Total dietary fiber in children's diets

Nondigestible carbohydrates in the diets of infants and young children: a commentary by the ESPGHAN Committee on Nutrition

The consumption of nondigestible carbohydrates is perceived as beneficial by health professionals and the general public, but the translation of this information into dietary practice, public health recommendations, and regulatory policy has proved difficult. Nondigestible carbohydrates are a heterogeneous entity, and their definition is problematic. Without a means to characterize the dietary components associated with particular health benefits, specific attributions of these cannot be made. Food labeling for "fiber" constituents can be given only in a general context, and the development of health policy, dietary advice, and education, and informed public understanding of nondigestible carbohydrates are limited. There have, however, been several important developments in our thinking about nondigestible carbohydrates during the past few years. The concept of fiber has expanded to include a range of nondigestible carbohydrates. Their fermentation, fate, and effects in the colon have become a defining characteristic; human milk, hitherto regarded as devoid of nondigestible carbohydrates, is now recognized as a source for infants, and the inclusion of nondigestible carbohydrates in the diet has been promoted for their "prebiotic" effects. Therefore, a review of the importance of nondigestible carbohydrates in the diets of infants and young children is timely. The aims of this commentary are to clarify the current definitions of nondigestible carbohydrates, to review published evidence for their biochemical, physiologic, nutritional, and clinical effects, and to discuss issues involved in defining dietary guidelines for infants and young children.

The 'age+5' rule: comparisons of dietary fiber intake among 4- to 10-year-old children

OBJECTIVE

To determine children's sources of dietary fiber and to identify the food group choices made by those who met the "age+5" rule, which recommends that children daily consume an amount of fiber that is equal to their age plus an additional 5 g fiber.

DESIGN

This study used 24-hour dietary recalls and 1-day food records to assess the nutrient intake and food group choices of children who did and did not meet the recommendations of the age+5 rule.

SUBJECTS

The 1989-1991 US Department of Agriculture Continuing Survey of Food Intakes by Individuals provided the study sample of 603 children between the ages of 4 and 6 years and 782 children between the ages of 7 and 10 years.

STATISTICAL ANALYSES

Differences in nutrient and food group intakes between age categories were determined by t tests.

RESULTS

Only 45% of 4- to 6-year-olds and 32% of 7- to 10-year-olds consumed adequate fiber to meet the age+5 rule. Those who met the age+5 rule did so by consuming significantly more high- and low-fiber breads and cereals, fruits, vegetables, legumes, nuts, and seeds. Children with low fiber intakes had significantly higher energy-adjusted intakes of fat and cholesterol, whereas those who met the age+5 rule had significantly higher energy-adjusted intakes of dietary fiber, vitamins A and E, folate, magnesium, and iron.

APPLICATIONS

The majority of the children had low intakes of dietary fiber, suggesting that they are at risk for future chronic disease. Parents and school foodservice personnel should strive to offer fiber-rich foods to children so their acceptance and consumption of them will be increased.

Influence of gender and socio-economic status on dietary patterns and nutrient intakes in 18-year-old Australians

This study used two-day diet records to examine dietary behaviours in 504 Australian 18 year-olds in relation to gender, socio-economic status (SES) and national dietary guidelines. Fat intake exceeded 30% of energy in about 80% of subjects and was greater than 40% in about one-quarter. Saturated fat provided more than 10% of dietary energy in more than 90% of participants; less than 1% achieved a polyunsaturated to saturated fat ratio of at least one. The major food groups contributing to fat intake were convenience foods (32% in men, 28% in women) and meat (27% in men, 25% in women). Fibre intake was less than 30 g/day in 93% of women and 77% of men. Intakes of calcium, magnesium, potassium, and vitamins C and A, as a ratio of energy consumption, were greater in women than men, while sodium intake was significantly higher in men. Convenience foods were the greatest contributors to sodium intake (27% in men, 22% in women) followed by meat, bread, and soups and sauces. Greater consumption of cereals, fruit, vegetables and low-fat foods in young women of higher SES was reflected in their nutrient profile with higher intake of fibre and vitamin C and lower intake of fat. Men ate more cereals, meat and sugary foods and less fruit, vegetables and low-fat foods. Only 2.5% of men and 4.1% of women conformed with the health promotion message, widely publicised locally, to eat two fruits and five vegetables daily. Not eating breakfast was associated with lower calcium intake in men and women, and lower iron and fibre in take in women. Achieving behavioural changes in young adults must take into account differences in dietary behaviour related to gender and SES.

Food intakes of US children and adolescents compared with recommendations

OBJECTIVES

To determine the proportion of youth meeting national recommendations for food group intake and to identify food intake patterns.

DESIGN

The US Department of Agriculture's 1989-1991 Continuing Surveys of Food Intakes by Individuals were used to estimate food intake. Intake was determined from 3 days of diet by disaggregating foods into their component ingredients and using weights that correspond to servings.

PARTICIPANTS

The sample included 3307 youth, 2 to 19 years of age, living in the 48 conterminous United States. Main Outcome Measures. Mean number of servings and percentage of individuals meeting national recommendations for food group intake according to demographic characteristics, patterns of intake, and nutrient profiles associated with each pattern.

RESULTS

Mean numbers of servings per day were below minimum recommendations for all food groups except the dairy group (ages 2 to 11). Percentages of youth meeting recommendations ranged from approximately 30% for fruit, grain, meat, and dairy to 36% for vegetables. Sixteen percent of youth did not meet any recommendations, and 1% met all recommendations. The pattern of meeting all recommendations resulted in nutrient intakes above the recommended dietary allowances and was high in fat. Conversely, meeting none of the recommendations resulted in intakes well below the recommended dietary allowances for some nutrients. Total fat and added sugars averaged 35% and 15% of energy, respectively, and levels were similar among most demographic groups.

CONCLUSION

Children and teens in the United States follow eating patterns that do not meet national recommendations. Nutrition education and intervention are needed among US children.

Importance of dietary fiber in childhood

Dietary fiber has important health benefits in childhood, especially in promoting normal laxation. Currently, children consume amounts of dietary fiber that appear to be inadequate for optimal health promotion and disease prevention. It is prudent to recommend that children older than 2 years of age increase dietary fiber intake to an amount equal to or greater than their age + 5 g/day. According to the "age + 5" rule dietary fiber intake would increase from 8 g/day at age 3 years to 25 g/day by age 20 years. After age 20, dietary fiber levels of 25 to 35 g/day are recommended. Dietary fiber intake should be increased gradually in childhood by increasing consumption of a variety of fruits, vegetables, legumes, cereals, and other whole-grain products. Although very high fiber intake in childhood could have adverse effects, the potential health benefits of a moderate increase in dietary fiber substantially outweigh the possible risks, especially in highly industrialized countries such as the United States. A safe range of dietary fiber intake for children may be between age + 5 and age + 10 g/day. This range is considered safe even for children and adolescents with marginal intakes of some vitamins and minerals; should provide enough dietary fiber for normal laxation; and may provide enough added dietary fiber to help prevent chronic diseases.

Soluble fiber enhances the hypocholesterolemic effect of the step I diet in childhood

BACKGROUND

Psyllium, a water-soluble fiber, has been shown to have a cholesterol-lowering effect in studies of adults. A small number of studies in children have produced variable results.

METHODS

A 12-week, randomized, single-blind, placebo-controlled, parallel clinical trial was conducted to test the effectiveness of psyllium in lowering total (TC) and low-density lipoprotein cholesterol (LDL-C) in 50 healthy 2 to 11 year old children. Children with two baseline LDL-C levels > or = 110 mg/dL were invited to participate in the trial, and were randomly assigned to follow a usual Step I (Control) diet of low dietary fat, saturated fat and cholesterol, or a Step I diet enriched with psyllium. Children consumed two 1-oz boxes of cereal per day, with each box of psyllium-enriched cereal containing 3.2 g of soluble fiber, and each box of placebo cereal containing less than 0.5 g of soluble fiber.

RESULTS

Greater reduction of total and LDL-cholesterol, and increase in HDL-cholesterol were noted after 12 weeks of the psyllium-enriched Step I diet compared to the Step I control diet. Total cholesterol decreased 21 mg/dL for the high fiber group compared with 11.5 mg/dL for the control group. LDL-C decreased 23 mg/dL for the high fiber group compared with 8.5 mg/dL for the control group. HDL-C increased 4 mg/dL for the high fiber group compared with 1 mg/dL for the controls. TC/HDL and LDL/HDL ratios decreased significantly more so for the high fiber group as well.

CONCLUSIONS

In this 12-week study, soluble fiber (psyllium) provided added benefit to the Step I diet in the treatment of hypercholesterolemia.

Dietary fiber intake of children and young adults: the Bogalusa Heart Study

OBJECTIVE

To determine dietary fiber intake of children and young adults.

DESIGN AND SETTING

Cross-sectional surveys of children and young adults in Bogalusa, La.

SUBJECTS

Twenty-four-hour dietary recalls were collected from 1976 to 1988 on five cohorts of 10-year-olds (n = 1,254), two cohorts of 13-year-olds (n = 360), and young adults (n = 504) 19 to 28 years of age.

STATISTICS

Dietary fiber intake data were analyzed for age, race, and gender differences and for secular trends. Descriptive and inferential statistics were calculated where appropriate. Dietary composition and food sources were examined for race-specific and gender-specific quartiles for dietary fiber intake adjusted per 1,000 kcal.

RESULTS

Even after adjusting for energy intake, total dietary fiber intake remained unchanged from 1976 to 1988, averaging 12 g or 5 g/1,000 kcal. Blacks and males had higher total fiber intakes than whites and females at all ages. Consumption of vegetables and soups and breads and grains accounted for 53% (10-year-olds) to 70% (13-year-olds) of the total fiber consumed. When children were stratified into quartiles on the basis of fiber intake per 1,000 kcal, the percentage of energy from total fat and saturated fat was lower, and the percentage of energy from carbohydrate was higher, in children with higher fiber intakes per 1,000 kcal.

APPLICATIONS

Dietary fiber intake of children has remained the same in the past 12 years and is comparable with the intake of young adults, which is well below the recommended level. Children with high fiber intakes (upper quartile) consumed less fat, particularly saturated fat, and more carbohydrate than children with low fiber intakes. Increasing consumption of whole-grain products, fruits, vegetables, and legumes (prepared with minimal added fat) will be necessary to reach the goal of optimal fiber intake and could result in an eating pattern that approaches the current recommendations for dietary fat and saturated fat.

Childhood origins of lifestyle-related risk factors for coronary heart disease in adulthood

Research over the past 40 years clearly points to childhood as a critical period when dietary and lifestyle patterns are initiated which have longterm implications for coronary heart disease risk in adult life. Smoking, high habitual dietary intake of total fat and saturated fat, low exercise level, and excessive alcohol consumption often occur in family aggregates. They are correlated with elevated serum cholesterol, obesity, and hypertension in children, as well as with a predisposition to premature death from coronary heart disease. Intervention studies in children and adolescents show, however, that these lifestyle-risk factors are controllable through education and dietary counselling of the affected individual and their family. Equally important are the emerging data in adults showing that vigorous longterm intervention involving reduction of dietary fat and work-related stress, increased exercise, and elimination of smoking all contribute to a significant improvement in coronary perfusion. Hence, effective dietary and lifestyle management of coronary heart disease can occur at early or later stages of the disease and needs better support from health authorities at the national and international level.