Factors influencing adolescent whole grain intake: A theory-based qualitative study

The feasibility of an anti-inflammatory diet in endometriosis: barriers and facilitators perceived by endometriosis patients

RESEARCH QUESTION

What is the feasibility of an anti-inflammatory diet in women diagnosed with endometriosis?

DESIGN

Qualitative study using semi-structured focus groups and individual interviews among patients with endometriosis. Transcripts of the focus groups and interviews were thematically analysed using ATLAS.ti 9. To identify and structure the ideas and views from the focus groups and interviews, two behavioural change models were used. The Capability Opportunity Motivation Behaviour (COM-B) model and domains of the Theoretical Domains Framework (TDF) helped to identify factors that make adherence to an anti-inflammatory diet more or less feasible for women with endometriosis.

RESULTS

The study population consisted of 23 patients with endometriosis. Numerous perceived barriers and facilitators were identified from all COM-B components and 13 out of 15 TDF domains. Knowledge and social influences were the most prominent TDF domains. Key barriers were eating with others; disbelief in a patients' own capability regarding specific dietary guidelines; concerns about taste; lack of knowledge on how to follow the diet; lack of noticeable beneficial effect; and lack of intention to follow the diet to full extent. Key facilitators were receiving social support; general confidence in a participant's own capabilities; knowing how and why to follow the diet; noticing beneficial effect; and belief that the diet would alleviate symptoms.

CONCLUSION

Provision of knowledge, stimulating social support and enhancing self-efficacy should be emphasized. Overall, an anti-inflammatory diet in endometriosis patients, especially when identified barriers and facilitators are addressed in an intervention, is feasible.

Fifty shades of grain - Increasing whole grain consumption through daily messages

Despite numerous health benefits, the majority of consumers, in particular young adults, show low levels of whole grain consumption behaviour (WGCB). In order to increase WGCB, this pre-registered experimental study investigates the effect of a two weeks message intervention. Participants (n = 329) received either information about health benefits, recipe suggestions, a combination of both, or about a control topic. We evaluated WGCB at three time points: prior to, immediately after (post), and one month after the intervention (follow-up). Our findings show that participants read the message on most of the days and on average, evaluate the health-only message most positively. Furthermore, we found that health messages, but not recipe suggestions significantly increase WGCB at the follow-up measure. This effect was serially mediated by attitudes and behavioural intentions at the post-intervention measure, with more positive attitudes and higher intentions leading to more WGCB. Although health messages are an effective tool to influence WGCB, the effect is small in magnitude and consumption levels remain rather low. We discuss implications for future research and for the communication of whole grain related health benefits among different stakeholders in the health sector.

Dietary Fibers in Healthy Children and in Pediatric Gastrointestinal Disorders: A Practical Guide

Dietary fibers include non-digestible plant carbohydrates, lignin and resistant starch. Dietary fibers provide immune, cardiovascular, metabolic and intestinal beneficial effects in humans. Fibers naturally present in foods (fruits, vegetables, legumes, cereals) or used as supplements have different physical, chemical and functional profiles. This narrative review provides an update to the knowledge on the effects of dietary fibers in healthy subjects and in children with gastrointestinal disorders. Soluble fibers are digested by gut bacteria, producing short-chain fatty acids and energy for colonocytes, and may exert prebiotic effects that promote the growth of bifidobacteria and lactobacilli. Non-soluble fibers are bulking agents and may improve intestinal transit. The exact amount and characteristics of the fiber requirement in infants and children need to be further established. There are limited data evaluating fibers in children with gastrointestinal disorders. The low intake of fibers has been associated with constipation, but the intake of excessive fibers is not recommended as it may cause flatulence and abdominal discomfort. Certain fibers (particularly psyllium in irritable bowel syndrome) have shown beneficial effects in children with gastrointestinal disorders, but the limited and heterogenous data do not currently allow a specific recommendation.

Food security and diet quality among urban poor adolescents in Kuala Lumpur, Malaysia

BACKGROUND/OBJECTIVES

This study aimed to examine the food security status of urban poor adolescents and its association with diet quality.

SUBJECTS/METHODS

A cross-sectional survey was conducted among 188 adolescents aged 13-18 yrs living in Kuala Lumpur, Malaysia. Household food insecurity and dietary intake data were collected using the Radimer/Cornell hunger and food insecurity instrument and 2-day 24-h dietary recalls, respectively. Diet quality was determined using the Malaysian Healthy Eating Index (HEI). Weight and height were measured and body mass index-for-age, as well as height-for-age z scores were calculated.

RESULTS

The present study revealed that 47.9% of the adolescents experienced household food insecurity, 24.5% experienced individual food insecurity, 18.6% household food security, and 9.0% child hunger. The mean score of diet quality was 56.83 ± 10.09, with a significantly lower HEI score among food insecure adolescents (household food insecure, individual food insecure, and child hunger) than household food secure adolescents (P = 0.001). The differences between food secure and food insecure households were found to be significant for energy (P = 0.001) and nutrients including proteins (P = 0.006), carbohydrates (P = 0.005), dietary fiber (P = 0.001), folate (P < 0.001), and vitamin C (P = 0.006). The multiple linear regression showed that adolescents who experienced food insecurity (β = -0.328; P = 0.003) were found to be significantly associated with poor diet quality (F = 2.726; P < 0.01), wherein 13.3% of the variation in the diet quality was explained by the food security status.

CONCLUSIONS

Experiencing food insecurity contributed to poor diet quality among urban poor adolescents. Further longitudinal studies are needed to comprehensively understand this association to improve food insecurity and diet quality among urban poor communities.

Adolescents' attitudes, preferences and perceived behaviours regarding healthy eating and whole grains from a gender and health interest perspective

Background

A healthy diet is important not only for the growth and development of the human body but also for the prevention of chronic diseases. However, most Swedish adolescents do not follow dietary recommendations, especially the intake of whole grain is very low. To create targeted conditions for healthy food choices amongst adolescents, comprehensive knowledge of factors related to adolescents' unhealthy and healthy eating is needed.

Objective

To investigate adolescents' attitudes, preferences and perceived behaviours regarding healthy eating, with a specific focus on whole grains and to evaluate differences between genders and between adolescents with higher versus lower health interest.

Design

A total of 1,178 Swedish adolescents responded to a questionnaire about their attitudes, preferences and perceived behabviours towards healthy eating and whole grains, and their general interest in nutrition and health. Results of girls and boys were compared, as well as adolescents with a higher versus lower health interest.

Results

Displays information about healthy eating among adolescents and a comprehensive set of factors that may affect their ability to eat healthier. Overall, adolescents had a positive attitude towards food and health, but less than half felt that they managed to eat healthy. The consumption of different whole grain products was low, although the willingness to eat healthier and more whole grain was high. The most reported barrier to healthy eating, as well as increasing whole grain intake, was the unavailability of tasty healthy products, taste being even more important for adolescents with a low health interest than those with a high interest. Whole grain consumption and factors increasing the willingness of whole grain consumption were most prominent not only in adolescents with high health interest but also in girls compared with boys.

Conclusion

The results show good potential to improve dietary habits amongst adolescents. Taste and availability of healthy products were rated the most important, whilst knowledge about the products' healthiness was rated the least important, especially amongst those with low health interest. By focusing on the attitudes and preferences of adolescents, the effectiveness may increase of initiatives to improve their dietary habits.

Health Effects of Whole Grains: A Bibliometric Analysis

Whole grains have been recommended in the diet in most countries, with numerous publications focusing on their health effect. A systematic analysis of these publications on different research methods, regions and perspectives will contribute to an understanding of the innovation pattern in this field. This bibliometric study analyzes the global publication characteristics, hotspots and frontiers of whole grain health benefit research, and discusses the trends and prospects of this topic. The overall number of publications is on the rise, with the United States contributing the most publications. The most cited literature shows that observational studies, systematic reviews and meta-analysis are the most widely used methods. The main focus in this area is on dietary fiber and bioactive substances, while the latter has received increased attention in recent years in particular. With the increasingly prominent problems of hidden hunger and chronic disease, the development of whole grain foods and their optimum intake have gradually become hot topics. In addition to the need to reveal the mechanism of whole grain health effects, consensus needs to be reached on standards and definitions for whole grain foods, and attention should be paid to the retention of taste and healthy nutrients in processing.

Familiarization with White Whole Wheat Improves Acceptability of Whole Grain-Based Baked Products Made with White Whole Wheat Among College Students

Research corroborates that high whole grain intake is associated with lower risk for obesity, type 2 diabetes, cardiovascular diseases, and cancers. Unfamiliarity with, and negative sensory appeal of whole grains limit voluntary food choices to increase their consumption. This study aimed to explore the effectiveness of familiarization with white whole wheat, to improve college students’ acceptability of shortened cakes, muffins, and yeast breads made with white whole wheat flour (WWWF). All-purpose flour (APF) was replaced with WWWF in standardized recipes, and the products scored by 102 college students. Independent t-test was used to analyze if sensory scores for appearance, taste, texture, and overall acceptability between APF and WWWF products were statistically significant. Before familiarization with WWWF, all three APF products scored significantly higher than whole grain counterparts ( P < .05). When participants were familiarized with health benefits and expected sensory profile of whole grain products, sensory scores for appearance, taste, and overall acceptability of WWWF products did not significantly differ from APF counterparts ( P > .05). Familiarization significantly increased overall acceptability scores of WWWF products ( P < .05). Familiarization also increased proportion of students willing to bake with WWWF. Results underscore that familiarization can improve acceptability of WWWF in baked products and students’ willingness to incorporate it in baking, with potential to stimulate dietary modifications.

The barriers to whole-grain consumption among Iranian students

Studies show that regularly consuming whole grains reduce the risk of obesity and a wide range of chronic diseases. Despite this, studies reveal that students are consuming fewer whole grains. In the present study, we aimed to investigate the barriers to the consumption of whole grains among Iranian students. This cross-sectional study examined students at Fasa, Iran in 2020–2021. The online questionnaires were completed by students after receiving informed consent. Statistical analysis was performed using SPSS 26 and Chi-square, t-test, and logistic regression (P > 0.05). The current study involved 1890 students (1287 (68.1%) girls and 603 (31.9%) boys). Despite the preference for white flour bread among 53.8% of all students, 77.4% ate other whole-grain products, and 75.2% consumed all products at least once a week. Additionally, barriers such as access issues (70.5%), family supply issues (91.8%), lack appeal (72.8%), non-consumption by classmates (96.2%), and high prices in recent years (43.9%) were identified as obstacles to whole grain consumption. Furthermore, white bread eating students had significantly lower appetite levels and tended to eat fast food more often than those who ate whole grains (P < 0.05). We found that slightly more than half of the participants preferred to eat bread prepared with refined flour. Several other factors, including lack of access, lack of attractiveness, product price, parents not purchasing whole-grain products, students not paying attention to nutrition labels, peers’ effect, and eating with friends instead of family, also contribute to students avoiding whole-grain products.

Sensory Features Introduced by Brewery Spent Grain with Impact on Consumers' Motivations and Emotions for Fibre-Enriched Products

The aim of this work was both to formulate three different fibre-enriched products by the addition of Brewery Spent Grain (BSG), and to evaluate the impact of this fibre enrichment on sensory quality, acceptability, and purchase intention under blind conditions. BSG was incorporated into bread, pasta, and chocolate milk at levels of 8.3%, 2.8%, and 0.35% (w/w), respectively. The fibre-enriched products and their regular counterparts were evaluated together by consumers through a CATA questionnaire, the EsSense 25 Profile, an overall acceptability rating, and a purchase intention ranking. Although fibre-enriched bread and chocolate milk ranked lower in overall acceptability compared with their counterparts, no significant difference was found for fibre-enriched pasta (p > 0.05). Purchase intention did not differ significantly for both bread and pasta (p > 0.05), yet the reasons for purchasing them differed significantly (p < 0.05). Consumers recognised the fibre enrichment in these two products and, therefore, were willing to partially compromise on sensory attributes. The fibre-enriched chocolate milk, nonetheless, scored significantly (p < 0.05) lower in purchase intention than the control. This work demonstrates that the effect of BSG addition is product-specific, and that fibre perception makes consumers feel more confident.

Identification of non-volatile compounds that negatively impact whole wheat bread flavor liking

Untargeted LC-MS flavoromic analysis was utilized to identify chemical compounds that impact consumer liking of whole wheat bread. Chemical fingerprints of thirteen whole wheat breads were modeled against consumer flavor liking scores by orthogonal partial least squares (OPLS) with good fit (R²Y = 0.98) and predictive ability (Q² = 0.95). The four most predictive features (negatively correlated) were identified as 9S,12S,13S-trihydroxy-octadec-10E-enoic acid (pinellic acid), 9S,12S,13S-trihydroxy-octadeca-10E,15Z-dienoic acid, 8R*,9R*,10S*-trihydroxy-octadec-6Z-enoic acid, and 1-(octadeca-9Z,12Z-dienoyl)-sn-glycero-3-phosphocholine. Sensory validation studies including bitter threshold determination and recombination tests confirmed the contribution of these compounds to the perceived bitterness intensity of the bread samples and the overall negative impact on flavor liking. Lipoxygenase activity of the flour was reported to have a significant impact on the formation of the three bitter compounds (trihydroxy fatty acids) in the bread samples.

Predictors of COVID-19 Preventive Behavior Adoption Intention in Malaysia

Preventive behavior adoption is the key to reduce the possibility of getting COVID-19 infection. This paper aims to examine the determinants of intention to adopt preventive behavior by incorporating perception of e-government information and services and perception of social media into the theory of reasoned action. A cross-sectional online survey was carried out among Malaysian residents. Four hundred four valid responses were obtained and used for data analysis. A partial least-square-based path analysis revealed direct effects of attitude and subjective norm in predicting intention to adopt preventive behavior. In addition, perception of e-government information and services and perception of social media were found to be significant predictors of attitude toward preventive behavior. The findings highlight the importance of digital platforms in improving people’s attitudes toward preventive behavior and in turn contain the spread of the infectious disease.

Facilitators and barriers to preparing and offering whole grains to children diagnosed with prediabetes: qualitative interviews with low-income caregivers

Background

The prevalence of U.S. youth with prediabetes and type 2 diabetes (T2D) is increasing, with those from racial/ethnic minority and low socioeconomic status (SES) backgrounds at greater risk. Dietary fiber (e.g., whole grains and vegetables) is shown to be inversely associated with T2D risk, yet dietary recommendations are not being met. Caregivers play an important role in home food availability, but low SES neighborhoods are shown to have limited access to fiber-rich foods such as whole grains. The overall aim of this qualitative study was to assess caregiver perceptions about facilitators and barriers to preparing and offering whole grains that they received as part of the 16-week Food Overcoming Our Diabetes Risk (FoodRx) pilot study.

Methods

A convenience sample of 60 youth (8–17 years) with obesity and prediabetes were recruited from an urban pediatric weight management clinic to participate in the FoodRx pilot study. Caregivers accompanied youth to a baseline clinic visit and completed a survey that asked about individual and household characteristics. Exit interviews were conducted at the follow-up clinic visit with caregivers of all youth who completed the study (n = 48) in order to assess facilitators and barriers experienced when preparing and offering whole grains. Interview transcripts were coded using the constant comparative method and grounded theory approaches.

Results

Caregivers (n = 48) had a mean age of 43 years and were primarily female (n = 46) and Hispanic (71%). Main facilitators to preparing and offering whole grains in the home were caregivers’ improved knowledge of whole grain health benefits and the development of strategies to encourage their children to consume whole grains (i.e., pairing whole grains with another liked food). A main barrier for caregivers was the lack of resources available to identify and prepare the novel whole grains that they received.

Conclusion

Findings suggest that caregivers are receptive to incorporating more whole grains into home-prepared meals, but they may need additional nutrition and cooking education to improve their self-efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10915-5.

Consumer Choices in the Bread Market: The Importance of Fiber in Consumer Decisions

The aim of the current study was two-fold: (1) to identify consumer segments based on bread selection motives and (2) to examine differences between the identified segments in terms of perception of bread and bread with added fiber, and information on the food label. The data were collected using a CAPI (computer-assisted personal interview) survey on a sample of 1013 consumers. The k-means clustering method was used to identify four clusters of consumers, namely, Enthusiastic, Involved, Ultra-Involved, and Neutral. The Enthusiastic was the group that expressed the most positive opinions about the bread and about the addition of fiber to white bread. Moreover, they appreciated the most the information placed on the bread label. On the other hand, the Ultra-Involved and the Involved presented moderate opinions on these issues. In contrast, the consumers from the Neutral segment agreed the least with the opinion that white bread fortified with fiber is healthier and more expensive compared to white bread without added fiber. Consumers belonging to the Enthusiastic segment declared, to a greater extent than others, that cereal products with added fiber facilitate a healthy lifestyle and can reduce the adverse effects of an inadequate diet. The obtained results indicated that relatively positive opinions on the addition of fiber to white bread, including its benefits for health, are an opportunity to further develop the market of cereal products with added fiber. However, the information about bread on the label and its readability should meet the expectations of consumers who differ significantly in terms of their motives for choice. Both now and in the future, this aspect will be a challenge for food entrepreneurs and organizations that are engaged in the education and development of information aimed at consumers.

Knowledge, attitudes and practices related to WG consumption among college students: a cross-sectional study in Chongqing, China

OBJECTIVES

This work aimed to investigate WG (WG)-related knowledge, attitudes, practices (KAPs) and factors affecting WG consumption among college students in Chongqing, China.

STUDY DESIGN

A cross-sectional study was performed among 2500 students from six universities using a self-administered questionnaire.

METHODS

The chi-squared test and binary logistic regression were used for data analysis.

RESULTS

Only 14.7% of the participants were aware of WG, 57.1% supported the consumption of WG, and only 8.5% consumed WG regularly in the last month. Participants with poor knowledge of WG were about 2 times more likely to not concern about chronic diseases (CDs) than concern about CDs (odds ratio [OR] = 2.241, 95% confidence interval [CI], 1.030-4.877). Women were less likely to have a poor attitude to WG compared with men (OR = 0.682, 95% CI, 0.529-0.878), whereas women were more likely to have a poor WG practice (OR = 2.335, 95% CI, 1.327-4.111).

CONCLUSIONS

Although results showed low levels of WG knowledge and practices, this study still supports positive attitudes to acquire WG-related knowledge among college students in Chongqing, China.

The Adherence of Singaporean Students in Different Educational Institutions to National Food-Based Dietary Guidelines

There are currently limited data on the dietary habits of young Singaporeans. This study aimed to evaluate the adherence of 17–21 year olds attending different educational institutions using a novel diet-quality scoring method. Dietary data were collected using a single weekday 24 h dietary recall in a cross section of 536 Singaporeans aged 17–21 years. An 11 category scoring system (0.0–100.0) was used to define adherence to food based dietary guidelines. Demographic and self-reported data were also collected via a questionnaire, BMI status, and using Mann-Whitney and Kruskal-Wallis (non-parametric) tests, with post-hoc Bonferroni-corrected tests. The median diet quality score was 48.5 (IQR 40.5, 56.4) for this cohort, with component scores for “Total fruit”, “Whole fruit”, “Total vegetables”, “Dark green leafy & orange vegetables”, “Whole grains”, “Dairy products”, and “Sodium” frequently scoring the minimum value. Median diet quality scores were statistically different for groups by ethnic origin (p < 0.001) and by educational institution (p < 0.001). Intake of fruit, vegetables, and whole grains is minimal, while sodium intake is frequently too high in young Singaporeans. Differences across ethnic groups and types of educational institutions suggest the need for targeted interventions to improve dietary habits in this population.

Main Factors Influencing Whole Grain Consumption in Children and Adults-A Narrative Review

Despite their recognized health benefits, intakes of whole grains (WG) are below recommended levels in almost all countries worldwide. This observation highlights the need to increase WG consumption by understanding factors influencing this consumption and how they could be favorably impacted. This review focused on facilitators of and barriers to WG consumption and how to improve the effectiveness of programs aiming at increasing WG consumption. The main methods to facilitate WG intakes in both adults and children seem to be to (i) increase the availability and the variety of foods containing WG, (ii) improve their sensory appeal, (iii) reduce their purchase cost, (iv) use a familiarization period to introduce them to consumers (with a gradual increase in consumed amounts and repeated exposure), and (v) improve communication and labeling to enhance consumers’ ability to identify products with WG. These strategies may be used to improve the effectiveness of programs aiming at promoting WG consumption, with a further emphasis on the need to apply them over a long period of time, and potentially to include tasting sessions of new foods containing WG. Finally, these strategies should involve broad partnerships between multiple stakeholders at the regulatory, institutional and industrial levels.

Developing and Validating an Instrument to Evaluate Theory-Based Behavioral Antecedents of Consuming a High-Fiber Diet

Obesity is a major public health concern, with low consumption of fiber-rich foods (e.g., fruits and vegetables) commonly cited as a causal factor. The purpose of this study was to evaluate the validity of a survey measuring the constructs of the Reasoned Action Approach under the context of consuming a high-fiber diet. After an initial draft of the survey was developed, it was evaluated by a panel of six experts to establish face and content validity. Next, data were collected from an adult sample (n = 878), and psychometric data revealed indices of reliability (Cronbach’s alpha) and validity (confirmatory factor analysis). The average age of adults was 51.5 years (±12.8), and a majority were Caucasian (81%), and women (93%). With regards to construct validity, the model structure had adequate fit (e.g., Comparative Fit Index = 0.960). In addition all items loaded significantly on its corresponding scale. For internal consistency reliability, all Cronbach’s alpha scores were > 0.70. Overall the survey appears to be a promising tool for researchers and practitioners. Understanding the theoretical determinants of fiber consumption will help tie theory together with practice.

Impact of Fermentation on the Phenolic Compounds and Antioxidant Activity of Whole Cereal Grains: A Mini Review

Urbanization, emergence, and prominence of diseases and ailments have led to conscious and deliberate consumption of health beneficial foods. Whole grain (WG) cereals are one type of food with an array of nutritionally important and healthy constituents, including carotenoids, inulin, β-glucan, lignans, vitamin E-related compounds, tocols, phytosterols, and phenolic compounds, which are beneficial for human consumption. They not only provide nutrition, but also confer health promoting effects in food, such as anti-carcinogenic, anti-microbial, and antioxidant properties. Fermentation is a viable processing technique to transform whole grains in edible foods since it is an affordable, less complicated technique, which not only transforms whole grains but also increases nutrient bioavailability and positively alters the levels of health-promoting components (particularly antioxidants) in derived whole grain products. This review addresses the impact of fermentation on phenolic compounds and antioxidant activities with most available studies indicating an increase in these health beneficial constituents. Such increases are mostly due to breakdown of the cereal cell wall and subsequent activities of enzymes that lead to the liberation of bound phenolic compounds, which increase antioxidant activities. In addition to the improvement of these valuable constituents, increasing the consumption of fermented whole grain cereals would be vital for the world's ever-growing population. Concerted efforts and adequate strategic synergy between concerned stakeholders (researchers, food industry, and government/policy makers) are still required in this regard to encourage consumption and dispel negative presumptions about whole grain foods.

Whole grain and high-fibre grain foods: How do knowledge, perceptions and attitudes affect food choice?

The health benefits of whole grains and dietary fibre are well established, however intakes of both remain low across the globe. Innovative added-fibre refined grain products may present a solution to increase fibre intakes given potential sensory barriers to whole grain intake. However, to consider the efficacy of such products, or potential alternative measures, an awareness of consumer knowledge, perceptions and attitudes towards both whole grain and added-fibre grain foods is needed. Focus groups (with adults with no formal nutrition education) were conducted to explore factors affecting consumer grain choice. Discussions were transcribed verbatim and analysed using inductive thematic analysis. Nine focus groups composed of 52 participants (23 men; 29 women) were conducted. Participants tended to report choosing 'grainy' bread but few other whole grain foods. Most participants were unaware of the long-term health benefits of whole grains, recommended whole grain intakes, or how to identify foods that were high in whole grains, thereby limiting motivation to increase intake. Additionally, scepticism surrounding the health value of carbohydrate-based foods appeared to hinder grain intakes in general. These findings suggest that further public education and promotion of whole grain benefits, with a focus on food-based targets and messaging, may be important in efforts to increase whole grain and subsequently fibre intakes. Added-fibre grain products may be a useful addition, specifically for avid whole grain-avoiders who are unlikely to accept whole grain sensory properties. However, as most participants were open to whole grain consumption, industry innovation should also focus efforts on increasing availability and variety of products high in whole grains.

Growing the Business of Whole Grain in the Australian Market: A 6-Year Impact Assessment

The Australia New Zealand Food Standards Code does not regulate on-pack claims describing the amount of whole grain in foods. In July 2013, The Grains & Legumes Nutrition Council^™ (GLNC) established a voluntary Code of Practice for Whole Grain Ingredient Content Claims (the Code) providing guidance for whole grain claims, with cut-off values and suggested wording ≥8 g, ≥16 g, and ≥24 g per manufacturer serve (contains; high and very high in whole grain), based on a 48 g whole grain daily target intake. The aim of this impact assessment was to report the uptake of the Code by manufacturers, changes in numbers of whole grain products, and claims on-pack since 2013, including compliance. The impact assessment was undertaken in August 2019, comparing current registered manufacturers (“users”) and their products to the total number of products in the market deemed eligible for registration through GLNC product audits since 2013. Reporting included breakfast cereals, bread products, crispbreads, crackers, rice/corn cakes, rice, pasta, noodles, couscous, other grains (e.g., quinoa, buckwheat, freekeh), and grain-based muesli bars. As of 30 June 2019, there were 33 registered users and 531 registered products in Australia and New Zealand representing 43% of the eligible manufacturers and 65% of the eligible whole grain foods. Three-quarters (78% and 74%) of the eligible breakfast cereals and bread products were registered with the Code in 2019, followed by 62% of grain-based muesli bars. Only 39% of crispbread, crackers, rice/corn cakes, and rice, pasta, noodles, couscous, and other grains were registered. From 2013 there has been a 71% increase in the number of whole grain foods making claims, demonstrating strong uptake by industry, with clearer, more consistent, and compliant on-pack communication regarding whole grain content.

Association between Adherence to the Mediterranean Diet and Physical Fitness with Body Composition Parameters in 1717 European Adolescents: The AdolesHealth Study

Obesity, low levels of physical fitness, and unhealthy eating patterns are responsible for part of the health problems of adolescents today. The current study aimed at examining the association between the adherence to the Mediterranean diet (MD), through each answer to the items of the Adherence to the MD Questionnaire (KIDMED), and physical fitness with body composition parameters (body mass index (BMI), percentage of body fat, and waist circumference) in 1717 European adolescents (N = 900 boys, N = 817 girls). Data of body composition, physical fitness results, and the answers to KIDMED were analyzed by the Student’s t-test. Additionally, the effect size (ES) was calculated and a Chi-square test analyzed the proportion of participants with and without over waist circumference, overfat, and overweight in each KIDMED question. The relative risk of suffering over waist circumference, overfat and overweight in relation to the responses was calculated by Odd-Ratio. Adherence to the MD did not influence the condition of over waist circumference, overfat and overweight, although certain dietary habits were identified as risk factors for their development. Over waist circumference, overfat, and overweight boys and girls presented higher levels of body mass, waist circumference, body fat percentage, and BMI (p < 0.001; ES = 1.73–3.38), as well as lower levels of all the parameters of the physical fitness analyzed (p < 0.001; ES = 0.45–1.08), except the handgrip test. A direct relationship between fitness and over waist circumference, overfat, and overweight was found.

The Influence of Health Messages in Nudging Consumption of Whole Grain Pasta

Health messages may be an important predictor in the selection of healthier food choices among young adults. The primary objective of our study is to test the impact of labeling whole grain pasta with a health message descriptor displayed at the point-of-purchase (POP) on consumer choice in a campus dining setting. The study was conducted in a large US college dining venue during lunch service; data were collected during a nine-week period, for a total of 18 days of observation. Each day, an information treatment (i.e., no-message condition; vitamin message; fiber message) was alternated assigned to whole grain penne. Over the study period, the selection of four pasta options (white penne, whole grain penne, spinach fettuccine, and tortellini) were recorded and compiled for analysis. Logistic regression and pairwise comparison analyses were performed to estimate the impact of health messages on diners’ decisions to choose whole grain penne among the four pasta types. Our results indicate that only the message about vitamin benefits had a significant effect on this choice, with a 7.4% higher probability of selecting this pasta than the no-message condition and 6.0% higher than the fiber message condition. These findings suggest that psychological health claims (e.g., reduction of fatigue) of whole grains seem more attractive than physiological health claims (e.g., maintaining a healthy weight) for university students. In line with the 2015–2020 Dietary Guidelines for Americans, our results suggest that small changes made at the POP have the potential to contribute to significant improvements in diet (e.g., achieving recommended levels of dietary fiber). These findings have important implications for food service practitioners in delivering information with the greatest impact on healthy food choices.

Factors Influencing British Adolescents' Intake of Whole Grains: A Pilot Feasibility Study Using SenseCam Assisted Interviews

High whole grain intake is beneficial for health. However, adolescents consume low levels of whole grain and the understanding of the underpinning reasons for this is poor. Using a visual, participatory method, we carried out a pilot feasibility study to elicit in-depth accounts of young people's whole grain consumption that were sensitive to their dietary, familial and social context. Furthermore, we explored barriers and suggested facilitators to whole grain intake and assessed the feasibility of using SenseCam to engage adolescents in research. Eight British adolescents (aged 11 to 16 years) wore a SenseCam device which auto-captured images every twenty seconds for three consecutive days. Participants then completed traditional 24-hour dietary recalls followed by in-depth interviews based on day three SenseCam images. Interview data were subjected to thematic analysis. Findings revealed that low adolescent whole grain intake was often due to difficulty in identifying whole grain products and their health benefits; and because of poor availability in and outside of the home. The images also captured the influence of parents and online media on adolescent daily life and choices. Low motivation to consume whole grains, a common explanation for poor diet quality, was rarely mentioned. Participants proposed that adolescent whole grain consumption could be increased by raising awareness through online media, improved sensory appeal, increased availability and variety, and tailoring of products for young people. SenseCam was effective in engaging young people in dietary research and capturing data relevant to dietary choices, which is useful for future research.

Dietary fibre and cardiovascular health: a review of current evidence and policy

Dietary fibre comprises many different, mainly plant-based, compounds that are not fully digested in the human gut. Insoluble fibres include cellulose, hemi-celluloses and lignin and soluble fibres include pectins, β-glucan and hydro-colloids. In the UK, the daily recommended amount has increased to 30 g but only 13 % of men and 4 % of women meet this recommendation. Currently the mean intake for adults is 21 g for men and 17 g for women. There is a wealth of epidemiological evidence based on systematic reviews of trials and cohorts to support the higher fibre recommendation. This includes evidence of reductions in the risk for CVD (both heart disease and stroke) and lower risk of type 2 diabetes, lower blood pressure, lower LDL-cholesterol, as well as some cancers. Beneficial effects of fibre operate via a diverse range of mechanisms throughout the digestive system including the mouth, stomach and small and large intestine; some of which are still not completely understood. The updated recommendation for fibre is a long way from a typical British diet and requires several daily portions of fruit and vegetables and wholegrain foods. Improving dietary fibre intakes will require a variety of actions and policies from stakeholders; however, there is currently more of a focus on reducing sugar than increasing fibre. In order to increase the number of adults meeting the fibre recommendation, social marketing and labelling of high-fibre foods are warranted as well as reformulation and wider availability of wholegrain versions of popular foods.

Infant Cereals: Current Status, Challenges, and Future Opportunities for Whole Grains

Infant cereals play an important role in the complementary feeding period. The aim of this study was to review existing research about the quantity, type, and degree of infant cereal processing, with a special focus on whole grain infant cereals. Accumulating evidence shows many benefits of whole grain consumption for human health. Likewise, consumers are frequently linking the term whole grains to healthiness and naturality, and sustainable food production becomes a more important aspect when choosing an infant cereal brand. Whole grain cereals should be consumed as early as possible, i.e., during infancy. However, there are several challenges that food manufacturers are facing that need to be addressed. Recommendations are needed for the intake of whole grain cereals for infants and young children, including product-labeling guidelines for whole grain foods targeting these age stages. Another challenge is minimizing the higher contaminant content in whole grains, as well as those formed during processing. Yet, the greatest challenge may be to drive consumers' acceptance, including taste. The complementary feeding period is absolutely key in shaping the infant's food preferences and habits; therefore, it is the appropriate stage in life at which to introduce whole grain cereals for the acceptance of whole grains across the entire lifespan.

Perceptions of college students in consuming whole grain foods made with Brewers' Spent Grain

One-third of all food produced for human consumption is wasted producing landfill accumulation and greenhouse gas emissions. Brewers' Spent Grains (BSGs) are the leftover grains from beer production, and each year approximately 30 million tons of BSG is generated globally by the brewing industry. Reclaiming BSG as a potential human food source is an opportunity for reducing food waste in the food supply chain. Six focus groups were conducted using 37 college students to determine their consumption of whole grains, perceptions of whole grains versus refined grains, and interest in or barriers related to consuming and purchasing foods made with BSG. Focus groups were transcribed verbatim and analyzed using constant comparative analysis to identify themes and discover relationships among the study aims. Thirteen themes emerged from focus group discussions with Concept of Health, Sensory, and Experience with BSG representing the top three discussed. Participants believed whole grains are healthier and contain more nutrients than refined grains. Most participants enjoyed the BSG foods provided; however, some noted a darker appearance and lingering fiber particles or aftertaste. Findings indicate participants who are hereditary whole grain consumers are acculturated to whole grain sensory attributes and nutritional benefits and would be more receptive to consuming BSG foods in future studies. We concluded most focus group participants were open to tasting BSG foods, but hereditary whole grain consumers should be the target consumer audience, and educating consumers on sensory attributes, potential health benefits, and environmental benefits is necessary to overcome the barriers associated with BSG.

Whole Grain Muffin Acceptance by Young Adults

Adolescents and young adults in the United States do not consume recommended amounts of whole grains. University dining services have opportunities to inform students about whole grains and to offer foods containing blends of whole grains with refined flour to increase daily consumption of these healthful foods. An online survey of university students (n = 100) found that 70% of respondents did not know the proportion of servings of whole grains that should be eaten daily. Mini blueberry muffins containing 50, 75, and 100% white whole wheat flour were served to 50 undergraduate students who rated their liking of the muffins using a nine-point hedonic scale. Respondents liked all muffin formulations similarly for appearance, taste, texture and overall liking. After the whole grain content of each muffin was revealed, 66% of students increased their liking of the muffins containing 100% whole wheat flour. Only half of the students increased their liking for the 75% whole wheat flour muffins, and most students reported no change in liking for the muffins made with the lowest percentage of whole wheat flour. Labeling whole grain foods in university foodservice operations may increase consumption of this food group by some students. Further research with actual purchase behavior is needed.