Healthy Mealtime Habits
The general dietary recommendations of the AHA for those aged 2 years and older stress a diet that primarily relies on fruits and vegetables, whole grains, low-fat and nonfat dairy products, beans, fish, and lean meat.1,13 These general recommendations echo other recent public health dietary guidelines in emphasizing low intakes of saturated and trans fat, cholesterol, and added sugar and salt; energy intake and physical activity appropriate for the maintenance of a normal weight for height; and adequate intake of micronutrients.14–16 Tables 1 and 2 provide strategies for implementing healthy cardiovascular nutrition. The recently published Dietary Guidelines for Americans (for those 2 years of age and older) and American Academy of Pediatrics Nutrition Handbook provide important supporting reference information with regard to overall diet composition, appropriate caloric intakes at different ages, macronutrients, micronutrients, portion size, and food choices.14,17,18 Table 3 provides daily estimated calorie and serving recommendations for grains, fruits, vegetables, and milk/dairy products by age and gender. Consistent with the Dietary Guidelines for Americans, 2005,14,18 nutrient and energy contributions from each food group are calculated according to the nutrient-dense forms of foods in each group (eg, lean meats and fat-free milk), with the exception of the guidelines for 1-year-old children, which included 2% fat milk. For youth 3 years of age and older, calorie estimates are based on a sedentary lifestyle. More physically active children and adolescents will require additional calories.14,17–19 This table is provided as a starting point for dietary counseling; recommendations will need to be individualized in clinical practice. Table 4 provides daily recommended intakes of sodium, potassium, and fiber.18 More complete guidelines for infants, particularly with regard to the transition from breast/formula-feeding to table foods, will be discussed below.
TABLE 1 AHA Pediatric Dietary Strategies for Individuals Aged > 2 Years: Recommendations to All Patients and Families
|Balance dietary calories with physical activity to maintain normal growth
60 min of moderate to vigorous play or physical activity daily
Eat vegetables and fruits daily, limit juice intake
Use vegetable oils and soft margarines low in saturated fat and trans fatty acids instead of butter or most other animal fats in the diet
Eat whole-grain breads and cereals rather than refined-grain products
Reduce the intake of sugar-sweetened beverages and foods
Use nonfat (skim) or low-fat milk and dairy products daily
Eat more fish, especially oily fish, broiled or baked
Reduce salt intake, including salt from processed foods
TABLE 2 Tips for Parents to Implement AHA Pediatric Dietary Guidelines
|Reduce added sugars, including sugar-sweetened drinks and juices
Use canola, soybean, corn oil, safflower oil, or other unsaturated oils in place of solid fats during food preparation
Use recommended portion sizes on food labels when preparing and serving food
Use fresh, frozen, and canned vegetables and fruits and serve at every meal; be careful with added sauces and sugar
Introduce and regularly serve fish as an entrée
Remove the skin from poultry before eating
Use only lean cuts of meat and reduced-fat meat products
Limit high-calorie sauces such as Alfredo, cream sauces, cheese sauces, and hollandaise
Eat whole-grain breads and cereals rather than refined products; read labels and ensure that "whole grain" is the first ingredient on the food label of these products
Eat more legumes (beans) and tofu in place of meat for some entrées
Breads, breakfast cereals, and prepared foods, including soups, may be high in salt and/or sugar; read food labels for content and choose high-fiber, low-salt/low-sugar alternatives
TABLE 3 Daily Estimated Calories and Recommended Servings for Grains, Fruits, Vegetables, and Milk/Dairy by Age and Gender
|Fat, % of total kcal||30-40||30-35||25-35||25-35||25-35|
|Milk / Dairy, cups b||2 c||2||2||3||3|
|Lean meat / Beans, oz||1.5||2||5|
|Fruits, cups d||1||1||1.5||1.5|
|Vegetables, cups d||3/4||1|
|Grains, oz e||2||3|
Calorie estimates are based on a sedentary lifestyle. Increased physical activity will require additional calories: by 0 to 200 kcal/day if moderately physically active and by 200 to 400 kcal/day if very physically active.
a For youth 2 years and older; adopted from Tables 2 and 3 and Appendix A-2 in US Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans. 6th ed. Washington, DC: US Government Printing Office; 2005; www.healthierus.gov/dietaryguidelines. Nutrient and energy contributions from each group are calculated according to the nutrient-dense forms of food in each group (eg, lean meats and fat-free milk).
b Milk listed is fat-free (except for children under the age of 2 years). If 1%, 2%, or whole-fat milk is substituted, this will utilize, for each cup, 19, 39, or 63 kcal of discretionary calories and add 2.6, 5.1, or 9.0 g of total fat, of which 1.3, 2.6, or 4.6 g are saturated fat.
c For 1-year-old children, calculations are based on 2% fat milk. If 2 cups of whole milk are substituted, 48 kcal of discretionary calories will be utilized. The American Academy of Pediatrics recommends that low-fat/reduced-fat milk not be started before 2 years of age.
d Serving sizes are 1/4 cup for 1 year of age, 1/3 cup for 2 to 3 years of age, and 1/2 cup for > 4 years of age. A variety of vegetables should be selected from each subgroup over the week.
e Half of all grains should be whole grains.
TABLE 4 Daily Recommended Intakes of Fiber, Sodium, and Potassium by Age and Gender
|Gender/Age||Fiber, g a||Sodium, mg||Potassium, mg|
Adapted from 2005 Dietary Guideline Advisory Committee. Nutrition and your health: dietary guidelines for Americans. Available at: www.health.gov/dietaryguidelines/dga2005/report/HTML/E_translation.htm.
a Total fiber preferred minimum 14 g/1000 kcal. Read labels to determine amounts on all packaged foods