Pediatric dietary lipid guidelines: a policy analysis.

Abstract

The 1992 AAP policy of dietary fat and cholesterol restrictions in all children over two is based on incomplete evidence. The low-fat diet has never been demonstrated to be beneficial for prepubescent healthy children, and the unguided rapid implementation of numerical guidelines could lead to ill effects. Caution in the face of incomplete data was the hallmark of the 1983 and 1986 AAP Committee positions. Subsequent AAP policy change should have awaited either the direct clinical evidence they had previously considered necessary to demonstrate efficacy or the more general availability of the dietary guidance needed for safe implementation of strict numerical guidelines. We are neither calling for paralysis of policy nor do we wish to imply that 30% dietary fat is necessarily unhealthful for children. However, we do foresee the need for greater nutritional guidance for parents. In the absence of better nutrition education, zealous parents could switch a 2-year old immediately to a low-fat regimen to such an extent that the child might not achieve adequate nutrient intake to assure optimal growth and development. Moreover, current changes in lifestyle result in less parental supervision in all spheres of behavior, making closer dietary supervision less likely. A prudent pediatric guideline should encourage moderation and the gradual reduction of dietary fat intake throughout the early childhood years, achieving the numerical standards set for adults during adolescence. Such a policy has not been shown to foster atherosclerosis or to provide the yoke of unhealthful dietary habits that must be broken in adulthood.