The CHILD 1 and DASH diets: rationale and translational applications.

PEDIATRIC ANNALS 42:9 | SEPTEMBER 2013 The National Heart, Lung, and Blood Institute convened an expert panel to develop integrated guidelines for cardiovascular health and risk reduction in children and adolescents. Because it is well documented that the roots of cardiovascular disease in adults are initiated in childhood, the expert panel sought to review the existing literature to address a broad array of questions related to prevention and translate these findings into practical, effective lifestyle guidelines.1,2 Among the many risk factors contributing to the development of disease, diet and eating behaviors are central to several of them, including dyslipidemia, hypertension, obesity, and diabetes. The panel evaluated research studies involving specific nutrients, such as dietary fatty acids, sodium, and fiber, as well as foods such as sugar-sweetened beverages and dietary patterns including the application of the Dietary Approaches to Stop Hypertension (DASH) diet.3-5 This allowed the comparison of different benefits/risks and applications of certain findings from several studies that collectively influenced the development of the Cardiovascular Health Integrated Lifestyle Diet (CHILD 1). The CHILD 1 diet is intended to be the first stage of diet intervention when a child is identified with one or more cardiovascular risk factors or a positive family history. The diet was carefully developed to meet the nutrient needs of growing children while minimizing dietary factors that contribute to excess calories, saturated/transfatty acids, sodium, and sugar. The CHILD 1 diet can be fully achieved by following a DASH-style eating pattern that emphasizes fat-free/low-fat dairy products; increased intake of fruits and vegetables, fish, and fresh lean meats; and lower sodium intake. The expert panel differentiated the diet recommendations by age group, starting with strongly advocating breast-feeding for as long as possible but at least until 6 months of age. Transitions to reduced-fat (2%) milk and then fat-free milk were recommended during the 12to 24-month period, with input and guidance from the pediatrician. A delayed introduction of solid foods until preferably 6 months of age was also recommended. Because of the prevalence of overweight and obesity, the expert panel further recommended limited sugar and solid fat intake, only one 4-oz serving of 100% fruit juice per day, and avoidance of sugar-sweetened beverages. In addition, the panel encouraged guidance regarding eating behaviors including modest portion sizes, regular breakfast eating, famThe CHILD 1 and DASH Diets: Rationale and Translational Applications