Nourishing the Future

February 2005

Nourishing the Future

By Angela M. Miraglio, R.D.Contributing Editor

Great progress to improve kids' nutrition and overall health occurred in the 20th century. Factors that helped overcome nutrient deficiencies and undernutrition included a plentiful food supply, government feeding and supplement programs, and new knowledge about links between nutrition and health. But ironically, childhood obesity ranks as a major challenge to society as the 21st century begins. Experts point to a multitude of changes in home and school environments, lifestyles, and available foods and beverages as major factors in this growing epidemic.

More is less Nutrition is key to growth and development in childhood and adolescence and lays the foundation for health or disease throughout adulthood. But an abundance of calories does not guarantee good nutrition. Consumption data from large nationwide surveys and smaller longitudinal studies show increased energy intake, mostly from an increase in carbohydrate-containing foods, such as grain mixtures (e.g., pizza and pasta) and sweetened beverages (e.g., soft drinks), from the 1970s through the 1990s. While the percent calories from total and saturated fat decreased, the actual amounts did not, with the majority of kids exceeding the current dietary recommendations. Fiber intake remained relatively steady at below recommended levels. USDA data analyses also demonstrated increased intake of iron and some B-vitamins, with decreased vitamin-B12 intake.

According to a USDA Agricultural Research Service report on trends in food and nutrient intake, most children and adolescents do not consume the recommended servings of the five major food groups from the Food Guide Pyramid but consume more sweets and fats than recommended. Specifically, a decrease in whole and total milk, yeast bread/rolls, some vegetables, beef, pork, and eggs occurred from 1977 to 1998. At the same time, intake of soft drinks, grain mixtures, snack foods, fried potatoes, noncitrus juices/nectars, lowfat and skim milk, cheese, candy and fruit drinks increased. The bottom-line recommendations are familiar -- eat more whole grains, dark-green and deep-yellow vegetables, fruits, legumes, skim or 1% milk, or lowfat dairy products; shift to lean meats and meat alternates; and decrease fat in cooking.

The shift in eating patterns that occurred since World War II plays a role in diet quality. Family dining at home leads to a better-quality diet with higher intakes of fruits and vegetables, fiber, folate, calcium, iron and vitamins B6, B12, C and E, and lower intakes of saturated and trans fats, soft drinks and fried foods. However, meals outside the home claim almost half of the family food dollars, with fast foods accounting for over one-third of the total food dollars. As children age, they eat more meals away from home, favoring fast-food restaurants more than half the time. Kids' fast-food consumption provides higher total and saturated fat, cholesterol and sodium intakes with lower fiber, calcium and iron intakes. Moreover, fewer kids eat breakfast today, but most have at least one snack a day. Recent research indicates that larger portions also lead to excessive caloric intake.

Setting goals In April 2004, the Chicago-based American Dietetic Association issued a position statement on dietary guidance for healthy children ages 2 to 11 years who "should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food and reduce risk of chronic disease through appropriate eating habits and participation in regular physical activity." The dietary reference intake (DRI) values from the Institute of Medicine's (IOM) Food and Nutrition Board provide the parameters for key nutrients:

· Carbohydrates: 45% to 65% of energy;

· Fat: for ages 1 to 3, 30% to 40% of energy; for ages 4 to 18, 25% to 35% of energy;

· Protein: for young children, 5% to 20% of energy; for older children, 10% to 30% of energy;

· Added sugars: less than 25% of energy;

· Saturated and trans fats and cholesterol: as low as possible within a nutritionally adequate diet;

· Total fiber: varies with age, starting at 19 grams for ages 1 to 3 and rising to 26 and 31 grams for 9- to 13-year-old girls and boys, respectively.

Other recommendations include increased fruit and vegetable consumption to five or more servings per day and two to three servings of milk or other dairy products, or calcium-fortified foods.

Since the 1970s, the number of overweight children ages 6 to 11 has tripled while the number of overweight adolescents has more than doubled. Several conferences, task forces and calls to action by leading health authorities, advocacy groups and government agencies have identified eating patterns and lack of physical activity as major contributing factors. And as more overweight kids develop adult diseases, like type 2 diabetes and hyperlipidemia, concerns about costs to health care, school performance and quality-of-life issues mount. In a recently released report, Action for Healthy Kids (AFHK), Skokie, IL, a nonprofit organization, documented that poor nutrition, inactivity and weight problems costs schools in achievement with poor test performance and attendance by poorly nourished, inactive students, as well as in actual dollars from loss of attendance-based funding.

Last September, the IOM Committee on Prevention of Obesity in Children and Youth released a prevention-focused action plan that lays out specific goals and recommendations for preventing childhood obesity. Three of the ten recommendations involve industry, starting with a charge to develop and promote "products, opportunities and information that will encourage healthful eating behaviors" through new products and packaging that consider energy and nutrient densities and appropriate serving sizes, and through healthier food options and nutrition information at point-of-purchase in restaurants.

The other two require action by government agencies as a starting point. One calls for FDA to delineate clearer, more-useful nutrition labeling, especially total calories and typical amounts consumed at an eating occasion, and to employ greater flexibility in the use of evidence-based nutrient and health claims on products. The third advocates a national conference directed by the secretary of Health and Human Services to develop advertising and marketing guidelines that minimize the risk of obesity in kids with the Federal Trade Commission assuming responsibility for monitoring compliance.

Partner power Critics point to segments of the food, beverage and restaurant industries as major causes of poor nutrition among kids. Increased soft-drink consumption is linked with decreased milk and dairy consumption, leading to a calcium-intake deficit among many kids. Competitive products, e.g., soft drinks and snacks sold in vending machines, decrease participation in government-sponsored, school feeding programs that provide nutritionally sound meals. Sugar-sweetened juice and fruit-based products with only a small percent of real fruit offer excess calories with little of the nutrition found in fruits. In response, many manufacturers and fast-food vendors are formulating new, kid-friendly, nutritious products that their product lines expand. According to AFHK, several school districts have successfully changed vending and foodservice options without loss of revenues. Apparently, students will buy healthful foods and beverages that are tasty, available and affordable.

The Child Nutrition and WIC Reauthorization Act of 2004 introduced several changes in school-based nutrition programs aimed at improving nutrition and preventing obesity. Among the key components is a requirement to develop local school wellness policies that incorporate nutrition guidelines for all foods sold on campus during the day. These will probably eliminate the availability of high-energy, low-nutrient-dense products, and most likely will increase demand for those offering good nutrition, taste and convenience in appropriate portions. The act also requires that schools offer fluid milk with varying fat content, lactose-free milk and soymilk upon request, and expands a successful Fruit and Vegetable Program that provides free fruit and vegetable snacks.

Industry partnerships with school districts and community-based programs can open up opportunities that benefit everyone. AFHK, a public-private partnership of national health and education organizations and government agencies, focuses on changes at school with volunteer State Teams. Alicia Moag-Stahlberg, M.S., R.D., executive director, AFHK, says: "We have many industry partnership opportunities on both the national and local level. In the past, we have used unrestricted grants to fund research and communications programs. We work with industry to do demonstration projects on national, regional and local levels. We are also seeking sponsors for our 'Healthy School Summit' next fall."

Angela M. Miraglio, M.S., R.D., ([email protected]) is a Fellow of the American Dietetic Association from Des Plaines, IL. Her firm, AMM Food & Nutrition Consulting, provides communications and technical support to the food and beverage industry.

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