IN THIS ISSUE:
Type 2 Diabetes in Children
PARENTS & KIDS: Active an Hour a Day?
RECIPE: Rabbit Pancakes
READER FEEDBACK: Nutrition Theme Bags
NEWS IN BRIEF:
Preschoolers plant the seeds for a healthy diet
Twelve-year old girls drink more milk, less soda than older teens
CDC Updates Pediatric Growth Charts Web Site
Recommended Site: Smart-mouth.org

Type 2 Diabetes in Children

Years ago when I was a dietetics student, we referred to Type 1 diabetes as “juvenile-onset” and Type 2 diabetes as “adult-onset.” In other words, children seen for diabetes were generally those with the insulin-dependent variety, a disease that had little to do with their lifestyle or diet. Adult-onset diabetes, on the other hand, occurred most often in overweight adults, particularly if their weight distribution was concentrated in the upper body.

Times, unfortunately, have changed. As children continue to become heavier at an earlier age, the incidence of Type 2 diabetes has risen drastically among youth in the US

HOW BAD IS THE PROBLEM?
Findings from the CDC National Health and Nutrition Examination Survey show a continued increase in the number of overweight children and teens. Among American kids, 13% of children and 14% of teens are considered overweight. Not only do these children face an uncertain future health picture, they are at risk right now for the debilitating effects of diabetes, including heart, kidney, eye and circulation problems.

Many obese children and adolescents have impaired glucose tolerance, a condition that often appears before the development of type 2 diabetes, according to research funded by the National Institutes of Health (NIH).

In a study published in the New England Journal of Medicine, researchers tested for impaired glucose tolerance in 55 obese children from 4 to 10 years of age, and 112 obese adolescents from 11 to 18 years of age. In all, 25 percent of the children and 21 percent of the adolescents had impaired glucose tolerance. The researchers also found that four of the adolescents in the study had silent type 2 diabetes, a form of diabetes that doesn't cause any symptoms.

PREVENTION AND CONTROL
The only effective way to prevent and control Type 2 diabetes in children is to promote a more healthful pattern of growth and development. Because kids are growing, they need plenty of calories and nutrients and should not follow calorie-restricted diets. A diet rich in fruits, vegetables, beans, whole grains, nuts, lean protein foods and nonfat dairy products should form the foundation of a health-promoting diet. A minimum of one hour of physical activity each day is crucial for both physical development and weight management.

PRACTICAL POINTERS FOR PARENTS
Working together as a family is the best way to succeed at weight management for children and adults alike. It is not a child's problem – it is a family issue that can be addressed by adopting positive health behaviors cooperatively. Below are a few tips to get families started:

Make a Family Plan:

• Set goals together as a family. Discuss problem areas and brainstorm solutions. (e.g. Too much fast food, late night snacking, unsupervised afternoon snacking, purchase of high calorie foods at school/work/social activities, too much high calorie food available in the house, too much “electronic” time, etc.)
• Eat together as a family as much as possible. Families who eat together tend to eat more healthfully and also function better as a supportive family unit.
• Reward progress with a fun shared activity or a family game night.

Skip the Skipping
In a misguided attempt to cut calories, many kids and teens skip meals, particularly breakfast. Not only does this affect academic performance, it also results in a higher overall caloric intake throughout the day.

Practice Portion Control
Even when you are making nutritious choices, it is possible to eat too much. Become aware of portion sizes and check the label for serving size information. You may want to break out the measuring cup occasionally for a “reality check” to see how many portions are really on your plate.

Walk more (& like you're in a hurry!)
In the mood for a movie? Walk to the neighborhood video store. Tired of waiting for the school bus and enduring all those stops? Start out a few minutes early and you may even beat the bus to school! Is your dog jumping up and down begging for some play time? Take him or her on a walk! You get the idea...

REFERENCES:
Sinha, R, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity.N Engl J Med. 2002 Mar 14;346(11):802-10. http://content.nejm.org/cgi/content/abstract/346/11/802

Data documenting the level of overweight among children and teens can be accessed at:
http://www.cdc.gov/od/oc/media/pressrel/r010312b.htm OR
http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm

A special thanks to Feeding Kids reader Joanne Kearns for suggesting this topic.

PARENTS & KIDS: Active an Hour a Day?

My 12 year-old son is writing a newsletter for his health class (and no, I'm not helping him nearly as much as I could). One of the articles he is working on is about kids and exercise. After his research led him to the conclusion that kids should exercise one hour each day, he said “No way! That's impossible with all the homework and stuff I have.”

I had to chuckle since a big part of his “stuff” involves sports, which he normally practices 3-4 days each week. Add in 2 periods of PE, a couple of dog walking sessions and outside play with his brother and friends and he's probably doing just fine.

After our discussion, I began thinking about ways that children could fit in this quantity of fitness in an average week. I created a puzzle on the topic that parents and children can complete together. Note: The word bank at the bottom is optional, particularly for older elementary students.

Active-An-Hour-a-Day

Across:
2. Run and chase your friends when you are "it" in this game.
4. Ride this two-wheeler up a hill for an extra exercise boost!
6. Perfect for kids who enjoy competition and teamwork.
7. Number of minutes you should spend being active each day.
8. Two-legged transportation that can get you lots of places!

Down:
1. Hip-hop, jazz, and ballet are just a few ways you can do this activity.
3. A break from classwork when you are at school. Make the most of it by playing ACTIVE games.
4. Jump, shoot and dunk your way to fitness.
5. This four-legged friend would love to take YOU for a walk
7. This fun activity will leave you soaked.

Thanks to extension educator Nancy Kershaw from Tillamook County, Oregon for sharing this recipe.

RECIPE:Rabbit Pancakes

Kids will love these wholesome oatmeal/carrot pancakes!

Ingredients:
½ cup whole wheat flour
½ cup quick-cooking oats
¾ cup nonfat buttermilk
½ cup nonfat or 1% milk
1 Tbsp. vegetable oil
1 Tbsp. sugar
1 tsp. baking powder
½ tsp. baking soda
½ tsp. salt
1 egg (or 2 egg whites)
½ cup grated carrots

Directions:

• Beat all ingredients in a medium-sized bowl with a hand beater until smooth.
• Spray griddle with non-stick cooking spray. Heat griddle. (To see if griddle is hot enough, sprinkle with a few drops of water. If bubbles skitter around, heat is just right).
• For each pancake, pour about ¼ cup of batter onto the hot griddle.
• Cook until pancakes are puffed and dry around edges. Turn and cook other side until golden brown.
• Top with applesauce, fresh fruit or non-fat yogurt.
  

Servings: Sixteen 4" pancakes

READER FEEDBACK: Nutrition Theme Bags

In response to the article on Nutrition Theme Bags (October 2002 Feeding Kid Newsletter), FK reader Susan Gross sent in the following idea:

Let the children make their own book. Use brown paper bags for the cover. Some ideas:

• Have the children bring in labels from foods they eat and like (e.g.- front of a cereal box, label from a can). Encourage them to draw or paint pictures of additional foods if they wish.
• Have them organize the foods any way they choose, such as what they eat, when they eat, according to food groups, etc. Promote creativity!
• Share finished books with parents/family.

For resources on getting schools started with gardening, check out the USDA Farm to School & School Gardening section on the school meals website.

NEWS IN BRIEF

Preschoolers plant the seeds for a healthy diet
Scientists at Texas A&M University studied 22 four- and five-year-olds to see whether weekly vegetable gardening can change the attitudes and preferences of children towards vegetables. While the children were willing to try vegetables before the study began, there were fewer refusals for tasting green beans, tomatoes, bell peppers and radishes after gardening. According to the researchers, vegetable gardening has the potential to increase children's willingness to try unfamiliar vegetables and to enhance preference.
Source: Lorenz, S.G. et al. Vegetable gardening and preschoolers' attitudes towards vegetables. J Am Diet Assoc. 2002;S102:A-59.

Twelve-year old girls drink more milk, less soda than older teens
Twelve-year-old girls drink significantly more milk – and less soda beverages – than 19-year-old females, according to a recent study. At age 12, 78% drank milk and had the lowest soft drink drink consumption, while at age 19, only 36% drank milk and consumed more soda. The older teens who did not drink milk had inadequate intakes of vitamin A, folate, calcium, phosphorus and magnesium.
Source: Bowman, S.A. Beverage choices of young females: changes and impact on nutrient intakes. J Am Diet Assoc. 2002;102:1234-1239.

CDC Updates Pediatric Growth Charts Web Site
The Centers for Disease Control and Prevention has recently revised the Pediatric Growth Chart Web site to include growth charts in Spanish and French, Frequently Asked Questions, a new entry page for the interactive web-based training modules, a revised PowerPoint presentation, and a link to WIC-specific growth charts (for ages 2 to 5 years). All growth charts and related material can be accessed at www.cdc.gov/growthcharts

RECOMMENDED SITE:
http://www.smart-mouth.org
Smart-Mouth.org uses games to teach middle-school-aged children how the food environment (advertising, portion sizes, school vending choices) influences their food choices. Kids can see how their favorite restaurant foods stack up, play "true or false" with a food industry spokesman, and "bite back" by asking food companies and government officials to support healthy eating.

The information contained in this newsletter is not intended as a substitute for medical and/or nutrition advice. See your physician and/or registered dietitian for individual health and/or dietary concerns.

©2003, by Connie Evers, All Rights Reserved. There is a modest reprint fee for reproducing the material in this newsletter in either print or electronic publications. Please send an email to reprint@nutritionforkids.com for details and rates.