Those children who met the recommendations had the highest levels of fiber and lowest amount of added sugars in their diet, but their fat intakes were still not as low as recommended (30 percent or less of total calories should be from fat).

"Food habits learned during childhood are carried into adulthood," noted Susan Krebs- Smith, Ph.D., one of the NCI researchers who conducted the study. "And poor dietary habits have been shown to increase adults' risks for many diseases, including cancer. Teaching children to choose a well-balanced diet can be an important step toward their long-term health." Kathyrn A. Munoz, Ph.D., an NCI cancer prevention research fellow, and others in NCI's Applied Research Branch also worked on this project.

The Food Guide Pyramid, created by the U.S. Department of Agriculture (USDA) in 1992, recommends numbers of servings of grains, vegetables, fruits, and meats based on the energy (calorie) needs of the child. Dairy food recommendations are based on age only, to ensure adequate calcium intake. Recommended servings, depending on energy needs, are: grains, six to 11 servings; vegetables three to five servings; fruits, two to four servings; dairy products, two to three servings, and lean meat, five to seven ounces per day (see chart, Page 4 for breakdown by calories and what constitutes a serving). Extra fats and added sugars are to be used sparingly.

NCI researchers used information from three-day food intakes of 3,307 children ages 2 to 19 years as part of USDA surveys in 1989-1991. By breaking down foods into component parts (such as pizza into bread, cheese, and tomato sauce), they determined how many food servings were being fulfilled. Key findings of the report:

• About 30 percent of kids and teens met dietary recommendations for fruit, grain, meat, or dairy foods and 36 percent met those for vegetables.
  
• Total fat made up, on average, 35 percent of calories and this did not vary by age, sex, ethnicity, or income. Extra, or discretionary, fat was most of this -- about 25 percent of calories. The Food Pyramid calculates servings based on the lowest fat option in any category -- lean meat, skim milk, etc. Any fat more than that, including higher fat options of foods such as whole milk as well as added butter or sauces, is considered "discretionary."
  
• Added sugar, which is sugar added to foods, not the natural sugars in fruits and grains, averages 15 percent of total calories.
  
• Children with the highest intakes of fruit had the lowest intakes of fat -- about 30 percent to 32 percent of total calories compared to 35 percent or more for other children.
  
• Intakes of milk in 2- to 5-year olds and 6- to 11-year olds are at or near the recommended level.
  
• Teenage boys were more likely to meet minimum recommendations for grains, vegetables, and meats than other groups. (Vegetables includes potatoes). Teenage girls met none of the minimums.
  
• Whites had higher intakes of grains and dairy foods, and blacks came closer to meeting recommendations for meat intake.
  
• Fruit and dairy intake increased with increasing income.
  
• The amount of vegetables eaten increased with age, but fruit intake decreased with age (teenage girls being the exception, possibly because they are eating fruits as an effort to diet.)
  

What can parents do? Krebs-Smith and her colleagues recommend starting with small substitutions: Change from whole milk to lower fat milk to reduce fat intake -- children over 2 years old do not need whole milk for adequate growth. Increase opportunities for children to eat fruits and vegetables -- have juices in the fridge instead of soda and keep raw vegetables and low-fat dips on hand. Choose pretzels instead of corn chips or potato chips for snacking. Suggest teens eat grilled chicken sandwiches instead of fried chicken nuggets or low-fat milk instead of a milkshake when they eat out.

NCI also has an Action Guide for Health Eating, with a variety of tips to help plan a well-balanced diet. This brochure is available through NCI's Cancer Information Service (1-800-4-CANCER).

Note: Dr. Munoz is now employed by Merck and Co., Inc., in Blue Bell, Pa.

* The study, titled "Food Intakes of U.S. Children and Adolescents Compared to Recommendations," was published in the September issue of the journal Pediatrics. The authors are Kathryn A. Munoz, Susan M. Krebs-Smith, Rachel Ballard-Barbash, and Linda E. Cleveland.

	Energy Level
Food Group	1600 Calories	2200 Calories	2800 Calories
Grain servings 1 slice of bread, 1 ounce ready-to-eat cereal, ½ cup of cooked rice or pasta	6	9	11
Vegetable servings ½ cup of cooked vegetables (including potatoes), 1 cup of raw leafy vegetables, 6 ounces of vegetable juice	3	4	5
Fruit servings ½ cup of cooked or chopped fruit, 1/4 cup dried fruit, 6 ounces of juice, medium piece of fruit	2	3	4
Dairy servings* 1 cup of milk or yogurt, 1 ½ ounces of natural cheese, 2 ounces of processed cheese	2-3	2-3	2-3
Meat in ounces	5	6	7

*dairy recommendation is not based on energy needs.

For children ages 2-3 who eat less than 1,600 calories a day, serving sizes are two-thirds the amounts listed above.

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