Heart Health for Kids: Dietary and Physical Activity Guidelines
American Family Children’s Hospital Pediatric Preventive Cardiology Clinic
Many things affect your child’s chances of having heart and blood vessel disease as an adult. Some of these risk factors, such as family history, age, and gender, cannot be changed. Some of the risk factors can be changed such as:
• food choices
• fitness
• obesity
• tobacco use and high blood pressure
If these changes are started as a child, they can lower the chances of future heart problems.
By making wise food choices now, your child can lower the risk of these problems when they are older.
• A stroke caused by blockages in the arteries that lead to the brain.
• A heart attack caused by blockages in the arteries around the heart.
• Peripheral vascular disease caused by blockages in arteries in the legs.
Risk Factors for Heart and Blood Vessel Disease
• Obesity and increased BMI, (Body Mass Index)
• Inactive lifestyle
• High LDL (low-density lipoproteins) or low HDL (high-density lipoproteins) levels
• Family history of heart disease, stroke, or peripheral vascular disease
• Tobacco use
• High blood pressure
• Diabetes
• Male gender
• Age
Body Mass Index
Body mass index, (BMI), is a ratio of weight to height. Because children grow, with boys and girls growing at different rates, BMI’s for children 2-20 years old are compared against growth charts of other girls and boys at the same age.
A child who’s BMI for age is:
• between 5-85% is considered to be at healthy weight
• 85-95% is considered to be overweight
• greater than 95% is considered to be obese.
Your BMI is ___________________________( ).
Fitness
Fitness strengthens your heart, raises your HDL, lowers your triglycerides, and helps with weight control. It can include aerobic activities like jogging, fitness walking (2.5 to 3.5 mph), biking, aerobic dancing, swimming, cross-country skiing, and rowing. It can also include normal daily movement like taking the stairs, mowing the lawn, and washing windows. Experts say to aim for 60 minutes of vigorous play or aerobic activity daily.
No more than two hours daily of screen time, including computer, TV, and gaming is recommended.
Blood Fats
Some fat is needed for our body. It is a big source of energy for muscles. It helps move vitamins throughout your body. Fat is also needed to make certain body tissues.
Even so, some blood fats can lead to a type of heart and blood vessel disease called atherosclerosis. This disease is a build up of cholesterol, calcium, and blood clotting factors in blood vessels. This buildup limits blood flow, which can increase the risk of a heart attack, stroke, leg pain or other problems.
Blood Fat Levels
The guidelines below apply to children 2-19years old. All values are in milligrams/deciliter.
| Acceptable | My readings (date) | My readings (date) | |
| Total Cholesterol | Less than 170 | ||
| LDL Cholesterol | Less than 110 | ||
| Triglycerides | Less than 125 | ||
| HDL- cholesterol | Greater than 45 | ||
| Lipoprotein A | Less than 30 |
What Do These Levels Mean?
Cholesterol is a substance found in all cells. It is needed for many body functions. Lipoproteins are particles that carry cholesterol and other fats throughout the blood stream. Two important types of lipoproteins are LDL and HDL.
Increased LDL levels have been found to increase the risk of heart and blood vessel disease. LDL cholesterol can collect in the arteries. This is why it is called “lousy” cholesterol.
Dietary factors which tend to raise LDL “Lousy” levels:
• Too much saturated and trans fats
• Too much cholesterol
• Not enough fiber in the diet
• Being overweight
To reduce your total LDL “Lousy” level:
• Lower saturated fats, trans fats, and cholesterol in your diet by choosing low-fat or no-fat dairy products, lean meats and vegetable oils.
• Lose extra weight.
• Eat more high-fiber foods – such as oatmeal, barley, fruits, vegetables, and legumes (split peas, navy beans, soy, etc).
Think about using foods with added plant sterols or stanols (Promise® Take Control® margarine or Supershots® yogurt).
HDLs remove extra cholesterol from your blood stream. This protects you from heart and blood vessel disease. For this reason, they are often called “healthy” or “happy” cholesterol.
To increase HDL “Healthy” levels:
• Get regular exercise such as walking, biking, swimming, or running.
• Don’t use tobacco.
• Lose weight if you weigh too much. Maintain a healthy body weight.
• Include some foods rich in monounsaturated fat:--nuts, olive oil, avocado, canola oil. Be sure that you do not eat so many that you gain weight.
Triglycerides are fats found in your food. Your liver can make them from extra calories, alcohol, and sugars in your diet. They are also found in extra body fat. When triglycerides levels are high, HDL levels tend to be low.
To lower triglycerides levels:
• Lose weight if you are overweight.
• Get regular exercise such as walking, biking, swimming, or running.
• Limit carbohydrates, including starches, sugars, and sweetened drinks.
• Use moderate amounts of unsaturated fat and low amounts of saturated fats.
• Limit or avoid alcohol.
Lipoprotein A particles are very small fat particles that are more likely to cause changes in the arteries due to their small size. This can be improved with good nutrition and fitness.
Sodium and Blood Pressure
Salt is sodium chloride. A low-sodium diet is used to prevent and treat high blood pressure. When you eat large amounts of salt, your body may hold fluid. This increases pressure on your arteries. Extra salt in the diet can also make it harder for high blood pressure medicines to work.
People with heart disease, high blood pressure, or congestive heart failure should limit their sodium to less than 1500 milligrams per day.
A meal plan that includes 8-10 servings of fruits and vegetables each day and 2-3 servings of low-fat dairy products each day has been shown to help lower blood pressure. This eating plan is called the DASH (Dietary Approaches to Stop Hypertension) diet. To learn more about this diet go to the web site listed below:
www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
Food Choice Guidelines
A Mediterranean-type Diet may be best for preventing heart and blood vessel disease. This eating pattern includes about 30% of the calories as fat, with saturated and trans fats less than 7%. Most of the fat is from monounsaturated fat (olive and canola oils, nuts and avocados). Cheese and meat are only eaten in small amounts. Fruits, vegetables, whole grains, fish and vegetable proteins make up most of the diet. This diet is higher in fat so portions may need to be lowered to prevent weight gain.
My Plate:
MyPlate is based on the 2010 Dietary Guidelines for Americans to help make better food choices. Balance your place setting with half your plate with fruit and vegetables. One quarter should be protein, and one quarter should be grains.
• Opt for whole grains.
• Switch to fat free or 1% milk.
• Drink water instead of sugary drinks.
• Use smaller sized plates.
• Eat less cake, cookies, chips, and energy drinks.
• Eat more vegetables, fruit, unsalted nuts, and seeds.
Fat
Although some fat is needed for good health, most Americans eat too much fat. If fat intake is lowered, it can help lower blood cholesterol levels and help in weight loss. To lower the amount of fat and calories in your diet, lower the amount of:
• Fatty meats
• Fried foods
• Whole milk dairy products and cheese
• Any added fats such as salad dressing, margarine, oil, or mayonnaise
Types of Fat
The fats in food can be placed into two main groups.
• Saturated and trans fat
• Unsaturated fat
Saturated fats tend to raise blood cholesterol levels and should be controlled in your diet. These types of fats are found in animal fats (meat fat, milk fat, butter) and tropical oils (palm and coconut oil).
To lower your fat intake:
• Choose skim or low-fat dairy products, including low-fat cheese and ice cream.
• Choose lean cuts of meat.
• Limit the amount of meat you eat to 6 ounces or less per day.
• Lower the amount of butter that you eat. Switch to vegetable oils or light tub margarines.
• Stay away from foods made with coconut or palm oil.
Trans fats are made when liquid vegetable oils are hardened to make shortening or margarine. They act like saturated fat by raising your cholesterol. You should try to stay away from trans fats.
To lower the amount of trans fat you eat
• Stay away from foods fried in hydrogenated oils (including many deep-fried foods).
• Limit donuts, cookies, pie crust, and other desserts.
• Use soft tub margarine or vegetable oil, rather than stick margarine.
Unsaturated fats are mostly liquid at room temperature. They lower LDL cholesterol. They may be used instead of saturated fats. Unsaturated fats have the same number of calories as saturated fat.
• Monounsaturated fats are found mostly in olive oil, canola oil, peanut oil, sesame oil, nuts, avocado and olives.
• Polyunsaturated fats are found in corn, soybean, safflower, sunflower and cottonseed oils. If unsaturated oils have been hardened or hydrogenated, they should be avoided.
Monounsaturated fats are chosen over polyunsaturated fats because they help protect LDL from oxidation and they do not lower HDL levels.
Tips for including unsaturated fats (both mono- and polyunsaturated):
• Use soft tub margarine and liquid oils. Olive and canola oil can often be used in cooking and baking.
• Stay away from butter, lard, or hardened vegetable shortenings.
• Snack on small amounts of nuts.
• Use avocado in salads.
Omega-3 Fat is the type of fat found in fatty fish like salmon, mackerel, herring, sardines and, in smaller amounts, in other fish. Some plant foods, such as flaxseed, walnuts and canola oil contain a form of omega-3 fat. Omega-3 fat can help lower triglycerides levels, help maintain HDL levels, lower the stickiness of blood cells, and lower inflammation in the blood vessel wall.
To increase your Omega-3 intake:
• Include fish at least 2 to 3 times per week.
• Use walnuts as a snack or add ground flaxseed to cereal.
• Your health care provider may recommend fish oil tablets for your child (if they do not have a fish allergy).
Plant sterols/stanols block cholesterol from being absorbed in the intestine. Including 2 grams of plant sterols per day can reduce LDL levels by 10% or more.
Plant sterols are found in fortified margarine (Promise® Take Control®), yogurt (Supershots®) and in plant sterol capsules.
Cholesterol is found in all foods from animals, such as meat, eggs, and milk. Cholesterol should be limited to 300 milligrams per day for the general public and 200 milligrams per day for people with heart disease or high cholesterol. Plant foods (fruits, vegetables, vegetable oils, grains, beans, nuts, peanut butter, and other plant products) do not contain cholesterol. Your body can make all the cholesterol it needs without depending on food sources.
To lower your cholesterol intake, limit the foods listed below.
• Egg yolks (no more than 4 yolks per week)
• Liver (no more than once a month)
• Organ meats
• Meat (no more than 6 oz per day)
• Whole milk dairy products
• Shrimp (can still be eaten once per week or less)
Note: Eating saturated fats increases blood cholesterol levels more than eating cholesterol-rich foods.
Carbohydrates
Carbohydrates include starches (bread, pasta, rice, noodles) and sugars. They are good sources of energy. But, if large amounts of carbohydrates are eaten, they can raise triglyceride and blood sugar levels. They can also provide too many calories, leading to weight gain or problems losing weight.
Starches can be made from whole grains (whole wheat bread, brown rice, whole wheat pasta) or they can be made from refined grains (white bread and pasta, white rice). Whole grain starches do not raise blood sugar and triglycerides as much as refined starches. They also contain more fiber, vitamins, and minerals than refined grains. Choose whole grain starches whenever you can. Eat small to medium-sized servings of all starches.
Sugars enter the blood very quickly after you eat them. This results in quick increases in blood sugar and triglycerides. Fruit juice (even the unsweetened kind) and soda sweetened with sugar contain about 10 teaspoons of sugar per 12 ounces. If you drink these liquids often, it will be hard to lose weight and control triglycerides and blood sugar. Limit your use of sugared drinks to 12 ounces per day or less. Drink more water instead.
Diet soda does not contain sugar or calories. It does not raise blood sugar or triglyceride levels.
Fiber
Fiber is the indigestible part of the plant foods we eat. Eating 20-30 grams of dietary fiber per day (with a focus on soluble fiber) will help to lower LDL by 5-15%. Soluble fiber is found in fruits and vegetables, barley, corn, dried peas and beans, and oats.
To increase your fiber intake:
• Use more fruits and vegetables (aim for 8-10 servings per day).
• Use whole grain breads and cereals. Include those with oats and barley.
• Plan meatless meals using navy beans, kidney beans, pinto beans, garbanzo beans, lentils, or split peas as a protein source.
Soy Protein
Soy protein is found in foods made from soybeans. If you include 25 grams of soy protein per day it may reduce LDL cholesterol by 5% and may have other health rewards.
To increase soy protein in your diet:
• Use frozen soy products (burgers, sausages, etc.) as meat substitutes.
• Drink soy milk or make a soy powder shake.
• Try tofu recipes.
• Use a handful of soy nuts as a snack.
Sodium in Foods
Sodium is in many foods without being added. It is also often added to foods while they are being made. Seventy-five percent of the sodium we eat comes from prepared or processed meats, hot dogs, spaghetti sauce mixes, frozen pizza, and other ready-to-eat products. The salt we add while making and eating food accounts for the rest of our sodium intake.
To lower your sodium intake
• Remove the salt shaker from your table.
• Try cooking with half as much salt as in the past or do not add any salt when you are cooking.
• Avoid high-sodium processed foods
• Use herbs and spices for flavor instead of salt.
• Make low-sodium choices when eating out.
Food Guidelines
Follow these guidelines to reduce your intake of fat, saturated fat, cholesterol, and calories. Choose “recommended” items most often and use “not recommended” items sparingly. A * indicates items high in sodium. Avoid these foods if you are trying to control your salt intake.
Milk and Dairy Products
| Recommended | Not Recommended |
| Skim milk, 1% milk | Whole/2% milk |
| Low fat/non-fat cream substitutes | Full-fat, natural cheese |
| Evaporated skim milk | Processed Cheese* |
| Low fat, part skim cheese such as mozzarella or farmers | Ice cream |
| Part-skim or non-fat ricotta | Frozen custard |
| Reduced fat cheese (5 gms fat per ounce or less | Sour cream |
| Low fat/non-fat cottage cheese | cream, half and half |
| Low fat/non-fat yogurt | Non-dairy creamers (from palm or coconut oil) |
| Low fat/non-fat sour cream | Cream cheese |
| Low fat/non-fat cream cheese | |
| Low fat/non-fat frozen yogurt | |
| Sherbet | |
| Low fat/non-fat ice cream | |
| Soy milk (calcium fortified) | |
| A * indicates high in sodium |
Protein Foods
| Recommended | Not Recommended |
| Lean beef- Top sirloin, tenderloin, top loin, round, ground round, rump, arm, flank | Fatty beef- regular hamburger, T-bone, prime rib, ribs, porterhouse |
| Lean pork- loin chop, tenderloin, ham* | Fatty pork- spare ribs, sausage*, bacon* |
| Game- venison, rabbit | Fatty poultry- poultry skin, duck, goose, self-basting turkeys |
| Poultry- chicken and turkey (skinless) | Luncheon meats/cold cuts* with more than 3 grams of fat per ounce |
| Fish, all types | Hot dogs* |
| Shrimp (limit to 4 ounces per week) | Bratwurst* |
| Egg white/Egg substitute | Deep fried meats and seafood |
| Peanut Butter | Egg yolk (limit to 4 per week) |
| Dried or canned beans, split peas, lentils | Creamed soups* |
| Textured vegetable protein | |
| Low fat TV dinners/frozen entrees* (Healthy Choice) | |
| Low fat turkey bacon or sausage* | |
| Low fat turkey luncheon meats (3 grams or less per ounce) * | |
| Low fat/fat-free hot dogs | |
| Turkey/Vegetable bratwurst* | |
| Vegetarian burgers or sausage* (made of soy) | |
| Low fat creamed soups* | |
| Tofu | |
| A * indicates items high in sodium |
Limit meat, poultry and low-fat cheese intake to a total of 6 ounces per day. One 3-ounce serving is about the size of a deck of cards. When buying meats, choose the leaner “select” cuts rather than “prime” choice cuts. Trim visible fat before cooking. Prepare by baking, roasting, broiling or grilling to reduce fat content. Try meatless meals 1 to 2 times per week to further lower fat intake and increase fiber.
Vegetables & Fruits – at least 5 servings per day
| Recommended | Not Recommended |
| Fresh, frozen, dried or canned fruits | Fried, deep-fried, creamed or au gratin vegetables |
| Fruit juices (limit quantity to control calories and sugar) | Coconut and coconut milk in large quantities |
| Fresh or frozen (plain) vegetables | Frozen vegetables in sauces or cheese |
| Canned vegetables or vegetable juices* | |
| Avocado | |
| Olives* | |
| Sauerkraut* | |
| Pickles* | |
| A * indicates items high in sodium |
Breads, Cereals & Grains
| Recommended | Not Recommended |
| Enriched or whole grain breads | Doughnuts and other fried breads |
| English muffins | Croissants |
| Bagels | Crescent rolls |
| Cereals, especially whole grain | Sweet rolls |
| Pancakes, waffles, (with 5 grams fat or less) | Muffins or biscuits made with saturated fat |
| Rice Cakes | Crackers with more than 2 gm fat per serving |
| Pita Bread | Chow mein noodles, ramen noodles with palm oil |
| Tortilla, corn or flour | Granola (unless lower than 2 grams of fat/serving) |
| Rice, barley or bulgar | Rice/noodle mixes * (unless fat is omitted) |
| Pasta, especially whole grain | |
| Soda crackers* | |
| Graham crackers | |
| Crackers* (with 2 gms of fat or less per serving) | |
| A * indicates items high in sodium |
Fats
Note: Recommended fats should be used in small amounts to control calories.
| Recommended | Not Recommended |
| Margarine with liquid oil as primary ingredient (soft tub or squeeze type) Reduced-calorie margarine | Margarine with hydrogenated oil as primary ingredient (most stick types) |
| Liquid vegetable oils- canola, olive, peanut or sesame oil, sunflower, safflower, corn, soybean or cottonseed | Butter or Lard |
| Salad dressings * (reduced calorie) | Bleu cheese salad dressing* |
| Mayonnaise and sandwich spreads (reduced calorie) | Cream Cheese |
| Nuts and seeds in moderate amounts | Hardened or hydrogenated vegetable shortening |
| Coconut and palm oil | |
| A * indicates items high in sodium | Regular gravy |
Snacks and Desserts
| Recommended | Not Recommded |
| Fruit | Regular tortilla, potato and corn chips* |
| Angel food cake | Chocolate candy |
| Puddings from skim milk | Cakes and cookies made with hardened fat and egg yolks |
| Cocoa powder | Pies, pastry |
| Cakes and cookies made with oil and egg whites | Regular granola bar |
| Low fat granola and breakfast bars | Ice cream |
| Pretzels* | |
| Baked potato or corn chips | |
| Popcorn with little or no added fat | |
| Sherbet, fruit ices, Popsicles® , sorbet | |
| Low fat ice cream or frozen yogurt | |
| Vanilla wafers, graham crackers, ginger snaps | |
| Hard candy, licorice, jelly beans | |
| Jelly, jam, honey, syrups | A * indicates items high in sodium |
Note: Although sugar does not increase cholesterol levels, amounts should be controlled for persons who are overweight. Persons with diabetes or high triglycerides should eat fewer servings of sugar and sweets. Snacks and desserts can lead to weight gain. Try to eat them in small servings or less often if you are overweight.
Resources
Cookbooks
The Road to a Healthy Heart Runs through the Kitchen, by Joe and Bernie Piscatella, Workman Publishing, 2006.
The New American Heart Association Cookbook, 7th Edition, Random House, 2004.
American Heart Association Low-Fat, Low-Cholesterol Cookbook, 3rd Edition, Random House. 2005.
American Heart Association Low-Salt Cookbook, 3rd Edition. Random House, 2006.
American Heart Association Quick and Easy Cookbook, Random House, 2001.
American Heart Association Low Calorie Cookbook, Random House, 2004.
Vegetarian Cooking
Moosewood Restaurant Low-Fat Favorites. The Moosewood Collective. Clarkson N Potter Publishers. 1996.
The Complete Idiot’s Guide to Being Vegetarian by Suzanne Havala. Alpha Books, 1999
Fast, Fresh and Spicy Vegetarian, 2nd Edition by John Ettinger. Prima Books. 1998
How to Cook Everything Vegetarian: Simple Meatless Recipes for Great Food by Mark Bittman and Alan Witschonke, 2007
The Complete Idiot's Guide to Vegan Living by Beverly Lynn Bennett and Ray Sammartano, 2005
Vegetarian Times Complete Cookbook by Vegetarian Times Magazine, 2005
Vegetarian Cooking for Everyone by Deborah Madison, 2007
General
Cooking Light – The Magazine of Food and Fitness, P.O. Box 830549, Birmingham, AL 35282. Phone 1-800-633-8628.
Eat, Drink and Weigh Less, by Mollie Katzen and Walter Willet, Hyperion, 2006.
The Diabetes and Heart Healthy Cookbook by American Diabetes Association/American Heart Association, 2004.
Web Sites
National Cholesterol Education Program, Live Healthier, Live Longer provides information on heart disease risk factors, menus, recipes, grocery shopping and eating out tips.
http://www.nhlbi.nih.gov/chd/
American Dietetic Association provides a variety of nutrition information. Excellent interactive website for children. http://www.eatright.org
Harvard Medical School’s Consumer Health Information offers nutrition updates, recipes and a nutrition database http://www.intelihealth.com
Cooking Light Magazine provides recipes and nutrition information http://www.cookinglight.com
Eating Well Magazine, http://www.eatingwell.com
American Heart Association has cholesterol and nutrition information and recipes and a children’s section. www.americanheart.org/cholesterol/
American Heart Association recipes http://www.deliciousdecisions.org
DASH (Dietary Approaches to Stop Hypertension) Diet
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/
http://Letsmove.gov Program developed by First Lady Michelle Obama to solve the epidemic of childhood obesity within a generation.
The Spanish version of this HFFY is #515
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 08/14/2012
Copyright © 04/12/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#520
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