of cancer.
But when it comes to children, the consensus ends. In general, the disagreement pits heart doctors against kids’ doctors. Many cardiologists believe that everyone should cut down on fat after infancy. However, some pediatricians worry that low-fat diets for children will lead to malnutrition.
Two Points of View
“It’s a matter of emphasis,” says Dr. Laurence Finberg, a pediatrician at the State University of New York in Brooklyn. “Pediatricians have a concern about adequate growth. Cardiologists come from the adult sector, and they see it a little differently.”
Kids need lots of calories to grow. Fat is nature’s richest source of calories. Pound for pound, fat contains twice as many calories as carbohydrates.
Pediatricians argue that if kids cut out high-fat food, such as whole milk and ordinary hamburgers, they will need to eat a lot more vegetables and other food to get enough calories.
While eating a low-fat diet with adequate calories is certainly possible, Dr. Marc S. Jacobson warns that parents sometimes go overboard. Even nutritionists have trouble figuring the precise percentage of fat in the diet. Parents sometimes overshoot and cut their youngster’s fat levels back to 20% or 25% of calories.
Not Enough Energy
As a result, the children may not get enough energy, especially if they are picky eaters, and their growth will be stunted.
“I tell parents not to change their children’s diet,” says Jacobson, a pediatrician at Long Island Jewish Medical Center in New Hyde Park, N.Y. “If they don’t have a family risk of heart disease, then I don’t think we should be doing anything at this point in time.”
The American Academy of Pediatrics recommends that children get 30% to 40% of their calories from fat, which is essentially what they are already eating. A federal survey found that American children get between 34% and 39% from fat.
Pediatricians and cardiologists agree that children with a family history of heart disease should have their cholesterol checked. And they should go on diets if their cholesterol levels are high. But pediatricians generally balk at rigorously squeezing the fat out of every youngster’s diet.
“I think run-of-the-mill parents should be aware that a high-fat diet is not good and should avoid a high-fat diet,” says Finberg, who is chairman of the academy’s nutrition committee. “You don’t need to say it any more stringently than that.”
Cases of Stunted Growth
To back up their concern, some pediatricians cite the studies of Dr. Fima Lifshitz of North Shore University Hospital in Manhasset, N.Y. Three years ago, he reported the cases of seven children who failed to grow adequately because their parents had put them on diets. The parents were worried about heart disease and obesity.
Despite such reports, many cardiologists believe the chances are remote that youngsters won’t get enough to eat, especially enough fat. On the other hand, the dangers of too much cholesterol in the blood are clear.
These doctors would like to see children’s cholesterol levels drop to 140 milligrams per deciliter of blood or lower. By the time they reach adulthood, their cholesterol would still average below 200, which is generally considered to be a healthy level.
“We believe that the ideal level of cholesterol in the blood would be between 110 and 140 for children,” says Dr. Curtis Ellison, a cardiologist at Boston University Medical School. “If we could achieve that, we could put every cardiologist out of business 20 years from now.”
Says Rules Are Simple
Probably the leading advocate of the prudent diet for children is the American Heart Assn. Dr. Frank A. Franklin of Louisiana State University, a member of the association’s nutrition committee, says children can easily cut their fat to a healthy level without making radical changes or sacrificing calories.
The rules are simple, he says. Stick with 1% milk, choose lean meat and low-fat cheese, and buy snacks and desserts that don’t contain lard or tropical oils.
“We are not talking about ripping cookies out of children’s hands and putting a cucumber there,” Franklin says. “We are being painted as puritans, as though we are trying to restructure American life through diet. We are only trying to make people live longer.”
