Unilever Health & Wellbeing Series
Optimal Fat Intake for Healthy Children
The quality of dietary fat in early life is emphasized in recent dietary recommendations
- not only for optimal growth and development, but also for longer-term cardiovascular
health. Health authorities warn for cardiovascular risk factors such as overweight,
high blood pressure, dyslipidemia, and type-2 diabetes. These risk factors, which
usually become more severe with age, are present in a growing number of children. As
preventive measures, health authorities recommend to introduce healthy eating habits
at the ages of two to five years, when children develop likings for certain foods.
In 2010, the World Health Organization (WHO) published recommendations on fat and
fatty acid requirements for infants (0-2 years) and for children (2-18 years). The aim of
this science review is to summarize the scientific underpinning of recommendations
on dietary fats for young children by WHO and other health authorities.
Authors: Rajwinder K Harika; Ans Eilander & Peter Zock (Unilever R&D)
Scientific review
Dietary fats, types of fatty acids
Fats are considered a necessary part of the dietary energy supply. Dietary fats are classified as
saturated, mono- and polyunsaturated fats. Polyunsaturated fatty acids (PUFA) are further classified
into two groups: omega-3 and omega-6 fatty acids. The omega-3 fatty acid alpha-linolenic acid (ALA)
and the omega-6 fatty acid linoleic acid (LA) are essential fatty acids (EFA) as they can not be
produced by the human body, and are needed for vital functions. These EFA’s are used by the body
to synthesize bioactive metabolites (eicosanoids, prostaglandins) via conversion to very-long--chain
fatty acid arachidonic acid (AA) from omega-6 LA and eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA) from omega-3 ALA. However, the conversion of LA and ALA to longerchains fatty acids is limited in humans (2), and EPA and DHA are often considered as semi-essential.
Sources of saturated fats (SAFA) are mainly dairy, meat and processed foods whereas
polyunsaturated fats are mainly provided by variety of vegetables oils and products made thereof.
Oils/seeds that contain the largest amounts of ALA include flaxseed, walnut, canola and soy. Oils
such as corn, sunflower, and peanut oil are high in LA but low in ALA. Long chain omega-3 fatty acids
are mainly present in sea foods and fish oils.
Recommendations on fat and fatty acids intake in children
Official international recommendations for children on fatty acids are recently published by the WHO
expert committee (2010) aiming normal growth and development of children and prevention of diet-
Optimal Fat Intake for Healthy Children (2012)
related future chronic diseases (particularly CVD)(1). Similar dietary guidelines are also adopted by
various health authorities such as the European Society for Paediatric Gastroenterology, Hepatology,
and Nutrition (3), and Institute of Medicine (4).
Total fat intake
There is no scientific evidence to set a specific age when dietary fat intake in children should reach
adult recommendations. Health authorities are in agreement that young children need to derive more
energy from fat than older children and adults. A gradual decrease of total fat content from 6 months
onwards is generally recommended. There is probable level of evidence based on dietary fat intake
and growth of children that the fat intake for children older than 2 years should be 25–35% of total
energy intake (1) (see table 1 for definition of probable and convincing as defined by WHO). In the
recent WHO (2010) guidelines, the upper-level of recommended total fat intake was reduced from
40% to 35% of energy in children “based on the need to control energy intake more diligently in order
to retard and even prevent the progression of the obesity epidemic” (1). At the same time, it is
stressed that adverse effects of low-fat diets (<25%E) on weight gain and longitudinal growth in young
children have been documented and therefore low fat diets (<25%E) are not recommended for
children.
SAFA and TFA
Health promotion efforts for the general population emphasize the importance of healthy dietary
patterns including dietary fats to prevent future chronic diseases. It is recommended that trans fats
(TFA) should be avoided (<1%E) and SAFA intake should be limited in children (2-18y), without
compromising a nutritionally adequate diet (1). The WHO expert judged that there is probable level of
evidence that SAFA intake increases CVD risk in children. WHO recommends SAFA intake <8% of
energy in children. (See table 1 for definition of probable as defined by WHO). These
recommendations may be arbitrarily set as the level of evidence is not enough to set such precise
cut-off. Broad consensus and various recommendations (3-6) on SAFA is <10% of energy which is
already very strict target compared to current intakes.
We strive to decrease SAFA (<10%E) in our products as reflected in our Unilever Sustainable Living
Plan (USLP) targets. Unilever product aim at helping families achieve SAFA target <10% of energy.
No specific recommendations have been given for SAFA in 6-24 months infants due to high total fat
requirements in this age group. However, it is important to keep SAFA intake as low as possible in
this age group as well (7;8). Currently, WHO evaluates the current SAFA and TFA recommendations,
including possible differences between individual SAFA and between ruminant and industrial TFA.
We will keep track of the progress and update the current Unilever Science Positions accordingly in
due course.
PUFA
There is a need to provide essential fatty acids to meet needs of children and maintain dietary fatty
acid intake patterns that contribute to the prevention of diet-related chronic diseases (9;10). The
Recommended range for PUFA intake is 6-11% of total energy intake (1)(WHO,2010). The maximum
recommended intake of PUFA is 15% of energy intake for infants (<2 years) and 11% of energy
intake for children (2-18years) (Table1) as set by WHO.
LA and ALA
There is convincing level of evidence, that adequate intake of EFA is needed for normal growth and
development of infants (<2years) with at least 3–4.5% of energy from LA and at least 0.4-0.6% of
energy from ALA (1) (Table 1). (See table 1 for definition of convincing as defined by WHO). For
children (2-18 years), LA (5-8% energy) and ALA (1-2% energy) recommendations are in line with the
WHO/FAO guidelines on adults for the prevention of chronic diseases (11). The upper limit for LA is
below 10% of energy and that for ALA is below 3% of energy in infants (1) (Table1).
EPA and DHA
There is convincing level of evidence that DHA plays a critical role in retina and brain development.
There is probable level of evidence, that DHA should be provided as 10-12 mg/kg/d (1) or Adequate
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Optimal Fat Intake for Healthy Children (2012)
Intake of 100mg per day in infants (6-24 months) (6). (See table 1 for definition of probable and
convincing as defined by WHO). In children (2-18 years), 100-250 mg of EPA and DHA is
recommended, which is targeted at prevention of chronic diseases (1)(Table1).
Current dietary intake of fatty acids is not in line with recommended intake
A review of available dietary intake data in children, show that the intake of SAFA is higher than
recommended (<10%E) in vast majority of countries (28 out of 30) (Figure 1). The same surveys also
clearly indicated that the intakes of PUFA is often lower than the recommended 6-11% of energy (21
out of 30 countries),(Figure 2)(12). EPA and DHA intake is scarcely reported in children. Available
data shows that the intake ranges from 10-60mg/d for EPA and from 30-120mg/d for DHA indicating
that intakes of EPA+DHA in children are below the recommendations in most countries (12).
Health effects of dietary fat and fatty acids
Growth and Cognitive development of children
WHO recommends exclusive breastfeeding for the first six months of life (13) and Unilever fully
supports this. After six months of age it becomes increasingly difficult for infants to meet their nutrient
needs from breast milk alone (14). The energy cost of growth is a major component of total energy
requirements for the first 6 months of life (typically approximately 20–30% of total energy
requirements). This progressively drops in relative terms to <5% at 12 months of age (15). However
the physical activity levels are high and therefore energy needs can vary greatly depending on the
activity level of children. Weight gain is therefore a sensitive indicator of overall dietary energy
adequacy for the first years of life (16;17).
Foods rich in fat are energy dense and can deliver the amount of energy needed for optimal infant
growth with relatively small volumes of food tolerated by young children below the age of 2 years. Fat
is also needed in the absorption of fat soluble vitamins. If the diet provides an adequate supply of
energy and essential nutrients, evidence shows that a dietary fat intake of 25-35% of energy supports
optimal growth and development of healthy children living in a clean environment (18;19). Studies
from developed populations show that growth faltering begins when fat intake comprises less than
25% energy and severe growth failure occurs when intake comprises less than 20% energy (19).
LA, ALA and their long-chain derivatives EPA, DHA and AA are important for numerous physiological
and developmental needs of children. PUFA's or LA and ALA affect growth through their role in
synthesis of prostaglandins, growth hormones and as functional membrane components (20;21). A
clinical deficiency of ALA or LA results in poor growth and neurological abnormalities (4). It is
recommended by the WHO that diets of children should provide at least 3–4.5% of energy from LA
and at least 0.4-0.6% of energy from ALA to ensure sufficient intakes of essential fatty acids
requirements for growth and development.
The brain is composed of large amounts of both DHA and AA. During the first year of life, the brain
grows rapidly and an adequate supply of both of these fatty acids is thought to be conditionally
essential for optimal development (22;23). DHA is also a major component of the retina and thus
affects visual acuity (23). AA and DHA are vital structural elements of cell membranes and, therefore,
instrumental in the formation of new tissues. Given the limited and highly variable formation of DHA
from ALA (1-5%E), and because of their critical role in normal retinal and brain development in
children, they should be considered conditionally essential during early development (0-6 months)
(24). The recommended intake for DHA is 10-12mg/kg/d in 6-24mo old children and 100-250mg/d
from the age of 2 years. However, majority of well designed randomised control trials have shown no
beneficial effect on growth and development with supplemental (high doses) LA and ALA and
LCPUFA in healthy term infants (25) and children (26;27). In line with the above evidence, the
European Food and Safety Authority (EFSA) has given positive opinion on fats, fatty acids and health
affects in children. These positive opinions are on 1) essential fatty acids needed for normal growth
and development of children (1-12years) (6) and 2) ALA and or DHA contribution to brain and nerve
tissue development of infants/children (0-3years)(28).
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Optimal Fat Intake for Healthy Children (2012)
In conclusion, there is convincing level of evidence that for optimal growth and development of
children, intake of both fat quantity (25-35%E) and fat quality (3-4.5%E of LA, 0.4-0.6%E of ALA and
10-12mg/kg/d of DHA) are important.
Future chronic diseases in children
CVD is a major cause of both morbidity and mortality worldwide. Dietary lipids affect cholesterol
metabolism at an early age, and can be associated with cardiovascular morbidity and mortality in later
life. A high serum LDL-cholesterol level predicts an increased risk of coronary heart diseases (CHD)
(29). For the prevention of CHD the fat quality of the diet is more important than quantity of fat (9;10).
Replacing SAFA in the diet with vegetable PUFA (mainly omega-6 LA plus some omega-3 ALA)
reduces LDL cholesterol levels (30) and the risk of CHD in adults (10;31). Similar to adults, in children
the replacement of SAFA with PUFA has also been shown to favourably affect LDL cholesterol levels
(32;33).
The Dietary Intervention Study in Children (DISC) was a randomized trial in which children were fed a
diet low in SAFA (<8%E) and cholesterol (34;35). The study was done in the US with 636 children
aged 8-11 years at start, who were followed for an average of 7.4 years. Another prospective
randomized dietary intervention cohort, the Special Turku Risk Intervention Program (STRIP), started
to follow 1062 children at the age of weaning and has followed them until the age of 14 years (36-38).
The intervention consisted of dietary advice to the parents and throughout the 14 years the
cholesterol profile of these children has been measured. Both studies achieved diets in intervention
groups that were consistent with current recommendations for therapeutic lifestyle changes to lower
elevated cholesterol levels, i.e. a total fat intake of 28-35% of energy, reduced intake of SAFA (<8<10%E) and cholesterol and higher PUFA (~10%E). These interventions resulted in lower LDL as
compared with control groups (34;36;39). An improved blood lipid profile in childhood can be
anticipated to slow the development of atherosclerosis and decrease CHD risk in later life (39-42).
However, more long-term, controlled intervention studies are needed to determine the extent to which
improvement of fat and fatty acid intake in childhood translates into less CHD events in adulthood.
Overall there is sufficient probable level of evidence that supports the importance of maintaining a
healthy blood lipid profile already from an early age by consuming diets low in SAFA (<10%E) and
high in PUFA (6-11%E).
Childhood obesity
Despite the need for a relatively high energy intake in childhood for growth and development, it is
important to take into account that childhood obesity is a matter of major public health concern
globally. In 2010 the number of overweight children under the age of five was estimated to be over 42
million. Risk factors for coronary heart diseases (CHD) such as hypertension, dyslipidemia, impaired
glucose tolerance, vascular abnormalities and diabetes are already increasingly seen in overweight
children (43-45). Overweight and obesity are notoriously difficult to correct after becoming
established, and there is an established risk of overweight during childhood persisting into
adolescence and adulthood (46).
Research suggests that total energy balance, frequency of feeding high energy density of foods are
more important than the percentage of fat in the diet in determining overweight among children. In
other words, it is not total fat content of the diet but rather excess energy intake causing increase in
childhood obesity (47). Nevertheless, In light of the childhood obesity epidemic WHO has lowered the
upper range of dietary fat from 40 to 35% of energy in children older than 2 years. High amounts of fat
intake may contribute to energy density of diet and facilitate overeating, and it is therefore prudent
that total fat intake of children is in line with the upper limit of 35% of energy recommended by the
WHO expert consultation(1).
High quality studies do not show an effect of fatty acid composition, such as relative amounts of
omega-6 and omega-3, on development of body fat mass of children (48;49)Overall, the obesity
epidemic points to the importance of matching appropriate energy intake to energy expenditure. Most
experts recommend increasing the physical activity of children rather than putting them on a diet(50).
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Optimal Fat Intake for Healthy Children (2012)
In conclusion, to prevent and treat child obesity, it is important that children consume diets providing
energy and fat in amounts that are in line with the WHO recommendations and have sufficient
physical activity to maintain a health energy balance.
Summary WHO recommendations
Infants from 6 months to 2 years of age
Fat and fatty acids intake, which are aimed at normal growth and development:
 Total fat intake should be reduced gradually from 40-60% of total energy intake during infancy to
35% of energy intake by the age of 2 years.
 Linoleic acid (LA) and Alpha linolenic acid (ALA) should be present at a level of at least 3.0-4.5%
and 0.4-0.6% of energy intake, respectively.
 The omega-3 very long chain fatty acid Docosahexaenoic acid should be present at a level of 1012 mg/kg/d.
 The maximum intake for total polyunsaturated fats (PUFA) is set at 15% of total energy intake.
No specific recommendations for intakes of saturated fats (SAFA) are provided.
Children beyond 2 years of age
Fat and fatty acids intake, which are aimed at preventing diet-related future chronic diseases:
 In light of the childhood obesity epidemic, the upper recommended level of fat in the diet should
be lowered from 40% to 35% of total energy intake, with a recommended range of 25-35% of
energy.
 The recommended range of total PUFA intake is set at 6-11% of energy intake;
 Daily intakes of very long chain omega-3 fatty acids (Eicosapentaenoic + Docosahexaenoic)
should increase with age from 100-150 mg/d for children aged 2-4 year to 200-250 mg/d for
children aged 6-10;
 The recommended ranges of LA and ALA intakes are set at 5-8% of energy and 1-2% of energy,
respectively;
 Dietary content of trans fatty acids should be less than 1% of energy intake.
The WHO recommends total SAFA intakes less than 8% of energy intake.
Conclusion

PUFA intakes of children beyond 2 years of age are below or at the lower end of the
recommended range of 6-11% of energy intake, whereas the average intake of SAFA is
higher than the recommended 10en%.

In our opinion is ot enough scientific evidence to set a precise cut-off point for SAFA
intake at a lower level than 10en% and, therefore, we keep the position – in line with the
majority of national and international authorities, that SAFA intakes should be less than
10en% in children beyond 2 years of age.
Page 5 of 12
Table1. Recommended dietary intakes by WHO for total fat and fatty acids: infants (6-24mo) and children (2-18y)
Fat/fatty acids
Total fat
SAFA
MUFA
Total PUFA
Age group
6-24mo
2-18y
2-18y
LA & ALA
LA
6-24mo
2-18y
2-18y
6-24 mo
6-24mo
ALA
2-18y
6-24mo
DHA
2-18y
6-24mo
EPA + DHA
TFA
2-4yr
4-6yr
6-10yr
2-18yr
Numeric amount
gradual reduction from 40-60%E (at 6 mo)
to 35%E (at age two, depending on physical
activity)
25-35%E
WHO <8%E (USP <10%E)
Total fat[%E]-SFA[%E]-PUFA[%E]-TFA[%E]
<15%E
11%E
6-11%E
Essential and indispensable
3.0-4.5%E
<10%E
5-8%
0.4-0.6%E
<3%E
1-2%
Critical role in retinal and brain development
10-12mg/kg
100-150mg
150-200mg
200-250mg
<1%E
Measure
Level of evidence*
Convincing
AMDR
U-AMDR
AMDR
U-AMDR
AMDR
AI
U-AMDR
ADMR
AMDR
U-AMDR
ADMR
AI
AI
Probable
Probable
Probable
Probable
Probable
Convincing
Convincing
Probable
Same as adults
Probable
Probable
Same as adults
Convincing
Probable
Probable
UL
Convincing
AMDR-Acceptable macronutrient distribution range; AI- Adequate intake (expressed as a range); U- AMDR- Upper value of acceptable macronutrient distribution range
* As defined by WHO
Convincing evidence
Evidence is based on epidemiological studies showing consistent associations between exposure and disease, with little or no evidence to the contrary. The available evidence is based on a substantial number of
studies including prospective observational studies and where relevant, randomized controlled trials of sufficient size, duration and quality showing consistent effects. The association should be biologically
plausible.
Probable evidence
Evidence is base on epidemiological studies showing fairly consistent associations between exposure and disease, but where there are perceived shortcomings in the available evidence or some evidence to the
contrary, precluding a more definite judgment. Shortcomings in the evidence may be any of the following: insufficient duration of trials (or studies); insufficient trials (or studies) available; inadequate sample sizes;
and incomplete follow-up. Laboratory evidence is usually supportive. Again, the association should be biologically plausible.
Optimal Fat Intake for Healthy Children (2012)
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Optimal Fat Intake for Healthy Children (2012)
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