Dietary recommendations for children to reduce the risk of cardiovascular disease

Age	Dietary recommendations
Birth to 6 months	Infants should be exclusively breastfed (no supplemental formula or other foods) until age 6 months*
6 to 12 months	Continue breastfeeding* until at least age 12 months while gradually adding solids; transition to iron-fortified formula until 12 months if reducing breastfeeding
	Fat intake in infants less than 12 months of age should not be restricted without medical indication
	Limit 100% fruit juice <4 oz/d; no sweetened beverages; encourage water
12 to 24 months	Transition to reduced-fat^¶ (2% to fat-free) unflavored cow's milk^Δ (see Supportive actions bullet 1)
	Limit/avoid sugar-sweetened beverage intake; encourage water
	Transition to table food with: Total fat 30% of daily kcal intake based on energy requirements Saturated fat 8 to 10% of daily intake based on energy requirements Avoid trans fat as much as possible Monounsaturated and polyunsaturated fat up to 20% of daily intake based on energy requirements Cholesterol <300 mg/d
	Supportive actions: The fat content of cow's milk to introduce at age 12 to 24 months should be decided together by parents and health care providers based on the child's growth, appetite, intake of other nutrient dense foods, intake of other sources of fat, and potential risk for obesity and CVD 100% fruit juice (from a cup) no more than 4 oz/d Limit sodium intake Consider DASH-type diet rich in fruits, vegetables, whole grains, low-fat/fat-free milk and milk products; lower in sugar
2 to 10 years	Primary beverage: Fat-free unflavored milk
	Limit/avoid sugar sweetened beverages; encourage water
	Fat content: Total fat 25 to 30% of daily kcal intake based on energy requirement Limit saturated fat 8 to 10% of daily kcal intake based on energy requirements Avoid trans fats as much as possible Monounsaturated and polyunsaturated fat up to 20% of daily kcal intake based on energy requirements Cholesterol <300 mg/d
	Encourage high dietary fiber intake from foods^◊
	Supportive actions: Teach portions based on energy requirements determined by activity level, age, and gender Encourage moderately increased energy intake during periods of rapid growth and/or regular moderate to vigorous physical activity Encourage dietary fiber from foods: Age plus 5 g/d^◊ Limit naturally sweetened juice (no added sugar) to 4 oz/d Limit sodium intake Support DASH-style eating plan
11 to 21 years	Primary beverage: Fat-free unflavored milk
	Limit/avoid sugar sweetened beverages; encourage water
	Fat content: Total fat 25 to 30% of daily kcal intake based on energy requirements Saturated fat 8 to 10% of daily caloric intake based on energy requirements for activity level/age/gender Avoid trans fat as much as possible Monounsaturated and polyunsaturated fat up to 20% Grade D of daily caloric intake based on energy requirements for activity level/age/gender Cholesterol <300 mg/d
	Encourage high dietary fiber intake from foods^◊
	Supportive actions: Teach portions based on energy requirements determined by activity level, age, and gender Encourage moderately increased energy intake during periods of rapid growth and/or regular moderate to vigorous physical activity Advocate dietary fiber: Goal of 14 g/1000 kcal^◊ Limit naturally sweetened juice (no added sugar) to 4 to 6 oz/d Limit sodium intake Encourage healthy eating habits: Breakfast every day, eating meals as a family, limiting fast food meals Support DASH-style eating plan

* Infants that cannot be fed directly at the breast should be fed expressed milk. Infants for whom expressed milk is not available should be fed iron-fortified infant formula.
¶ Toddlers 12 to 24 months of age with a family history of obesity, heart disease, or high cholesterol should discuss transition to reduced-fat milk with pediatric care provider after 12 months of age.
Δ Continued breastfeeding is still appropriate and nutritionally superior to cow's milk. Milk reduced in fat should be used only in the context of an overall diet that supplies 30% of calories from fat.
◊ Naturally fiber-rich foods are recommended (fruits, vegetables, and whole grains); fiber supplements are not advised. Limit refined carbohydrates (sugars, white rice, and white bread).

Modified from: Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Available at: https://www.nhlbi.nih.gov/node/80139 (Accessed January 3, 2012).

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Dietary recommendations for children to reduce the risk of cardiovascular disease