A Heart-Healthy Diet for Kids

BY MARY ANN LITTELL

Next time your child asks, "What's for dinner?" you might want to forget about cheeseburgers, hot dogs, milk and cookies. Instead, try serving up veggieburgers, brown rice, soy milk, tofu and maybe a little tempeh on the side.

That's the recommendation from no less a child-rearing expert than Dr. Benjamin Spock. In the latest edition of his best-selling book, "Your Baby and Child," Spock advocates a vegan, or all-plant, diet for children over the age of 2 as a way of reducing dietary fat and cholesterol.

Spock, who died earlier this year at 94, was a recent - and enthusiastic - convert to vegetarianism. He and other supporters of a vegan diet for children see it as the best way to avoid the risk of heart disease later in life.

"We know high cholesterol is a serious health problem in adults," says Norman L. Lasser, MD, PhD, director of the Preventive Cardiology Program at UMDNJ-New Jersey Medical School. "Unfortunately, there is much less awareness about the dangers of high cholesterol levels in children."

Approximately 40 million children in the US have high cholesterol, and more than half of them will maintain elevated cholesterol levels into adulthood. Many studies indicate that the process of atherosclerosis begins in childhood and is related to high levels of blood cholesterol. Atherosclerosis, the deposit of plaques containing cholesterol and lipids on the interior walls of arteries, is a primary cause of coronary heart disease.

According to Lasser, if a child's blood cholesterol level is above 170, new dietary approaches should be considered. Is a vegan diet the way to go? Not necessarily. "A vegan diet is very restrictive and extreme. Even adults have a hard time following it," says Lasser. "There are easier ways to help reduce a child's cholesterol."

In 1987, Lasser and his wife, Vera I. Lasser, MA, RD, director of nutrition for the Preventive Cardiology Program, began their participation in a 10-year national multicenter study of 600 children ages 7 to 10 with high cholesterol. The purpose of the study, which was funded by the National Heart, Lung, and Blood Institute, of the NIH, was to evaluate the effect of a low-fat diet on cholesterol levels. More than 44,000 children across the country were prescreened. The children with high cholesterol (175 or more) who were selected for the study were divided into two groups - intervention and usual care - and followed for eight years.

Prior to the study, there were questions about whether cholesterol lowering (lower fat) diets were safe for children. Some of the concerns included possible deficits in growth and insufficient intake of certain nutrients, particularly iron, since intake of animal foods would be reduced.

"The study was designed to address these concerns," says Vera Lasser, "particularly during puberty, when rapid growth occurs."

Children in the intervention group and their parents/guardians attended frequent meetings, where they received intensive dietary counseling. They were taught which foods to eat and which to cut back. Healthy dinners and snacks were served and recipes distributed. The research team created a dictionary of foods, rating them for fat and cholesterol content, and gave a copy to each family.

Parents/guardians of children in the usual care group were told that their child's cholesterol was high. They did not participate in dietary counseling sessions. Both study groups received educational pamphlets on healthy eating habits.

The goal for the intervention group was to reduce total calories from fat to 28 percent, with less than 8 percent of total calories from saturated fat, and to reduce dietary cholesterol intake to less than 150 mg a day. Written records were kept of everything the participants ate.

The results of the study, published in JAMA (May 10, 1995), were somewhat surprising. After three years, dietary fat, saturated fat, and cholesterol levels decreased in both the intervention group and the usual care group, with greater decreases occurring in the intervention group. However, the difference in reduction between the two groups, while statistically significant, was somewhat smaller than anticipated.

The researchers believe that changing hormone levels are responsible for the drop in blood cholesterol levels for both groups. "During puberty, when hormones are active, diet seems to play a less important role in reducing blood cholesterol," says Norman Lasser. "Cholesterol levels then rise again at the end of the teen years, as hormones decrease."

The screening process itself also may have increased awareness about the hazards of high cholesterol in children. "Once we raised the issue of high cholesterol, many parents became concerned and asked questions," Lasser says. "It may have caused some people in the usual care group to modify their children's diets."

The study provides evidence that dietary intervention is effective in achieving modest lowering of cholesterol levels while maintaining adequate growth and iron stores. Children who require dietary modification to lower cholesterol levels can safely and successfully do so under proper supervision. A well-planned nutrition education program can have a positive impact on children's eating habits, promoting healthy food choices.

The Lassers believe that children should be screened for high cholesterol after the age of 6 if there is a history of heart disease or high cholesterol in the family. While it's not necessary to "go vegan," they also advise all parents to teach children healthy eating habits. Eating a variety of foods that are high in fiber and low in fat and cholesterol will help maintain good health.

"With a few modifications-skim instead of whole milk, grilled chicken instead of hamburgers, and low-fat snacks, chips, and desserts, you can eliminate quite a bit of fat from your diet," says Vera Lasser.

Tempeh, anyone?