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American Journal of Clinical Nutrition, Vol. 72, No. 5, 1399S-1403s, November 2000
© 2000 American Society for Clinical Nutrition

Supplement

Dietary fat intake and body mass index in Spanish children1,2,3,4

Luis A Moreno, Antonio Sarría, Aurora Lázaro and Manuel Bueno

1 From the Departamento de Pediatría and EU Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain.

2 Presented at the symposium Fat Intake During Childhood, held in Houston, June 8–9, 1998.

3 Supported by grants from Diputación General de Aragón (PCM 5/92), the University of Zaragoza (215-35), and the Spanish Ministry of Health (FIS 97/0531).

4 Address reprint requests to LA Moreno, EU Ciencias de la Salud, Universidad de Zaragoza, Avda. Domingo Miral s/n 50009 Zaragoza, Spain. E-mail: lmoreno{at}posta.unizar.es.


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 DIETARY FAT INTAKE
 DIETARY FAT INTAKE AND...
 DIETARY FAT INTAKE AND...
 CONCLUSIONS
 REFERENCES
 
Our objectives were to describe the pattern of dietary fat intake and to present data on trends of growth in Spanish children in past decades. In 1984 a nationwide nutritional survey was conducted in Spain. The average nationwide fat intake was 42% of energy. Across different regions, saturated fat intakes ranged from 13% to 15% of energy and monounsaturated fat intakes ranged from 18% to 19% of energy. More recently, some surveys were conducted at a regional or local level. In children aged 6–10 y, total fat intake ranged from 38% to 48% of energy, of which saturated fat intake ranged from 16% to 18% and monounsaturated fat ranged from 19% to 20%. In children aged 11–14 y, total fat intake ranged from 41% to 51% of energy, of which saturated fat intake ranged from 12% to 18% and monounsaturated fat intake accounted for 20%. In our region of Aragón, we observed a significant trend in children's growth, especially when we accounted for body mass index. The results reflect an increasing total fat consumption in Spain, especially of saturated and monounsaturated fat. The following question remains unanswered: what percentage of fat intake should be recommended when monounsaturated fat is the principal source of fat? Trends on body mass index values in children of our region during the past decades could be related to the amount of fat intake in our population. To confirm these findings we must measure dietary fat intake and nutritional status in the same population of children and adolescents.

Key Words: Dietary fat • nutritional intake • dietary surveys • olive oil • growth • body mass index • obesity • vitamins • minerals • children • Spain • monounsaturated fat


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
DIETARY FAT INTAKE
 DIETARY FAT INTAKE AND...
 DIETARY FAT INTAKE AND...
 CONCLUSIONS
 REFERENCES
 
Excessive intake of dietary fat has been related to the main causes of mortality in developed countries, ie, cardiovascular diseases and cancer, but the epidemiologic evidence is not very relevant (1–3). However, epidemiologic data are compatible with the hypothesis that dietary fat intake affects the risk of coronary heart disease and cancer by its effect on other risk factors, ie, serum cholesterol concentrations and obesity (4, 5). Dietary fat intake, fat quality, and cholesterol intake markedly regulate serum lipid concentrations in childhood as in adulthood (6, 7). Dietary fat seems also to be associated with the occurrence of obesity (5).

The main goal of recommendations aimed at decreasing the risk of coronary heart disease in children is the reduction of dietary fat intake, specifically a reduced intake of saturated fat and cholesterol (8, 9). Fears of low intakes of energy, essential fatty acids, and fat-soluble vitamins with possible deleterious effects on growth and development have hampered efforts to reduce dietary fat intake in childhood (10, 11). Therefore, our objectives were to describe the pattern of dietary fat intake in Spanish children, present data on trends of growth, and comment about the adequacy of micronutrient intakes in children consuming a low-fat diet.


   DIETARY FAT INTAKE
TOP
 ABSTRACT
 INTRODUCTION
 DIETARY FAT INTAKE
DIETARY FAT INTAKE AND...
 DIETARY FAT INTAKE AND...
 CONCLUSIONS
 REFERENCES
 
Household dietary information
To estimate the pattern of dietary intake in a population, household budget surveys represent a valuable resource that has been long overlooked (12). Studies based on individuals and analytic epidemiologic investigations are superior in many ways (13), but they are costly, usually cover a limited time period, and do not use standard protocols to ensure comparability. Household dietary information in Spain was obtained from 3 household budget surveys conducted by the National Institute of Statistics in 1964–1965, 1980–1981, and 1990–1991 (14). The study sample of those surveys was selected by a 2-stage stratified sampling scheme and included 20800 households in 1964–1965, 24000 in 1980–1981, and 28000 in 1990–1991. Trained interviewers visited the household every day (1964–1965 survey) or every other day (1980–1981 and 1990–1991 surveys) for a week.

These surveys showed a rise in the energy supplied by fat from 30% in 1964–1965 to 40% in 1980–1981 and to 41.5% in 1990–1991. In the latter survey, saturated fat represented 11.9%, monounsaturated fat 18.8%, and polyunsaturated fat 6.8% of total energy intake. In our region of Aragón, fat intake represents 44.3% of total energy intake: 12.4% saturated fat, 20.8% monounsaturated fat, and 7.0% polyunsaturated fat.

We think these data could be extrapolated to children because in the aforementioned surveys there were no significant differences between households with or without children. Moreover, the Framingham Study showed that husbands and wives tend to consume fairly similar amounts of all nutrients except potassium and sodium; the degree of similarity between parents (especially the mother) and children was high for all nutrients, particularly for total fat, saturated fat, unsaturated fat, cholesterol, and carbohydrates (15).

Individual dietary surveys
Evaluation of energy and nutrient intakes present major problems, especially in childhood, and comparison between studies is particularly difficult. Some methods involve recording food intake on certain days of the week (sometimes including a Saturday or Sunday), whereas other methods include recording food intake for all days of the week. Data recording may be the responsibility of the parents, of the parents and the child, or of the child alone. Mothers tend to have little information about what their children eat at school and away from home in general and the reports of the children themselves tend to be unreliable.

In 1984 a nationwide nutritional survey was conducted in Spain (16). The study sample of this survey included 4231 children (2271 boys and 1960 girls) aged 6–14 y. The average fat intake nationwide was 42% of energy. Dietary fat intakes by region and by type of fatty acid are shown in Figure 1Go. Saturated fat intake ranged from 13% to 15% and monounsaturated fat intake ranged from 18% to 19% of energy.



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  		FIGURE 1. Dietary fat intake in Spanish children, by region, on the basis of the Paidos '84 survey. In each region, the first number represents the percentage of energy from total fat, the second number represents the percentage of energy from saturated fat, and the third number represents the percentage of energy from monounsaturated fat.

 
The cost of setting up these surveys has prevented the establishment of more individual surveys in Spain; more recently, surveys have only been conducted at a regional or local level and the methodology used has not always been the same. Despite the problems of among-study comparisons, we reviewed recent studies of the dietary habits of children in Spain. In Table 1Go and Table 2Go, we present data on fat intake in the best designed surveys (17–21). In children aged 6–10 y, total fat intake ranged from 38% to 48% of energy, of which saturated fat ranged from 16% to 18% and monounsaturated fat ranged from 19% to 20%. In children aged 11–14 y, total fat intake ranged from 41% to 51% of energy, saturated fat from 12% to 18%, and monounsaturated fat accounted for 20%.


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  		TABLE 1 Dietary fat intake in Spanish children aged 6–10 y
 

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  		TABLE 2 Dietary fat intake in Spanish children aged 11–14 y
 
Comments
A common finding of the individual surveys reviewed in the past is the high intake of total fat due to an elevated intake of saturated and monounsaturated fat. We expected this finding because olive oil is Spain's principal source of fat and characteristically is used in the place of animal fats typical of northern European diets. Olive oil contains a large proportion of monounsaturated fat (oleic acid), is relatively low in saturated fat, and is a source of the antioxidant vitamin E.

Studies have shown that olive oil increases HDL cholesterol and reduces LDL cholesterol, promoting in a balanced way a desirable blood lipid profile. Oleic acid is also considered to be antithrombotic compared with saturated fatty acids (22). Moreover, diets high in monounsaturated fat are less likely than those diets high in polyunsaturated fat to be involved in the oxidation of LDL, a process thought to increase the risk of atherogenesis and coronary heart disease (23). Furthermore, epidemiologic studies have repeatedly indicated that olive oil may have beneficial effects, not only on cardiovascular health but also on the incidence of cancer (3).

Mediterranean people have used olive oil as their major dietary fat for a few thousand years with no evidence of harm. The following question remains unanswered: what percentage of total fat from energy should be recommended when olive oil is the principal source of fat? Evidence suggests that the proportion of energy from total fat in Mediterranean diets varies widely throughout the region, from 28% to 40%. Proportions of energy from fat across this range appear to have been compatible with excellent adult health with diets in which most of the fat was derived from olive oil (24).


   DIETARY FAT INTAKE AND CHILDREN'S GROWTH
TOP
 ABSTRACT
 INTRODUCTION
 DIETARY FAT INTAKE
 DIETARY FAT INTAKE AND...
DIETARY FAT INTAKE AND...
 CONCLUSIONS
 REFERENCES
 
A healthy diet in children is one that permits optimum growth, development, and health. Some concerns have been raised about the safety of reduced-fat diets in growing children. Case studies of poor growth from reduced-fat diets have been reported (25).

In some well-controlled studies (26, 27), lower fat intakes seem to be nutritionally adequate for growth and fat intake as a percentage of energy seems not to be associated significantly with the growth of these children. In our lipid's clinic, we did not observe growth retardation in hypercholesterolemic children who consumed a low-fat, low-cholesterol diet (28).

On the other hand, recent studies conducted in adults seem to confirm the notion that high-fat diets might, over time, lead to excess body fat deposition. Saturated and monounsaturated fat intakes also seem to be predictors of actual adiposity markers, whereas high polyunsaturated fat intake seems to exert no effect on these markers (29). Some longitudinal studies determined that the fat content of a diet is a significant predictor of body weight gain (30). Moreover, consumption of a diet restricted in total fat, saturated fat, and cholesterol, under weight-maintenance and ad libitum conditions, was accompanied by significant weight loss (5).

In children, high fat intakes are associated with obesity even when controlling for potential confounders (ie, sex, total energy intake, physical fitness, and parental body mass) (31, 32) and greater weight gain (33) are controlled for. In Spanish adolescents, obese subjects derived a greater proportion of their energy from fat when compared with normal-weight individuals (34). Moreover, overweight in children has been increasing in prevalence (35).

In our region of Aragón, we observed a significant trend in children's growth, especially when we accounted for body mass index (BMI; in kg/m2) (36). We assessed the growth of 3 similar school-age populations of Zaragoza, Spain, whose heights and weights were measured during the years 1972, 1982, and 1990. In 1972 the sample included 4375 children; in 1982, 3082; and in 1990, 3199 (36). As recommended by a World Health Organization Expert Committee (37), BMI values were compared with US reference standards (38) and we have calculated SD scores or z scores. There was a significant increasing trend in BMI, especially in boys (Figure 2Go and Figure 3Go). The increase was observed in the 1982–1990 period. This change may have been due to an increase in fat intake over the period (14) and to the sedentary habits of these children; however, physical activity seems not to be a major determinant of BMI (39).



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  		FIGURE 2. Body mass index (BMI), expressed as z scores, in boys in 3 cross-sectional studies ({blacksquare}, 1972; {blacktriangleup}, 1982; •, 1990) conducted in Zaragoza, Spain.

 


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  		FIGURE 3. Body mass index (BMI), expressed as z scores, in girls in 3 cross-sectional studies ({blacksquare}, 1972; {blacktriangleup}, 1982; •, 1990) conducted in Zaragoza, Spain.

 
One explanation for the association between dietary fat and adiposity could be that excess dietary fat leads to greater fat accumulation than does excess dietary carbohydrate (40). At least part of the increased efficiency of gaining weight by eating too much fat is the experimental demonstration of a theoretical consideration. Less energy is expended to store fat in the body from dietary fat than from dietary carbohydrate. Dietary fat is stored as triacylglycerol in the body at a metabolic cost of 3% of ingested energy, whereas dietary carbohydrate is stored in fat at the metabolic cost of 23% of the ingested energy (41).

In the past years, research has focused on central or abdominal adipose tissue distribution that is already present in children (42, 43). However, dietary fat seems to not specifically influence fat accretion in the intraabdominal region (4).


   DIETARY FAT INTAKE AND NUTRITIONAL ADEQUACY
TOP
 ABSTRACT
 INTRODUCTION
 DIETARY FAT INTAKE
 DIETARY FAT INTAKE AND...
 DIETARY FAT INTAKE AND...
CONCLUSIONS
 REFERENCES
 
Reductions in fat intake lead to an organoleptically monotonous diet and at the same time necessitate an increase in the amount of food ingested. This increase in the amount of food eaten is often difficult for the subject to achieve. In addition, and even if energy intake is maintained, a reduction in fat intake may increase the risk of micronutrient deficiency. In the Bogalusa Heart Study, children in whom fat accounted for <30% of total energy intake ingested significantly less vitamin B-1, B-2, B-6, B-12, and E than did children in whom the corresponding figure was >40% (44). In other countries, a self-selected low-fat intake among children from average to high socioeconomic backgrounds does not compromise their intake of nutrients (45).

In children of different ages, there was no significant differences in vitamin, mineral, and trace element intakes between those who reduced their fat intakes and those who did not (46–48). In adolescents, lower-fat diets were related to lower self-reported intakes of several nutrients; however, no adverse effects were observed on blood biochemical measures of nutritional status (27). Therefore, it seems that, at least under well-controlled conditions, it is possible for young children to lower their fat intake safely to reduce their risk of heart disease (28).


   CONCLUSIONS
TOP
 ABSTRACT
 INTRODUCTION
 DIETARY FAT INTAKE
 DIETARY FAT INTAKE AND...
 DIETARY FAT INTAKE AND...
 CONCLUSIONS
REFERENCES
 
Results from family and individual dietary surveys indicate increasing total fat consumption in Spain over recent decades, especially of saturated and monounsaturated fat, as was shown also for other Mediterranean countries (49, 50). The following question remains unanswered: what percentage of fat intake should be recommended when monounsaturated fat is the principal source of fat? Trends in BMI values in children in our region of Aragón during recent decades could be related to the amount of fat intake in our population. To confirm these findings we must design studies that measure dietary fat intake and nutritional status in the same population of children and adolescents.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 DIETARY FAT INTAKE
 DIETARY FAT INTAKE AND...
 DIETARY FAT INTAKE AND...
 CONCLUSIONS
 REFERENCES
 

  1. Ascherio A, Rimm EB, Giovannucci EL, Spiegelman D, Stampfer M, Willett WC. Dietary fat and risk of coronary heart disease in men: cohort follow up study in the United States. BMJ 1996;313:84–90.[Abstract/Free Full Text]
  2. Potischman N, Weiss HA, Swanson CA, et al. Diet during adolescence and risk of breast cancer among young women. J Natl Cancer Inst 1998;90:226–33.[Abstract/Free Full Text]
  3. Braga C, La Vecchia C, Franceschi S, et al. Olive oil, other seasoning fats, and the risk of colorectal carcinoma. Cancer 1998;82:448–53.[Medline]
  4. Larson DE, Hunter GR, Williams MJ, Kekes-Szabo T, Nyikos I, Goran MI. Dietary fat in relation to body fat and intraabdominal adipose tissue: a cross-sectional analysis. Am J Clin Nutr 1996;64: 677–84.[Abstract/Free Full Text]
  5. Schaefer EJ, Lichtenstein AH, Lamon-Fava S, et al. Body weight and low-density lipoprotein cholesterol changes after consumption of a low-fat ad libitum diet. JAMA 1995;274:1450–5.[Abstract]
  6. Nicklas TA, Farris RP, Smoak CG, et al. Dietary factors relate to cardiovascular risk factors in early life. Bogalusa Heart Study. Arteriosclerosis 1988;8:193–9.[Abstract/Free Full Text]
  7. González-Requejo A, Sanchez-Bayle M, Baeza J, et al. Relations between nutrient intake and serum lipid and apolipoprotein levels. J Pediatr 1995;127:53–7.[Medline]
  8. NCEP. National Cholesterol Education Program (NCEP): highlights of the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pediatrics 1992;89:495–501.[Abstract/Free Full Text]
  9. Aggett PJ, Haschke F, Heine W, et al. ESPGAN Committee on Nutrition report: childhood diet and prevention of coronary heart disease. J Pediatr Gastroenterol Nutr 1994;19:261–9.[Medline]
  10. American Academy of Pediatrics, Committee on Nutrition. Prudent life-style for children: dietary fat and cholesterol. Pediatrics 1986; 78:521–5.[Abstract/Free Full Text]
  11. Lifshitz F. Children on adult diets: is it harmful? Is it healthful? J Am Coll Nutr 1992;11:84S–90S.
  12. Trichopoulou A. Monitoring food intake in Europe: a food data bank based on household budget surveys. Eur J Clin Nutr 1992; 46(suppl):53–8.[Medline]
  13. Willett W. Nutritional epidemiology. New York: Oxford University Press, 1990.
  14. INE. Encuesta de presupuestos familiares 1990–91. Estudio nacional de nutrición y alimentación. (Household budget survey 1990–91. National study of nutrition and diet.) Madrid: Instituto Nacional de Estadística, 1995 (in Spanish).
  15. Oliveria S, Ellison RC, Moore LL, et al. Parent-child relationships in nutrient intake: the Framingham Children's Study. Am J Clin Nutr 1992;56:593–8.[Abstract/Free Full Text]
  16. Bueno M, Sarría A. Datos de una encuesta nutricional en escolares españoles. (Data from a nutritional survey in Spanish school age children.) Madrid: Nilo, 1988 (in Spanish).
  17. Tojo R, Leis R, Recarey D, Pavón P. Dietary habits of preschool and school-aged children: health risks and strategies for intervention. In: Ballabriga A, ed. Feeding from toddlers to adolescence. Philadelphia: Lippincott-Raven, 1996:93–113.
  18. Vázquez C, De Cos AI, Martínez de Icaya P, et al. Consumo de alimentos y nutrientes por edades y sexo en escolares de la Comunidad Autónoma de Madrid (CAENPE). (Food and nutrient intakes by age and sex in school age children in the Autonomous Community of Madrid.) Rev Clín Esp 1996;196:501–8 (in Spanish).
  19. Marti-Henneberg C, Arija V, Salas J. Reciente evolución de la dieta Mediterránea en España. (Recent evolution of Mediterranean diet in Spain.) Alim Nutr Salud 1994;1:7–14 (in Spanish).
  20. López MC, Ruiz M, Olea MF. Nutrición de la población escolar de Granada. (Nutrition of a school age population in Granada.) Nutr Clin 1993;6:26–30 (in Spanish).
  21. Mur L, Fleta J, Moreno L. Ingesta de alimentos a lo largo del día en niños zaragozanos. (Dietary intake during the day in children of Zaragoza.) Nutr Clin 1994;14:19–30 (in Spanish).
  22. Ulbricht TL, Southgate DA. Coronary heart disease: seven dietary factors. Lancet 1991;338:985–92.[Medline]
  23. Reaven P, Parthasarathy S, Grasse BJ, et al. Feasibility of using oleate-rich diet to reduce the susceptibility of low-density lipoprotein to oxidative modification in humans. Am J Clin Nutr 1991;54:701–6.[Abstract/Free Full Text]
  24. Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 1995;61(suppl):1402S–6S.[Abstract]
  25. Lifshitz F, Moses N. Growth failure. A complication of dietary treatment of hypercholesterolemia. Am J Dis Child 1989;143:537–42.[Abstract]
  26. Niinikoski H, Viikari J, Rönnemaa T, et al. Regulation of growth of 7- to 36-month-old children by energy and fat intake in the prospective, randomized STRIP baby trial. Pediatrics 1997;100:810–6.[Abstract/Free Full Text]
  27. Obarzanek E, Hunsberger SA, Van Horn L, et al. Safety of a fat-reduced diet: the Dietary Intervention Study in Children (DISC). Pediatrics 1997;100:51–9.[Abstract/Free Full Text]
  28. Moreno L, Sarría A, Mur M, et al. Variabilidad en la respuesta a una dieta pobre en grasa y en colesterol en niños afectos de distintos tipos de dislipoproteinemia. (Variability of the effect of a low-fat, low-cholesterol diet in children with different types of hypercholesterolemia.) An Esp Pediatr 1994;41:377–82 (in Spanish).
  29. Doucet E, Almeras N, White MD, Despres JP, Bouchard C, Tremblay A. Dietary fat composition and human adiposity. Eur J Clin Nutr 1998;52:2–6.[Medline]
  30. Klesges RC, Klesges LM, Haddock CK, Eck LH. A longitudinal analysis of the impact of dietary intake and physical activity on weight change in adults. Am J Clin Nutr 1992;55:818–22.[Abstract/Free Full Text]
  31. Obarzanek E, Schreiber GB, Crawford PB, et al. Energy intake and physical activity in relation to indexes of body fat: the National Heart, Lung, and Blood Institute Growth and Health Study. Am J Clin Nutr 1994;60:15–22.[Abstract/Free Full Text]
  32. Tucker LA, Seljaas GT, Hager RL. Body fat percentage of children varies according to their diet composition. J Am Diet Assoc 1997; 97:981–6.[Medline]
  33. Klesges RC, Klesges LM, Eck LH, Shelton ML. A longitudinal analysis of accelerated weight gain in preschool children. Pediatrics 1995;95:126–30.[Abstract/Free Full Text]
  34. Ortega RM, Requejo AM, Andrés P, Lopez-Sobaler AM, Redondo R, González-Fernández M. Relationship between diet composition and body mass index in a group of Spanish adolescents. Br J Nutr 1995;74:765–73.[Medline]
  35. Troiano RP, Flegal KM, Kuczmarski RJ, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents: the National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995;49:1085–91.
  36. Bueno MM. Aceleración del crecimiento en niños Aragoneses de ambos sexos en las últimas décadas del siglo XX. (Secular trends on growth of children from Aragón in the last decades of XXth century.) PhD thesis. University of Zaragoza, Spain, 1996.
  37. de Onis M, Habicht JP. Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. Am J Clin Nutr 1996;64:650–8.[Abstract/Free Full Text]
  38. Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status. Ann Arbor, MI: The University of Michigan Press, 1990.
  39. Moreno LA, Mur L, Fleta J. Relationship between physical activity and body composition in adolescents. Ann N Y Acad Sci 1997;817: 372–4.[Free Full Text]
  40. Horton TJ, Drougas H, Brachey A, Reed GW, Peters JC, Hill JO. Fat and carbohydrate overfeeding in humans: different effects on energy storage. Am J Clin Nutr 1995;62:19–29.[Abstract/Free Full Text]
  41. Danforth E Jr. Diet and obesity. Am J Clin Nutr 1985;41:1132–45.[Free Full Text]
  42. Moreno LA, Fleta J, Mur L, Feja C, Sarría A, Bueno M. Indices of body fat distribution in Spanish children aged 4.0 to 14.9 years. J Pediatr Gastroenterol Nutr 1997;25:175–81.[Medline]
  43. Moreno LA, Fleta J, Mur L, Sarría A, Bueno M. Fat distribution in obese and non-obese children and adolescents. J Pediatr Gastroenterol Nutr 1998;27:176–80.[Medline]
  44. Nicklas TA, Webber LS, Koschak M, Berenson GS. Nutrient adequacy of low fat intakes for children: the Bogalusa Heart Study. Pediatrics 1992;89:221–8.[Abstract/Free Full Text]
  45. Tonstad S, Sivertsen M. Relation between dietary fat and energy and micronutrient intakes. Arch Dis Child 1997;76:416–20.[Abstract/Free Full Text]
  46. Lagström H, Jokinen E, Seppänen R, et al. Nutrient intakes by young children in a prospective randomized trial of a low-saturated fat, low-cholesterol diet. The STRIP baby project. Arch Pediatr Adolesc Med 1997;151:181–8.[Abstract]
  47. Niinikoski H, Koskinen P, Punnonen K, et al. Intake and indicators of iron and zinc status in children consuming diets low in saturated fat and cholesterol: the STRIP baby study. Special Turku Coronary Risk Factor Intervention Project for Babies. Am J Clin Nutr 1997; 66:569–74.[Abstract/Free Full Text]
  48. Dixon LB, McKenzie J, Shannon BM, Mitchell DC, Smiciklas-Wright H, Tershakovec AM. The effect of changes in dietary fat on the food group and nutrient intake of 4- to 10-year-old children. Pediatrics 1997;100:863–72.[Abstract/Free Full Text]
  49. Serra-Majem L, Ribas L, Lloveras G, Salleras L. Changing patterns of fat consumption in Spain. Eur J Clin Nutr 1993;47(suppl):S13–20.
  50. Fidanza F. The Mediterranean Italian diet: keys to contemporary thinking. Proc Nutr Soc 1991;50:519–26.[Medline]




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