Fat children - 50,000 of them, or nearly one in 10 here - have a 'significantly' higher risk of suffering a heart attack when they become adults compared with their skinnier friends.

Doctors here have been trying to convince parents of this, but many still think 'fatter is better'. Such parents seem more worried when their children are skinny.

Now, a new Danish study reinforces the doctors' mantra. It directly links fat children with higher rates of heart attacks when they become adults.

The study has generated interest because it is huge, covering 280,000 Danes. It showed that chubby, not just obese, children are far more likely to suffer heart attacks as adults than thin kids.

The risk of fat children getting coronary heart disease from the ages of 25 to 60 goes up significantly with every one-point increase in body mass index (BMI).

Coronary heart disease refers to both angina or chest pains caused by blocked arteries, as well as a full-blown heart attack. It is one of the main causes of deaths here.

BMI is measured by dividing weight (in kilograms) by the square of height (in metres). The ideal BMI for children varies with age. A BMI of 23 is normal for a 15-year- old, but is considered overweight for a 10-year-old.

Associate Professor Quek Swee Chye, a senior consultant at the National University Hospital who specialises in children's heart problems, noted that many parents here have the misguided belief that 'the more a child eats and the bigger he is, the better'.

He said that obese children are at higher risk to all kinds of illnesses, such as diabetes and hypertension.

Dr Warren Lee of KK Women's and Children's Hospital (KKH) agreed: 'Parents put their children on calorie-fortified milk in the mistaken assumption that fussy eaters need to be a little chubby to prove that they are healthy.'

One consequence is increasing obesity in children under five years old here.

Doctors at KKH are also seeing more teens with high blood pressure and diabetes, he said.

Dr Lee said: 'A healthy child is one who is lean, not chubby. Parents have to ensure that their children are healthily active and eating right.'

He said that while a fat child is not necessarily a heart attack candidate, the odds are against him.

Such a child can stave off coronary heart disease in future by losing weight, increasing fitness and treating whatever cardiovascular risk factors he already has.

Dr Lee said: 'Effective corrective action can begin at any age, but it is of course better to ensure that your child is not fat in the first instance.'

Cardiologist Terrance Chua of the National Heart Centre said the Danish study 'gives strong support' to the various programmes here to prevent childhood obesity.

Singapore is scrapping its 15-year-old Trim and Fit programme in schools next year. Fat kids now form 9.5 per cent of schoolchildren here, down from 14 per cent when the scheme started in 1992.

In its place is a new healthy lifestyle programme which will promote a child's social, mental and physical health. Parents had been upset over the perceived stigma their children felt when enrolled in the old scheme.

Both Prof Quek and Dr Lee said it is critical that fat children cut their unhealthy food intake and exercise more.

A Health Promotion Board survey found that 29 per cent of children take at least one sweet drink a day, and only 19 per cent did some exercise five days a week.

Dr Lee said: 'What they need is a high degree of motivation and commitment to regular exercise and dietary prudence.

'This is not easy. The child requires all the encouragement that parents, family and school teachers must give.'

The Danish study was done by an Institute of Preventive Medicine team in Copenhagen. Its results were released in the New England Journal of Medicine last week.

salma@sph.com.sg