## 4 Discussion
### Total Fat  
While total fat intake is too low in 88-89% of studies in the younger age groups (1-3 years), for the older age groups, both low- (poor rural areas in Africa or Asia, or National surveys from South Korea, the Philippines or United Arab Emirates [esp. girls]) and high- (esp. in Mediterranean countries) fat intakes were reported. These results differ from those of previous reviews [14; 15], which concluded that total fat intake in children less than 10 years of age was too high in most countries. This difference is because of the large age range used in these studies and the 30%E maximum RNI used (as per 2003 WHO adult recommendation [108]). This relatively low value of 30%E may not be an appropriate comparison to use for children of a young age. The high fat consumption observed in 3-7-year-old children in several Mediterranean countries is in accordance with the findings of [PERSON] [16] in school age children of the Eastern Mediterranean region.  
Providing children with adequate dietary fat is of great importance given the essentiality of dietary fat and specific fatty acids for healthy growth and development in early life [1]. Dietary fat is energy dense and thus helps children meet the high energy needs of rapid growth, without ingesting large volumes of food. Given the rising prevalence of childhood obesity, and its high energy density, dietary fat is greatly scrutinized and suspected as a causal factor. Results of a recent Cochrane review commissioned by the WHO suggest that in trials among children aged 2-18 years where a lower fat intake (30%E or less) was provided compared with usual or modified fat intake, small reductions in body mass index, total- and LDL-cholesterol were observed [109]. However, in two of the three identified intervention studies, children were hypercholesterolemia, which limits the applicability of the findings to the general population of healthy children.  
In the same review of [PERSON] et al., [109], half of the 21 included cohort studies suggested that increased total fat intake was associated with increased body fatness (body weight and body mass index), nevertheless, some studies showed the opposite, and given the general low quality of recovered studies, no conclusion could be reached. It should be noted that twenty-three of the 24 included studies in [PERSON] et al.'s review were done in children from high income countries. Moreover, given the design of the review (only randomised controlled trials included), some relevant studies were not included, such as the long-term follow-up study of [PERSON] et al., [110]. They demonstrated that fat intake at 2 years of age was negatively associated with body fat--particularly abdominal fat--at the age of 20 years [110]. This is in line with recommendations against restricting fat intake and those supporting a gradual reduction in fat intake over the course of the first 3-4 years of life [1; 18].  
In our review, we identified excess fat intake in no more than 7 of the 50 studies from high income countries and overall, our findings, which are based on a more globally representative sample of countries, do not suggest a need for children from 1-7 y to reduce their intake of total fat. In line with this, data from the Generation R cohort also show no associations between a higher intake of total fat or SFA, MUFA, or PUFA with growth, adiposity, or cardiometabolic health when fat was consumed at the expense of carbohydrates [111]. Further studies investigating the intake of the other macronutrientsby these age groups are required to provide a more holistic overview of their potential influence on body weight regulation. This is particularly important for carbohydrates, where, for example, sugar-sweetened beverages are consumed by up to half of children in this age group in certain countries [112] and are known to contribute significantly to weight gain [113] and incidence of overweight [114].