Predictors of dietary milk fat intake by preschool children.

BACKGROUND: High-fat whole milk is the major dietary source of total and saturated fat for young children. Children from low-income families have higher total and saturated fat intakes and their parents have higher rates of cardiovascular disease compared with children from higher income families. We identified factors that predict the use of either high-fat whole milk or low-fat (1% and/or skim) milk by children to facilitate the development of targeted intervention strategies to reduce their dietary fat intakes. METHODS: Adults (91% mothers) with children > or =1 through <5 years of age, participating in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) at 50 agencies throughout New York State, completed questionnaires. RESULTS: Most (75%) of the 1,938 children drank whole milk, while only 6.9% consumed exclusively 1% and/or skim milk. The children tended to drink the same type of milk as other family members. In multivariate logistic regression, use of whole milk was associated with younger child age, black race or Hispanic ethnicity, parent/guardian belief that whole milk was healthier for children over 2, and parent/guardian having never tried reduced-fat milks (all P < 0.0001). In contrast, use of 1% and/or skim milk was associated with older child age, female gender, nonblack race, older parent/guardian age, parent/guardian belief that reduced-fat milks were healthier for children over 2, and parent/guardian having tried 1%-fat milk (all P < 0.01). CONCLUSIONS: Individualized family-based strategies are needed to target specific behaviors and/or health beliefs held by different parent groups. For example, taste testing might be an effective strategy for parents who have never tasted reduced-fat milk. Interventions to overcome cultural barriers to the use of low-fat milk may require changing parental health beliefs, in addition to providing education about the health benefits of low-fat milk.

Development and validation of an instrument to assess child dietary fat intake.

BACKGROUND: brief dietary assessment instrument to assess dietary intakes of total fat, saturated fatty acids (SFA), and cholesterol in young children was developed and validated. METHODS: Young children and their parent or primary caretaker were recruited from a general primary care health center and local Head Start programs. Dietary records, entered and analyzed using the Minnesota Nutrition Data System, were used to calculate children's mean dietary intakes. Stepwise linear regression analysis was used to select questionnaire items that best predicted total fat, SFA, and dietary cholesterol intakes. RESULTS: This yielded a 17-item Child Dietary Fat Questionnaire (CDFQ); 9 questions correlated with total fat intake (r = 0.68, P < 0.0001); 15 questions correlated with SFA intake (r = 0.75, P < 0.0001); and 4 questions correlated with dietary cholesterol intake (r = 0.57, P < 0.0001). The test-retest reliabilities of the CDFQ in predicting children's dietary intakes of total fat, SFA, and cholesterol were 0.41, 0.66, and 0.64, respectively. The criterion-based validity of the CDFQ, evaluated against 4 days of dietary records, yielded correlations of 0.54 (P < 0.0001) for total fat, 0.36 (P < 0.01) for SFA, and 0.55 (P < 0. 0001) for dietary cholesterol intake. CONCLUSIONS: The 17-item CDFQ is a brief, easy-to-use dietary assessment instrument that could be used to identify children with high, as well as low, dietary intakes of total fat, SFA, and/or cholesterol.

Children's growth parameters vary by type of fruit juice consumed.

BACKGROUND: Excessive fruit juice consumption in young children has been associated with nonorganic failure to thrive and short stature in some children and with obesity in others. OBJECTIVE: To evaluate, in a sample of healthy young children, whether the associations between fruit juice intakes and growth parameters differ by the type of fruit juice consumed. DESIGN: Cross-sectional study. SETTING: General primary care health center in upstate New York. PARTICIPANTS: One hundred sixteen two-year-old children and one hundred seven five-year-old children, who were scheduled for a nonacute visit, and their primary care-takers or parents were recruited over a two-year period. METHODS: For 163 children (73% of total), 14 days of dietary records were available. The dietary records were entered and analyzed using the Nutrition Data System (NDS). Type of fruit juice was classified according to Nutrition Coordinating Center food codes. Height was measured using a Harpenden Stadiometer. Weight was measured using a standard balance beam scale. RESULTS: The children consumed, on average, 5.5 fluid oz/day of fruit juices, which were classified by the NDS software as 35% apple juice, 31% orange juice, 25% grape juice and 9% other types and/or mixtures of fruit juice. Children with higher fruit juice intakes had lower total fat, saturated fat and cholesterol intakes. Child height was inversely related to apple juice intake (p=0.007) and grape juice intake (p=0.02), after adjustment for child age, gender and energy intake (excluding fruit juice) and maternal height. Apple juice intake was correlated with child body mass index (p<0.05) and ponderal index (p<0.005), after adjustment for the above covariates. Total cholesterol, LDL-cholesterol, triglyceride and lipoprotein(a) levels were not related to intakes of any of the fruit juices examined. The children's ratios of total cholesterol to HDL cholesterol were correlated with grape juice intakes, while HDL-cholesterol levels were inversely related to grape juice intakes. There were no significant relationships between fruit juice intake and measures of anemia (hematocrit or mean corpuscular volume). CONCLUSIONS: The previously reported associations between short stature and high intakes of fruit juice were observed for intakes of both apple juice and grape juice. The associations between high fruit juice intakes and obesity were observed with apple juice intakes only. Because most of the fruit juice mixtures were classified as single fruit juices, the findings, especially those with grape juice, need to be cautiously interpreted. High intakes of fruit juice, however, appear to be associated with growth extremes in young children. Thus, it would seem prudent for parents and caretakers to moderate the fruit juice intakes of their young children.

Fruit and vegetable intake in young children.

BACKGROUND: Current recommendations call for most Americans, 2 years of age and over, to ent more fruits and vegetables. OBJECTIVE: To determine, in a sample of healthy children, the extent to which young children's diets include the recommended numbers of fruit and vegetable servings per day. DESIGN: Cross-sectional study. SETTING: A general primary care health center in upstate New York. PARTICIPANTS: One-hundred-sixteen 2-year-old children and 107 5-year-old children, who were scheduled for a non-acute visit, and their parent/primary caretaker (PPC) were recruited between 1992 and 1993. MEASUREMENTS: For 168 children (94 2-year-old children and 74 5-year-old children), mean dietary intakes were calculated from 7 days of written dietary records, entered and analyzed using the Minnesota Nutrition Data System. The numbers of fruit and vegetable servings/day were calculated according to USDA definitions of serving sizes. RESULTS: The 2-year-old children consumed the same amounts of fruits, 100% fruit juice, and total fruits and vegetables as the 5-year-old children (0.8 and 0.7 fruit servings/day, 1.0 and 0.8 juice servings/day, and 2.2 and 2.1 total fruit and vegetable servings/day, respectively). Fruit juice accounted for 54% of all fruit servings consumed and 42% of all fruit and vegetable servings consumed. Total fruit consumption (fruits plus juice) was correlated with carbohydrate intake (R = 0.46), and inversely correlated with total fat and saturated fat intakes (R = -0.48 and R = -0.36, respectively, both p < 0.0001) and with cholesterol intake (R = -0.21, p < 0.01). Citrus fruit and juice consumption was strongly correlated with vitamin C intake (R = 0.56, p < 0.0001). Total vegetable consumption was strongly correlated with beta-carotene and vitamin A intakes (R = 0.63 and R = 0.32, respectively, both p < 0.0001). Total fruit and vegetable consumption correlated with intakes of beta-carotene, vitamin A, vitamin C, fiber, and potassium (R = 0.55, R = 0.31, R = 0.56, R = 0.58, and R = 0.66, respectively, all p < 0.0001). Forty percent of 2-year-old children and 50% of 5-year-old children consumed < 2 servings/day of fruits and vegetables. Ninety-five percent of children consuming > or = 2 servings/day of fruits and vegetables met the RDA for vitamin C vs. 50% of those consuming < 2 servings/day (p < 0.001). CONCLUSIONS: In this study, preschool-aged children consumed, on average, about 80% of the recommended fruit servings/day, but only 25% of the recommended vegetable servings/day. Low intakes of fruits and vegetables were associated with inadequate intakes of vitamin A, vitamin C, and dietary fiber, in addition to high intakes of total fat and saturated fat.

Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity.

BACKGROUND: In a referral population of young children, excessive fruit juice consumption has been reported to be a contributing factor in nonorganic failure to thrive. OBJECTIVE: To evaluate, in a population-based sample of healthy children, fruit juice consumption and its effects on growth parameters during early childhood. DESIGN: Cross-sectional study. SETTING: General primary care health center in upstate New York. PARTICIPANTS: One hundred sixteen 2-year-old children and one hundred seven 5-year-old children, who were scheduled for a nonacute visit, and their primary care taker/parent were recruited over a 2-year period. MEASUREMENTS: For 168 children (ninety-four 2-year-old children and seventy-four 5-year-old children), mean dietary intake was calculated from 7 days of written dietary records, entered, and analyzed using the Minnesota Nutrition Data System. Height was measured using a Harpenden Stadiometer. Weight was measured using a standard balance beam scale. RESULTS: The 2-year-old and 5-year-old children consumed, on average, 5.9 and 5.0 fl oz/day of fruit juice and 9.8 and 11.0 fl oz/day of milk, respectively. Nineteen children (11%) consumed > or = 12 fl oz/day of juice. Forty-two percent of children consuming > or = 12 fl oz/day of juice had short stature (height less than 20th sex-specific percentile for age) vs 14% of children drinking less than 12 fl oz/day of juice. Obesity was more common among children drinking > or = 12 fl oz/day of juice compared with those drinking less juice: 53% vs 32% had a body mass index > or = 75th age- and sex-specific percentile; 32% vs 9% had a body mass index > or = 90th age- and sex-specific percentile; and 32% vs 5% had a ponderal index > or = 90th age-specific percentile. After adjustment for maternal height, child age, child sex, and child age-sex interaction, children consuming > or = 12 fl oz/day of juice, compared with those drinking less than 12 fl oz/day of juice, were shorter (86.5 vs 89.3 cm and 106.5 vs 111.2 cm for the 2-year-old and 5-year-old children, respectively) and more overweight (body mass index = 17.2 vs 16.3 kg/m2 and ponderal index = 18.4 vs 16.8 kg/m3). CONCLUSIONS: Consumption of > or = 12 fl oz/day of fruit juice by young children was associated with short stature and with obesity. Parents and care takers should limit young children's consumption of fruit juice to less than 12 fl oz/day.

Fruit juice consumption by infants and children: a review.

The pattern of fruit juice consumption has changed over time. Fifty years ago, orange juice was the major juice produced and it was consumed primarily to prevent scurvy. Now, apple juice is the juice of choice for the under 5 age group. While fruit juice is a healthy, low-fat, nutritious beverage, there have been some health concerns regarding juice consumption. Nursing bottle caries have long been recognized as a consequence of feeding juice in bottles, using the bottle as a pacifier, and prolonged bottle feeding. Non-specific chronic diarrhea or "toddler's" diarrhea has been associated with juice consumption, especially juices high in sorbitol and those with a high fructose to glucose ratio. This relates to carbohydrate malabsorption, which varies by the type, concentration, and mixture of sugars present in different fruit juices. Fruit juice consumption by preschoolers has recently increased from 3.2 to about 5.5 fl oz/day. Consumption of fruit juice helps fulfill the recommendation to eat more fruits and vegetables, with fruit juice accounting for 50% of all fruit servings consumed by children, aged 2 through 18 years, and 1/3 of all fruits and vegetables consumed by preschoolers. Concomitant with the increase in fruit juice consumption has been a decline in milk intake. This is concerning as milk is the major source of calcium in the diet, and at present, only 50% of children, aged 1 through 5 years, meet the RDA for calcium. Studies of newborn infants and preschool-aged children have demonstrated a preference for sweet-tasting foods and beverages. Thus, it is not surprising that some children, if given the opportunity, might consume more fruit juice than is considered optimal. Eleven percent of healthy preschoolers consumed > or = 12 fl oz/day of fruit juice, which is considered excessive. Excess fruit juice consumption has been reported as a contributing factor in some children with nonorganic failure to thrive and in some children with decreased stature. In other children, excessive fruit juice consumption has been associated with an increased caloric intake and obesity. This paper reviews the role of fruit juice in the diets of infants and children and outlines areas for future research. Recommendations regarding fruit juice consumption based on current data are also given.

Challenges to implementing the current pediatric cholesterol screening guidelines into practice.

OBJECTIVE: The Expert Panel on Blood Cholesterol Levels in Children and Adolescents of the National Cholesterol Education Program (NCEP) recommends selective screening of children for high blood cholesterol. We determined the number of children, who, according to the guidelines, should be targeted for cholesterol screening. DESIGN: Population survey. SETTING: Permanent household residents in Otsego County, NY. PARTICIPANTS: Total population-based sample of 17,444 households (86.6% response rate) including 44,565 participants, of whom 10,457 were children, aged 2 through 19 years. MAIN OUTCOME MEASURES: Percent of children qualifying for cholesterol screening under the NCEP Children's Panel guidelines. RESULTS: Children from two-parent families were more likely to have known family history of coronary heart disease (CHD) before 60 years of age (41.8% vs 25.8%, P < .001), and twice as likely as children from single-parent families to have known parental hypercholesterolemia (18.8% vs 9.5%, P < .001). Only 39% of parents reported having had their cholesterol level checked; they were better educated and more likely to have health insurance. Parents with a first-degree relative with CHD before 60 years of age were more likely to report having their cholesterol level checked and to report a high cholesterol level. We calculated that 27% of children (18% of children from single-parent households and 29% of children from two-parent households) would report a known family history of premature CHD (ie, CHD before 55 years of age) and qualify for lipoprotein analysis, and that 11% of children would qualify for total cholesterol screening because of known parental hypercholesterolemia without a family history of premature CHD. Thirty-five percent of children had incomplete or unavailable family health history and/or unknown parental cholesterol status. CONCLUSIONS: In this population, 38% of children would be targeted for cholesterol screening, exceeding the estimate of the NCEP Children and Adolescents Panel. The selection process, however, would tend to miss children from single-parent families, children with incomplete family health history, and children whose parents have not had their cholesterol levels measured. The currently recommended pediatric cholesterol screening policy needs to be evaluated further in additional communities and population settings. Alternative cholesterol screening strategies are needed when family health history is incomplete and/or parental cholesterol status is unknown.

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 Agriculture's 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. Children's 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 children's intakes of saturated fats, fat, and dietary cholesterol could be achieved.

Randomized, double-blind, placebo-controlled, two-period crossover clinical trial of psyllium fiber in children with hypercholesterolemia.

A randomized, double-blind, placebo-controlled, crossover clinical trial was designed to test the efficacy of psyllium fiber in lowering elevated low-density lipoprotein cholesterol (LDL-C) levels in children 5 to 17 years of age. Subjects with LDL-C levels > 2.84 mmol/L (110 mg/dl) after at least 3 months of a low total fat, low saturated fat, low cholesterol diet were enrolled. Two ready-to-eat cereals, with water-soluble psyllium fiber (6 gm/day) and without, were prescribed for 4 to 5 weeks each, with an intervening 2-week washout phase. Reported compliance rates exceeded 80% in the 20 subjects who completed the study. Mean initial total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglyceride values were 5.23, 3.60, 1.18, and 2.22 mmol/L, respectively. Comparison of the mean changes (from baseline) in lipid values after the two periods of cereal consumption revealed no statistically nor clinically significant differences in total cholesterol, LDL-C, or high-density lipoprotein cholesterol values. Triglyceride levels, however, increased 0.68 mmol/L (26 mg/dl; p < 0.05) after the control cereal in comparison with the psyllium cereal. No significant differences were noted in the children's dietary intake (assessed by 7-day diet records) during the two study periods. Measures of growth (height, weight, and skin-fold thicknesses), and blood vitamin (folic acid; vitamins A, D, and E) and mineral (iron, zinc, and calcium) levels were not affected. In this study, psyllium fiber had no additional lowering effect on total cholesterol or LDL-C levels in children who were already following low total fat, low saturated fat, low cholesterol diets.

Measurement of apolipoprotein B as a screening test for identifying children with elevated levels of low-density lipoprotein cholesterol.

We compared the efficacy of two screening tests, measurement of apolipoprotein B (apo B) levels and measurement of serum total cholesterol levels, in detecting elevated low-density lipoprotein cholesterol (LDL-C) values in children. We studied 2850 children, aged 5 to 17 years, who had fasting lipid, lipoprotein, and apolipoprotein levels measured as part of the Bogalusa Heart Study. The test characteristics of apo B were superior to those of serum total cholesterol in screening children to detect elevated levels of LDL-C (greater than or equal to 95th percentile) and moderately elevated LDL-C levels (greater than or equal to 80th percentile). Unusually high or low values of high-density lipoprotein cholesterol are responsible for most of the misclassification that occurs when measurement of total cholesterol is used as a screening test for identifying children with elevated levels of LDL-C. This confounding effect of high-density lipoprotein cholesterol was eliminated when measurement of apo B levels was used as a screening test. Because the apo B test is more specific at a given sensitivity than the total cholesterol test, the apo B test can cost more and still be less expensive as a screening strategy. As the methods for determining apolipoprotein levels become standardized and readily available, the measurement of apolipoproteins could be developed into superior screening tests for the identification of patients with dyslipidemias.

Serum total cholesterol screening for the detection of elevated low-density lipoprotein in children and adolescents: the Bogalusa Heart Study.

The use of serum total cholesterol measurement was evaluated as a screening tool to predict elevated levels of low-density lipoprotein cholesterol in 2857 children and adolescents, aged 5 to 17 years, examined in 1981 and 1982. Subjects were from the biracial community of Bogalusa, Louisiana. For selected serum total cholesterol values (150 to 210 mg/dL, 3.88 to 5.43 mmol/L), sensitivities were higher for blacks than whites and higher for females than males, whereas the positive predictive values were higher for whites than blacks and higher for males than females. With the age-, race-, and sex-specific 95th percentiles of serum total cholesterol levels as cutoff points, only 44% to 50% of subjects with elevated low-density lipoprotein cholesterol levels (greater than or equal to 95th percentile) were detected, and approximately 50% of those identified had false-positive results. Lowering the serum total cholesterol cutoff point increased the sensitivity, but decreased the specificity and positive predictive value. At the 75th percentiles of serum total cholesterol levels, sensitivities were 92% to 95% for females and 100% for males and specificities were 78% to 79%, but the false-positive results increased to 81% to 84%. The low cost and ease of obtaining serum total cholesterol measurements contribute to its appeal as a screening tool for hyperlipidemia. However, its poor test characteristics make serum total cholesterol measurement inefficient as a screening tool for detecting elevated levels of low-density lipoprotein cholesterol in children and adolescents.

Parental history of cardiovascular disease as an indication for screening for lipoprotein abnormalities in children.

We studied the relationship between parental history of cardiovascular disease and risk for adverse lipid and lipoprotein levels in a total community study of 3313 children (ages 4 to 17 years, 63% white, 37% black). Older white children (11 to 17 years) with a parental history of heart attack or diabetes were 4.3 and 5.6 times, respectively, more likely to have high levels (greater than or equal to 95th percentile) of serum total cholesterol than those without such a history (all p less than 0.05). White children with a parental history of heart attack or diabetes were twice as likely to have an elevated (greater than or equal to 95th percentile) low-density lipoprotein cholesterol (LDL-C) level than those without such a history (both p less than 0.05). In contrast, parental history of cardiovascular disease did not predict elevated levels of total cholesterol or LDL-C in black children. However, older black children with a parental history of heart attack, hypertension, or diabetes were 4 1/2 to 5 times more likely to have low levels (less than or equal to 5th percentile) of high-density lipoprotein cholesterol than those without such a history (all p less than 0.05). Only 40% of white children and 21% of black children with elevated LDL-C levels had a parental history of vascular disease. These findings raise questions about the current practice of screening only children with a family history of cardiovascular disease to identify those with elevated total cholesterol and LDL-C levels.

Childhood physical fitness tests: predictor of adult physical activity levels?

Regular physical activity has both short- and long-term health benefits in adults. No study has investigated childhood determinants of adult physical activity patterns, however. In a nonconcurrent prospective study, the physical activity levels of 453 young men, 23 to 25 years of age, were compared with their physical fitness test scores as children (10 to 11 years of age and 15 to 18 years of age). The physically active adults had significantly better childhood physical fitness test scores than did the inactive adults. In 224 children, 2 years of fitness test results were available. The risk of physical inactivity in young adulthood was linearly related to the number of low scores on the 548.6-m (600-yd) run and sit-ups tests as children (P less than .001). In stepwise multivariate discriminant analysis, the childhood 548.6-m run score was the best discriminator between currently physically active and inactive adults. Reported parental encouragement of exercise, level of education, participation in organized sports after high school, and reported spousal encouragement of exercise also contributed significantly to the discriminant function. These results demonstrate that physical fitness testing in boys facilitates the identification of those at increased risk of becoming physically inactive young adults.

Radiogenic changes in the behavior and physiology of the spontaneously hypertensive rat: evidence for a dissociation between acute hypotension and incapacitation.

Immediately following exposure to a sufficiently large dose of ionizing radiation, rats and several other species experience a transient period of acute hypotension and an accompanying deficit in performance. Although significant correlations have been reported between the drop in blood pressure and the early transient incapacitation (ETI) and a causal relationship has been suggested, the extent to which hypotension precipitates the occurrence of the behavioral deficits remains uncertain. The present experiments investigated both radiogenic blood pressure and performance changes in a strain of rat bred for hypertension (spontaneously hypertensive rat: SHR) in order to determine if high blood pressure might attenuate ETI. Although male SHRs experienced a severe ETI and a drop in blood pressure, much of the data is inconsistent with the hypothesis that hypotension causes performance decrements. In an additional series of studies, blood volume and serum chemistry data were analyzed. Male SHRs were significantly higher than normotensive controls on several blood chemistry determinations. Exposure to ionizing radiation, more often than not, enhanced these differences. These results could not be explained on the basis of radiogenic blood volume fluctuations.

Biotin-binding protein from chicken egg yolk. Assay and relationship to egg-white avidin.

1. Biotin in chicken egg yolk is non-covalently bound to a specific protein that comprises 0.03% of the total yolk protein (0.8 mg/yolk). This biotin-binding protein is not detectable by the normal avidin assay owing to the biotin being tightly bound. Exchange of [14C]biotin for bound biotin at 65 degrees C is the basis of an assay for this protein. 2. Biotin-binding protein from egg yolk is distinguishable from egg-white avidin on Sephadex G-100 gel filtration, although the sizes of the two proteins appear quite similar. 3. Biotin-binding protein is denatured at a lower temperature and freely exchanges biotin at lower temperatures than does avidin. 4. The biotin-binding protein in egg yolk is postulated to be responsible for the deposition of biotin in egg yolk. D-[carboxyl-14C]Biotin injected into laying hens rapidly appears in the egg bound to yolk biotin-binding protein and avidin. Over 60% of the radioactivity is eventually deposited in eggs. The kinetics of biotin deposition in the egg suggests a 25 day half-life for an intracellular biotinyl-coenzyme pool in the laying hen.