In addition to checking growth and health, administering immunizations and prescribing medications, pediatricians have something else on their to-do list: checking cholesterol levels in all children.

In November, a report from the National Heart, Lung and Blood Institute (NHLBI), endorsed by the American Acedemy of Pediatrics (AAP), put out new recommendations for cholesterol screening and treatment in children.  These recommendations replace the 2008 recommendations from the AAP that recommend screening high-risk children, including those with a family history of early heart disease or high cholesterol and certain conditions such as obesity, high blood pressure or diabetes.

While much of the previous recommendations still stands, the revised recommendations include universal screening for all children between the ages of 9 to 11. The reason that this age range has been chosen is that cholesterol drops during puberty but then increases again as adolescents approach adulthood.

Why the change?
According to the NHLBI report, atherosclerotic cardiovascular disease (CVD), in which the artery walls thicken as a result of the accumulation of fatty materials such as cholesterol, is the leading cause of death in North Americans. While the true form of “atherosclerosis” is rare in childhood and adolescence, the risk factors and risk behaviors in childhood can accelerate the development of it.

Here are key points from the NHLBI report on why universal testing is needed:

-Approximately 30-60% of children with high cholesterol are missed with the current testing protocol, as many do not have reliable or accurate family histories to guide them.

-Studies show that children with abnormal lipid levels such as high cholesterol are at increased risk for CVD as adults

-Better identification and control of abnormal lipids in childhood should reduce CVD risk beginning in early adulthood. Of particular importance are those with heterozygous hypercholesterolemia (FH), a genetic condition of high cholesterol levels typically requiring medication to keep cholesterol levels down.

-When the original guidelines were made, the focus was on identifying children with high LDL (bad cholesterol). But now a new combined pattern of abnormal lipids associated with obesity includes normal to mild elevation of LDL, high Triglycerides (type of fat in blood stream) and low HDL (good cholesterol). This new pattern has also been shown to increase CVD risk in adulthood.

Reactions
There have been some not-so-favorable reactions to these new recommendations. In this news article, Dr. Chad Teeters, a cardiologist at the University of Rochester Medical Center, points out that testing will be expensive and provide little benefit unless children get on cholesterol lowering medication — with no evidence that such drugs will help long term.

Yoni Freedhof, MD who blogs at Weighty Matters doesn’t agree with universal testing either:

In medical school I was taught that over 90% of diagnoses can be made on the basis of history alone. Rather than recommending a blood test, how about recommending physicians take lifestyle histories and that way, instead of just focusing on those kids who are unfortunate and predisposed enough to be developing “adult” style chronic diseases at a frighteningly young age, we can focus on all kids, including those whose youth might still be protecting them against an awful lifestyle. Don’t those kids need help too?

I agree with Freedhof that prevention for all is key — and that it’s not beneficial to only counsel children (and their parents) with high cholesterol. Additionally, research shows that half of children with high cholesterol will have it as adults. So that means the other half won’t. So does it help (or hurt) to alarm those children who will grow out of their high cholesterol?

On the other hand, a high cholesterol may be the wake-up call some parents need to get on a healthier path and a select few will be glad to discover their child has a genetic condition (like FH) so they can act early.

What do you think of all of this? Do you want your child being screened for high cholesterol as early as age 9?

For those who want more details, see the testing recommendations below or go to the full report.

Review of the recommendations

What the numbers mean for children
Total cholesterol: Acceptable <170mg/DL, borderline 170-199, high >200
LDL: Acceptable <110, borderline 110-129, high >130
HDL: Acceptable >45, borderline 40-45, low <40
Triglycerides 0-9 years: Acceptable 75, borderline 75-99, high >100
Triglycerides 9-16 years: Acceptable 90, borderline 90-129, high >130

Birth to 2 years: no screening
2-8 years: no routine screening unless the child has:
-a parent, grandparent, aunt/uncle, or sibling with heart attack, chest pain, stroke, any cardiac surgery <55 years in males and <65 years in females.
-a parent with Total cholesterol ≥240 mg/dL
-diabetes, hypertension, BMI ≥95th percentile or smokes cigarettes
9-11 years: universal screening
12-16 years: no routine screening unless the child has:
- a parent, grandparent, aunt/uncle or sibling with heart attack, chest pain, stroke, cardiac surgery, sudden death at < 55 years in males, < 65 years in females
-a parent with TC ≥240 mg/dL
-other high risk conditions
17-21 years: Universal Screening

I’m exhausted coming off a weekend of two kiddie birthday parties and a BBQ we hosted. I realize this way too much for Big A after witnessing her meltdown at my mother in law’s last night.

I’ve learned my lesson: one party a weekend is enough.

So we are easing into this week with some easy meals but will be trying some new stuff as the week progresses. I’ve been eyeing this baked chicken and shrimp recipe for a while. We grilled some shrimp over the weekend and it was yummy!

For meal planning ideas see Org Junkie.

Monday: Quesadillas with toppings

Tuesday: Spaghetti with meatballs, bread, roasted broccoli and salad

Wednesday: Kids Choice

Thursday: Garlic Chicken, mashed sweet potatoes, fruit and salad

Friday: Grilled Teriyaki Shrimp with brown rice salad, fruit and roasted cauliflower

The New Food Icon is Here — MyPlate

Last week there was big news in the nutrition world. The Food Guide Pyramid has been replaced with the new food icon — MyPlate.

This article in the Huffington post reflects on the history of food guides. Food guides are not new — the government has been making recommendations for more than 100 years. There has been The Basic 5, The Basic 7, The Basic 4 and in 1992 the Food Guide Pyramid. In 2005 the pyramid got a makeover with MyPyramid, but that never really took off.

The hope is that MyPlate will make it easier for people to make healthy choices. The idea is to portion your plate with half fruits and vegetables, a protein source and a serving of grains. And don’t forget the side of dairy.

The key messages that go along with the plate are:

• Enjoy your food, but eat less.
• Avoid oversized portions.
• Make half your plate fruits and vegetables.
• Switch to fat-free or low-fat milk.
• Make at least half your grains whole grains.
• Compare sodium in foods like soup, bread and frozen meals and choose foods with lower numbers.
• Drink water instead of sugary drinks

What I like? It’s a nice visual that is really easy to understand. Simple is always best when it comes to visual food guides.

It’s shortcomings? Anytime you go simple, you leave things out. Fat is not included and it may be hard for people to translate this guide to mixed dishes such as lasagna and burritos. It also doesn’t take into account the different nutritional needs of children, which I’ll be talking more about in my continuation of the Kids’ Nutrition Series.

In the end it’s all about balancing the plate, which is always good. Put your food on a plate, sit down and enjoy it.

What do you think?

This week the LA Times ran this article about how some school districts are considering banning chocolate milk. This is not the first time specific foods have been banned to help fight childhood obesity. We’ve seen everything from banning the sale of homemade goods in New York to “sweet-free” zones and “no second helpings” in Minnesota.

I’ve been thinking about this banning business for some time now and cringe every time I hear about it being used as a strategy to help kids eat well. It’s not that proponents of these ban don’t have some points, it’s the message banning food sends to kids that bothers me:

We can’t trust you around these foods, you are helpless to their allure.

Eating just one less-than-perfect food is bad for health and weight.

Be afraid kids, be very afraid.

Why fear and food don’t mix

When we teach kids that some foods are “bad,” it’s very conflicting to them. One the one hand they enjoy these foods, but on the other hand, they keep hearing how bad they are for them. How many adults feel these same feelings of conflict: “I know I shouldn’t eat dessert but I can’t help myself.”

In some kids, but not all, banning and making single foods out to be bad make them even more attractive. The topic of banning chocolate milk came up on one of my nutrition list serves and dietitian Rosanne Rust, author of Restaurant Calorie Counter for Dummies, summed my thoughts on this perfectly:

Even though many seem to think we aren’t getting anywhere with the concept of “moderation”, I don’t think we should give up trying to teach people how to choose proper portions of imperfect foods in the proper frequency. Children particularly need to understand this concept. Trying to create some sort of nutrition utopia for them isn’t going to help them make their own choices later in life.

Rosanne goes onto explain how she bans nothing in her home of 3 active boys. Her children get the choice of 1% white, chocolate or strawberry milk at home. Her kids choose white most of the time, but have the choice and enjoy the flavored milk occasionally. They are also allowed to eat some packaged snacks and even Pop Tarts on occasion because she finds that what teens can’t get at home they seek out at neighbors’ homes, and possibly resent their parents for never buying them anything “good”.

She also feeds her kids lots of fresh food – they are offered vegetables daily, eat fruit daily and they prefer whole grain breads and cereals. They enjoy the harvest of the family’s summer vegetable garden and help gather eggs every day from their six backyard hens.

“The whole idea of ‘banning’ food choices frustrates me because I happen to believe that children need to learn to make good choices independently,” she says. “Making balanced choices takes guidance from a parent initially, but every time these types of ‘rules’ are made, the choice is made for them, taking away the opportunity to learn how to balance ‘treat foods’ with more wholesome ones.”

A better alternative?

Jill Castle, MS, RD helped re-vamp the food offerings of the cafeteria program at a private school in Tennessee. She said some parents wanted to get rid of the chocolate milk but instead, after hearing about the pros and cons, decided to offer it once a week.

After sales of milk went way down, they decided to offer chocolate milk twice a week and everyone ended up pleased with the result.

“I don’t agree with vilifying any food because of the message it sends to kids, ” Jill says. “Ban chocolate milk because it is bad.”

This a great idea — offering items like chocolate milk less often or on certain days. This way, kids learn how all foods fit into a balanced diet.

And we can’t forget foods items like chocolate milk offer vital nutrition too — and some kids simply don’t like the taste of milk.  For more on this topic see this post. 

Shelley Rael, MS, RD hated milk growing up but never had the choice of chocolate milk or even calcium supplements (her doctor thought they were only for old ladies).  Now at the age of 41, she goes between osteopenia (low bone mass) and osteoporosis on her scans. 

“So, I do not agree with chocolate milk being banned,” she says. “If I had it I would have consumed it.”

What do you think about these food bans? Anything heating up in your area??

The 2010 Dietary Guidelines for Americans were released on January 31st.  The guidelines, updated every 5 years, are a very big deal in the nutrition world.  But I don’t think the public cares or notices the nuanced changes. 

I think you should care and I’m going to tell you why.

While the Dietary Guidelines are not perfect, they do summarize the research.  And at a time when everyone is doling out nutrition advice this can be helpful.

You see, when you receive nutrition advice, or someone quotes a study, they may or may not include all the evidence available.  So if there’s one study saying  too much of X is bad for you, there might be 10 other studies saying it isn’t.  So it’s really important to look at what researchers call “the weight of the evidence.”

So I spent last weekend curled up with the Dietary Guidelines Policy Report, (great read — totally recommend it!) and pulled out important tidbits of information for my readers.

Message one: Balance Calories to Manage Weight:

Background: There’s a big focus on obesity prevention — and the guidelines talk about how Americans are in calorie imbalance (taking in more than burning).  While people still try to target specific food groups (like carbs or the glycemic index) as being more weight promoting, research still shows that total calories matter most.  Strong evidence shows children who consume sugar-sweetened beverages have higher body weights than those who don’t.  The same is not seen with 100% fruit juice.

There is strong evidence that regular physical activity helps maintain weight and prevent excess gains.  Increased screen time, especially TV viewing, is associated with higher weights in children, adolescents and adults (strong evidence).

Recommendations:   Control total calorie intake and increase physical activity to manage weight and stay in “calorie balance” through all stages of life.  

What’s missing? There’s nothing about the how of eating: watching hunger or fullness, eating meals at the table and tuning into your body.  People don’t count calories — and they shouldn’t.  Having to fend off food and eat less than you really want never works.  Eating slowly, enjoying and stopping when you start to feel full/satisfied is much more powerful not to mention doable.

Message two: Reduce certain foods and nutrients

Background:  A strong body of evidence shows that high sodium intake increases blood pressure.  Most sodium comes from the added salt during food processing.  The type of fat someone consumes is more important than the total amount.  A strong body of evidence shows that saturated fatty acids (animal fats)  is associated with higher total cholesterol and LDL cholesterol.  Man-made trans fat, also bad for the heart, has decreased substantially from the food supply since the 2006 label law went into effect. Dietary cholesterol may increase bad cholesterol (LDL) in certain individuals.  Added sugars contribute 16% of total calories in the American diet (too much).

Recommendations: Reduce sodium to 2300mg in the general population and 1500mg for those 51 and older, all African Americans, and people with hypertension and diabetes (average American sodium intakes is 3400mg). Consume less than 10% of calories from saturated fats and replace with unsaturated fats (10% of 2000 calories = 20g saturated fat).  Consume less than 300mg cholesterol per day (1 egg =212 mg).  Keep trans fat as low as possible.  Reduce the intake of calories from solid fats and sugars.

What’s Missing?  A new tool (like the old food pyramid) is going to be created to help people utilize the guidelines.  I think they will benefit from showing people how to eat nutrition-poor foods.  For example, the policy report says “Foods containing solid fats and added sugars are no more likely to contribute to weight gain than another source of calories in an eating pattern that is within calorie limits.”  And they go on to state that 5-15% of the diet can come from solid fats and added sugar.  So let’s show people how to navigate the real would and sensibly include all foods in their diet instead of just telling them to “reduce” or “avoid” certain foods.

Message three: Increase Certain Foods and Nutrients 

Background:  There is moderate evidence for the health benefits of fruits, vegetables, whole grains, dairy products, nuts and seeds and fish intake.  Many Americans are not meeting their needs for potassium, fiber, calcium and vitamin D.  Dietary potassiumcan help lower blood pressure by counteracting the effect of sodium. Certain population groups have special nutrition needs, such as pregnant women and those capable of becoming pregnant who need more iron and folic acid.  People over 50 need additional vitamin B12 as  absorption rates decrease with age.

For the first time the benefits of eating more seafood , including the essential fatty acids DHA/EPA, were highlighted, especially for pregnancy and developing children.  The average intake of seafood is 3.5 ounces per week, while 8 ounces is associated with health benefits.  Amounts are not specified for children as they will just eat “smaller portions” than adults.

Recommendations: Eat more fruits, vegetables (especially dark green, organ veggies and beans and peas), whole grains (half of grain intake), fat-free or low fat milk and milk products, lean protein foods (lean meat, beans, seafood, eggs, poultry, soy and nuts and seeds), seafood and replace vegetable oils with solids fats when possible.  Choose foods higher in potassium, dietary fiber, calcium and vitamin D.

Women capable of becoming pregnant should choose foods that supply more iron and 400mcg folic acid from fortified food or supplements.  Women who are pregnant or breastfeeding should consume 8-12 ounces of low-mercury seafood per week from a variety of seafood types.  People who are 50 or older should get a supplemental source of vitamin B12.

What’s missing?  They fail to say that most people will not be able to get enough vitamin D through food.  One of my readers asked about vitamin D during pregnancy.  I recommend all adults, especially those who are planning on becoming pregnant (or are), get a vitamin D test.  If your D levels are low, most people will need to take more than their prenatal or multivitamin contains.  The guidelines also don’t mention that people can take fish oils if they fall short on fish intake.

The guidelines wrap up discussing dietary patterns and how to help people adopt the guidelines.  This is the real issue — how to help people eat better.  From my experience, telling people what is healthy for them is not motivating over the long haul.

There’s nowhere in the guidelines about eating food that tastes good, a number one motivator for people.  In fact, I encourage people to make food decisions based on three areas: taste, nutrition and how food makes them feel.  I mean, I love cookies and ice cream but if I ate them all day I’d be a slug.  It’s that balance of all food I aim for so I get taste, lasting energy and the nutrition I need.

I recently talked to a man who only eats for taste.  He said, “I eat what I want!”  He told me he eats a sausage and egg breakfast every morning.  I ask him how that makes him feel and he said, “I take a nap a half an hour after I eat it.”  I replied, “Well maybe if you ate something different you would have more energy all day long — and then you could eat that on Sunday when there’s less to do.”

“I’m retired,” he said with a smile.

In early December the Healthy, Hunger-Free Kids Act of 2010 was signed into law. It had been 10 years since the government reauthorized child nutrition programs — and with childhood obesity on the rise many were fighting for real change.

The new bill incorporates many positive changes with its $4.5 billion of additional funding for child nutrition programs over the next 10 years. But how does this bill translate into the daily lives of children? Here are the highlights…

• Better food choices all around: The USDA already sets nutrition standards for school lunches but now they’ll have the authority to set standards for “other food” sold at school including vending machines, a la carte items and school stores. This may take a while to put in place but the result will be more nutritious food available outside of school lunches.

• More money for lunches: For the first time in 30 years, there will be more money going to school lunches that meet new nutrition standards. There will also be more auditing to ensure school districts are complying with the standards.

• More local food: More funding will go to farm-to-school programs aiming to get more local food into schools.

• More children will qualify: More children will have access to school meal programs due to changes in eligibility and processing.

• New school wellness programs: New standards will be set for nutrition promotion and education and physical activity.

• Safer Food: New requirements will help improve the safety of food at schools.

I know many proponents of this bill wanted even more resources to go to school nutrition programs but this is definitely a step in the right direction.  This, combined with the creative ideas for Smarter Lunchrooms developed by Brian Wansink, means a healthier future for our kids.

What do you think? Does this address any concerns you have at your child’s school? Anyone working in school nutrition care to comment?

Big news rocked the nutrition world last week. And it was about two of the most talked about nutrients of the last decade: calcium and vitamin D.

In recent years, the U.S. and Canadian governments have asked the Institute of Medicine (IOM) to review the research and update the DRIs (dietary reference intakes) for calcium and vitamin D.

It was getting a little embarrassing since the DRIs hadn’t been updated since 1997 — all while low vitamin D levels had been tied to variety of conditions such as cancer, heart disease, autoimmune disorders, diabetes and metabolic syndrome.

Something had to be done. And it was.

What the IOM committee concluded
After reviewing over 1000 studies, and listening to researchers in the field, the IOM committee concluded that the strongest evidence for calcium and vitamin D’s health attributes are their roles in bone health. In the IOM’s report, they say that studies are inconclusive regarding D’s role in other health conditions.

The IOM report details some of the problems with the current literature. Many studies include both vitamin D and calcium making it hard to distinguish the benefits of each. There is a lack of dose response studies to prove cause and effect (vs. population studies that show associations). Lastly, there is no consensus in the scientific community about optimal levels of vitamin D in the blood. What one researcher calls “inadequate” another might say is “optimal.”

How are we doing?
To the surprise of many health professionals (including me) they say most people are getting adequate amounts of both D and calcium excluding certain populations. The population group not getting enough calcium through food are girls aged 9-18 years old, who have the highest needs, and women over 50. They add that women over 50 usually get enough, if not too much, from supplementing their diet.

While intakes of vitamin D are below current recommendations, the IOM committee says blood levels are adequate to support optimal bone health — 20 ng/ml (nanograms per milliliter). Even though many physicians use 30 ng/ml as the cut off, some vitamin D experts believe much higher levels are needed, 50-80 ng/ml, to optimize health and prevent disease.

Those at highest risk for low vitamin D levels include people who carry extra weight, live in upper latitudes in North America, are dark skinned, wear sunscreen or are indoors most of the time, are vegans and babies born premature.

The New DRIs for Vitamin D and Calcium
Below is a chart summarizing the new DRIs for calcium and vitamin D (click on the chart to enlarge). The RDA (Recommended Dietary Allowance, in middle column) is the amount to shoot for. The vitamin D requirement assumes that most individuals get a minimum amount of sun exposure which is why levels increased significantly from 1997 — from 200 IU to 600 IU for most people. Calcium didn’t change much except for younger ages. It went from 500 mg to 700 mg for children 1-3 and from 800 to 1000 for children 4-8.

To give you an idea how these numbers relate to food, an 8-ounce glass of milk, 6-8 ounces of yogurt or 1.5 ounces of cheese contains about 300 mg of calcium. The primary source of vitamin D is the sun but it can also be found in fish (a 3 ounce portion of salmon has about 300 IU) and fortified milk and food products. Milk typically contains 100 IU per 1 cup serving and other fortified beverages contain the same or more. On the other hand, 30 minutes spent in the summer sunshine without sunscreen provides about 10,000 IU!

Reactions to the Report
There have been mixed reactions to the IOM report and recommendations. Some health professionals believe the IOM committee does not acknowledge the science demonstrating an increased need for vitamin D. The following is a response from the Vitamin D Council:

“Disturbingly, this FNB committee focused on bone health, just like they did 14 years ago. They ignored the thousands of studies from the last ten years that showed higher doses of vitamin D helps: heart health, brain health, breast health, prostate health, pancreatic health, muscle health, nerve health, eye health, immune health, colon health, liver health, mood health, skin health, and especially fetal health.”

Dr. David Katz, Director of Yale University’s Prevention Research Center, summarized his view in a nice piece published in the Huffington Post:

“Calcium and vitamin D are important nutrients. As with all nutrients, enough is good — too little or too much is bad. The IOM invokes the precautionary principle to offer recommendations that are reasonable, and willfully conservative. But a relative absence of evidence means that guidance is as much about judgment as science. My judgment, and familiarity with the literature, leaves me quite comfortable with the IOM conclusion about calcium, but with a bit more doubt regarding their conclusions for vitamin D.”

What do I think?
I agree with the statement made by Dr. Katz. Government reports and recommendations are always conservative — and they should be. That doesn’t mean that people don’t need even more vitamin D than what is recommended. What is really needed are better — and more — studies.

It’s important to note that the RDAs for vitamin D are even higher for children 1 year and older. The American Academy of Pediatrics recommends 400 IU and the RDAs are now 600. Most children will not get enough from their diet and will benefit from supplementation. I will also be watching my 4-year old’s calcium intake as her needs just went up to 1000 mg!

As for me, I have a physical scheduled in January and plan to have my vitamin D levels checked. I’ve been taking 2000 IU for several months now. Even though there isn’t widespread consensus on the blood levels that are optimal, the test will help me decide where I stand. I’ll be sure to report back my findings.

I’m curious what you all think about this vitamin D situation. I’d love to hear from health professionals too!

Multivitamins have been in the news lately — and the news is not so great.  Studies are showing that multivitamin supplements do little to help prevent chronic disease and promote health.  And preliminary research shows that in certain populations, they could even do harm.

Yet more than half of the US populations take multivitamins (53 percent) every day.  Kids take them too — 30 percent according to a 2009 study published in the Archives of Pediatrics and Adolescent Medicine.

Before you ditch multivitamins from your household, consider whether or not they truly enhance the health and well being of your family.  Here are three things to consider when making your decision.

1. Do they promote health? According to the 2010 Dietary Guidelines Report, there is little evidence that multivitamins prevent chronic disease.  On the other hand, people with healthy diets including fruits, vegetables, whole grains, nuts, beans, fish and little meat, have been shown to have lower chronic disease risk.

It is not just the vitamins and minerals in healthy foods that prevent diseases like diabetes and cancer, but the synergistic effects of phytonutrients, fiber and vitamins and minerals naturally found in food.  Research also dismisses the need to take additional amounts of antioxidant vitamins such as vitamins A, C and E as they do not appear to improve health outcomes as previously thought.

2. Is there any harm in taking them?  It is one thing if multivitamins don’t prevent disease but another if they are actually bad for health.  While most research shows no adverse effects of taking multivitamins, there are potential problems with getting too much, especially given the fact that many food products are fortified, including cereals, bars and drinks. 

While adequate folic acid in one’s diet is good for health, too much may not be good.  Some studies suggest that too much folic acid may increase the risk of cancers, especially colon cancer.  A recent Swedish study revealed that in a small sub-set of women, high folic acid blood levels increased breast cancer risk.  Research has also shown that supplementing with beta carotene increases the risk of lung cancer in smokers.

It’s important to note that the research in this area is far from conclusive and studies contain many inconsistencies.  There’s simply too much researchers don’t know about the combination of supplements people take and how they affect health.   The key is to aim for a healthy, varied diet and avoid excess amounts of vitamins and minerals through fortified foods and supplements.   

3. Am I (or my kids) missing out on key nutrients? The 2010 Dietary Guidelines Report acknowledges that multivitamins and supplementing with key nutrients are beneficial for certain populations.  The main reason for taking a supplement should not be for insurance, but to address key nutrients that are lacking in one’s diet.  Here are some tips to help you decide:

• Two recent studies showed most infants, toddlers and preschoolers get most adequate nutrition through food (except vitamin D). If children eat a variety of food, including fruits and (some) vegetables, they probably don’t need one.   Before giving kids multivitamins, check the amount of vitamins and minerals that come from fortified products.  Some children under 3 may benefit from a multivitamin with iron if they eat little meat and iron-fortified cereals. 
• The Center for Science for Public Interestrecommends men and post-menopausal women who consume multivitamins take them every other day so they don’t get too much folic acid.  On the other hand, women capable of becoming pregnant should take a multivitamin with 400 mcg of folic acid daily to lower their risk of having a baby with neural tube defects.
• Most people need additional vitamin D because the primary source is the sun.  Adults can get their blood levels checked at a routine physical and supplement if needed.  The AAP recommends that kids consuming less than 4 cups of milk daily take a supplement with 400IU daily.

 In my next series, I’ll address key nutrients that are most likely to be missing in your family’s diet, making the decision to supplement much easier.  Not knowing if your child is meeting his or her nutritional needs is unnerving so the goal of the series is to give you peace of mind.

Got any questions about this sticky topic of multivitamins?  Leave them in the comments.

References
2010 Dietary Guidelines Report

Shaikh U, Byrd RS, Auinger P. Vitamin and mineral supplement use by children and adolescents in the 1999-2004 National Health and Nutrition Examination Survey: relationship with nutrition, food security, physical activity, and health care access. Arch Pediatr Adolesc Med. 2009 Feb;163(2):150-7.

Ericson U, Borgquist S, Ivarsson MI, Sonestedt E, Gullberg B, Carlson J, Olsson H, Jirström K, Wirfält. Plasma folate concentrations are positively associated with risk of estrogen receptor beta negative breast cancer in a Swedish nested case control study. J Nutr. 2010 Sep;140(9):1661-8.

Okay, I lied. I decided to post one more meal plan before the big move which is being delayed a bit.

That beautiful picture is a pumpkin I carved all by myself. Thanks to a stencil kit and my helpful mother- in-law, it wasn’t that hard (I’m not very good at this stuff). We had the pumpkin with dinner last night and it was so tasty.

This week I’m trying a couple of new recipes. My friend Dan sent me a recipe for roasted cauliflower and pasta and the breaded fish dish is another attempt at including another fish besides salmon. I’m working Thursdays now so will make that slow cook day. I plan to freeze some of the leftovers from the spaghetti for our move week.

For more meal plans see Org Junkie.

What’s Cooking This Week?

Monday: Chicken and Bean Quesadillas with salsa and guacamole

Tuesday: Pasta with Roasted Cauliflower, bread and fruit salad

Wednesday: Baked breaded white fish (6 O’Clock Scramble Newsletter), roasted butternut squash, bread and salad

Thursday: Slow cooker spaghetti,green beans with Parmesan and bread

Friday: Leftovers/potluck

Challenges — pushing limits
My daughter just turned four and has been testing limits at home in everything from what she wears to what she eats. She is trying to get a rise out of me — and sometimes she succeeds.

She used to like peanut butter and now she doesn’t. She used to eat my fruit and veggie muffins and now she doesn’t. She makes a point to shun the fruit I put out at breakfast (but still eats it for a snack and with lunch). She used to eat broccoli and now can’t stand the smell and calls it “gross.”

I admit to letting this get to me. I try not to let it show but kids have a sixth sense about these things. It’s seems the more I want her to eat something, the less interested she is.

Times like this make following the division of responsibility extremely difficult. But the truth is I can’t make her eat anything. And the more I make it an issue, the longer the stage will last.

I totally understand the temptation parents face to give in and only give kids the items they know they’ll eat. But I think this is more for the parents benefit than the child’s. You see, my daughter doesn’t have a problem with the food I provide her. I’m the one having a problem with what she’s choosing to eat, which given her young age and previous history is VERY likely to change.

If I chase her “food preferences of the month” than she will learn that mommy only serves what she likes. So I stay in the middle — provide her with the foods she likes while giving her the opportunity to eat other foods.

I guess what I’m trying to say is I’m not immune to feeling insecure and doubtful of myself when it comes to feeding my kids. But I really do try to focus on what counts the most — providing my child with a variety of nutritious and good tasting foods in a pleasant environment. Forcing, pressuring and manipulating will only backfire, which is the perfect segue to our next topic…

News — smarter lunchrooms
A couple of weeks ago the USDA announced it will be funding the Cornell Center for Behavioral Economics in Child Nutrition Program. The co-directors, Brian Wansink and David Just, will work to find easy, low-cost solutions for making school lunchrooms smarter by using theories of behavioral economics.

Their research shows that simply re-arranging where food is placed in a cafeteria has significant results. One school in upstate New York increased the consumption of salads by almost 300% by moving the salad bar near the check-out line. Another school increased fruit sales by 105% by making apples and oranges more visible by putting them in attractive baskets in a well-lit area. For more on these amazing case studies see Smarter Lunchrooms.

I believe this approach is much better than banning foods and mandates for serving “healthy” options which naturally makes kids want to rebel. As I talked about in my helping kids eat healthy postI interviewed Wansink, we can do these same type of things in our home by making healthier options more accessible and attractive.

Wansink sums it up nicely by saying…”Food isn’t nutritious until it is eaten. We don’t improve school lunches by making children take healthier items. When forced upon them, children will resist and dislike not only the heavy-handed approach, but the food associated with that heavy hand. We improve school lunches by nudging children to make the right choices on their own. That way, when they take the apple instead of the cookie, it was their idea.”

This gets to the idea that I often stress on this blog: how we feed kids is just as important as what we feed them. None of the proposed solutions involve new recipes, expensive equipment or major revamps. It’s simply changing how food is offered.

So what do you think? Do you agree with these changes? Anyone from school nutrition have any thoughts?

This may be my last weekly meal plan for the rest of the month — and part of November too.  We will be moving into our new place by the 1st of November and I’m going to be getting to work (I really, really, really want to use this move to get organized). 

That means it will be super-simple meals for our family.  Our new place’s kitchen may not even be ready by the time we move in so we may have to rough it.  But when it’s done it will be nice.

I’m trying some new meals this week.  I’m going to make bean and rice burritos and freeze some for easy lunches.  I’m also going to finally make baked chicken nuggets.  My 4-year old really likes breaded chicken so we’ll see if she goes for the homemade version.  And I found this easy recipe for lentil soup with kale for slow cooker day. 

Don’t forget to check out Org Junkie for more weekly meal plans around the web.

What’s Cooking this Week?

Monday: Bean, Rice & Cheese Burritos

Tuesday: Baked chicken Nuggets,sweet potatoes and green beans with parmesan cheese

Wednesday: Marinated Wild Salmon, mac and cheese and broccoli

Thursday: Slow Cooker Lentil soup, bread, green salad and fruit

Friday: Leftovers/potluck

American Academy of Pediatrics (AAP) Iron Recommendations

One of my goals with this site is to keep my readers informed of the latest public health recommendations.  Last week the AAP released its new policy statement on iron for infants and toddlers.  This report is a revision of their 1999 statement on iron-fortified infant formulas.  The AAP regularly publishes policy statements on nutrition-related topics.  

Background

Even though Iron deficiency (ID) and iron deficiency anemia (IDA) has decreased significantly since 1970, it’s still common in infants in toddlers.  While there are no statistics for children under 12 months of age, according to the AAP report, 6.6% to 15% of toddlers (1-3) may be iron deficient. 

The problem is both ID (iron deficiency without anemia) and IDA (more severe form — iron deficient with anemia) are believed to adversely affect long-term neurodevelopment and behavior that is sometimes irreversible.  That means a child is at risk for not developing normally those critical first years of life.

When babies are born, 80% of the iron stored in their bodies is accumulated in the third trimester. So premature babies, anemia during pregnancy, maternal hypertension with intrauterine growth restriction and gestational diabetes all can cause babies to be born with less-than-adequete  iron stores. 

Healthy term infants with ideal circumstances have iron stores to last them the first 4-6 months of life.  The RDA during the first 6 months is quite low, .27mg/day.  This jumps to 11mg from 6 months to 1 year and then goes back down to 7mg from ages 1-3.

In the first year of life babies go through phenomenal growth where their weight almost triples.  Iron is essential as it transports much-needed oxygen to cells in the body.  While it is absorbed well, the amount of iron in breast milk is not enough to support the rapid growth that takes place when iron stores begin to dwindle.   According to the AAP, iron in breast milk is highly variable and there is no guarantee that it will meet the needs of the baby long term.

AAP Recommendations

The AAP’s aim with the following recommendations is to help prevent ID and IDA from happening in the first place.  Remember to check with your pediatrician.

Preterm Infants (born <37weeks gestation): Should be get 2mg iron/kg* body weight, starting at 1 month and extending through 12 months.  Iron-fortified formula meets these needs but breastfed babies will need to supplement with this amount until they are weaned to formula or can get enough through complementary food.

Term breastfed or partially breastfed infants: Breastfed babies will need to supplement with 1mg iron/kg weight starting at 4 months until iron-rich complementary foods can be started.  Many health organizations recommend waiting until babies are 6 months before starting solids.

Infants 6-12 months: Babies need 11mg of iron from iron-fortified cereals, red meat and vegetables high in iron (see list below).  Whole milk should not be introduced until one year due to its low iron content.

Toddlers 1-3: If unable to get the recommended amount of iron (7mg/day), parents can give liquid supplement or multivitamin with iron.

Screening at one year: AAP recommends pediatricians screen for iron deficiency at one year.  Make sure to check with your doctor at your child’s one year well visit or at any other doctor’s visit if you suspect your child is at risk for iron deficiency.

*to figure out weight in kg divide weight in pounds by 2.2

What do I think?

I think these recommendations are reasonable.  If you have a child under three, become familiar with the iron content of foods and try to meet their needs.  I will be discussing more about this in my upcoming series on helping kids meet their nutrient needs. 

Below is a chart that is in the public AAP paper with iron content of common foods for babies and toddlers along with sources of vitamin C that increase absorption.  It’s especially important to include vitamin C sources if baby is receiving iron from vegetable sources (non heme) as those aren’t absorbed as well. 

Got any questions?  Leave it in the comments!

Amount of Iron in commonly eaten foods — from the American Academy of Pediatrics Clinical Report

Baby food, heme iron (better absorption)
Baby food, lamb, junior, 1 jar (2.5 oz) 1.2
Baby food, chicken, strained, 1 jar (2.5 oz) 1.0
Baby food, lamb, strained, 1 jar (2.5 oz) 0.8
Baby food, beef, junior, 1 jar (2.5 oz) 0.7
Baby food, beef, strained, 1 jar (2.5 oz) 0.7
Baby food, chicken, junior, 1 jar (2.5 oz) 0.7
Baby food, pork, strained, 1 jar (2.5 oz) 0.7
Baby food, ham, strained, 1 jar (2.5 oz) 0.7
Baby food, ham, junior, 1 jar (2.5 oz) 0.7
Baby food, turkey, strained, 1 jar (2.5 oz) 0.5
Baby food, veal, strained, 1 jar (2.5 oz) 0.5

Commercial baby food,a nonheme iron
Baby food, green beans, junior, 1 jar (6 oz) 1.8
Baby food, peas, strained, 1 jar (3.4 oz) 0.9
Baby food, green beans, strained, 1 jar (4 oz) 0.8
Baby food, spinach, creamed, strained, 1 jar (4 oz) 0.7
Baby food, sweet potatoes, junior (6 oz) 0.7

Cereals
Baby food, brown rice cereal, dry, instant, 1 tbsp 1.8
Baby food, oatmeal cereal, dry, 1 tbsp 1.6
Baby food, rice cereal, dry, 1 tbsp 1.2
Baby food, barley cereal, dry, 1 tbsp 1.1

Table food, heme iron
Clams, canned, drained solids, 3 oz 23.8
Chicken liver, cooked, simmered, 3 oz 9.9
Oysters, Eastern canned, 3 oz 5.7
Beef liver, cooked, braised, 3 oz 5.6
Shrimp, cooked moist heat, 3 oz 2.6
Beef, composite of trimmed cuts, lean only, all grades, cooked, 3 oz 2.5
Sardines, Atlantic, canned in oil, drained solids with bone, 3 oz 2.5
Turkey, all classes, dark meat, roasted, 3 oz 2.0
Lamb, domestic, composite of trimmed retail cuts, separable lean only,
choice, cooked, 3 oz 1.7
Fish, tuna, light, canned in water, drained solids, 3 oz 1.3
Chicken, broiler or fryer, dark meat, roasted, 3 oz 1.1
Turkey, all classes, light meat, roasted, 3 oz 1.1
Veal, composite of trimmed cuts, lean only, cooked, 3 oz 1.0
Chicken, broiler or fryer, breast, roasted, 3 oz 0.9
Pork, composite of trimmed cuts (leg, loin, shoulder), lean only, cooked, 3 oz 0.9
Fish, salmon, pink, cooked, 3 oz 0.8

Table food, nonheme iron
Oatmeal, instant, fortified, cooked, 1 cup 14.0
Blackstrap molasses,b 2 tbsp 7.4
Tofu, raw, regular, 1⁄2 cup 6.7
Wheat germ, toasted, 1⁄2 cup 5.1
Ready-to-eat cereal, fortified at different levels, 1 cup _4.5 to 18
Soybeans, mature seeds, cooked, boiled, 1⁄2 cup 4.4
Apricots, dehydrated (low-moisture), uncooked, 1⁄2 cup 3.8
Sunflower seeds, dried, 1⁄2 cup 3.7
Lentils, mature seeds, cooked, 1⁄2 cup 3.3
Spinach, cooked, boiled, drained, 1⁄2 cup 3.2
Chickpeas, mature seeds, cooked, 1⁄2 cup 2.4
Prunes, dehydrated (low-moisture), uncooked, 1⁄2 cup 2.3
Lima beans, large, mature seeds, cooked, 1⁄2 cup 2.2
Navy beans, mature seeds, cooked, 1⁄2 cup 2.2
Kidney beans, all types, mature seeds, cooked, 1⁄2 cup 2.0
Molasses, 2 tbsp 1.9
Pinto beans, mature seeds, cooked, 1⁄2 cup 1.8
Raisins, seedless, packed, 1⁄2 cup 1.6
Prunes, dehydrated (low moisture), stewed, 1⁄2 cup 1.6
Prune juice, canned, 4 fl oz 1.5
Green peas, cooked, boiled, drain, 1⁄2 cup 1.2
Enriched white rice, long-grain, regular, cooked, 1⁄2 cup 1.0
Whole egg, cooked (fried or poached), 1 large egg 0.9
Enriched spaghetti, cooked, 1⁄2 cup 0.9
White bread, commercially prepared, 1 slice 0.9
Whole-wheat bread, commercially prepared, 1 slice 0.7
Spaghetti or macaroni, whole wheat, cooked, 1⁄2 cup 0.7
Peanut butter, smooth style, 2 tbsp 0.6
Brown rice, medium-grain, cooked, 1⁄2 cup 0.5

Vitamin C Sources to Increase Iron Absorption

Citrus fruits (eg, orange, tangerine, grapefruit) Green, red, and yellow peppers, Pineapples, Broccoli, Fruit juices enriched with vitamin C, Tomatoes, Strawberries, Cabbages, Cantaloupe, Potatoes, Kiwi, Leafy Green Vegetables, Raspberries, Cauliflower

No doubt you’ve heard about the harmful effects that BPA (Bisphenol-A) can have on health. As a busy parent you’re probably concerned but may be overwhelmed with yet another health hazard to watch out for.

It’s important to consider the evidence when looking beyond the hype of potentially harmful additives. Is BPA really that bad? And should you be taking extra steps to protect your family?

I hope to give you some answers by providing an overview of the potential risks of BPA, what’s being done to determine its safety and super easy ways to make your family BPA free (well, almost).

What and where is it? BPA is a chemical used to make polycarbonate plastics and is found in epoxy resins, the lining of metal based food and beverage cans. As a result, it’s found in canned products and any item made with polycarbonate plastics such as food and drink packaging, food storage containers and water and baby bottles. Since the 1960s the FDA has allowed the use of BPA under its food additive regulation.

What are the risks? Until recent years the FDA has considered BPA safe. But results of recent animal studies, with BPA intakes similar to human consumption, have brought up the question of safety. The National Toxicology Program (NTP) reviewed the weight of the evidence and decided there was some concern for BPA’s effects on the brain, behavior, and prostate gland in fetuses, infants, and children at current levels of consumption (see chart).

The report concludes that many of the studies are conflicting and that the uncertainties of BPA’s safety remain. There’s a lack of human studies — and there are limitations when extrapolating results of animal studies to humans. So this doesn’t mean BPA isn’t safe, but there’s more research that needs to be done.

What’s being done? The FDA and NTP are calling for in-depth studies to clarify the risks of BPA. In the mean time, the FDA supports the effort to stop making BPA-containing baby bottles and feeding cups, and is looking for alternatives to replace BPA in products. See this report for more details.

How to reduce your family’s exposure: The 2003-2004 National Health and Nutrition Examination Survey (NHANES III) found detectable BPA levels in 93 percent of 2317 urine samples (age 6 and older). Until we have more answers it makes sense to reduce exposure to BPA, especially in young children who are more vulnerable.

So here are four easy ways get your family on the road to being BPA free. The added bonus? Many of these changes are also good for the environment.

1. Switch from plastic food storage to glass: Before having kids I never had to worry about leftovers. But it seems almost every night my husband and I are packing away some of our dinner. These make great lunches or even repeat dinners.

Switching to glass storage like Pyrex is a win win. It’s just nicer to store food in glass because it doesn’t absorb the odors the way plastic does. Oh, and it’s BPA free.

And if you are still using plastic, never microwave food in it because the heat causes BPA to leach into the food.

2. Reduce your use of canned goods: Now this is a tough one. There are many healthy canned items such as beans and tomatoes. Look for products that are boxed instead of canned like these Pomi tomatoes pictured and broth.

But the reality is that many soups and beans are still canned. One of my goals is to make more beans in the slow cooker and freeze them as Stephanie suggests at A Year of Slow Cooking. And let’s face it, soup just tastes better when it’s homemade (again, perfect for the slow cooker).

And if you’re feeling really adventurous you can “can” your own food in glass jars. Simple Bites has some great posts on how to do it.

3. Choose stainless steel water bottles: Make the switch to a BPA-free water container like stainless steel over hard plastic and water bottles. I like stainless steel because it’s durable and many of the tops actually seem to keep the water from leaking.

4. Choose “BPA free” products:While many baby bottles and sippy cups are BPA free, make sure “BPA free” is on the label or on the bottom of the cup. Companies are not required to tell consumers which of their products have BPA — but when you see the BPA free label you know it’s free of the chemical.

You can also check the bottom of the container to look for the number 7 which may indicate it contains BPA (some controversy about this). For more BPA free products check out The Soft Landing page and for top BPA free products in the grocery store see this article.

As new changes in regulations come about I’ll be sure to keep you informed. So tell me, have you been avoiding BPA for a while or are you new to all of this?