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April 22/29, 1998

Modifying Coronary Heart Disease Risk Factors in Children: Is It Ever Too Early to Start?—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(16):1261-1262. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-16-jac80007

In Reply.—We agree with Ms Lagström and colleagues1 and Dr Ressler that improved nutrition and dietary habits have to be started early in life. In the STRIP trial in Finland, the authors were able show the importance of dietary reduction of saturated fat and cholesterol on reducing total cholesterol levels during the first 3 years of life and without causing any undue effect on height, weight, and gross developmental changes in infants over the period of 3 years of infancy. Our data show that essentially by 1 year of age infants are consuming a diet composition comparable to adults, ie, high-fat, high-cholesterol, and high-sodium intake. Further, serum total cholesterol levels developed by 2 years of age in our birth cohort study are comparable to levels found in young adults. Bogalusa Heart Study dietary data also show that approximately 80% of children exceed the American Heart Association guidelines for total fat (less than 30% of energy) and saturated fatty acid (less than 10% of energy) intake.1 Although several trials have demonstrated the safety of reducing saturated fat in the diet of infants and children, we want to emphasize that any alteration of diets for children must provide several essential elements, ie, adequate energy for growth, essential amino acids, essential fatty acids, minerals, and vitamins.