Watch What You Eat, Kid

By Anastasia Toufexis

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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With reporting by Andrew Purvis/New York