Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

We often hear about overweight and obesity in children, but underweight, or slow weight gain can also be a cause for concern.  This week, Registered Dietitian Amy Braglia-Tarpey discusses the importance of including healthy fats in your child’s diet to manage the challenge of underweight.

Amy Braglia-Tarpey, MS RD B.A. in Psychology from the University of Arizona M.S. in Nutritional Science from California State University, Long Beach Registered Dietitian, Certified Nutrition Support Clinician,  and Board Certified Specialist in Renal Nutrition Worked as a clinical dietitian at Salinas Valley Memorial Hospital , with over 10 years of experience working in the field of nutrition Expert in nutrition support and nutrition for Chronic Kidney Disease Twitter: @RD4Change LinkedIn Profile Contact via email – ATarpeyRD@gmail.com

Question: I have a very underweight toddler. What are the best ways to add calories to food? I am often told to add cream, olive oil, or butter, but that just doesn’t seem healthy.

Answer:

Many parents are concerned about the quantities and amounts of fats their children are consuming.  Fear of fat has been instilled in us due to recommendations by the American Heart Association to reduce total fat, saturated fat, and cholesterol in our diets.  However, this advice is meant for adults, and is currently under scrutiny as research provides new information about the roles of different fats in our health.  Children require more fat in their diets than adults to support growth.  Moreover, the type of fat is more important than the overall quantity in most cases.  In pediatric underweight, adding calories for growth is extremely important.  Because fat provides more calories per gram than carbohydrate or protein, adding more to the diet is the most efficient strategy to promote weight gain.

In humans, fats are essential for building the membranes of cells.  In childhood, a balance of saturated, polyunsaturated, and monounsaturated fats is necessary to give new cells structure.  Without any one of these components, cell membranes can become too rigid or weak.  Therefore, some quantity of each of these types of fats should be provided by the child’s diet.

While it is true that the majority of calorie additions should come from monounsaturated and polyunsaturated fats, saturated fats in moderate quantities can add calories as well as palatability.  Monounsaturated fats are found primarily in plant oils, although meat fats contain some as well.  Olive and canola oils, avocado, and almond butter are good sources of monounsaturated fat.  Most polyunsaturated fats come from plant oils as well, and appear in the largest quantities in vegetable oils such as soybean oil.  Another type of polyunsaturated fat, Omega-3 fatty acids, are abundant in fish and marine oils, as well as flaxseed and walnuts.  Saturated fats in the diet come mostly from meats and dairy, although smaller amounts are present in vegetable oils.

Adding calories to aid in weight gain can be quite challenging.  Some calorie-dense foods are not well-tolerated by children, and some are rejected due to individual tastes.  If there is an underlying disease or condition that is preventing weight gain, it may be difficult to find calorie additions that adhere to the restrictions of the child’s diet.  Here are some suggestions for healthful calorie additions:

• Avocado- Add to sandwiches, wraps, and soups.  Spread on toast as you would butter, or make guacamole as a dip for veggies, crackers, and bread.
• Almond or peanut butter- Add to hot cereals such as oatmeal.  Use instead of butter when making cookies, spread on bread or crackers.  Freshly ground flaxseeds can also be mixed into cereals.
• Stir extra olive oil or canola oil into soups.  Canola oil has a neutral flavor and can be added to most cooked as well as baked goods.
• Drizzle olive oil over fish, chicken and pork.   Add olive oil to pastas, sweet potatoes, and other side dishes.  Make pesto, a calorie-dense blend of olive oil, nuts, and herbs (cheese optional).
• Cheese is a great source of protein, calcium, and phosphorus, as well as calories.  Kids love it!  Try string cheese for snacks, and stir cheese into casseroles and dips.  Melt it over eggs and vegetables.

Choose the majority of calorie additions each day from the above groups.  Cream may also be used, but with greater moderation.  ¼ cup of heavy cream supplies 200 calories, with one third of its total fat provided by mono- and poly-unsaturated types.  Use to add calories to cereals, soups, casseroles, and scrambled eggs.

What has worked for you? Share your experience in comments below.

©2010 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

Ask The Expert is a weekly column on Littlestomaks.com. The idea is to have a reader-submitted question answered by a nutrition expert or a pediatrician. Feel free to submit your question in the comments section below.

This week, Registered Dietitian Elizabeth Rahavi describes why omega-3 fats are essential for children and how you can include them in your child’s diet.

Question: Is Omega-3 proven to be helpful for children? Are there any concerns I should be aware of?

Answer:

Fat is an important yet often overlooked nutrient that is needed for an overall healthful diet. In fact, a certain type of omega-3 fat known as linolenic acid is essential for healthy growth and development in children. According to the latest Dietary Guidelines for Americans report, released in 2005, children are encouraged to get most of their fats from unsaturated fats, including omega-3 fats. Food sources of omega-3 fats include soybean and canola oil, flaxseed and flaxseed oil, walnuts, and fish such as salmon, trout, and herring. For people who do not like fish, certain eggs, milk and other products have been reformulated to include omega-3s.

While fish is an important part of a healthy diet, and many organization such as the American Heart Association recommend consuming fish at least twice a week. The U.S. Food and Drug Administration (FDA) and U.S. Environmental Protection Agency (EPA) recommend that young children avoid certain species of fish such as swordfish, shark, tilefish and king mackerel and limit their consumption of other fish to an average of 12 cooked ounces per week (that’s about two six ounce servings of fish per week). The reason for this recommendation is that, while nearly all fish contain some trace amounts of methylmercury, an environmental contaminant, large fish that are higher up in the food chain such as swordfish, shark, tilefish and king mackerel contain the most. Excess exposure to methylmercury from these species of fish can harm a young child’s developing nervous system. For most people, the risk from mercury by eating fish and shellfish is not a health concern.

What’s next?
One thing that is often over looked in conversations about nutrition is that, indeed it is a science. To help provided consensus on the state of nutrition science, the United States Department of Agriculture and the Department of Health and Human Services enlist a group of nutrition and food scientists to serve as members of the Dietary Guidelines for Americans Advisory Committee. The Committee comes together every five years to develop a report that makes nutrition recommendations for all Americans ages 2 years and older. This Advisory group is currently in deliberations, and we look forward to an upcoming review of the state of science for dietary fats that is scheduled to be released next year.

©2009 Littlestomaks.com. All Rights Reserved

Disclaimer – Information provided in Ask The Expert column on Littlestomaks.com is intended to give you general guidance on a question related to toddler nutrition. It is not meant to be treated as medical advice. You are welcome to contact this expert for a detailed consultation on your specific situation to determine what actions, if any, you should take regarding nutrition and health of your toddlers. We do not recommend you to take any action based solely on the information presented in this column. Experts have agreed to provide their professional opinion on toddler nutrition related questions on a voluntary basis and no compensation is offered to them by Littlestomaks.com.

The word “fat” has become such an awful thing that everybody wants to get rid of it! Believe it or not, we can’t live without it even though so many of us are walking around with so much of around our waistlines. That is why, when one of my readers asked me to consider writing a post on healthy fats for children, I was immediately hooked on the idea. Here is a summary of what I found in my research from various sources. Leave a comment if you would like to know more about anything specific or if you want to suggest a topic for me to research and write about.

Why fats?

Fats are a very important part of diet, especially for growing children, because they serve many functions -

• supply energy (2 times as many calories as carbohydrates and proteins for the same weight)
• build tissues, especially brain tissue which is 60% fat
• dissolve vitamins A, D, E and K for absorption in the body
• protect the body from shock, maintain temperature
• maintain healthy skin and hair
• all cells have a fatty outer layer which controls what goes in and what goes out

What are fats?

Chemically, fats are long, chain-like molecules containing a “backbone” of glycerol and “side-links” of fatty acids. They are also called triglycerides.

A triglyceride molecule (wikipedia)

Glycerol, commonly known as glycerin, is a small molecule containing carbon, hydrogen and oxygen. It has three hydroxyl functional groups, which make it soluble in water. The fatty acids, on the other hand, are longer chains containing carbon and hydrogen with an acid functional group at the end. They are not soluble in water. When glycerol and fatty acids combine, the acid group from the long chain fatty acids attaches with the hydroxyl groups on the glycerol to make a strong chemical bond. Because glycerol has three hydroxyl functional groups, three chains of fatty acids can combine to form a triglyceride. You can imagine a triglyceride molecule in the shape of a capital letter E as shown in this molecular model. You may have heard your doctor talk about the amount of your triglycerides after doing a blood test.

The exact chemical nature of the long-chain fatty acids linked to the glycerol backbone determines the overall nature of the fat molecule. Fats can be solids or liquids, saturated or unsaturated, trans or cis depending on the size and structure of these chains. You may have heard these different types of fats:

• Unsaturated fat – the chemical bonds between the carbon atoms of the fatty acid chains in unsaturated fats are double bonds. Double bonds are less stable, which means that unsaturated fats can be “broken” more easily by oxygen. Since the fatty acid chains can have a lot of carbon atoms, there can be one or more double bonds in these chains. Generally, unsaturated fats are in a liquid form at room temperature, that is why they are also known as oils. Oils from plants and nuts contain mostly unsaturated fats.
• Monounsaturated fat – these fats have only one double bond.
• Polyunsaturated fat – these fats have more than one double bond.
• trans fat - when double bonds are present in a fat molecule, the structure of the fatty acid chains can be either straight or kinked because of the arrangement of carbon and hydrogen atoms around the double bonds. In trans-fat, the chain is more straight compared to the other type called the cis-fat. As a result, the trans fats have a higher melting point and are usually solids at room temperature or even body temperatures. Cathy from A Life Less Sweet has written an excellent post on trans fats if you would like to learn more.
• Saturated fat – when there are no double bonds in the fat molecule, it is called a saturated fat. Dairy and meat products contain some of the natural fats. Most of the saturated fat in food products comes from hydrogenation of unsaturated fats.
• Omega-3 and omega-6 fatty acids – these are called essential fatty acids because the human body cannot make them, therefore they need to come from the diet. Example of omega-3 fatty acids are: ALA (alpha-linolenic acid), EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Linoleic acid is an example of omega-6 fatty acids.

How much fat?

Here are some guidelines from the American Heart Association and the USDA -

• Children under the age of 3 should get about 30 – 35% of daily calories from fats
• Children between 4 – 18 years old should get about 25 – 30% of daily calories from fats
• Adults should get about 20 – 35% (preferably closer to 20%) of daily calories from fats

Each gram of fat contains about 9 calories, so a 2000 calorie diet should not have more than 67 g of fat for the 30% requirement. Active kids between 2 – 5 years old, who need about 1600 daily calories, should get about 55 g of fat.

Even though both omega-3 and omega-6 fatty acids are essential, too much of omega-6 and too little of omega-3 is also not good. In the modern meat-rich diet, the ratio of the two is about 20 to 1, which is much higher than the 2:1 recommended ratio.

What types of fats are good?

Simply put, select foods with unsaturated fats and essential fatty acids and stay away from saturated fats and trans fats.

Here are a few sources of “good” fats -

Monounsaturated fats – nuts, olive oil, canola oil, avocado

Polyunsaturated fats and fatty acids – plant oils (watch out for partially hydrogenated oils, see below), nuts, fish, flax seeds or powder, sunflower seeds, grass-fed beef

What types of fats should I avoid?

Some saturated fat is ok (about 10% of daily calories), but trans fat is a big no-no. The best way to check if trans fat is present in the food is to look for “partially hydrogenated” oils in the list of ingredients. Don’t fall for the zero trans fat on the nutrition facts panel because FDA allows it if the level of trans fat is less than 0.5 g per serving.

Here are a few sources of saturated and trans-fats- Cheese, beef, whole milk, baked foods, margarine, chips, fried foods, eggs, poultry.

Here are a few good resoures for further reading if you are interested:

Fear not the healthy fats – Seattle’s Child Magazine

2005 dietary guidelines for Americans – USDA, Dept of Health & Human Services

fat, trans fat, omega-3 fatty acid, essential fatty acid – Wikipedia