Impact of adopting lower-fat food choices on nutrient intake of American children.

OBJECTIVE To compare the overall nutrient intake of American children (ages 2 to 19) who exclusively use skim milk instead of 1%, 2%, or whole milk; lean meats instead of higher-fat meats; or fat-modified products instead of full-fat products. STUDY DESIGN A unique sorting procedure was used to categorize respondents to the 1989-1991 Continuing Survey of Food Intake by Individuals according to reported use or nonuse of certain fat-reduction strategies. Differences in intake of 23 macronutrients and micronutrients, as well as energy, by exclusive users, mixed users, and nonusers of each strategy were statistically analyzed using analysis of variance with Scheffe's test. The number of fat-reduction strategies used by the children as well as demographic characteristics also were analyzed. RESULTS Only a small number of children qualified as exclusive users of skim milk (3%), lean meats (2%), and fat-modified products (1%). Energy intakes for all children were below 100% of the recommended dietary allowance. However, children (n = 85) who used skim milk exclusively in place of higher-fat milks closely approximated the current dietary recommendations (30% energy from fat, less than 10% from saturated fat, and less than 300 mg cholesterol) while maintaining adequate micronutrient intake and without significantly impacting energy. Children (n = 52) who used lean meats in place of higher-fat meats achieved the guideline for total fat; however, energy intake was 70% of the recommended dietary allowance and vitamin E was 63%. Children (n = 20) who use only fat-modified versions of cheese, salad dressing, cake, pudding, and yogurt made no significant impact on their energy, fat, or micronutrient intake. Of the 3299 children in the data set, only 3 qualified as users of two fat-reduction strategies and none qualified as users of all three strategies. Exclusive users of skim milk, lean meat, or fat-modified products were more likely to be female, white, and live in families with higher incomes. Those using skim milk or lean meat exclusively also were more likely to be older, whereas those exclusively using fat-modified products were younger. Furthermore, those using skim milk or fat-modified products exclusively were more likely to live in households where the head had more years of education, whereas those exclusively using lean meats were from households headed by those with slightly less years of education. CONCLUSIONS Despite the inherent limitations of population-based food surveys (including issues of underreporting, lack of biological markers and accurate anthropometric measures, and limited nutrient databases), these results provide insight into the rate of use of certain lower-fat food choices by children and suggest exclusive use can facilitate achievement of contemporary dietary recommendations. The impact of using these fat-reduction strategies on children's overall nutrient intake differs depending on the strategy used. Use of skim milk is an economical single-food strategy that facilitates achievement of contemporary dietary guidelines while maintaining nutrient adequacy. Professional guidance is recommended for children who exclusively use lean meats to assure adequate intake of energy and vitamin E. The impact of fat-modified products needs to be monitored closely as the number of such products increases in the marketplace. Results of this study can be used by health professionals working with children and their parents to highlight the overall efficacy of dietary recommendations while alerting them to potential pitfalls.