Barbara A. Dennison

Dietary Recommendations for Children and Adolescents: A Guide for Practitioners

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of childrens cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents A Scientific Statement From the American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee, Council of Cardiovascular Disease in the Young, With the Council on Cardiovascular Nursing

Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy.

Dietary Recommendations for Children and Adolescents A Guide for Practitioners: Consensus Statement From the American Heart Association

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of childrens cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Fruit juice intake predicts increased adiposity gain in children from low-income families : Weight status-by-environment interaction

OBJECTIVE. Our goal was to test the hypothesis that increased fruit juice intake and parental restriction of childrens eating are associated with increased adiposity gain and whether exposure to nutritional counseling predicted reduced adiposity gain among children. PATIENTS AND METHODS. A sample of parents or guardians of children aged 1 to 4 years who attended 1 of 49 Special Supplemental Nutrition Program for Women, Infants, and Children agencies in New York State were surveyed in 1999 or 2000 (N = 2801). The survey addressed childrens dietary intake, parental feeding practices, and parental exposure to nutritional counseling messages to increase fruit, vegetable, and low-fat milk intakes. Each childs height and weight were measured approximately every 6 months for up to 48 months. A prospective cohort design was used in which survey variables were the predictors and the outcome was change in childrens adiposity, defined as change in age- and gender-standardized BMI per month (ie, BMI z-score slope). RESULTS. Controlling for gender and ethnicity, the relationship between juice intake and adiposity gain depended on childrens initial overweight status. Among children who were initially either at risk for overweight or overweight, increased fruit juice intake was associated with excess adiposity gain, whereas parental offerings of whole fruits were associated with reduced adiposity gain. Each additional daily serving of fruit juice was associated with an excess adiposity gain of 0.009 SD per month. Feeding restriction was greater among parents whose children were initially at risk for overweight or overweight compared with those at a healthy weight. Parental exposure to nutritional messages was not associated with reduced child adiposity gain. CONCLUSION. This study supports the Institute of Medicine recommendations to reduce fruit juice intake as a strategy for overweight prevention in high-risk children.

Rapid Infant Weight Gain Predicts Childhood Overweight

Objective: To determine among a contemporary cohort whether rapid weight gain between birth and 6 months is associated with risk of childhood overweight and if this risk differs by ethnicity and/or breast‐feeding history.

Cardiovascular Health Promotion in the Schools A Statement for Health and Education Professionals and Child Health Advocates From the Committee on Atherosclerosis, Hypertension, and Obesity in Youth (AHOY) of the Council on Cardiovascular Disease in the Young, American Heart Association

Cardiovascular disease (CVD) is a major cause of morbidity and premature mortality in men and women in the United States, most of the industrialized world, and many developing countries.1 Primary prevention of CVD beginning in early childhood is supported by extensive evidence culled from epidemiological, clinical, and laboratory studies.2–16 Taken together, these data provided the impetus for the American Heart Association (AHA) Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood17 and support the need for population-based approaches to cardiovascular health promotion and risk reduction. Specifically, the population-based approach, which is aimed at modifying the food and physical activity environments of children, is an important concomitant to the high-risk approach because without the proper environment, the high-risk strategy cannot be optimally implemented. School health programs initiated in preschool and extending through high school have the potential to influence the cardiovascular health of the majority of US children and youth. Toward this goal, this statement is intended for health and education professionals, child health advocates, policymakers, and community leaders who are interested in optimizing the school environment as an integral part of population-based strategies designed to promote cardiovascular health for all US children and youth and reduce the risk and public health burden of CVD. Several lines of evidence underscore the importance of primary prevention of CVD beginning in childhood and the need for population-based approaches to cardiovascular health promotion and risk reduction. Autopsy studies (after the unexpected deaths of children and youth)2–5 document significant positive associations between established risk factors and the presence and extent of atherosclerotic lesions in the aorta and coronary arteries of children and youth. Specifically, data from the Bogalusa Heart Study3,4 and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY)2,5 study link potentially modifiable risk factors, including atherogenic …

A Meta-analysis of Interventions That Target Children's Screen Time for Reduction

BACKGROUND: Screen time, especially television viewing, is associated with risk of overweight and obesity in children. Although several interventions have been developed to reduce childrens screen time, no systematic review of these interventions exists to date. OBJECTIVE: This is a systematic review and meta-analysis of interventions targeting a reduction in childrens screen time. METHODS: Effect sizes and associated 95% confidence intervals (CIs) were calculated by using a random-effects model. Heterogeneity tests, moderator analyses, assessment of bias, and sensitivity analyses were conducted. Reliability was assessed with Cohens κ. RESULTS: The systematic search identified 3002 documents; 33 were eligible for inclusion, and 29 were included in analyses. Most reported preintervention and postintervention data and were published in peer-reviewed journals. Although heterogeneity was present, no moderators were identified. Overall Hedges g (−0.144 [95% CI: −0.217 to −0.072]) and standard mean difference (SMD) (−0.148 [95% CI: −0.224 to −0.071]) indicated that interventions were linked with small but statistically significant reductions in screen time in children. The results were robust; the failsafe N was large, and the funnel plot and trim-and-fill methods identified few missing studies. CONCLUSIONS: Results show that interventions to reduce childrens screen time have a small but statistically significant effect. As the evidence base expands, and the number of screen-time interventions increases, future research can expand on these findings by examining the clinical relevance and sustainability of effects, conducting a more thorough analysis of effect modifiers, and identifying critical components of effective interventions.

Dietary sources of fats and cholesterol in US children aged 2 through 5 years.

OBJECTIVES This study of lipid intakes among preschool children (1) analyzed the contributions of 38 food groups to fat, saturated fat, and cholesterol intakes; (2) estimated the effects of food substitutions on intakes; and (3) examined demographic differences in food group intake and food group sources of these lipids. METHODS The sample consisted of 547 children, aged 2 to 5 years, from the US Department of Agricultures 1985 and 1986 Continuing Surveys of Food Intakes by Individuals. Dietary information for 4 nonconsecutive days throughout a year was used. All foods were classified into groups and the lipids contributed from each group were computed. RESULTS Over 80% of the children consumed more total fat, saturated fats, and cholesterol than is recommended. The major source of total fat and saturated fats was whole milk; the major sources of dietary cholesterol were eggs and whole milk. Childrens food consumption patterns differed by region of the country and race/ethnicity, providing opportunities to refine nutrition education interventions and evaluations. CONCLUSIONS By substituting lower-fat foods for the major sources of saturated fats, significant reductions in preschool childrens intakes of saturated fats, fat, and dietary cholesterol could be achieved.

Dietary Recommendations for Children and Adolescents

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of childrens cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

The role of childcare providers in the prevention of childhood overweight

Childhood overweight has received increased national attention as a social and health problem. Childcare providers play an increasingly prominent role in the lives of young children and are therefore important in initiating change. This qualitative study determined the role of childcare professionals in the prevention of childhood overweight. Facilitated focus group sessions were conducted with childcare professionals to ascertain their beliefs and practices in four domains: 1) foods and beverages; 2) physical activity; 3) TV, video, and computer game viewing; and 4) behaviors with respect to eating and/or activity. The researchers and childcare staff then collaboratively identified ways to develop innovative policy and environmental changes to improve the health and fitness of young children. Though more research is needed, engaging the support of the childcare profession is a promising avenue to improve the health and fitness of young children.