Monday, June 29, 2015

New Recommendations on Obesity Prevention in Kids

The American Academy of Pediatrics just issued a new report on how to prevent excessive weight gain in kids. Here are the highlights:

  1. Education and advice are unlikely to be effective. Environmental change and more advanced behavior modification are more effective.
  2. Beverages: eliminate sugary beverages. Limit juice and encourage fruit instead. Water is the ideal beverage for kids to drink. 
  3. Limit foods with high caloric density. (I think they got this terminology slightly wrong. Nuts, for instance, are highly caloric, but are also highly healthy. I think they should have said "limit processed food".)
  4. Children less than 2 years of age should not have any interaction with electronic entertainment/communication (including tablets, phones, TVs). Those older than 2 should be limited to 2 hours. (My thought: Parents might consider doing the same for themselves!)
  5. Kids should be active for 60 or more per day. 
  6. Prevention should start before birth by focusing on healthy weight gain and other practices in pregnancy. (My comment: it is hard to work on "healthy habits" once women are pregnant. It is much more effective to get healthy before getting pregnant.)
Of course, these recommendations are worded as being just focused on pediatricians. But, they really apply to any physician or provider taking care of children. Family physicians have a critical role, as we often take care of the Mother before she comes pregnant, and can help initiate prevention earlier than pediatricians and obstetricians. 

Remember 5-2-1-0 for kids (and families):
5 Fruits/Veggies a Day 
2 or less hours of screen time (for those older than 2)
1 hour of physical activity
0 sugary beverages

Friday, June 19, 2015

Reducing Saturated Fat: Worth it?

We recently published an article that was a "Mythbusters" on nutrition.  One of the controversial parts of the article was whether reducing saturated fats was a worthwhile nutritional focus. Of course, all of the major groups, including the IOM, reinforce the importance of reducing saturated fats.

One of the major studies we relied on was a Cochrane review. Cochrane reviews are the "gold standard" of evidence-based medicine. They take all the of the studies on a topic and use a standardized method to compile the evidence. The Cochrane review we relied on was just updated with new data. The results are the same. The plain language summary is:

"The review found that cutting down on saturated fat led to a 17% reduction in the risk of cardiovascular disease (including heart disease and strokes), but no effects on the risk of dying."

Let's break this down. If you replace saturated fats with other fats (but not with carbs), you will not reduce your risk of death. However, you will reduce your risk of a cardiovascular event. But here are what the numbers look like.

In the regular saturated fat group 83 people out of 1000 had Cardiovascular Events over 4.7 years, compared to 70 (95% CI 61 to 80) out of 1000 for the reduced saturated fat group.

Here is the visual for the regular group:
 And here it is for the reduced saturated fat group:

So out of 1000 people on the reduced diet, 13 less will have an event, with no effect on mortality.
Is it worth it?
Either way, it is beneficial to eat less meat and more vegetables. That reduces mortality.