Nutrition Standards for Foods in Schools Leading the Way Toward Healthier Youth (2007) / Chapter Skim
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2 Nutrition-Related Health Concerns, Dietary Intakes, and Eating Behaviors of Children and Adolescents
2 Nutrition-Related Health Concerns, Dietary Intakes, and Eating Behaviors of Children and Adolescents
Pages 29-72
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From page 29... ...
. This chapter provides an overview on nutrition-related health concerns, current dietary and nutrient intakes, and dietary trends over the past 20–40 years for children and adolescents.
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Obesity in children and adolescents is associated with a number of immediate health risks, such as high blood pressure, type 2 diabetes (T2D) , metabolic syndrome, sleep disturbances, orthopedic problems, and psychosocial problems (Daniels, 2006; IOM, 2005b)
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Children represent the nation's present and its future. OVERVIEW OF CHILDREN'S NUTRITION RELATED HEALTH CONCERNS The rising rate of obesity in children has become a major health concern, both because of its impact on childhood health and its potential effect on the development of chronic disease in adulthood.
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The rates of obesity in African American children were 18 percent for boys and 26 percent for girls, and among Mexican-American children, the rates were 22 percent for boys and 17 percent for girls. Other research has shown similar or higher rates of obesity (Sorof et al., 2004)
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In a population-based sample, approximately 60 percent of obese children aged 5 to 10 years had at least one physiological CVD risk factor, such as elevated total cholesterol, triglycerides, insulin, or blood pressure, and 25 percent had two or more CVD risk factors (Freedman et al., 1999)
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. Metabolic Syndrome Metabolic syndrome is a constellation of clinical findings, including abdominal obesity, high blood pressure, dyslipidemia, and high glucose levels, that confers increased risk for CVD and T2D.
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. Another study found that the prevalence of metabolic syndrome increased with the severity of obesity and reached 50 percent in severely obese children and adolescents (Weiss et al., 2004)
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. Maintaining adequate calcium intake during childhood and adolescence is critical to achieving peak bone mass (Greer and Krebs, 2006)
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found that, among all children aged 2 to 11 years, 41 percent had dental caries in primary teeth. There are disparities evident with children in lower-income households and African American, Hispanic, and American Indian children having a higher prevalence of dental problems (DHHS, 2000, 2004b)
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. Tooth erosion is increasing in industrialized countries and is thought to be related to increased consumption of acidic beverages (e.g., soft drinks, sports drinks, and fruit juices)
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The guidelines stress meeting recommended dietary intakes within energy needs; consuming a variety of nutrient-dense foods and beverages; and limiting intakes of total, saturated, and trans fat, cholesterol, salt, and added sugars. The guidelines, as they pertain to children and adolescents, are consistent with other dietary recommendations for children and adolescents put forth by the American Heart Association (Gidding et al., 2005)
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The consumption of added sugars, saturated fats, and trans fats provides calories but few essential nutrients (DHHS/USDA, 2005)
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These points reinforce the need for nutrition standards to go beyond the criteria of upper limits (for fat, saturated fat, etc.) and qualifying levels (for vitamins and minerals)
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The committee also found that in general, Americans consume too many calories and too much saturated and trans fat, cholesterol, added sugars, and salt (DHHS/USDA, 2004)
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. In the CSFII data for the same period, substantial increases were reported in the mean energy intakes of children and adolescents from the mid-1970s to the mid-1990s.
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. Increased sodium intake is associated with elevated blood pressure, which in turn is a risk factor for cardiovascular and renal diseases.
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In considering nonnutritive sweeteners in competitive foods and beverages for school-age children, four related topics were evaluated: safety of nonnutritive sweeteners for children; effect of intake of foods and beverages containing nonnutritive sweeteners on intake of other foods and beverages to be encouraged (fruits, vegetables, whole grains, and nonfat or low-fat dairy products) ; efficacy of intake of foods and beverages containing nonnutritive sweeteners in contributing to maintenance of a healthy weight in children; and choice (see Chapter 3 for discussion)
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TABLE 2-1 Comparison of Nonnutritive Sweeteners Nonnutritive Approval Labeling Sweetener Characteristics Status Requirements Aspartame 200× sweeter than sugar; contains Approved Must state that the phenylalanine, a potential harm for product contains individuals with phenylketonuria phenylalanine Acesulfame-K 130× sweeter than sugar; cannot Approved None be metabolized so contributes no calories Saccharin 300× sweeter than sugar; safety Approved Must state that use of concerns about carcinogenicity in the product may be rodent models hazardous to health Cyclamate Safety concerns about potential Banned None carcinogenicity
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From page 47... ...
from foods and beverages. They found that assessing the carcinogenic potential of a single sweetener from dietary exposure was not feasible, but that the overall carcinogenic risk from nonnutritive sweeteners was negligible.
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did not review evidence about nonnutritive-sweetened foods and beverages in the diets of Americans. Efficacy of nonnutritive sweeteners Evidence that using nonnutritivesweetened beverages is effective in promoting weight loss in controlled settings compared with nonnutritive-sweetened foods is inconclusive.
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In contrast to the above-described studies, those subjects who consumed additional foods and beverages containing nonnutritive sweeteners in place of sucrose did not compensate for the lost sucrose calories. The control subjects who consumed additional foods sweetened with sucrose increased their energy intake, body weight and fatness, and blood pressure.
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Among children, the study found caffeine consumption in all age groups: 76 percent of those aged 2–5 years consumed an average of 16 mg/day or 0.4 mg/kg body weight; among those aged 6–11 years, 86 percent consumed an average of 26 mg/day or 0.4 mg/kg body weight. Among males and females aged 12–17 years, 91 percent and 88 percent respectively consumed an average of 80 and 59 mg/day, or 0.5 mg/kg body weight.
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Hypertension Nonusers of caffeine may experience an increase in blood pressure when administered an acute dose of caffeine, although the evidence is inconclusive (Green and Suls, 1996; Myers, 2004; Umemura et al., 2006; Winkelmayer et al., 2005)
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Baer (1987) investigated the effects of small doses of caffeine (1.6–2.5 mg/kg body weight)
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On average, fruits and vegetables are low in energy density and fat, and high in fiber and other nutrients. Thus incorporating fruits and vegetables into the diet can promote satiety and decrease energy intake (Rolls et al., 2004)
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children using data from the 1994–1996 CSFII, the average whole-grain intake for children aged 6–11 years was 0.9 servings per day; for adolescents it was one serving per day. The proportion of children and adolescents consuming an average of two or more servings of whole grains daily was only 15 percent (Harnack et al., 2003)
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. FDA whole-grain health claim The FDA requires that any food product that carries the whole-grain health claim must by regulation contain 51 percent or more whole-grain ingredients by weight per reference amount and be low in fat (Box 2-2)
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This is a voluntary resource and may not be available for all eligible foods. Consumption of Calcium-Rich Foods Osteoporosis may be considered a pediatric disease manifesting itself in later life, and therefore dietary intake of calcium-rich foods and beverages is important for school-age children.
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. Only 10 percent of adolescent females achieve the recommended adequate dietary intake of calcium (Greer and
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Most flavored milk contains about 15–16 grams of added sugars, comprising about 35–40 percent of calories. Consumption data from the 1994–1996 and 1998 CSFII on the intake of added sugars show that, for children aged 6–17 years who provided two full days of dietary data, sweetened dairy products were positively associated with calcium intake.
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A measure based on total calories instead of weight is a reasonable option until analytical methods and labeling regulations are established to measure and label the added sugars content of foods and beverages. Consumption of Sugar-Sweetened Beerages Although there are naturally occurring sugars in many foods and beverages (milk, fruits, some vegetables)
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Increased added sugars intake has been shown to result in increased energy intake for children (Bowman, 1999)
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In general, reducing consumption of sweetened beverages is viewed as an important component of a broad strategy to reduce excess energy intake (Dietz, 2006; Popkin et al., 2006)
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. The CSFII 1994–1996 survey found that added sugars and fat contributed 45 percent of total energy intake in school-age children, with sugars contributing 20 percent of total calories and discretionary fat calories 25 percent (Gleason and Suitor, 2001a)
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The committee estimated the amount of dietary energy available for discretionary energy consumption as snacks based on daily energy requirements for boys and girls as a function of age and physical activity level (IOM, 2002/2005) Estimating that approximately 25 percent of daily energy intake would be consumed at breakfast, 33 percent at lunch, and 33 percent at dinner would leave approximately 9 percent of total daily energy intake for discretionary calorie consumption.
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3,000 3,500 2,500 3,000 2,500 2,000 2,000 1,500 1,500 1,000 1,000 Calories per Day, Female Calories per Day, Male 500 500 0 0 t t t t t t e y y y y e e te e y y y y e e te ar ac tiv ar ac tiv ar ac ctiv ar ac ctiv ar ac ctiv ar ac ctiv ar ac ctiv ar ac ctiv nt d nt d nt d nt d nt d nt d nt d Ac nt d Ac de Mo 8 A de Mo 3 A de Mo 8 A de Mo 8 A de Mo 3 A de Mo 8 A de Mo –3 de Mo –3 Se 3 2 Se 8 4– Se 3 2 Se 8 4– Se 13 9–1 Se 18 4–1 Se 13 9–1 Se 18 4–1 3 2– 8 4– 3 2– 8 4– 13 9– 18 4– 1 13 9– 18 4– 1 2– 4– 2– 4– 9– 4– 1 9– 4– 1 1 1 Essential calories Essential calories Discretionary calories Discretionary calories FIGURE 2-3 Essential and discretionary calories by gender, age, and level of activity. SOURCE: Reprinted, with permission, from Pediatrics 117(2)
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CSFII data showed that children who consumed fast food compared with those who did not consumed more total energy (187 calories) , total fat, and soft drinks, and less milk, fruits, and non-starchy vegetables (Bowman et al., 2004)
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, with 34 percent not eating breakfast. Among all school-age children and adolescents, breakfast provided an average of 18 percent of total daily energy intake.
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SOCIODEMOGRAPHIC FACTORS AFFECTING DIETS IN CHILDHOOD AND ADOLESCENCE Gender Gender differences in dietary intakes emerge as children move into adolescence. During childhood, food intakes of girls and boys tend to be similar.
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. Adolescent males are also more likely to have diets higher in total fat and saturated fat (Gleason and Suitor, 2001a)
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include • increased consumption of foods prepared away from home; • increased percentage of total calories from snacks; • increased consumption of calorie-dense foods; • increased portion sizes of foods; • increased consumption of sweetened beverage; and • decreased consumption of milk. Trends in Dietary and Nutrient Intakes A recent study examined dietary intake trends among children and adolescents over a 20-year period using data from three USDA national surveys: Nationwide Food Consumption survey 1977–1978; CSFII 1989–1991; and CSFII 1994–1996, 1998 (Enns et al., 2002, 2003)
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For example, between 1965 and 1991, breakfast consumption declined 9 percent in children aged 8 to 10 years and 13 to 20 percent in adolescent males and females. The greatest decline (20 percent)
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Although it is recognized that self-reported dietary intake data reflects underestimates of food intake and, in turn, energy intake, the magnitude of this effect in different populations is not clear. Studies using doubly-labeled water show that underreporting of food intake is pervasive in adults.
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. Social desirability may influence not only self-reported total energy intake, but also the likelihood of underreporting socially undesirable food intake patterns such as the consumption of high-fat, high-sugar foods and beverages (Maurer et al., 2006)
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