| Sample Menu |
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| One way to help fight childhood overweight and obesity is by providing menu options that cater to this alarmingly huge segment of our population. For example, rather than serving up kid's meals that are slathered with butter, tumbled in sugar or loaded with saturated fats, consider creating a menu for minors with natural appeal using the following suggestions as a starting point. |
BREAKFAST |
1 large egg, scrambled
1 slice of whole wheat toast with peanut butter
1 cup of low fat milk, skim or 1%
1 serving of fruit, i.e., blueberries or strawberries
Additional ideas include steel cut oatmeal or whole grain waffles instead of the toast |
LUNCH |
Chicken salad which includes black ripe olives, apples and celery or Swiss cheese served in a whole wheat pita, stuffed with baby spinach leaves
Raw veggies, such as mini carrots or broccoli
Fruit serving
Low fat yogurt
Water or diluted fruit juice |
DINNER |
3 ounces of grilled flank steak
1/2 cup of pinto beans
1 cup or more of grilled veggies or salad made with extra virgin olive oil
Whole wheat wraps
Fruit |
SNACKS |
Whole grain crackers with peanut or almond butter
Almonds, walnuts, peanuts
Air popped corn
Fruit with yogurt
Dark chocolate, occasionally for sweets |
SUMMARY: EACH DAY AIM FOR THE FOLLOWING GUIDELINES |
3 servings of low fat dairy
At least 9 servings of fruit and vegetables, aim for more color and variety
4 servings of whole grains
4-6 ounces of lean protein
3-4 servings of added healthy fats such as olives, nuts, avocado, olive oil, omega 3 fatty acids |
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Metabolic Syndrome and Larger Waists in Youth Point to Health Risks on Horizon
by Connie
Guttersen, RD PhD,
author of the Sonoma Diet
The magnitude and the prevalence of childhood obesity have increased at unprecedented levels over the past decade. This has renewed an interest in the study of metabolic syndrome in children. Researcher Dr. Ram Weiss states that metabolic syndrome is far more common among children and adolescents than previously reported, and its prevalence is directly related to the degree of obesity.
Studies Conclude Metabolic Syndrome a Major Threat to Obese Minors
The NHANES III study, conducted between 1988 and 1994, estimated the prevalence of metabolic syndrome at 6.8% among overweight adolescents and 28% among obese adolescents. The occurrence reached 39% in moderately obese and 50% in severely obese youngsters. Furthermore, Weiss found that biomarkers of an increased risk of adverse cardiovascular outcomes are already present in obese youngsters.
As health professionals, we have always been aware of the epidemic of obesity among children and sensitive to the epidemic of diabetes among adolescents. Now, on the horizon, is the prediction of cardiovascular disease for this generation. Weiss comments, "A dramatic increase in the incidence of type II diabetes may represent the tip of the iceberg and may herald the emergence of an epidemic of advanced cardiovascular disease due to the synergistic effects of other components of the metabolic syndrome, as well as chronic low grade inflammation, as obese adolescents become obese young adults."
The astonishing factor is that this may be occurring at an earlier age than most would imagine. A recent study led by Katrina DuBose, presented at the 53rd annual meeting of the American College of Sports Medicine, shows that out of 375 second and third graders, 5% had metabolic syndrome and 45% had one or more risk factors for it. The most common risk factor to be diagnosed was hypertension.
 Similar implications were found in the New England Journal of Medicine, led by Sonia Caprio, MD. She concluded that obese children, some not yet attending elementary school, are already displaying warning signs of cardiovascular risk factors that in past generations took years to develop. In her study, researchers found that 40 – 50% of children who were moderately to severely obese had metabolic syndrome. Caprio tracked 20 normal weight children, 31 overweight children, and 439 obese children between the ages of 4 and 20. Overall, the heavier the children the more likely they were to have hypertension, dyslipidemia and insulin resistance, lower levels of good HDL cholesterol and higher blood markers of inflammation associated with heart disease. In children as young as 4-6 years old, one in every three studied developed significant health risks very quickly, in particular for high blood pressure. There were no reported differences for ethnicity as Caprio concludes, "being obese is dangerous for children and adults, no matter who you are." TOP
Early Treatment of Childhood Obesity Offers Healthiest Future
The compelling message from this study is that there is a dose response effect. For each step increase in body weight and obesity, there is an increase in cardiovascular risk factors. Many times people will say that children will grow out of their obesity as they get older and taller, but unfortunately for the 15% of children who are classified as clinically obese this will not prove to be true. Treating obesity in children before puberty is important since the success rate is better than treating them as adults.
The number of prescriptions for type II diabetes drugs taken by children ages 5 – 19 years doubled between 2002 and 2005, according to an analysis by one of the nation's largest pharmacy benefit management companies. The increase in the use of the diabetes drugs was most pronounced in children 10-14 years, rising 106% during the study period. What may be compelling is that the study may have underestimated the prevalence of diabetes in children, since the disease is often undiagnosed for 5 to 10 years. The next phase of this study may examine diabetes related complications, such as cardiovascular disease related to the increase in childhood obesity. TOP
 Determining Childhood Cardiovascular Disease Risk
In the March 2006 issue of the American Journal of Cardiology, a group of investigators revealed that children who met the criteria for metabolic syndrome had significantly greater stiffness of the carotid artery and higher levels of C-reactive protein than those without the condition. Researcher Weiss and his colleagues in a separate study also found biomarkers of inflammation (C-reactive protein and interleukin-6 levels) and potential predictors of adverse cardiovascular outcomes to increase as obesity increased. In addition, adiponectin, a biomarker of insulin sensitivity decreased as obesity increased. Adiponectin is a cytokine secreted by adipose tissue which has been shown to improve insulin sensitivity, regulate glucose and lipid metabolism, and to have pronounced anti-atherosclerotic effects. Other studies have also shown that lower plasma adiponectin concentrations are associated with insulin resistance and cardiovascular disease. TOP
Waist Circumference Identifies Metabolic Syndrome Risk
Measuring a child’s waist could be a simple way to identify kids at risk of metabolic syndrome. Waist circumference is a strong predictor for the risk factors associated with metabolic syndrome. Below are some examples of risky waist sizes for children.
- 5 year old girl or boy with a waist size of 22 inches or more
- 10 year old boy with a waist size of 26 inches or more
- 10 year old girl with a waist size of 25 inches or more
- 15 year old boy with a waist size of 31 inches or more
- 15 year old girl with a waist size of 28 inches or more
Pathophysiology of Metabolic Syndrome in Childhood
There is still some controversy regarding the etiologic factors which define and cause metabolic syndrome in childhood. The most accepted hypothesis is that obesity-visceral abdominal obesity, and insulin resistance precedes the metabolic syndrome in childhood.
 A decreased response to insulin in late childhood, along with the degree of change in insulin resistance between ages 13 and 19, is significantly associated with insulin resistance in early adulthood and is highly correlated with a clustering of cardiovascular risk factors, according to the results of a new study by Sinaiko et al. Although investigators showed that childhood insulin resistance significantly predicts these future risk factors, the effects of childhood insulin resistance were independent of the effects of obesity. In the multiple-regression analysis, insulin resistance at age 13 significantly predicted systolic blood pressure, triglyceride levels, and the insulin-resistance metabolic-syndrome. The change in insulin resistance between late childhood and early adulthood also significantly predicted future triglyceride levels and insulin-resistance metabolic-syndrome score. "The message is that while obesity is really important, it might not be the whole answer," said Sinaiko. "There are other things that are important in establishing risk and we need to be looking at them." TOP
Strategies for Treatment of the Metabolic Syndrome
Identification of children with metabolic syndrome will greatly help direct treatment strategies of the underlying patho-physiology, such as insulin resistance and will prevent focusing on individual risk factors. Targeting the insulin resistance, as opposed to weight loss, may be more effective in preventing or delaying the onset of cardiovascular disease and type II diabetes in high risk groups. Strategies which aim solely at weight reduction have not been too successful. Exercise, lifestyle modification, and key dietary plans work together to have a synergistic effect. Monounsaturated fats, omega 3 fatty acids, magnesium, whole grains, phytoestrogens, soy, and nuts have been well documented for their protective effects for insulin sensitivity and lower body mass index.
As health professionals we continue to gain insight of how food can truly act as medicine.
Incorporating healthy items into creative meals for minors could be the best defense in battling childhood obesity. Consider this menu with natural appeal as a starting point. TOP
Magnesium
content of local foods by
Seasonal Availability |
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| Daily Requirement: 280 mg women (age 19 to 50); 350 mg men (age 19 to 50) |
| Season/Item |
Quantity |
Amount of Magnesium |
| SUMMER |
| Kale |
1 cup, cooked |
179 mg |
| Bok Choy, Cabbage |
1 cup, cooked |
158 mg |
| Beet Greens |
1 cup, cooked |
97 mg |
| FALL |
| Spinach |
1 cup, cooked |
157 mg |
| Sunflower Seeds, dried |
1/4 cup |
128 mg |
| Pinto Beans, dry |
1 cup, cooked |
103 mg |
| WINTER |
| Broccoli |
1 cup, cooked |
106 mg |
| Navy Beans, dry |
1 cup, cooked |
89 mg |
| Brown Rice |
1 cup, cooked |
72 mg |
| SPRING |
| Almonds |
3/4 cup, dry roasted |
304 mg |
| Trout |
3 ounces, cooked |
259 mg |
| Walnuts, English |
1/2 cup |
101 mg |
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A Closer look at Magnesium and Metabolic Syndrome
Magnesium is a mineral which is needed in all cells. It is especially important for reactions which are involved in the balance between sugars and insulin. Studies of large groups of people have shown that a deficiency of magnesium increases the risk factors associated with type II diabetes and elevated blood pressure. In a recent study which reviewed information from the Coronary Artery Risk Development in Young Adults Program, found that higher intakes of magnesium were associated with a reduced risk for developing metabolic syndrome - including a reduction of the risk factors associated elevated blood sugar, a larger waist and lower level of HDL, the good cholesterol. The question is: will higher magnesium intake prevent people from developing metabolic syndrome?
Dietary sources of magnesium include wheat bran, whole grains, leafy green vegetables, meat, milk, nuts, beans, bananas, and apricots.
Listed to the right are the magnesium contents of various foods. TOP
Fighting Metabolic Syndrome with Whole Grains
Scientific literature is emphasizing that what is important for preventing and managing metabolic syndrome is not just the total amount of carbohydrate but the type of carbohydrate we eat. For consumers who have relied on white bread and potatoes to meet their Food Guide Pyramid’s recommendation of 6-11 servings of bread, cereal, rice, and pasta per day, this may be a challenging issue. Researchers from Tufts University found that individuals who eat three or more servings of whole grains a day, especially high fiber ones, had better insulin sensitivity and were less likely to have metabolic syndrome.
Whole grain intake has been shown to be inversely related to body mass index (BMI) and waist to hip ratio for adults and adolescents. In an investigation based on participants from the Framingham Offspring Study which computed an average whole grain consumption of 8 servings per week to 20 servings per week of refined grain found astonishing results. As more whole grains were consumed, insulin levels went down. So did cholesterol levels, LDL levels, and the waist-to-hip ratio, which is a known risk factor for cardiovascular disease.
Clearly, it is necessary to look beyond the concept of weight loss as a cosmetic issue for children and take a look at smarter food choices and their combinations to achieve healthier children.
Proposed Cut Off Values for the Various Features of the MS in Children and Adults
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Summary of Pediatric Guidelines for the Prevention and Treatment of Disease States Associated with the Metabolic Syndrome
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