GOOD HEALTH MAGAZINE : NUTRITION : WHAT (AND WHAT NOT) TO FEED THE KIDS : YEARS OF RESEARCH HAVE ONLY LEFT PARENTS CONFUSED. BUT EXPERTS SAY THE HOME IS THE BEST PLACE TO LAY A STRONG NUTRITIONAL FOUNDATION FOR ADULTHOOD.

Everyone’s ultimate parental guilt trip: Wondering whether you are driving your children toward a heart attack, cancer or diabetes by the way you’re feeding them.

Perhaps you are, experts say.

Researchers know that by age 3, children can develop fatty streaks--deposits in blood vessels that many doctors believe are precursors to cholesterol-clogged arteries and heart attacks in adults. Recent studies have found that some fatty streaks in a 15-year-old boy are converted to actual heart-attack-causing lesions by age 30. Even children without cholesterol-related hereditary factors can have high levels of cholesterol in their blood.

On the other hand, panicked parents have been known to--literally, if inadvertently--stunt their children’s growth by restricting fat intake too early in life.

Researchers know that by age 3, children can develop fatty streaks--deposits in blood vessels that many doctors believe are precursors to cholesterol-clogged arteries and heart attacks in adults.

Years of research have led to stacks of scientific papers and textbooks geared to the biochemical minutiae of human nutrition. Today, a thoughtful parent hears that the hot cure-all is beta carotene or psyllium. Yesterday it was oat bran, zinc, or iron, or Vitamin C. Each new detail overshadows the last or makes the total picture more confusing.

“It makes you long for the days when being a parent was a little more guided by the heart and not so much by the intellect,” says Dr. William Vincent, pediatric cardiologist at St. Vincent Medical Center in Los Angeles.

So how does a parent negotiate this nutritional quagmire and end up with healthy kids who will grow into healthy adults?

First, one must give up on finding any single food prescription for raising children. Instead, researchers and clinicians say, the answer lies in seeking a balanced diet as part of an overall fitness picture for children, not as an end in itself.

In other words, your mother was right:

It’s best for children to eat their vegetables and drink their milk. Mealtimes should present youngsters with a balance of foods. Sweets and fat-rich treats are fine in moderation but should not be the mainstay of the diet. And it is good for children to run, jump and play outdoors--a lot.

In that framework, the best thing a parent can do is to give children the foundation of good health habits on which their future fitness will be built. Restricting children above age 2 to eating no more than 30% of their calories from fat is widely endorsed as a key part of that framework.

Although it has not been proven that holding down fat consumption or encouraging regular exercise in childhood will prevent a specific child from growing into a 45-year-old heart attack victim--it might.

It is known that some American nutritional and life-style patterns are associated with the health problems dominant by the time middle age sets in: obesity, diabetes, cardiovascular disease, stroke, cancer and osteoporosis.

So, the thinking goes, it’s at least prudent--and at best preventive--to develop dietary patterns in childhood that will serve well in adulthood.

Furthermore, as the peer-pressured teen-age years set in, good nutrition at home will help balance out consumption of fast food, a practice that most experts acknowledge is inevitable.

The one place a parent can make a difference is in the foods that are easily available at home. Worried parents can allay many of their concerns about nutrition by giving their teen-agers a basic vitamin-mineral pill every day or two, suggests Paul Saltman, the UC San Diego biochemist who wrote “The California Nutrition Book.” Fortified breakfast cereals also can serve that function. Both strategies at least will assure healthy growth until the youngsters get past the junk-food stage, he says.

Just as important in trying to create a nutritional nirvana at home is the idea that the calories consumed need to be used to build healthy young bodies, not to be stored as fat; that is, children need to learn that an active life style is a healthy life style.

But even in Southern California, an area with an image as the center of a new health-consciousness in America, children are fatter and less physically fit than they should be.

“If you go to a park, you’ll find the adults are running and the kids aren’t,” says Stan Bassin, professor of health and physical education at California State Polytechnic University-Pomona.

In a study of 800 children in the Montebello School District, Bassin and his colleagues at Cal Poly Pomona and UC Irvine found that more than a third had levels of body fat that qualified them as obese. The children also had elevated cholesterol levels and showed poor performance in various physical fitness tests.

This is part of a national trend that in the two decades before 1980 saw obesity increase 54% in American children between ages 6 and 11, and 39% in adolescents.

In 1985, Dr. William H. Dietz Jr. of Tufts University and Steven L. Gortmaker of Harvard University concluded that a quarter of the obesity cases in children could be accounted for by their choosing television over exercise.

Obesity in adults is strongly associated with increased risk of heart disease, hypertension, diabetes and its complications, cancer and gallbladder disease. An obese child is more likely than other children to grow into a fat adult, and the more extreme the obesity, the more likely it is to persist. More than 80% of obese adolescents remain obese into adulthood.

However, it is not clear whether being a fat child necessarily predicts health problems later in life.

For instance, studies have shown that hypertension is greater among people who first gained their extra weight as adults than it is among moderately obese adults who were fat as children, says Dr. Evan Charney, chairman of pediatrics at the University of Massachusetts.

Even if childhood obesity does not predict later health problems, however, it could be accompanied by eating and activity patterns that would be hard to change in adulthood--a time when sticking to healthier habits can become a life or death proposition.

On the other hand, nutritionists and pediatricians caution parents against worrying so much about nutrition or obesity that they turn mealtimes or family outings into battlegrounds. “The degree of concern about whether or not a child eats a chocolate bar is almost always way out of proportion to its relevance to the individual child,” says Dr. Ronald Barr, who heads the child development program at Montreal Children’s Hospital in Canada. “What it’s more likely to mean is that there’s going to be an incredible amount of strain and anger between the parent and the child about something that need not be a source of anger.”

Charney adds that special weight-loss programs for children don’t work for most children, and this failure lowers the child’s self esteem.

“We put (children) on a diet, they do not lose weight and they they don’t come back to us,” Charney says. “We are ‘another expert’ who has confirmed that they are somehow inadequate. And I think that’s probably more of a hazard than the obesity.”

Some pediatricians suggest instead letting children “grow into their weight” by helping them maintain their current weight as their height increases.

Noting that the self-starvation known as anorexia nervosa is a danger, especially in girls in more affluent families, health experts advise casting any discussions about fatty or other high-calorie foods in health terms rather than body-image terms.

Despite the lack of definitive prescriptions for the feeding of your child, nutritionists agree generally on broad plans of action to help avoid certain diseases as an adult:

CARDIOVASCULAR DISEASE

The Cal Poly Pomona study found that 33% of 800 children in fifth through eighth grade had cholesterol levels greater than 180 milligrams per deciliter of blood. This is 20 to 30 points higher than is average for children, and above the level at which the American Academy of Pediatrics recommends mild dietary intervention, 176 milligrams.

Although there is disagreement over the optimum cholesterol level for children, groups such as the American Heart Assn. and a National Institutes of Health consensus conference have endorsed a lower-fat diet--limiting fat to about 30% of a child’s calorie intake--for children over age 2.

Experts also suggest limiting intake of pure cholesterol to 300 milligrams a day (slightly more than the amount in one egg). But the National Research Council favors phasing in this lower-fat diet between ages 2 and 5.

And the American Academy of Pediatrics concluded in 1984 that the figure should stay between 30% and 40% throughout the first two decades of life. That is because, especially before age 5, fats are necessary for growth and development, particularly in the brain and the nervous system.

In addition, pediatricians say that skim milk should never be used in children under 2 years old, because its low fat content makes it difficult for infants and toddlers to get enough calories for growth. Skim milk is permissible after age 2, but some doctors suggest moderation instead: 2% or 1% fat milk at least through the preschool years.

As a practical matter, the prescription for reducing fats in a child’s diet without going overboard means:

After consulting a doctor about the adequacy of the child’s growth pattern, sometime between ages 2 and 5, switch from whole milk to 2% or 1% fat milk. That alone will greatly reduce the amount of saturated fat in the child’s diet. If a child balks at the thinner consistency of low-fat milk, get creative: Mix it with whole milk at first and gradually work your way to low-fat milk.

Cut down on fats added during cooking by using non-stick pans and/or cooking sprays and cutting down on gravies. When fats are necessary, use vegetable oils rather than lard or bacon grease.

Oils high in mono-unsaturated fats, such as canola and olive oils, are the type that in adults have been shown to lower blood levels of artery-clogging LDL cholesterol while allowing the level of “good” HDL cholesterol to remain elevated.

Soluble fiber--contained in oat bran, beans and peas--also is suspected of favorably altering cholesterol levels. But there’s no guarantee that it will make any difference. In January, oat bran’s image was severely tarnished when Harvard scientists reported that it appears to have little specific cholesterol-lowering effect in people with normal cholesterol levels. The researchers found that large amounts of high-fiber oat bran are no more effective in a cholesterol-lowering diet than low-fiber refined wheat. This suggested that people’s cholesterol levels are lowered not by any unique property of oat bran but simply because people eat less fatty food when they are full with carbohydrates. Other researchers, though, believe that large amounts of oat bran may still have direct cholesterol-lowering effects. But beware: Some cereals marketed as containing oat bran don’t have much in them. Including oatmeal, beans and peas regularly in a child’s diet should be sufficient, nutritionists say.

Eggs are a good source of complete protein as well as vitamins, so nutritionists balk at the idea of cutting them entirely out of a child’s diet. But one can reduce their negative impact by poaching or boiling, rather than frying, them.

At fast-food restaurants, a small hamburger provides less fat than fried chicken pieces. Avoid “double” or “super” size, which doubles the fat content. Even a salad bar can be a fatty nightmare; watch the added dressings and the salads slathered in mayonnaise.

Read labels, especially on processed foods. That “healthy” granola, for instance, may be made with coconut oil, which is high in cholesterol-raising saturated fats. Many crackers also are high in fat; rice cakes or even dry breakfast cereal can make a good substitute snack.

Advertisers make fast food appealing to kids by adding prizes and other attractions. Nutritionist Jody L. Spector, of St. Vincent Medical Center in Los Angeles, suggests that parents launch some promotion of their own. Pancakes or sandwiches in special shapes can help, as will letting kids help plan and shop for “special” (low-fat) meals or having “theme” dinners with prizes for the diners, she says.

Even children who like fruit sometimes want a treat such as a fat-rich ice cream sundae. Instead of keeping the fixings temptingly at home, go out for such snacks.

One of the most widespread cardiovascular diseases in adults is high blood pressure, but it is unclear whether a child’s diet can prevent that affliction from developing. Among the genetically susceptible, salt consumption can trigger high blood pressure.

Since there is no way to identify children with such genetic predispositions, moderation in salt intake is considered wise. A child who doesn’t learn to prefer salty food won’t seek it out as an adult, when salt might make more of a difference, dietitians point out.

DIABETES

Your grandmother was wrong, scientists say. Eating too much sugar does not cause diabetes.

In both juvenile-onset diabetes and the non-insulin-dependent type that shows up in adults, family history of diabetes is a key factor. However, occurrence of adult-onset diabetes is also strongly influenced by obesity. Overweight Latinos and Native Americans particularly show a tendency toward adult-onset diabetes.

In Southern California, with its heavy Latino population, there is particular significance to the Cal Poly Pomona findings. They show that 41.4% of the boys and 45.7% of the girls--most of them Mexican-American--in the study had an unhealthy percentage of body fat.

It is uncertain whether these findings represent a special health problem for Latinos, because health norms are based on Anglo data, says Dr. Michael Stern, professor of medicine at the University of Texas Health ScienceCenter in San Antonio, who has studied obesity patterns in Mexican-Americans.

Stern notes that statistics do not indicate a higher mortality rate for Mexican-Americans than for Anglos, despite the Latinos’ obesity problem. It may be, Stern suggests, that certain populations are genetically adapted to a stockier body type, so the obesity in such groups would have to be extreme by Anglo standards before causing the mortality rate to climb.

Nonetheless, nutritionists are proceeding on the assumption that obesity among Latinos and their children may be related to health problems, including diabetes, and that members of this group would benefit from lower-fat, lower-calorie strategies.

Dietitians say the traditional Mexican diet--high in beans, rice and tortillas--could very easily be used to battle obesity if the amount of added fats in the diet is reduced. For instance, pinto beans should be eaten boiled, not fried in lard or even in vegetable fats.

A new cookbook with suggestions for adapting one Latino group’s diet, “Mexican American Food Practices, Customs and Holidays,” is available from the American Diabetes Assn.

OSTEOPOROSIS

A decade or two ago, doctors knew that women suffered sharp decreases in bone density that led to bone fractures after menopause, but it was thought that nothing could be done to prevent it.

Now, they say that regular exercise and adequate calcium consumption throughout life--but particularly in the teen-age and young-adult years--can make a difference.

So, particularly with the move to curtail saturated fat consumption, there is concern that parents will cut down on their childrens’ milk-products consumption, and that American youngsters will not get enough calcium.

Calcium is the raw material necessary to build bones, which are continuously degraded and replaced in the body. (Exercise is helpful during this process because it encourages the bones to grow at their maximum rate.) The idea is to build a woman’s peak bone mass as high as possible by age 30. Between ages 35 and 45, the amount of bone mass levels off and gradually drops off. (Regular exercise is thought to slow the drop-off.)

Men also can be afflicted with osteoporic bone fractures, which tend to increase after age 60. So the bone mass men build early is crucial for them as well.

The recently revised Recommended Dietary Allowances advisory issued by the National Research Council call for these daily minimums:

--Under 6 months of age, 400 milligrams of calcium, in breast milk or formula.

--6 months to 1 year of age, 600 milligrams.

--1 to 10 years old, 800 milligrams.

--11-24 years, 1,200 milligrams.

--25 and older, 800 milligrams (except during pregnancy).

There are about 250-300 milligrams of calcium in an 8-ounce glass of milk. The same amount of calcium can be obtained from 1 ounce of Swiss cheese; six or seven sardines; 6 ounces of plain yogurt or 8 ounces of fruit yogurt; 3/4 cup of macaroni and cheese; three half-cup servings of ice cream; five corn tortillas; or four half-cup servings of kale or collard greens.

If calcium supplements are given to a child, they work best in small doses over the course of a day. A large dose of calcium impairs the body’s use of other minerals, such as iron, copper, zinc and manganese.

CANCER

Whereas researchers can point a finger very clearly at the cholesterol that clogs arteries, they cannot identify one single phenomenon as causing all cancers.

The predominant thought today is that cancer cells are initiated by genetics or environment regularly in everyone, but they remain dormant for the most part until a “promoter” triggers them to grow uncontrollably.

All parents would want their children to have the best chance of avoiding cancer, so what promoters of the disease can be eliminated from the youngsters’ diet? And what protections can be added?

One prominent suspected promoter--linked to colon, rectal, breast, prostate and reproductive-system cancers--is dietary fat from any source. Consequently, reducing Americans’ daily fat consumption to 30% of calories would reduce cancer, health authorities generally believe.

A variety of substances that are incidental to food also have links to cancer. Nitrites, used as preservatives in some foods and in cured meats such as bacon and ham, are changed in the body into nitrosamines, which have been linked to gastric and esophageal cancer. Large amounts of salt, such as in cultures that emphasize cured meats, have been linked to stomach cancer.

Parents should think twice about how to prepare foods for their children. When fat drips on an open flame, the smoke that makes the meat taste barbecued also produces cancer-promoting substances called polycyclic aromatic hydrocarbons. However, studies of the effects of PAHs have been conducted only in animals.

The only foods that appear to protect humans from cancer are from plants.

Dietary fiber--from grains, fruits and vegetables--seems to cut down on cancer of the colon, apparently because it decreases the exposure of the intestinal tract to carcinogens.

Easy ways of getting fiber, fruits and vegetables into a child’s diet include using whole-grain breads and emphasizing fiber-containing cereals and fresh fruits at breakfast. Shredded vegetables can be used as filler in dishes such as meat loaf or tuna salad. Fresh fruits should be always available for snacks.

A NOTE ABOUT SUGAR

Scientists say there is little basis for believing that a high sugar intake negatively affects children’s development in any consequential way.

Most research has shown that neither hyperactive nor normal children are made more frenetic or aggressive by a high-sugar diet, says Dr. Esther Wender, chief of the division of developmental and behavioral pediatrics at Albert Einstein College of Medicine in New York.

One study did show that hyperactive children tended to have a diet higher in sugar than did other children, but it relied on parents’ memories of what their children ate--a notoriously unreliable research method. And a recent study by Wender found children to be slightly less attentive if they had an exclusively carbohydrate breakfast--such as plain toast, without milk or other protein--followed by a sugar snack one hour later.

But parents won’t find much else in science to support the folklore that sugar turns Johnny or Janey into a wild child, Wender says.

Mom was definitely right, though, when she said you wouldn’t eat your dinner if you ate candy all day. In that sense, too many treats can affect a child’s nutrition, doctors say--but there’s no need to rule out sweets altogether.

“It’s not so much whether you have junk food; it’s whether you have only junk food that’s an issue,” says Barr of Montreal Children’s Hospital.

As for dental cavities, any carbohydrate in the diet is a potential cavity causer, but some delivery systems are more efficient than others.

The frequency with which simple sugars are consumed increases the incidence of cavities, as does the consistency of the food itself. Sticky treats such as raisins or gummy candy cause more cavities than do sugary drinks.

And studies in the early 1980s found that eating a piece of cheese after a sweet snack decreases the quantity of bacteria-promoting ions in the mouth.

In the end, experts say, millions of dollars of research on children’s nutrition point to one overall conclusion: Moderation is the key. Whether the food is cheeseburgers or tofu, too much of it will prevent a child from getting a good balance of the foods needed to grow up healthy.

So relax, Mom and Dad. Pay attention to what your kids eat, and offer them a healthy variety--but don’t be obsessed by it.