Nutrition Hotline




QUESTION: I recently read that kids with high cholesterol levels do not necessarily have high cholesterol levels as adults. Could you please tell me more about this?

ANSWER: In December several articles in the popular press spoke about a study which indicated that children with high blood cholesterol levels do not necessarily have high cholesterol levels as adults. Not one, but three articles on children and cholesterol were published in the Journal of the American Medical Association, December 19, 1990.

The first study (Relationship of Atherosclerosis in Young Men...) collected arteries and blood from 390 males, 15 to 34 years old, who had died of violent causes. Those with high levels of blood LDL + VLDL cholesterol (often called "bad" cholesterol) had more atherosclerosis than those with lower levels of LDL + VLDL cholesterol. Those with high HDL cholesterol (often called "good" cholesterol) levels had less atherosclerosis. This study suggests that if a young man has high blood LDL + VLDL cholesterol levels, he has a greater risk of ultimately having a heart attack because he has more signs of atherosclerosis at a young age.

The second study (Use of Cholesterol Measurements in Childhood...) was probably the one you read about. Here investigators took children who had different blood cholesterol levels at ages 8 to 18 and followed them until they were ages 20 to 30. They did not find that children who had high cholesterol levels necessarily had high blood cholesterol as adults. Although no intervention (diet or drugs) was offered to those with high cholesterol levels, some parents could have been concerned enough about their child's high levels and improved their diets without consulting the author of this study. Perhaps it is more Important to look at VLDL + LDL or LDL cholesterol levels than to just look at total cholesterol when evaluating children.

The third article (The Case against Childhood Cholesterol Screening) is more of an opinion piece saying that cholesterol screening in childhood is a waste of time and money. These authors feel that it is not possible to markedly lower blood cholesterol levels in children, that many parents will put their children on overly restrictive diets that will compromise their growth, and that the child on a "prudent diet" will be stigmatized because he/she is different from other children.

A markedly different approach was taken by The National Cholesterol Education Program. In April 1991, they presented a major report on blood cholesterol levels in children and adolescents. The authors of the report looked at many studies of blood cholesterol levels in children. They concluded that children in the United States have higher blood cholesterol levels and diets which are higher in saturated fat and cholesterol than children in many other countries. They felt that atherosclerosis begins in childhood and progresses into adulthood, where it often leads to coronary heart disease, the major cause of death in this country. The committee which prepared this report recommended that the average level of blood cholesterol in children and adolescents in the United States be lowered through population-wide changes in eating patterns.

Specifically, the committee recommended that all children from age 2 on should be on a diet which has about 30% of the calories coming from fat, less than 10% of calories from saturated fat, and less than 300 milligrams of cholesterol daily. Parents are encouraged to serve more grains, beans, fruits and vegetables and fewer high-fat meat and dairy products.

The type of diet which is recommended for children and adolescents is the same as has been recommended in the past for adults. Health professionals should be encouraging the entire family to make a change to a healthier diet. The committee also recommended that schools serve meals which conform to the new guidelines and that nutrition education aimed at reducing heart disease risk factors be a priority.

Kids with high cholesterol levels will not necessarily have high cholesterol levers as adults. But kids growing up in the United States and eating a traditional American diet have a higher risk of having coronary heart disease as adults than do kids eating diets which are lower in fat, saturated fat, and cholesterol.


QUESTION: I am interested in updating on principles of the vegetarian diet. What is the latest on the need to combine complementary protein? Must they be eaten together, the same day, or not necessary to consider.

ANSWER: The RDA for protein for adults is 63 grams per day for men and 50 grams per day for women. It is very easy for a vegetarian diet to meet or exceed these recommendations. Nearly all vegetables, beans, grains, nuts, and seeds contain some, and often much, protein. Fruits, fats and alcohol do not provide much protein; so a diet based only on these foods would have a good chance of being too low in protein. Vegetarians eating varied diets containing vegetables, beans, grains, nuts, and seeds rarely have any difficulty getting enough protein as long as their diet contains enough energy (calories) to maintain weight.

Protein complementing was originally proposed to make sure that plant-based diets had enough of all of the essential amino acids. However, the strict sort of protein combining advocated in early editions of Diet for a Small Planet is not necessary for people eating a varied diet. As the American Dietetic Association position paper, Vegetarian Diets, states, "A mixture of plant proteins throughout the day will provide enough essential amino acids."

In fact, even if a person ate only one major source of protein and not the variety of foods typical of vegetarian diets, they would probably get enough protein and essential amino acids. Almost all protein sources of non-animal origin contain all the essential amino acids. A person would have to eat a lot of the protein source (if there was only one source of protein in their diet) to meet essential amino acid needs. The table below shows the amounts of various foods an adult male would have to eat if he relied on a single food source for his protein needs. Females would need about 20 percent less of each food because of the lower protein recommendation for women. I do not advocate eating this way but wanted to illustrate that protein combining is not necessary to meet amino acid requirements.

The Vegetarian Resource Group, Inc.


By Reed Mangels

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