A New

Christine

Recommendation

L. Williams,

MD,

MPH;

for

Marguerite

Pediatricians

and

others

who

well aware
of the importance
optimal
growth
and development.
ognized
that diet in childhood
only
the
impact
in
status
of
adequate

care

for

the

health

AHF,
and

of children

are

of adequate
nutrition
to support
More recently
it has been
recand adolescence
influences
not

immediate
a positive
children.
to support

health
of children
but
or negative
manner
on the
An optimal
diet
during
normal,
and
sometimes
and development,4
and at the same time it
the risk of diet-related
chronic
diseases
during
ing coronary
heart
disease,7
some
cancers
creas,
ovary,
endometrium,
and
prostate),89

Health
Foundation,
Valhalla,
NY.
1995 by the American
Acad-

MS.

RD;

in Childhood

and

Ernst

L. Wynder,

MD

and cholesterol
in children
2 years of age and older
(Table
1).
These guidelines
have been endorsed
by the American
Academy
of Pediatrics
(AAP), the National
Cholesterol
Education
Program
of the National
Institutes
of Health,
the American
Heart Association, the American
Health
Foundation
(AHF), the US Department
of Agriculture,
and other
organizations
concerned
with child
health.#{176}
None
specific

ever,

of the present
level
of dietary

recommend

national
dietary
guidelines
recommend
fiber
intake
during
childhood.
All,

an increase

in consumption

of complex

hydrates,
which
include
a variety
of foods
that
This article
describes
a proposal
by the American

lion for
rationale

a specific
level of fiber
for the recommendation

parison

with

other

CURRENT
the

National

suggested

data

are

on

Health
and
II (1976 to 1980),

(NHANES)
Survey
(1987
and
NHANES
III (1988

III estimates

1988),
and
to 1991).h114

of childrens

carbo-

are high
Health

of dietary

in fiber.
Founda-

fiber.

PATTERNS

available

a
how-

intake
during
childhood.
The
is discussed,
as well as a corn-

levels

DIETARY

At present,

OF

childrens

Nutrition
the National
limited
Table

dietary

CHILDREN

dietary

intake

Examination
Food

preliminary
I compares

intake

from

Survey
Consumption

data
from
the
NHANES
II and

versus

recommended

dietary
goals.
Compared
with
pediatric
dietary
goals,
children
consume
higher
than
recommended
amounts
of total
and
saturated
fat and cholesterol
and less than
recommended
amounts
of
complex
carbohydrates
and dietary
fiber.46
Dietary
fiber
intake
for
2- to 19-year-old
children
in the
NHANES
II was 12.4 g/d,
and estimates
from
the 1987 and 1988
National
Food
Consumption
Survey
provide
similar
values.718
Comparison
of the 1977-1978
and 1987-1988
National
Food
Consumption
Surveys
has
shown
that
consumption
of vegetables
among
children
has decreased
significantly
between
1977
and
1987. Fiber
consumption
remained
unchanged,
however,
because

there was an increase

in consumption
Other studies
of pediatric
dietary
the United
States also have provided

of cereal.8
patterns
in specific
areas
data on secular
trends

of
of

dietary
fat and
fiber
consumption
in childhood.
Data
from
the
Bogalusa
Heart
Study,
spanning
a 14-year
period
from
1974 to
1988, suggest
that childrens
diets
have
improved
during
this time
and are currently
lower
in total fat and saturated
fat than in 1974.
From
1974 to 1988 the percent
of energy
from
total fat in childrens

TABLE
1.
Than 2 Years

Actual

Versus

Dietary

Dietary

Children

Polyunsaturated

up

Monounsaturated
Carbohydrate
Protein
Cholesterol

(mg/d)

Percentages

are

(2-17

<30%
<10%

fat

to 10%

Older

NHANES

33-34%
12-13%

6%

NA

13%
50%
15%

NA
NA
NA
NA

calories.

t Adapted
from National
Cholesterol
Education
Program
lines.8
:1:NHANES
II data for children
2 to 17 years
of age. Adapted
Kimm
et al.4
NHANES
III data for children
3 to 19 years
of age. Adapted

Lenfant

III

1988-1991
(3-19 y)

148

<300
of total

y)

36%
13%

10-15%
50-60%
15-20%
percent

II

1976-1980

(>2 y)t

for

NHANES

Goal
Fat, total
Saturated

Goal

of Age*

Nutrient

also
may
have
an
future
adult health
childhood
must
be
very
rapid,
growth
must
aim to reduce
adulthood,
includ(breast,
colon,
panstroke,
adult-onset

diabetes,
obesity,
and hypertension.#{176}
Guidelines
recently
have been established
for recommended
dietary
intake
of total fat and fatty acids, protein,
carbohydrate,

From the Child Health Center,

American
PEDIATRICS
(ISSN 0031 4005). Copyright
emy of Pediatrics.

Fiber

Bollella,

ABSTRACT.
Objective.
The
consumption
of dietary
fiber
in childhood
is associated
with
important
health
benefits,
especially
with
respect
to promoting
normal
taxation.
Dietary
fiber
also may help
reduce
the future
risk
of cardiovascular
disease,
some
cancers,
and adultonset
diabetes.
At present,
there
are few specific
guidelines
for dietary
fiber
intake
in childhood.
Our goals
were
to review
the benefits
and risks
of dietary
fiber
in
childhood
and to propose
a safe and effective
quantitafive recommendation
for the US pediatric
population.
Method.
Current
intake
of dietary
fiber in childhood
was reviewed,
including
data from the US Department
of
Agriculture
Nationwide
Food
Consumption
(1987-1988)
and National
Health
and Nutrition
Examination
II (19761980) Survey.
Current
intake
was compared
with existing
fiber recommendations,
including
the O.5-glkg
guideline
proposed
by the American
Academy
of Pediatrics
Cornrnittee
on Nutrition.
Recommended
fiber
intake
was reviewed
with respect
to levels
required
for specific
health
benefits,
as well
as levels
that may
result
in adverse
health
effects.
Results
and Conclusions.
A new recommendation
for
dietary
fiber
intake
was developed,
based
on the age of
the child,
health
benefits,
and safety
concerns.
We recommended
that children
older
than 2 years
of age consume
a minimal
amount
of dietary
fiber
equivalent
to
age plus
5 g/d. A safe range
of dietary
fiber
intake
for
children
is suggested
to be between
age plus 5 and age
plus 10 g/d. This range
of dietary
fiber
intake
is thought
to be safe even
if intake
of some vitamins
and minerals
is
marginal,
should
provide
enough
fiber
for normal
laxation,
and
may
help
prevent
future
chronic
disease.
Pediatrics
1995;96:985-988;
dietary
fiber,
children,
recommendation.

ABBREVIATIONS.
AAP,
American
Academy
of Pediatrics;
American
Health
Foundation;
NHANES,
National
Health
Nutrition
Examination
Survey;
kcal,
kilocalorie.

Dietary

guidefrom
from

et al.32

PEDIATRICS
Downloaded from by guest on December
11, 2016 Vol. 96 No.

5 November

1995

985

diets decreased
similarly
from

from 38% to 36%, whereas

saturated
fat decreased
16% to 13% of kilocalories
(kcal)/d.
On the negative

side,
however,
consumption
period,
from 3.3 to 3.7
increase
in dietary
fiber

g/1000
kcal.5
Thus, several

of sodium

national

surveys,

gional
studies,
have
reported
averaging
about
12 g/d,
with

to 19-year-old

boys

and

PREVIOUS

increased

during

this

g/d
(1974 to 1988), and there
intake,
with an average
of 12
as well

/d

as estimates

for 3- to 19-year-old

PEDIATRIC

DIETARY

no
or 5

from

reintake,
for 3-

similar
levels
of dietary
fiber
a range
of about
8 to 15 g/d

8 to I I g/d

time

was

girls.3

of dietary

FIBER

RECOMMENDATIONS
The AAP Committee
on Nutrition
has recommended
a dietary
fiber intake of 0.5 g/kg body
weight.9
Based on National
Center
for Health
Statistics
median
weight
for age, dietary
fiber intake
following
this recommendation
would
range
from
6.8 to 34.5 g/d
for 3- to 19-year-old
boys and from 6 to 28.5 g/d for 3- to 19-yearold girls. Table 2 compares
these recommended
levels with current levels of fiber intake.
AAP recommended
fiber intake for older, heavier
adolescents
whose body weights
are significantly
above the median
weight for
age could
well approach
40 g/d;
however,
the AAP guideline
places a cap on recommended
daily fiber intake at 35 g/d. From a

TABLE

2.

Selected

Fiber

years,

Compared

With

Curre

Age
(y)

AAP
0.5 g/kg

10 g/1000
kcal

Intake

for

nt Estimates

Children,

Ages

of Dietary

AHF
Recommendation

3 to

Fiber

18

Intake*

Current
Intake,
NFCS/

Age#{247}5 Age#{247}10
(Mm)
(Max)

NHANES

II

Boys
3

7.5+

is recommended.

These

recommendations

are

for

could
be recommended
at 4 to 6 years
of age if this formula
is
used.
If dietary
fiber is recommended
at a level of 12 g/1000
kcal,
this amounts
to about
22 g/d
at a calorie
intake
of 1800 kcal.
The US Department
of Agriculture
Food
Pyramid
does
not
specify
a recommended
amount
of dietary
fiber per day; however,
estimates
may be made based on number
of servings
and usual
serving
size.
With caloric
intakes
of 2200 and 2800 kcal, fiber

intake

could

g/serving
vegetables.

be 32 to 40 g/d,

if the fiber

content
and

of bread
group,
2 g/small
fruit,
For smaller
children
at a 1600-kcal

is estimated
at 2
2 g/#{189}cup of

level,

who

would

receive half-size
be about 19 g/d.

servings
of vegetables,
dietary
fiber intake would
Consumption
of low-fiber
breads
and cereals and
fruit
juice
rather
than whole
fruit
would
decrease
the estimated
fiber, however.
Larger
fruits and higher-fiber
breads
and cereals
would
increase
the estimate.

14

13

8.5
9
10
11.5

17
17
18
18

9
10
11
12

14
15
16
17

8
9

12.5
14

19
19

13
14

18
19

10

15.5

22

15

20

help

prevent

11

17.5

22

16

21

levels

and,

12
13

20
22.5

27
27

17
18

22
23

14

25

27

19

24
25

help prevent
obesity
and the risk of adult-onset
diabetes.44
National
pediatric
dietary
goals are targeted
for children
older
than 2 years of age, with a suggestion
that age 2 to 3 years be a
transition
year.7 The proposed
dietary
fiber recommendations,

15

28.5

27

20

16

31.5

27

21

26

17
18

33
34.5

27
28

22
23

27
28

8-11.6g/d

11.5-13.4g/d

14-15.4g/d

RECOMMENDATION
INTAKE

AHF

g/d

14.1 g/d

FOR DIETARY
CHILDHOOD

IN

Data
suggest
that
American
inadequate
amounts
of dietary
consumption
should
be increased

therefore,
15.4

Girls

diet-related
therefore,

are

also

children,
like
adults,
consume
fiber
for optimal
health,
and
that
to promote
normal
laxation,
to

cancer,
the

targeted

risk

FIBER

to help
of

toward

reduce

coronary

serum

heart

children

older

cholesterol

disease,

than

and

2 years

to

of

age.
The AHF recommends
that a reasonable
goal for minimal
intake of dietary
fiber for children
and adolescents
3 to 20 years of
age be the equivalent
of the age of the child plus 5 g of dietary
fiber
per day (age plus 5) (Figure
1). Based
on this recommenda-

14

13

17

14

5
6
7

9
10
11

17
18
18

10
11
12

15
16
17

children
Compared

12.5

19

13

18

9
10
11
12

14
16
17.5
20.5

19
22
22
22

14
15
16
17

19
20
21
22

11.5-13.4g/d

for preadolescent
children
and a larger increase
(70% to 100%) for
many adolescents.
The age plus 5 level of fiber intake for children
is similar
to the
AAP9 recommendation
(0.5 g/kg body weight)
up to the age of 10

13
14
15

23
25
27

22
23
23

18
19
20

23
24
25

10.6-10.9g/d

16

28.5

23

21

26

17
18

28.5
28.5

23
23

22
23

27
28

9-10.4g/d

fiber

recommendations

are

given

years;

10.2

as grams

g/d

10.8 g/d
of dietary

per kilogram
of body
weight
(AAP), grams of dietary
fiber
per 1000 kcal of energy
intake, or as grams of dietary
fiber per day
equal
to the childs age plus 5 or plus 10 g (AHF). NFCS, Nation-

SUPPLEMENT

for median

weights

minimal

fiber

intake

would

range

from

to 25 g/d by age 20 years and remain

with current
dietary
fiber intake

5 recommendation

however,

represents

it is

lower

for

a smaller

older

8 g/d

in 3-year-old

constant
thereafter.
in children,
the age
increase

adolescents

(25%

(Fig

to 50%)

2, 3).

In

addition,
the age plus 5 recommendation
is consistent
with current guidelines
for adult dietary
fiber intake (25 to 35 g/d) made
by the AHF,
the National
Cancer
Institute,n
and others.26

fiber

wide Food Consumption

Survey.
t AAP dietary
fiber intake is calculated
age based on NCHS growth
charts.33

tion,

plus

mean,
Dietary

986

fiber

about
12 g of dietary
fiber per 1000 kcal consumed.
Similar
amounts
of dietary
fiber have been recommended
for children.2
Dietary
fiber intake based on the 10- to 12-g/1000
kcal recommendation
is lower than AAP recommended
levels for most adolescents,
especially
girls, whose
caloric
intakes
average
about
2000 kcal/d.
On the other hand, fiber intake based on this formula
may
be too high
for young
preschool
children.
Recommended
caloric
intake for 4- to 6-year-old
children
averages
1800 kcal/d
(range, 1300 to 2300 kcal/d)?
Thus, 15.6 to 27.6 g/d dietary
fiber

4
5
6
7

mean,

perspective
of safety,
however,
levels of dietary
fiber intake
of
more than 30 g/d for adolescents
with borderline
or inadequate
intake of some essential
minerals
(calcium,
iron, and zinc) potentially could lead to deficiencies.2#{176} On the other hand, up to 25 g/d
(or about 10 to 12 g/1000
kcal) during
adolescence
should
not be
deleterious,
even with suboptimal
mineral
intake.#{176}
Recommended
fiber intake based on the new Food and Drug
Administration
food
labels is based on caloric intake,
rather than
body
weight,
and does not make separate
recommendations
for
children.
For individuals
consuming
2000 kcal/d,
25 g of dietary
fiber is recommended,
and for those
consuming
2500 kcal/d,
30 g

at each

Safety

Considerations

It is important
to consider
not
only
the
health
benefits
of
increasing
dietary
fiber
in childhood,
but also the potential
risks.
High-fiber
diets
have
the potential
for reduced
energy
density,
reduced
caloric
intake,
and poor
growth,
especially
in very young
children.
In addition,
such
diets
may
reduce
the bioavailability
of
minerals,
such
as iron,
calcium,
and zinc.20
Such
effects,
however,
are unlikely
to occur
in highly
industrialized
countries
such

as the United
sume adequate

States, where
omnivorous
calories
from a variety

Downloaded from by guest on December 11, 2016

children
generally
of foods and where

conintake

TABLE

3.

Guidelines

for Achieving

Ag e (y)

Fiber

Minimal

Recommended

Suggested

(g/d)

11

13

15

in Childhood:

Dietary

Sources

2.2

#{189}
oz
#{189}
medium

2.5
I .7

Raisin

bran

#{190}
cup

5.0

Carrot
Peanut
Apple

(raw)
butter

I medium
I tbsp
I medium

2.3
1.0
3.0

Apple

Raisin

#{189}
cup

3.0

1.5 oz
#{189}
cup
1 medium

4.5
3.0
2.4

I cup
#{189}
cup

3.3
3.0

I cup
2 cups

6.7
2.0

2 oz
10 halves

6.7
3.2

I cup
0.5 cup

6.2
2.0

#{189}
cup

3.0

cereal

Crisp

dry

cereal

roast

Bran cereal
popped
dry
dried

Raisin bran
Broccoli

roasted

cereal

19

Frosted

Mini

Wheat

16

21

Pear
Branola
bread
Refried
beans
Baked beans
Blackberries
Muesilix
cereal
Peanut
butter

18

23

Peanuts,

dry

cereal

I medium
2 slice
4 oz
1 cup
#{189}
cup
2.3 cup
2 tbsp
roasted

All

Bran

Chili
All

cereal

w/beans
Bran

4.4

I medium

2.6

#{189}
cup

9.0

extra

fiber

#{189}
cup

Baked potato
Trail mix*
Strawberries
Trail

mix

of dietary
mendation
thought

consists

fiber

of #{189}
cup

of raisins

is relatively

low.#{176}
In addition,

for dietary
fiber
intake
to provide
known
health

the

in childhood
benefits
without

AHF

recom-

is within
a range
a potential
risk

to either mineral
balance
or caloric intake in children
3 years of age
and older.
With respect
to a recommended
range of dietary
fiber intake,
levels between
age plus 5 to age plus 10 g/d seem to represent
a
safe and tolerable
level for most children
based on current
knowledge. The age plus 10 upper level of fiber intake is similar in some
respects
to levels based on 10 to 12 g/1000
kcal. These
levels have
been
suggested
as safe even for Japanese
adolescents,
who traditionally
have low levels of calcium
intake.2 These data, along with
a larger body
of information
on potential
harmful
effects of very
high levels of dietary
fiber, suggest
that the age plus 5 to 10 range
fits

conservatively

Practical

within

a safe

range

of fiber

intake.#{176}

Considerations

An advantage
of the age plus 5 recommendation
is that it is
easy for health professionals,
parents,
and children
to remember
and, therefore,
might prove useful
as a simple
tool for enhancing
nutrition
counseling
in clinical and education
settings.
The recommended
increase
in dietary
fiber is best accomplished

by

etables,

cereals,

increasing

adequate

intake

and

intake

other

of a variety

grain

of calories

products

to support

of fiber-rich

(Table

fruits,

2), while

normal

growth

veg-

assuring
and

devel-

medically

recommended

treatment
childhood.

of hypercholesterolemia,

as

an

effective

adjunct

obesity,

and

to

the

constipation

dietary

in

15.0 g/d

18.1 g/d

19.1 g/d

21.0 g/d

23.0 g/d

26.2 g/d

(1.0 g).

Because
dietary
fiber increases
water retention
in the colon, and
in that way leads to bulkier
and softer stools, water intake should
be increased
commensurate
with fiber intake.
The amount
of
water needed
for children
to produce
soft bulky
stools is estimated
to be 6 to 8 cups/d.#{176} Others
have recommended
6 cups/d
for
children

weighing

26 lb, increasing

weighing
about 99 lb (the mean
Water intake for older adolescents
need to be even higher.

up

weight
with

to 10.5

cups/d

for children

of a 13-year-old
boy).3
higher
fiber intakes
may

SUMMARY
Dietary
fiber has important
health benefits
in childhood,
especially in promoting
normal
laxation.
In addition,
fiber may help
reduce
the risk of some cancers
(breast,
colon, pancreas,
ovary,
endometrium,
and prostate),
as well as the risk of cardiovascular
disease
and adult-onset
diabetes
mellitus
(by reducing
obesity,
blood cholesterol,
and blood glucose
levels).
Children
currently
consume
amounts
of dietary
fiber that are
inadequate
for health promotion
and disease
prevention.872426
It is recommended,
therefore,
that children
older than 2 years of
age increase
their intake
of dietary
fiber to an amount
equal or
greater
to their age plus 5 g/d as a suggested
goal for a minimal
amount
of dietary
fiber intake.
Following
this rule, fiber intake
would
increase
from 8 g/d at age 3 years to 25 g/d by age 20
years.

opment
and to supply
adequate
amounts
of essential
nutrients
(Table 3). Fiber supplements
for children
are not recommended
as
a means
of meeting
dietary
fiber goals. However,
they may be

dates

two

12.9 g/d

2.3
6.0
3.9

1 cup
(2.2 g), and

11.3 g/d

14.0

I medium

(2.7 g), I oz of peanuts

9.4 g/d

7.0

1 cup

with

7.4 g/d

4.3
5.8
6.0
12.7
3.3
3.0
2.0

2 oz

Kiwi

Total

Rye Krisp crackers

Sweet potato

Almonds,
Apricots,

25

(g)

Nectarine

Popcorn,

20

5 Rule

1.0
1.8
3.0

Fruitful

14

Plus

#{189}
#{189}
cup
I

Blueberries

17

of Fiber

Age

Banana
Applesauce
Waffle (Nutri-Grain)

Peas

12

AHF

1.6
3.0

bread
Square
cereal

Almonds,
Corn
Orange
10

Intake

1 slice
#{189}
cup

Whole-wheat
Blueberry

Fiber

After

age

20 years,

adult

guidelines

of 25 to 35 g/d

dietary

fiber remain
the goal.
Dietary
fiber intake should
be increased
gradually
in childhood
and may be accomplished
relatively
easily
by increasing
consumption
of a variety
of fruits,
vegetables,
cereal,
and other
whole-grain
products,
accompanied
by an increased
intake
of
water.

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SUPPLEMENT

987

fiber

Although
intake

erate

there
are some
potential
in childhood,
the potential

increase

weigh

the

in dietary

potential

trialized

fiber

risks

countries

adverse
health

in childhood

significantly,

such

effects
benefits

as the

are

especially

United

15.

of very
high
of a mod-

thought

to out-

in highly

indus-

States.

intake
of some
vitamins
and
minerals,
should
fiber for normal
laxation,
and may provide
enough
fiber
to help
prevent
future
chronic
disease.

J.

2. Dwyer

Dis

Diets

Child.

for children

Academy
in the

4. American

18.

diet.

meet

Disease
CL.

Preventive

dietary

in the
on

Cardiology-A

in

on

the

Nutrition.

An,

GS,

Young.

Plant

child.

Circulation.

fiber

Task

Force

20.
21.

Strong

WB.

tional

Institutes

Education
Levels

Boston:

et al.

MV,

ed.

fiber

in childrens

DR.

of

the

diets.

NY

Ann

Grove

in dietary
of

intake

1977-78

among

versus

Presented

at the

1987-88
FASEB

An-

Abstract
Pediatrics,

fiber.

Trends

comparison
Surveys.

1994.

dietary

Elk

Keast

age:

Consumption

Academy

and

CL,

Committee

In: Barness

Village,

Bollella
T,

IL:

on

L, ed.

Nutrition.

Pediatric

American

Carbohy-

Nutrition

Academy

M. Is a high-fiber

23.

Brown

Nutr

ed.

Prey

Sci

disease

Med.

1989;18:

Program.

in C!,ildren

of Health,

and

National

of

Report
Adolescents.

Heart,

the

Expert

Vitaninol

Handbook.

of Pediatrics;

1993:

diet

safe

Y, et

al.

for

children?

Pediatrics.

Lung,

and

Blood

Na-

DC:

New
25.

JH,
G,

York:

ed.

DC:

fiber

intake

daily

of

allowance.

Guide

Pyramid.

1992.

Publication

BS, Rose

D, Cohen

fibers
and

Allowa,,ces.

10th

Hyattsville,

MD:

1989

Service;

of dietary
Press;

Dietary
Press;

Tl,e Food

Antirnutagenesis

Cancer

ington,

Institute;

Reddy

Plenum

National

Academy

Information

mechanisms

Dietary

recommended

Reco,nn,endtd

National

of Agriculture.

Nutrition

the

1993;39:263-278

of Sciences.

Washington,

Weisburger

on

MD:

Konishi
and

(Tokyo).

Academy

Protective

Pane!

Bethesda,

1,

generations

US Department

24.

artery

Sumimoto

younger

National

JK, eds.

Little

Coronary

perspective.

CL,

Bollella

M, Williams

In: DeVita
Co;

GM.

VT, ed. Cancer

Cancer

Disease

and

Human

Objectives.

a;zd
and

DHHS

HG252

L, Kendall

ME,

Wynder

EL.

in nutritional

carcinogenesis.

In:

Anticarcinogenesis

Mecl,anisms

III.

1993:45-63

Institute.

Diet,

Nutritio,,

US Government

and

Printing

Cancer

Office;

Wash-

Prevention.

1987.

NIH

publication

Cancer

Prete,,tion.

Human

Natio,,aI
DC:

Health

Health

US Department

Publication

(PFIS)

US

of Food

Nationuide
Intakes

of Agriculture;

US Department

of Agriculture.
Nationwide

US Government
13. National
Center
980.

Full

Report

29.

Consuniption

MD:

US

Human

series

II, No.

231

Kimm

SYS,

Gergen

Services;

1983.

Intakes:

Individuals

Survey.

M,

for disease

Dietary

NCHS

et al.

publication

Dietary

prevention.

Fiber

Theresa

DC:

(PHS)

patterns
Prey

Med.

Intake

A. Nicklas,

of

and

PEDIATRICS
(ISSN
emy of Pediatrics.

of Applied
Center

Tropical
0031

SUPPLEMENT

for

Health

4005).

Copyright

New

and
Health,

Myers,

Orleans,
1995

and

School

of

of the

and

health.

JAMA.

1989;262:

Expert

Advisory

Branch,

Health

Committee
and

on

Welfare

C,

Research

N.

DC:

1987
fiber.

US

Effects

US

USDA

Department

In: EkvaII

of

of

Health

Prevention,
Press;

Con-

of Agricul-

SW, ed. Pediatric

University

Manual

and

Department

Disorders:

Oxford
A.

Nutrition
Assessment

1993:301-309

Pediatric

Nutrition.

2nd

ed.

1990

Daily

Health

dietary

and

fat

and

Nutrition

total

energy
Survey,

food

Examination

intakesphase

Drizd

TA,

Johnson

National

CL,

Center

Reed

for

Health

RB, Roche

AF,

Statistics

Moore

percentiles.

WM.
An,

1979;32:607-629

Bogalusa

and

Gerald

Heart

S. Berenson,

Study

MD

(n
108), and 17 (n
89) years
was examined
from 1976
to 1988. Total
dietary
fiber
intake
remained
unchanged
from 1976 to 1988, even
after adjusting
for energy
intake;

averaging
had

higher

12 or 5 g/1000
fiber

intakes

calories

(kcal).

per

kcal

1000

dren from ages 10 to 17 years.

Consumption
and/or
soups
and breads
and/or
cereals
(10 years)
to 70% (13 years)
of the
sumed.
When
children
were
stratified

Black
than

children
white

chil-

of vegetables
accounted
for
total
fiber
coninto
quartiles

LA.
by

the

American

Acad-

1,

1994;43:116-125

growth:

The

for Ansericans.
DC:

Physiologic

Developnental

York:

MMWR.

Office.

Safety;
and

Walker

Ernst

Guidelines

Washington,

Washington,

and

New

National
PV,

Dietary
ed.

232

BC Decker;

Nutr.

PhD;

Protection

2nd

Fiber.

Diseases
K,

Hamill
Clin

Biostatistics
Tulane

Sciences

Treatment.

Physical

of Children:

Science

Cardiovascular

Medicine,

Chronic

Lenfant

school

Leann

No.

of Dietary

1988-91.

Age
and
secular
trends
in dietary
fiber
of children
were
examined
using
the 24-hour
dietary
recall
method.
Dietary
fiber
intake
of five cohorts
of 1O-year-olds
(n = 1254);
two cohorts
of 13-year-olds
(n
360); and children
ages 10 (n
767), 13 (n
249), 15

Tulane

Life

Third

1990;19:432-444

DrPH;

Report

Health

Bulleti;,.

1985.

Hendricks

32.

intake

Departments

31.

83-1681,
US

fiber

of Agriculture.

Garden

Philadelphia:

ABSTRACT.

the

and

and

in 48 States,

Washington

33.
P. Malloy

implications

Epidemiology,

30.

ii,

Consunptio

Canada.

ture, Center
for Food
Ekvall SW. Constipation

Survey,

Hyattsville,

Dietary

1985

Department

FASEB

85-1

Nutrient
Food

Food

Individuals.

Affairs.

Ottawa:

Agriculture;

of Health

Printing
Office; 1984. Report
1-2
for Health
Statistics.
Dietary
Source
Data: United
States
and Health
Statistics.
Hyattsville,
MD: US Department

Vital
and

by

1985.

Year

1977-1978,

Welfare

Fiber.

Home

and

91-50212.

and

Canada;

987.

Pro,notio,,

Scientific

Dietary

Be-

Services;

on

542-546

JB Lip-

sequences

Agriculture.

Survey

Department

Health

Council

28.

Washington,

1991.

of

Continuing

children:

26.

commentary.

11. US Department

of Health

Philadelphia:

in

27.

Services;

with

1976-1

beginning

1993:1-3

Prevention

report,

prevention

Prevention.

Cancer
Institute.
Diet,
Nutrition
thesda,
MD: US Department
of Health
Publication
(NIH) 87-2878
10. Public Health
Service.
Healthy
People 2000.

988

of children:

87-2878

Williams
pincott

Public

1993;57:930-937
intake

1995;96:988-994

Total

of

April

Nishimune

22.

IS, Ockene

Approach.

9. National

From

Food

Meeting,

Williams

in

1983;67:14U-1414

In: Ockene

pediatric

Cholesterol
C!,olesterol

childhood.

14.

years

Bronzetti

Blood

Nutr.
fiber

in

the

100-106

199

12.

Yagalla

3rd

323-409

8.

LG,

Human

cholesterol-a

7. National

MA.

2-18

Japanese

healthy

childhood.

BiohcI,azioral

and Co; 992:433-467

6. Wynder
EL, Berenson

Mackey

children

American

goals.

I Clii,

trends

children:

1991;623:369-379

Saldanha

nual

1981;67:572-575

Diet

Intervention

prevention:

Committee

Pediatrics.

Association.

Cardiovascular

Sci.

Secular

of 10 yr-old

1995;96:1014-1019

of Pediatrics,

pediatric

Heart

5. Williams

that

Am

dietary

1983;7L78-80

adolescents

(1973-1988).

GS.

factors

VL,

Fulgoni
Acad

1987;134:1073-1080

3. American
intake

and

Study

Berenson

risk

17.

Nationwide

Toward

SR.

cardiovascular

GS. Dietary

provide
added

on Nutrition.

LS, Srinivasan

and

Heart

drate

Committee

Webber

TA, Myers
L, Berenson
Heart Study.
Pediatrics.

19.

Academy
of Pediatrics,
diet for children.
Pediatrics.

intake

16. Nicklas
Bogalusa

REFERENCES
1. American
prudent

TA,

dietary
Bogalusa

A safe range of dietary

fiber intake for children
is suggested
to
be between
age plus 5 and age plus 10 g/d.
This
range
of fiber
intake is thought
to be safe even for children
and adolescents
with
marginal
enough
dietary

Nicklas

based
from

on fiber
total
fat

intake
per 1000 kcal, the percent
of energy
and saturated
fat was lower,
and the per-

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A New Recommendation for Dietary Fiber in Childhood

Christine L. Williams, Marguerite Bollella and Ernst L. Wynder
Pediatrics 1995;96;985
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright 1995 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.

Downloaded from by guest on December 11, 2016

A New Recommendation for Dietary Fiber in Childhood

Christine L. Williams, Marguerite Bollella and Ernst L. Wynder
Pediatrics 1995;96;985

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
/content/96/5/985

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright 1995 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.

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