Normally I wait until the end to offer my comments, but I just wanted to preface this one by saying that this is an excellent example of a study, whose results are misrepresented by the media. Reports on this study proclaimed "Study finds no neurological harm in young kids' low-fat diets" and "Toddlers may benefit from fat-restricted diet". However, these are dangerous assertions and are certainly not supported by the study. I will comment further at the conclusion.

According to a new report, reducing children's fat intake to prevent heart disease later in life can start before age 2 without harming their brains. This contradicts current U.S. guidelines, which recommend against restricting fat intake before age 2, largely out of concern that fat deficiency could impair proper development of children's rapidly growing brains.

• 496 Finnish children were followed from 7 months of age to 5 years and were divided into 2 groups.

• The parents in one group were asked to put their youngsters on a low-fat diet, with a goal of limiting fat to no more than 30 percent to 35 percent of daily calories and were told to give them nonfat milk after they were weaned. They were also told to add 2 or 3 teaspoons of soft margarine or canola oil to their children's food until they reached 2 years of age.

• The parents of the children in the other group were advised to give them cow's milk containing at least 1.9 percent fat starting at age 1 but otherwise received no specific guidelines on fat intake.

At 13 months, average daily fat intake was 25.5 percent for the low-fat group and 27.6 percent for the control group (2.1% difference). It approached 30 percent by age 2 for the low-fat group and remained at about that level for the rest of the study. For the control group, it was closer to 33 percent for years 2 to 5 (2.8% difference).

• At age 5, children on a "reduced-fat" diet and those on a regular diet performed similarly on tests of speech, language, motor functioning and visual skills.

• Researchers said that the children on the "reduced fat" diets fared well nutritionally except for vitamin D and iron, and they recommended supplements until age 2.

• Cholesterol levels in the low-fat group averaged about 5 points less than the control group.

Dr. Gilman Grave, chief of endocrinology, nutrition and growth at the National Institute of Child Health and Human Development, said the results could help address the nation's "epidemic of childhood obesity, " although other nutrition experts disagree.

Because the children's arteries were not examined and they were not followed into adulthood, the long-term effect of their diets is unknown, said Sheah Rarback, a pediatric dietitian and spokeswoman for the American Dietetic Association. "They haven't proven the necessity," Rarback said. She also questioned whether the modest reductions in cholesterol achieved by children in the low-fat group were worth the risk.

"These are the growth years," she said. "You need to know the long-term benefit to make those types of changes."

In an interview with Reuters Health, Roxanne Moore, a dietitian with St. Joseph Medical Center in Maryland, said restricting fat more than 30% can interfere with growth and development in children under 2 years. "The calorie and protein needs of children are so high compared with adults," Moore explained. Children who are not getting enough to eat might fall below the 50th percentile of height and weight on growth charts and their social and vocabulary skills might also develop at a slower rate than their peers.

The Journal of the American Medical Association 2000;284:993-1000.

Dr. Mercola's Comment:

This study makes several assumptions, neither of which are supported by the eveidence presented. One is the claim that putting children on 'reduced-fat' diets will reduce their risk of heart disease later in life. Another false claim is that a 'reduced-fat' diet is safe for infants and young children and will not cause any neurological harm. Lastly, it is also incorrect to assume that these 'reduced-fat' diets will help to reduce the current obesity epidemic among our kids.

Concerning the reduction in heart disease claim, consider the following:

1. Although total serum cholesterol did go down slightly (5 mg/dL) in the 'reduced-fat' group, so did the beneficial HDL cholesterol. The all-important ratio of HDL/Total cholesterol remained unchanged. It is completely ludicrous to use total cholesterol as a measure of heart disease risk, when it consists of both beneficial (HDL) and negative (LDL and VLDL) components.

2. Triglyceride levels went UP slightly in the 'reduced-fat' group. This actually increases the risk of heart disease, rather than lower it. Some may be surprised that reducing fat in the diet causes the fat (triglycerides) in the blood to go up, but this occurs in adults on low-fat diets as well, and is the result of elevated insulin production.

3. Nearly all cholesterol measurements in this study were taken without fasting. This is a no-brainer. It is absolutely imperative to fast (water only) for this test. According to Mosby's 'Diagnostic and Laboratory Test Reference' manual, the test must be done on a 12 to 14 hour fast.

4. Total serum cholesterol levels were only 170 mg/dL in the control group and 165 mg/dL in the 'reduced-fat' kids. I don't know of any studies showing that there is any danger of a cholesterol level of 170 or that there is any benefit to be incurred by reducing it.

5. Many other risk factors for heart disease were not measured. Even if there were a potential benefit to be had by reducing the kids' cholesterol slightly, the only way that this would reduce their heart disease risk would be if no other risk factors were adversely affected. As I already mentioned, triglycerides went up. But what about other important parameters such as homocysteine, fasting glucose, lipoprotein(a), C-reactive protein, ferritin, and many others.

Concerning the claim that a 'reduced-fat' diet is safe, the main problem with this conclusion is that these children were not on a 'reduced-fat' diet, at least not according to the data presented. Let's take a look:

• At 13 months of age the difference in "reported" fat intake between the two groups was 2.1%

• At 5 years of age, the difference was 2.8%.

This means that if the margin of error in the study's data were just 1-1.4%, the 2 groups could have had the same exact dietary fat intake. If the margin of error was over 1.4%, then it is even possible that the 'reduced-fat' group had a higher fat intake than the control group.

To see how accurate the collected data could be, let's take a look at how it was collected:

• The children's diets were analyzed by having 3 or 4-day diet surveys completed approximately twice a year. This means that there were 6-8 days of data per year. Out of 365 days, this is about a 2% sample size.

• Many of the children were in daycare for much of the study period. Therefore, the daycare personnel had to fill out the surveys. Of course they had many children to care for and I don't see how they could provide accurate data with the time that they had to devote to the effort.

• Parents in the 'reduced-fat' group were given specific dietary guidelines, but the daycare personnel were not. Therefore, most likely the 'reduced-fat' kids ate exactly like everyone else during their days in daycare.

• It has been shown that many, if not all, clinical trials have a certain degree of "non-compliance", which basically means that patients don't follow the instructions or protocol they are given and very often lie about it to their doctors or researchers. For example, a very recent report found that 30% of patients (almost 1 in every 3) lied about taking their asthma medication and actually emptied out their inhalers into the garbage to fool researchers (Chest 2000;118:290-295). Therefore, it is not practical to assume that all parents in the 'reduced-fat' group actually complied with the dietary advice, especially considering the fact that they knew that the instructions that they were given conflicted with the current guidelines.

• The fat-intake of breastfed infants was not calculated, so diet composition percentages was only based on formula-fed infants, at least until breastfed infants were weaned.

The authors admit that it is possible that parents of children with developmental impairment may be more likely to be among the people who dropped out of the study, and therefore could have skewed the data.

Worse than the claims of safety by the researchers, is how it was reported in the press, who made it sound like there is no problem with putting kids on very low-fat diets.

Even if the data was precise and the reported diets were 100% accurate, the diets still would only have differed by 2.8%, hardly a big enough difference to declare that "Toddlers may benefit from fat-restricted diet".

Another one of the benefits that are expected to be gained by reducing the fat intake in these children is a reduction in weight. The problem with this theory is that a low-fat diet will not, in most people, result in better weight control. This is why I recommend a low-grain diet approach, which I have found provides the greatest benefit to my patients (and myself as well).

Researchers also made the assertion that the 'reduced-fat' children were only deficient in 2 nutrients - vitamin D and iron. However, this statement was not based upon any diagnostic testing. It was just a simple analysis of the completed surveys, which as I previously stated, are likely not very accurate.

Lastly, I would STRONGLY disagree with the instructions that parents in the 'reduced-fat' group were given about giving the children either margarine or canola oil. Margarine is a very toxic non-food and should not be used by anyone, as it is essentially liquid plastic.

Canola oil is also not a healthy choice in my opinion. To make matters worse, Dr. Mary Enig states that one of the problems with canola oil is that it is too unsaturated, but that some of the undesirable effects of canola oil can be rectified by a diet which is higher in saturated fats. Unfortunately, the children receiving the canola oil were also the ones supposedly on a lower saturated fat diet.

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