TIME: Almanac 1993/TIME Almanac 1993.iso/time/042291/0422130.000

Text File | 1992-08-28 | 6.0 KB | 136 lines

                                                                                HEALTH, Page 76

Watch What You Eat, Kid


A U.S. panel urges better diets and cholesterol tests for
children, but the report draws fire from both sides of the issue

By ANASTASIA TOUFEXIS -- Reported by Andrew Purvis/New York


    Deny a child an ice-cream cone? Take away those glazed
doughnuts? Or that double cheeseburger, fries and milk shake?
It sounds cruel and downright un-American. Everyone knows that
adults should watch their diets and cholesterol levels, but is
it really necessary for junk-food-loving youngsters to do the
same?

    Yes, according to a report issued last week by the
National Cholesterol Education Program of the National Heart,
Lung and Blood Institute. The NCEP's medical experts concluded
that the best way to avoid heart trouble later in life is to
take preventive steps early in childhood. The report urges that
all children above age two follow the same low-cholesterol,
low-fat diet that is recommended for adults. Fat should make up
no more than 30% of daily calories. In American children, like
adults, fat now accounts for about 36%. The NCEP also calls for
blood cholesterol tests in children whose parents or
grandparents have histories of heart disease or high
cholesterol. Such screening would affect about 15 million
youngsters -- 25% of all kids between the ages of two and 18.

    These guidelines have won the endorsement of major health
organizations, including the American Heart Association, the
American Academy of Pediatrics and the American Medical
Association. Despite such consensus, however, much of the
medical community is polarized over the entire issue of
cholesterol and children. In fact, the NCEP report adroitly
takes a middle ground between activists, who advocate even more
radical measures, and conservatives, who contend that any
intervention in children is premature.

    Critics of the aggressive approach point out that the
origins of heart disease are still murky. High cholesterol as
a child does not necessarily mean high cholesterol as an adult.
A study in the Journal of the American Medical Association last
December, which tracked more than 2,300 young people for 12
years, reported that 30% of boys and 57% of girls who had high
cholesterol readings as children had normal levels after
reaching their 20s.

    Moreover, there are as yet no studies demonstrating that
lowering cholesterol in childhood directly prevents heart
disease in adulthood. Even if the thesis were proved, the
benefits might be minimal. By one estimate, 100 to 200 boys (or
300 to 600 girls) would need to follow a cholesterol-lowering
diet for 50 years to prevent one premature cardiac death. Says
Dr. Thomas Newman, a professor of pediatrics at the University
of California at San Francisco: "These benefits are going to be
so tiny that it seems unethical to do screening." Not to mention
expensive. The NCEP estimates that a program to test 15 million
kids will need $350 million to start up and $23 million a year
thereafter.

    Opponents also contend that the activist strategy can
spark enormous anxiety in children and their parents. One boy
was so depressed at his high cholesterol reading that he
refused to join friends at picnics and beach parties. Says Dr.
Abraham Bergman of the University of Washington, who has studied
the psychological toll on youngsters of benign heart murmurs
and sickle-cell trait: "Children pay a price for being
labeled." There is concern too that overzealous parents will put
their offspring on overly stringent diets that can deprive them
of essential calories and nutrients and stunt their growth.

    Activists counter that there is plenty of data to support
intervention, including clear evidence of incipient heart
disease in youngsters. Autopsies of children killed in
accidents, for example, have revealed fatty fibrous plaques
clogging the coronary arteries of 15-year-olds and fatty
deposits along the aortic walls of children as young as two or
three. "We see a strong correlation between cholesterol and
these lesions," says Dr. Gerald Berenson, director of the
landmark Bogalusa Heart Study that monitored 12,000 children for
18 years. Moreover, youngsters in the U.S. have much higher
cholesterol levels than do children in countries like Japan and
China, where the diet stresses vegetables over meats and dairy
products. In those nations heart disease is less common.

    Berenson and others argue that cholesterol testing should
be done on all U.S. children. They charge that limiting
screening to youngsters in families with a history of high
cholesterol or heart disease will miss as many as 50% of
children with a serious cholesterol problem. Among the reasons:
parents are often unaware of their own cholesterol level, and
many children live in homes where either the parents are absent
or where parents and even grandparents are so young that heart
disease is not yet evident.

    No one can deny that American children have deplorable
eating habits. Depending on age, a child gets between 10% and
22% of daily calories from snacks and fast foods, many of which
are notoriously high in fats and cholesterol. It is not
necessary to cut out these treats altogether, but simple
prudence calls for greater moderation. The main problem is that
switching to healthier foods is not easy when parents are often
such poor role models. Mom and Dad will have to remove those
ice-cream cones from their own mouths before they take one out
of their child's.


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TALE OF THE TUBE

    Cholesterol guidelines in mg/dL set by NCEP:

             Children               Adults

                       Acceptable

           less than 170        less than 200

                       Borderline

            170 to 199            200 to 239

                          High

           200 and above         240 and above