This is a guest post by registered dietitian Susan Dopart. Check out her excellent book A Recipe for Life for more tips and recipes.

photo credit: Www.CourtneyCarmody.com/
Recent studies reveal children with heart disease are not as unusual as you might expect.  Artery autopsies done on children who had fatal accidents showed the presence of fatty streaks.

Although I had knowledge of this phenomenon it still came as a shock to fathom children having fatty streaks and blockages in the arteries.  Isn’t that only supposed to happen to older adults?

Times have changed but I have to wonder if the current philosophy of feeding our youth needs an adjustment.  Where does the solution start?  Will pediatricians start prescribing statin drugs for children to fix the problem of unbalanced eating and inactivity like they do in adults?

Los Angeles Times article “A Sticking Issue with Kids” discusses the Center for Disease Control report which showed that cholesterol abnormalities – i.e. high bad cholesterol and low good cholesterol values – are far more common in children than in past times, particularly overweight children.  The article questioned whether we should start checking children’s cholesterol panels.  Pediatrician’s views are mixed.

When do we start looking at the cause rather than the symptom?  Taking control of our youth’s health and happiness is having time for family dinners, cooking at home, and making meals from whole unprocessed foods.

Our bodies are happy to get rid of bad cholesterol and avoid making plaque when we feed them “clean’ foods in their natural forms.  I hear from parents – “they only want pizza, burgers and fries.”  Who’s controlling the food?  When I was growing up I ate what was served without too many questions.

If I did not like a particular item served I was encouraged to have a few “no thank you” bites.

Many children have aversions to vegetables since they can have strong flavors.  Have your child try a “no thank you” serving each time a different vegetable is served.  A “no thank you” serving is having a bite or two (one or two teaspoons) of something they do not particularly enjoy.

Eating a bite or two of food that is foreign or not to their tastes can change the way they feel about that food over time and starts the conditioning process that nutritious food comes from the ground and not in a package.

Having whole fruits cut up with interesting additions helps satisfy the taste for sweet with natural foods.  Here are some ideas to try:

Healthy Snack Alternatives

1.  Mix vanilla and plain yogurt together and add nuts, sunflower seeds or Healthy Nut Mix
2.  Cheese and apples slices
3.  Hummus and carrots
4.  Sliced apples with spreadable cheese and dried cranberries on top
5.  Celery with natural peanut butter or sunflower butter and a few raisins on top

These healthy snacks can set the tone or change the norm of grabbing processed packaged foods.

Running around on the weekend with our kids and engaging them in outdoor activities is also essential to keeping their little arteries supple and healthy.

It’s not too late to start now.  Even if your child is overweight and has high cholesterol studies show a turnaround is possible in as little as 2 weeks.  The body responds quickly to dietary changes.

©2010 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.

Thinking about introducing your little one to fish and other seafood but worried about food allergy? Check out these handy tips from Registered Dietitian Keri Gans!

Question: We want to introduce our 2 year old to fish and other seafood. What should we be worried about? Are there any safe seafood we can try first?

Answer:

The good news is that as of January 2008 the American Academy of Pediatrics declared that there is no convincing evidence that delaying any food beyond 4 to 6 months reduces the risk of developing an allergy to it. So even though fish is one of the top eight allergenic foods, no need to worry, it is definitely time for your 2-year old to start enjoying it.

What is important to remember is that fish and shellfish are an important part of a healthy diet. They contain high quality protein and other essential nutrients that are low in saturated fat. The Omega 3 fatty acids found in fish are considered beneficial for cardiovascular health and preliminary research suggest they can enhance brain development and improve learning, behavior and vision. The American Heart Association currently recommends recommending two servings 2-3 ounces of fish a week for children as an early prevention of cardiovascular disease.

Follow these recommendations for your young child:

1. Do not serve shark, swordfish, king mackerel or tilefish because they contain high levels of mercury.
2. Ok for your child to eat up to 12 ounces a week of a variety of fish and shellfish that are lower in mercury, such as shrimp, canned light tuna, salmon, pollock and catfish.
3. Serve no more than 6 ounces of fresh or canned albacore (white) tuna. They have more mercury than light tuna.
   Make sure your fish is thoroughly cooked to avoid food borne bacteria and viruses.
4. Buy fish from reputable sources.
5. Introduce only one type of fish at a time.

After introducing any new food in your child’s diet wait 3 days until moving on to another food. Watch for signs of a food allergy, swelling of the tongue, lips or face, skin rash, wheezing, abdominal cramping, vomiting or diarrhea. If symptoms appear call your doctor right away.

Also remember that you are a food role model for you child. If they don’t see you eating fish they will not grow up eating fish. There is also no need to try and disguise the fish, by heavily breading and frying it. Serve it to them just as you would yourself, hopefully that is grilled, broiled or baked.  I remember when my niece was around 3 years old….she loved tilapia, but thought she was eating chicken.

Great resources on seafood:
Environmental Protection Agency
Seafood WATCH
Kid Safe Seafood

©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.

For this week’s Ask the Expert, I asked Registered Dietitian Elisa Zied, MS, RD, CDN, to share one of her video tips for kids. She is the author of Nutrition at Your Fingertips which just came out in November 2009 and is a “Go-to guide” according to More magazine. Her channel on YouTube has lots of great videos on nutrition tips for both adults and kids; check it out!

Elisa earned a bachelor of arts in psychology from the University of Pennsylvania and a master of science in clinical nutrition from New York University.

She blogs at The Zied Guide. You can follow her on Twitter @elisazied.

Here are  few tips from this video to help you make healthy choices for your kids when eating out.

• Keep portion size small – limit sodium, fat, saturated fat and cholesterol
• Emphasize fruits and vegetables
• Lean meats, chicken without breading and unfried
• Share “grown up” food – lead by example and pick healthy choices
• Soups and salads may be a hit with kids – give ‘em a try
• Look up calorie information if available – 400- 500 calorie for a little kid is perfectly fine

Enjoy and eat healthy!

©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.

Remember Louis the Lifeguard who rescues a potato from drowning in sour cream? This goes back to the ’80′s and I stumbled upon it by chance. Not having grown up on the USA, I can’t claim to have watched it at that time. But the jingle is catchy and the idea very simple – that the food as cooked can taste just fine and there is no need to “drown” it in all kind of condiments.

We seem to have forgotten the advice of Louis the Lifeguard because the condiment industry has literally exploded since then. US is the biggest market with an estimated $11 billion in annual sales of all kinds of condiments and sauces. Condiments are a way of life these days, especially when it comes to fast food. No surprise then that Louis the Lifeguard has taken a prolonged vacation, probably never to return again! Who will save us from drowning now?

It is fine to use these condiments once in a while. Kids love to get messy playing with ketchup and mustard. Chips and salsa is must-have at any party.

But take a closer look – most of these condiments are loaded with sodium and some like sour cream and mayonnaise are full of fat and cholesterol. No wonder they taste so good on any food!

Sour cream -loaded with saturated fat and cholesterol, reduced fat versions hardly any better
Mayonnaise – fat, cholesterol and sodium
Ketchup – watch out for sugar and sodium
Mustard – high sodium
Pickle Relish, Hot Dog – high in sodium
Soy Sauce – super high in sodium
Salsa – high in sodium

(Source: Calorie Count)

When you prepare food from scratch, it is very easy to enhance the taste without having to rely on condiments. Give it a try! Check out our simple recipes, or share your own favorite in comments below.

Happy 4th of July! If you haven’t yet entered my Independence Day Giveaway, don’t miss out on a chance to win a $50 Target card! It is open until midnight EST tonight (July 3rd).

Here are 5 interesting nutrition stories of the week that caught my eye. Enjoy and drop a comment to let me know what’s on your mind.

30 states have 30% or higher childhood obesity rates

Scary statistics, and nothing to be proud of in my opinion. This data comes from a new report called F as in Fat – How Obesity Policies are Failing in America 2009 published by the Trust for America’s Health (TFAH) and Robert Wood Johnson Foundation (RWJF). Mississippi got the top honor for its 44% childhood obesity rate – that is nearly 1 in 2 children 10-17 years old is either overweight or obese. 8 of the 10 states with highest rates of childhood obesity are in the South. Another study of children 2-5 years old in low income families shows that nearly 15% of these children are obese compared to about 12% nationwide.  It is not that we don’t know the reason for this trend – children eat junk food, they spend too much time watching TV or in front of a computer, they don’t exercise, and schools are not up to standard when it comes to providing healthy meals. Still, nothing is being done about it, and seems like we have no control over the expanding waistlines of our children. Clearly, childhood obesity is a problem we need to confront with all our creativity and resources since it has terrible implications for the long term health of our nation.

Animal fats linked to pancreatic cancer

In another study linking saturated and trans-fats to cancer, researchers from the National Cancer Institute found positive association between pancreatic cancer and fats from red meat and dairy food sources. Why the cancer of the pancreas and not any other? One theory blames the enzymes produced by the pancreas in the digestion of these fats. Another idea is that diets high in saturated fats lead to insulin resistance and increase in the risk of Type 2 diabetes, which in turn increases the risk of pancreatic cancer. There is no reason to panic and stop eating fats – in fact there are healthy fats that I have written about recently. Unsaturated fats and essential fatty acids are good sources of fats and should be a part of your daily diet in the right amounts. Same goes for children since these healthy fats are needed to support their growth and brain development. Besides red meat and dairy sources, saturated and trans-fats are present in many of the packaged foods, so you should check the label carefully before buying them.

Walnuts can cut cholesterol

Researchers from Harvard’s Nutrition department analyzed data from published trials which compared the effect of walnut-rich diets against control diets to conclude that walnuts can decrease the total cholesterol and LDL cholesterol(“bad”) even over a short period of time. Other benefits were antioxidant and anit-inflammation capacity without any negative effects on body weight. Granted that this is based on a limited number of trials and subjects, and that there may be other factors involved. Still, can’t argue with the fact that walnuts are an excellent source of unsaturated fat and omega-3 fatty acids, so overall they are very healthy. We usually add walnuts to our salads at dinner each night, which is one way we have been able to include them in our daily diet without much preparation. Do you have a favorite walnut recipe you would like to share?

Try this nutty 4th of July fruit salad

I really liked this recipe for a coconut fruit salad from Jenna on her Food with Kid Appeal blog. The red (watermelon), white (coconut) and blue (blueberries) colors are quite appropriate for a July 4th celebration! Coconut meat (the white inside part of a mature coconut) is one of my favorites since I grew up on desserts made from it. It is soft, sweet and very chewy with a rich texture. Coconut milk is also very delicious; you may have heard about it being used extensively in Thai recipes. She provides a lot of great details about the nutritious value of coconuts even though they are high in saturated fats and suggests to use in moderation. Coconut oil is very rich in these fats; it is widely used for cooking and even skin care in India. Because of its nutritional value, coconut is part of almost every major religious ceremony in India and considered to be a a valuable fruit.

Good health comes in small bites

Another great article by one of my favorite bloggers and Pediatrician Dr. Ayala. In Small Bites for Health, she writes about a recent study which looked at the effect of bite size and the chewing time on the amount of food eaten in one sitting. Small bites resulted in lower food intake, in fact large bites resulted in volunteers eating nearly 100 g more (or about 100 extra calories in the chocolate custard used in the study) before they felt full. Also they ate more when they ate faster so that the each bite spent only 3 seconds in their mouth compared to the 9 seconds in the slow eating group. We are a fast-food nation where food is eaten on the go and big portions disappear in our mouths within seconds while driving at 60 miles an hour! No wonder an average American consumes 300 more calories today compared to 25 years ago. We seem to “need” to eat a lot more than actually needed before we feel full and satisfied. A simple trick like a small bites and good chewing can help us reduce the amount we eat. Grandma’s advice eat slowly with small bites is still so correct after all!

Enjoy your holiday weekend! And let me know what you think.

Photo source - Spiralz on Flickr
©2009 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

My son loves these organic cookies from Earth’s Best. “Cookie Monster” seems to be his favorite expression whenever he wants this snack. I have mixed feelings about this product. Although it is rich in iron, zinc and vitamins, and reasonably low in sugar, it’s overall fat content could be lower. Each serving is 9 cookies which gives 90 calories out of which 35 are from fat (that is quite high in my opinion ~ 40%). Also it has a lot of saturated fat. That is why we try not to give him too many of these cookies to snack.

We usually buy it from Earth’s Best Online store where 2 packages of 5.3 oz are listed at $5.18 and 6 packages at $14.76.

Overall, we are neutral on this product. However, we have not found a better alternative for these cookies yet. We are trying to get him to eat more fruits (his favorites are strawberries and blueberries).

What is your toddler’s favorite snack?

Imagine driving through a busy intersection that has no traffic lights. Instead there are boards showing the driving rules in large print that you must read and quickly understand so you can pass through safely. And to make things worse, every intersection has different rules even though the boards look pretty much the same from a distance. It would be a disaster!

I think this is exactly the case with food labels. They all look the same but they pack a lot of information that you are supposed to digest (pun intended!) so you can make a healthy choice. And remember, all the bad stuff is usually hidden in the fine print on the label! Let us say your grocery cart on your weekly shopping trip has about 50 different items. Even if you spend just 1 minute trying to figure out the food label, it would take you almost an hour just to read and understand the information. Add to that all the walking through the aisles you need to do to get everything on your list, and you can be sure to spend your entire Saturday afternoon in the store. And if you have a screaming toddler trying to jump out of the cart, then simply forget it! You will likely look for the same items and brands every week without even looking at the label.

Traffic lights work because they are simple and easy to understand. The red-yellow-green lights have become a part of our nature. This leads to automatic action, which by habit and practice, is the correct action (in most cases, unless you are drunk!). So why not use the same idea and make the decision-making simple when it comes to food shopping?

I was really excited to learn that this is exactly what many supermarkets in the UK have started doing for their store brands. The standard nutrition label has not gone away, rather there is a simple color chart on the front panel of the package showing in red-amber-green, the levels of fat, saturated fat, salt and total sugars. We know that if we want to eat a healthy diet, one of the key things we should be doing is trying to cut down on fat (especially saturated fat), salt and added sugars. The message from the traffic light label is simple and clear – choose foods that show more “greens” than “reds” if you are trying to decide between two similar products.

One of the early adopters of the traffic light labeling system recommended by UK’s Food Standards Agency (similar to our FDA) was the Sainsbury supermarket chain, which now has nearly 5000 of its own branded food products showing this front-of-pack multiple traffic light (MTL) nutritional labeling. Even better, they have now developed a new ‘Just for Kids’ multiple traffic light labelingspecifically for the nutritional requirements of children.  This is based on Guideline Daily Amounts (GDA) for 4-6 year olds. Not surprisingly, the consumer response has been overwhelmingly positive. In a recent survey, 92% of the customers found the MTL labeling easy to understand and 54% felt that MTL labeling, rather than the corresponding GDA approach, gave the“best at-a-glance indication of the healthiness of the food”. In another survey, they found that out of those aware of the MTL labeling, 57% said the symbol has helped them eat more healthy, with 17% saying it helped them eat ‘a lot more’ healthy. Clearly, the system works for most consumers.

Not everyone is equally excited of course. I was browsing through the comments on a blog post by Andrew Wadge of the FSA on this topic. Some find it too simplistic and arbitrary. Others see it as a tool to pressure the food industry to adopt a new labeling requirement. One particularly interesting criticism was that the color coding system does not work for color blind people!

Surely, this cannot be a substitute for the detailed nutrition information label. In addition to avoiding the bad stuff, we need to also look for the good stuff like proteins, vitamins and minerals. Still, I think that such a system, if adopted by the food companies here at home, could make life easier for us busy people. What do you think?

Here are a few links if you want to learn more:

1. A detailed overview on Netmums.com
2. An article on food labels from FSA
3. Sainsbury’s traffic light labeling system
4. Traffic light label adopters in UK