The Downfall of a The Downfall of a Girl’s DietGirl’s Diet
Dr Bob Murray
Nationwide Children’s Hospital
Children are Overweight and Undernourished
0
20
40
60
80
100
120
6-11 Mo. 1 Yr. 1-4 Yrs. 5-8 Yrs. 9-14 Yrs. 15-19 Yrs.
CalciumFolate
% Children Consuming
Daily Recommende
d Intake
Magnesium
Vitamin A
Vitamin C
Zinc
Iron
Phosphorus
Critical Age
Data compiled by Dr. John Lasekan, Ross Labsfrom NHANES 1999-2000 and the Continuing Food Survey 1994-96, 1998
Missing NutrientsMissing Nutrients High School Students
Males• Vit A, Vit C, Vit E• Magnesium, potassium• Fiber• Calcium
Females• Vit A, Vit C, Vit E• Magnesium, potassium• Vit B-6• Folate• Thiamin• Iron• Phosphorous• Zinc• Fiber• Calcium
Clark, Fox, JADA 2009; s44
The U.S. Dietary Guidelines
• Food intake is based on daily activity
• Meals and snacks – Vegetables– Fruits– whole grains – Low-fat milk and dairy– Quality proteins
• To make every calorie count, choose nutrient rich foods
Activity Level
FemalesAge (years)
Sedentary Pretty Active Very Active
Calories Calories Calories
4-89-13
14-1819-3031-50
1,2001,6001,8002,0001,800
1,400-1,6001,600-2,000
2,0002,000-2,200
2,000
1,400-1,8001,800-2200
2,4002,4002,200
Activity = CaloriesActivity = Calories
What are the Right Amounts?
• 9 year old with moderate activity• 1400 - 1600 calories
– Breakfast 400 calories– Lunch 400 calories– Dinner 500 calories– Snack 200 calories
1500 calories
Focus on fruits.Focus on fruits.
Vary your veggies.Vary your veggies.
Get calcium-rich foods.Get calcium-rich foods.
Make half your grains whole.Make half your grains whole.
Go lean with protein.Go lean with protein.
Know the limits on fats, Know the limits on fats, salt, and sugars.salt, and sugars.
Naturally Nutrient Rich
US Dietary Guidelines
CurrentChildren’s
Diet
Kids & Snack Foods
Snack foods and drinks = 1/3 of daily calories
2/3 of this comes from added sugar
½ of the sugar comes from
sweet drinks
Which account for 10% of daily calories
NHANES III, Kant Arch Ped Adol Med 2003; 157:789
Beverage Ounces CaloriesWater, diet cola 20 0
Milk, fat free 8 80
Orange juice 8 110
Gatorade 20 130
Grape juice 8 150
Snapple 16 220
Coke, 7-up 20 250
Biggie Coke 32 310
TCBY fruit smoothie 20 410
7-11 Big Gulp 44 410
McD’s Vanilla shake 16 580
Nutr Action Letter, June 2006
Milk’s Nutrients
• Calcium (30% DV*)• Potassium (11% DV)• Phosphorus (20% DV)• Protein (16% DV)• Vitamin A (10% DV)• Vitamin D (25% DV)• Vitamin B12 (13% DV)• Riboflavin (24% DV)• Niacin (10% DV)
MyPyramid: Dairy products
• 3-a-Day = cups of fat-free or low-fat milk or dairy
– 2 to 8 years old 2 cups per day
– 9 to 18 years old 3 cups per day • 8 oz. milk• 1 cup yogurt
• 1½ oz. natural cheese• 2 oz. processed cheese
Too Many Children Avoid Dairy
• Low daily calcium– Take in only 400 mg – Need 1300 mg
• Reasons given– Feel bad taste lifestyle
• More broken bones
Black et al, Am J Clin Nutr 2002; 76:675
More Snacks, More Calories
Total MALES FEMALES
0 Snacks 11% 2156 kcal 1501 kcal
1 Snack 25% 2391 kcal 1812 kcal
2 Snacks 26% 2505 kcal 1944 kcal
3 Snacks 19% 2916 kcal 2136 kcal
4 Snacks 18% 3249 kcal 2437 kcal
Sebastian, J Adol Health 2008; 42:503
“GRAZING is the new norm”
Snacks are Low Quality Food
FOOD GROUPS SNACKS
Grains chips, puffs, breads, cookiesVegetables potato chips, pizza, french friesFruits OJ, apples, non-citrus juicesMilk white, flavored, frozen dairyMeat/beans hot dogs, lunch meats
Oils corn chips, puffs, potato chips Solid fats frozen dairy, cookies, milkAdded sugars soft drinks, fruit drinks, candies
Sebastian, J Adol Health 2008; 42:503
Less fat, fewer calories, but NOT more nutrientsLess fat, fewer calories, but NOT more nutrients
Does it deserve this?
The Most Important Things
• Limit sweetened beverages
• Eat 5 servings per day of fruits & vegetables
• Eat a nutritious breakfast every day
• Limit portion sizes• Have regular family
meals
• Limit screens to a maximum of 2hrs
• No television in the bedroom
• Moderate to vigorous physical activity for 60 mins/ day
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