Almost 30 years after the UN International Year of the Child , 2008 is shaping up to be a banner year focused upon improving the health of our children through the provision of nutritional information and recommendations for improvements to their lifestyle.
It seems a bit odd to be referring to lifestyle improvements for children; after all, don't children do what they've always done?
Wrong!
The lifestyles of children have changed dramatically and most of these changes are not positive for their health. Eating a breakfast bar during the morning bus commute to school is OK but it is not the same as sitting down at the kitchen table, having breakfast and then marching off to school. Playing the Wii game for a few hours a day in front of the widescreen is a lot of fun, but it is not the same as running your heart out chasing a soccer ball. Not the same for a child's mind nor a child's body.
Having a pizza delivered, with double everything and cheese product extruded into the crust might be great to order one night, but unless someone insists that everyone take a 5 km run afterwards, the extra calories have only one unflattering place to go. Do that or something similar a few times a week and you are beginning to talk about some pretty serious caloric and nutrient imbalances.
Maybe referring to children's lifestyle issues is not such a bad idea, after all.
The recent GMA Industry Health and Wellness Report highlights the goal of reducing obesity rates and encouraging healthy lifestyles for children. Not only do children have to be encouraged to pursue a fully balanced diet as shown in MyPyramid , but they should be taught the simple concept of energy balance and encouraged to do far more aerobic physical activity to keep their weight in check and their metabolic processes toned up.
In a recent paper entitled, "Children's diets: looking at the bigger picture ", Charlotte Musgrove, a nutrition scientist at the British Nutrition Foundation in London states that previously, the main focus was to provide enough energy and nutrients to meet the needs of a growing child. However, today there is a stronger emphasis on making sure that children are having a varied and balanced diet, and an active lifestyle. Of particular interest, is the finding that the message to eat at least five portions of fruit and vegetables a day appears to be gaining ground. Although many children are still not consuming the recommended amount of fruit and vegetables, their intakes have increased over recent years. In 2000, children were on average eating only 2 portions of fruit and vegetables a day. One in five children did not report eating any fruit, and three in five children did not report eating any green leafy vegetables over an average week. Between 2001 and 2004, average intakes of fruit and vegetable portions per day increased slightly, with boys consuming 2.5 portions per day, and girls consuming 2.6. Data from 2005 shows the average number of daily portions of fruit and vegetables eaten was 3.1 (for both boys and girls) and there was an increase in the proportion of children eating five or more portions per day (Health Survey for England 2005 ). Good news, but still a long way to go.
Together with the balance of nutrients from the rest of the diet, with physical fitness programs to ensure their bodies are kept in tune and a social environment where they can flourish with support and mentoring, our children will thrive in good health.
Slowly, slowly, we are moving away from the single, silver bullet solutions to children's health problems, because although they seem easy and they have made many rich and famous - they don't work - they never have. Life is just not that simple. It's the whole diet as part of the whole lifestyle that will direct us to good health for our children.
Everything should be made as simple as possible, but not simpler - Albert Einstein
Anyone promoting the addition or reduction of any single nutrient as the key solution to children's diseases is little different from the snake-oil salesmen of days gone by.
The problem is, they sold an awful lot of the stuff.
This week's (January 5th) National Journal cover story, "Data Bomb ," set off reverberations in my mind. The article recounts the release of grossly-misleading data immediately prior to the 2006 Congressional elections that exaggerated tenfold the number of deaths in Iraq; the study fed popular disillusionment with U.S. engagement in Iraq and contributed to capture of both houses of Congress in the elections several weeks later. The study was produced by the Johns Hopkins School of Public Health. The researchers, it turned out, were anti-war activists, though they claimed their errors didn't reflect their political views.
Bad memories. Six years earlier, researchers from the Johns Hopkins School of Public Health published misleading statistics in the DASH-Sodium trial - and refused to release further statistical calculations that would likely have unmasked their charade. Again, the Johns Hopkins researcher was an activist, a member of the lobby group World Action on Salt and Health (WASH). Again, the incompletely-reported and misleading research was instrumental in an important policy decision - to establish a Daily Recommended Intake level for sodium and a Dietary Guideline supporting reduced salt intake. Even worse, this time, despite the incontrovertible conflict represented both by his WASH lobby group membership and heavy involvement in the research itself, the researcher was installed as chair of the DRI project committee and the Dietary Guidelines subcommittee where he blocked consideration of the full data from the study.
Putting the National Journal aside, I plunged into an editorial in the journal of another advocacy organization, reading an editorial entitled "Eat your fruits and vegetables, but hold the salt ." The editorial writer acknowledged his funding support from the same federal agency that had funded DASH-Sodium for a study he has underway exploring the effects of the "DASH Diet" on individuals with isolated systolic hypertension. I expected little comfort, but hoped that, perhaps, the editorial would confess the over-interpretation of the results (as had an earlier article in 2005 where a DASH-Sodium investigator revealed that in six of the eight subgroups - subgroups that represented a large majority of the public - the reported findings were statistically insignificant even though the authors described them as valid.
All these discussions of DASH-Sodium have attempted to portray the DASH Diet as salt-reduced and demonstrating benefit from lower sodium intakes. This has been frustrating to those of us - including the salt industry - who have strongly endorsed the DASH Diet because it does not reduce salt and the blood pressure effect is produced by the fruits, vegetables and dairy products - not the salt. But the federally-funded PR juggernaut rolls on.
In the editorial, Dr. Paul Conlin of Harvard University's Brigham and Women's Hospital, indeed, endorsed salt reduction and noted a study of blood pressure in chimpanzees supported increased intakes of fruits and vegetables, two of the triumvirate of "good" foods in the DASH Diet. But note the caveats Conlin incorporates into his conclusions:
Elliott et all have provided new information, albeit in chimpanzees, showing that long-term salt restriction in the setting of a diet rich in fruits and vegetables produces sustained reductions in blood pressure. These data are relevant to humans but should be approached with caution and respect for the sample size, the lesser effects when adjusted for key factors, and the inability to add knowledge on the health and/or cardiovascular benefits of salt restriction beyond blood pressure lowering. Major next steps include …confirming that eating such a dietary pattern provides unquestioned health benefits. (emphasis added)
Last year, other WASH advocates took an important step forward in conceding the validity of health outcomes measures instead of controversial statistical extrapolations based solely on blood pressure (ignoring other metabolic changes that occur in salt reduction). As one observer sagely observed, their embrace of health outcomes in a Finnish study "backfired" when the data showed that improvements in Finns' cardiovascular health lagged their European and North American peers. Still, anti-salt advocates have claimed it would be "immoral" to ask study subjects to consume "normal" levels of salt since they "know" it is unhealthy. The Conlin editorial cedes the point, admitting that such a study is not only feasible and moral, but needed to "add knowledge on the health and/or cardiovascular benefits of salt restriction beyond blood pressure lowering" and confirm "that eating such a dietary pattern provides unquestioned health benefits." Those benefits - projected to be improved cardiovascular outcomes like less heart attacks and cardiovascular disease - have not been confirmed in the several studies that have examined them.
The Salt Institute has called for a controlled trial of whether there is any health benefit from reducing dietary sodium. Now, even those who support salt reduction for blood pressure lowering are beginning to see that this isn't the right question and are embracing our view of the need for a new study.
Perhaps those bad memories of incomplete data reporting by Johns Hopkins' researchers can, indeed, be relegated to history and not the basis of public policy.
