Prospective associations among cereal intake in childhood and adiposity, lipid levels, and physical activity during late adolescence

The Impact of Ready-to-Eat Cereal Intake on Body Weight and Body Composition in Children and Adolescents: A Systematic Review of Observational Studies and Controlled Trials

Results from observational studies suggest that children and adolescents consuming ready-to-eat cereals (RTECs) have a healthier BMI and lower odds of overweight and obesity than consumers of other breakfasts or breakfast skippers. However, randomized controlled trials in children and adolescents are few and have been inconsistent in demonstrating a causal relationship between RTEC intake and body weight or body composition. The objective of this study was to evaluate the effect of RTEC intake on body weight and body composition outcomes in children and adolescents. Prospective cohort, cross-sectional and controlled trials in children or adolescents were included. Retrospective studies and studies in subjects with disease, other than obesity, type-2 diabetes (T2D), metabolic syndrome, or prediabetes, were excluded. A search in PubMed and CENTRAL databases yielded 25 relevant studies, which were qualitatively analyzed. Fourteen of the 20 observational studies demonstrated that children and adolescents consuming RTEC have a lower BMI, lower prevalence and odds of overweight/obesity and more favorable indicators of abdominal obesity than nonconsumers or less frequent consumers. Controlled trials were few and only one reported a loss of 0.9 kg in overweight/obese children with RTEC consumption when accompanied by nutrition education. The risk of bias was low for most studies, but six had some concerns or high risk. The results were similar with presweetened and nonpresweetened RTEC. No studies reported a positive association of RTEC intake with body weight or body composition. Although controlled trials do not show a direct effect of RTEC consumption on body weight or body composition, the preponderance of observational data supports the inclusion of RTEC as part of a healthy dietary pattern for children and adolescents. Evidence also suggests similar benefits on body weight and body composition regardless of the sugar content. Additional trials are needed to determine the causality between RTEC intake and body weight and body composition outcomes. PROSPERO REGISTRATION: CRD42022311805.

A 3 Year Longitudinal Prospective Review Examining the Dietary Profile and Contribution Made by Special Low Protein Foods to Energy and Macronutrient Intake in Children with Phenylketonuria

The nutritional composition of special low protein foods (SLPFs) is controlled under EU legislation for 'Foods for Special Medical Purposes (FSMP)'. They are designed to meet the energy needs of patients unable to eat a normal protein containing diet. In phenylketonuria (PKU), the macronutrient contribution of SLPFs has been inadequately examined.

AIM

A 3-year longitudinal prospective study investigating the contribution of SLPFs to the macronutrient intake of children with early treated PKU.

METHODS

48 children (27 boys) with a mean recruitment age of 9.3 y were studied. Semi-quantitative dietary assessments and food frequency questionnaires (FFQ) were collected three to four times/year for 3 years.

RESULTS

The mean energy intake provided by SLPFs was 33% (SD ± 8), and this figure was 42% (SD ± 13) for normal food and 21% (SD ± 5) for protein substitutes (PS). SLPFs supplied a mean intake of 40% carbohydrate (SD ± 10), 51% starch (SD ± 18), 21% sugar (SD ± 8), and 38% fat (SD ± 13). Fibre intake met 83% of the Scientific Advisory Committee on Nutrition (SACN) reference value, with 50% coming from SLPFs with added gums and hydrocolloids. Low protein bread, pasta and milk provided the highest energy contribution, and the intake of sweet SLPFs (e.g., biscuits, cakes, and chocolate) was minimal. Children averaged three portions fruit/vegetable daily, and children aged ≥ 12 y had irregular meal patterns.

CONCLUSION

SLPFs provide essential energy in phenylalanine restricted diets. Optimising the nutritional quality of SLPFs deserves more attention.

Consumption of Ready-to-Eat Cereal in Canada and Its Contribution to Nutrient Intake and Nutrient Density among Canadians

In recent years, ready-to-eat cereal (RTEC) has become a common breakfast option in Canada and worldwide. This study used the nationally representative cross-sectional data from the Canadian Community Health Survey (CCHS) 2015-Nutrition to determine patterns of RTEC consumption in Canada and the contribution to nutrient intake among Canadians who were ≥2 years, of whom 22 ± 0.6% consumed RTEC on any given day. The prevalence of RTEC consumption was highest in children aged two to 12 years (37.6 ± 1.2%), followed by adolescents aged 13 to 18 years (28.8 ± 1.4%), and then by adults ≥19 years (18.9 ± 0.6%). RTEC consumers had higher intakes of "nutrients to encourage" compared to the RTEC non-consumers. More than 15% of the daily intake of some nutrients, such as folic acid, iron, thiamin, and vitamin B₆, were contributed by RTEC. It was noted that nearly 66% of milk consumption was co-consumed with RTEC among RTEC consumers. The nutrient density of the diet, as defined by Nutrient-Rich Food Index (NRF 9.3), was significantly higher among RTEC consumers compared to non-consumers. RTEC consumption was not associated with overweight/obesity. RTEC consumption considerably contributed to the intake of some key nutrients among all age groups in Canada.

Diet and body fat in adolescence and early adulthood: a systematic review of longitudinal studies

Adipose tissue is a vital component of the human body, but in excess, it represents a risk to health. According to the World Health Organization, one of the main factors determining excessive body adiposity is the dietary habit. This systematic review investigated longitudinal studies that assessed the association between diet and body fat in adolescents and young adults. Twenty-one relevant papers published between 2001 and 2015 were selected. The most used method for estimating body fat was the body mass index (15 studies). Diet was most commonly assessed by estimating the consumption of food groups (cereals, milk and dairy products) and specific foods (sugar-sweetened beverages, soft drinks, fast foods, milk, etc.). Ten studies found a direct association between diet and quantity of body fat. During adolescence, adhering to a dietary pattern characterized by high consumption of energy-dense food, fast foods, sugar-sweetened beverages and soft drinks, as well as low fiber intake, appears to contribute to an increase in body fat in early adulthood. The findings of the present study suggest that the frequent consumption of unhealthy foods and food groups (higher energy density and lower nutrient content) in adolescence is associated with higher quantity of body fat in early adulthood.

Breakfast Cereal Consumption and Obesity Risk amongst the Mid-Age Cohort of the Australian Longitudinal Study on Women's Health

Obesity affects 27.5% of Australian women. Breakfast cereal consumption has been proposed to be protective against obesity. This study investigated the association of breakfast cereal consumption with the risk of developing obesity (Body Mass Index (BMI) ≥ 30 kg/m²) over 12 years among mid-age participants in the Australian Longitudinal Study on Women’s Health (ALSWH). Dietary data were obtained at S3 and obesity incidence at S4–S7. Women were excluded if: dietary data were incomplete, energy intake was <4500 or >20,000 kJ/day, or they reported being overweight or obese at S3. Logistic regressions with discrete time survival analysis investigated the association between breakfast cereal intake and incident obesity and were adjusted for: area of residency, income, smoking, physical activity, hypertension, dietary intakes and a discrete measure of time. There were 308 incident cases of obesity. Any breakfast cereal intake was not associated with incident obesity (Odds Ratio (OR): 0.92; p = 0.68). Oat-based cereal (OR: 0.71; p = 0.01), muesli (OR: 0.57; p = 0.00) and All-Bran (OR: 0.62; p = 0.01) intakes were associated with a significant reduction in obesity risk. Among this cohort, muesli on its own, or as part of oat-based cereals, and All-Bran, were associated with a reduction in obesity. This effect may be due to particular characteristics of these cereal eaters, but the relationship warrants further investigation.

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers

Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.

European adolescent ready-to-eat-cereal (RTEC) consumers have a healthier dietary intake and body composition compared with non-RTEC consumers

Purpose

This study aims to analyse the association of European adolescents’ ready-to-eat-cereal (RTEC) consumption frequency with their dietary intake by applying the concept of diet quality index and nutritional status.

Methods

From the multi-centre European HELENA study, relevant data were available in 1,215 adolescents (12.5–17.5 years). RTEC consumption was identified from a food frequency questionnaire. A diet quality index, daily nutrient intakes and daily milk/yoghurt and fruit intake were calculated from two 24-h dietary recalls. BMI, waist and hip circumference and body fat were measured for body composition. Cross-sectional regression analyses were adjusted for sex, age, socio-economic status, city and breakfast skipping. Differences in sub-regions within Europe were explored.

Results

RTEC consumers showed a more favourable daily micronutrient intake (vitamin B2, B5, B7, D, calcium, phosphorus and potassium), a better diet quality index, more frequent fruit (57 vs. 51 %) and milk/yoghurt consumption (81.2 vs. 56 %) and less breakfast skipping (25.1 vs. 36.7 %). No differences in energy and macronutrient intake were observed. Daily RTEC consumers were 57 % less likely to be overweight than RTEC non-consumers but did not differ in glucose and lipid status (N = 387).

Conclusion

This is the first comprehensive pan-European survey elucidating socio-demographic determinants of European adolescents’ RTEC consumption and indicating better dietary habits in RTEC consumers. The improved dietary profile was reflected in a more beneficial body composition. Our results have also shown the advantage of using an all-integrating diet quality index by capturing the diet complexity.

The benefits of breakfast cereal consumption: a systematic review of the evidence base

There have been no comprehensive reviews of the relation of breakfast cereal consumption to nutrition and health. This systematic review of all articles on breakfast cereals to October 2013 in the Scopus and Medline databases identified 232 articles with outcomes related to nutrient intake, weight, diabetes, cardiovascular disease, hypertension, digestive health, dental and mental health, and cognition. Sufficient evidence was available to develop 21 summary evidence statements, ranked from A (can be trusted to guide practice) to D (weak and must be applied with caution). Breakfast cereal consumption is associated with diets higher in vitamins and minerals and lower in fat (grade B) but is not associated with increased intakes of total energy or sodium (grade C) or risk of dental caries (grade B). Most studies on the nutritional impact are cross-sectional, with very few intervention studies, so breakfast cereal consumption may be a marker of an overall healthy lifestyle. Oat-, barley-, or psyllium-based cereals can help lower cholesterol concentrations (grade A), and high-fiber, wheat-based cereals can improve bowel function (grade A). Regular breakfast cereal consumption is associated with a lower body mass index and less risk of being overweight or obese (grade B). Presweetened breakfast cereals do not increase the risk of overweight and obesity in children (grade C). Whole-grain or high-fiber breakfast cereals are associated with a lower risk of diabetes (grade B) and cardiovascular disease (grade C). There is emerging evidence of associations with feelings of greater well-being and a lower risk of hypertension (grade D), but more research is required.

Food consumption, physical activity and socio-economic status related to BMI, waist circumference and waist-to-height ratio in adolescents

OBJECTIVE

To examine the association between obesity and food group intakes, physical activity and socio-economic status in adolescents.

DESIGN

A cross-sectional study was carried out in 2008. Cole's cut-off points were used to categorize BMI. Abdominal obesity was defined by a waist circumference at or above the 90th percentile, as well as a waist-to-height ratio at or above 0·500. Diet was evaluated using an FFQ, and the food group consumption was categorized using sex-specific tertiles of each food group amount. Physical activity was assessed via a self-report questionnaire. Socio-economic status was assessed referring to parental education and employment status. Data were analysed separately for girls and boys and the associations among food consumption, physical activity, socio-economic status and BMI, waist circumference and waist-to-height ratio were evaluated using logistic regression analysis, adjusting the results for potential confounders.

SETTING

Public schools in the Azorean Archipelago, Portugal.

SUBJECTS

Adolescents (n 1209) aged 15-18 years.

RESULTS

After adjustment, in boys, higher intake of ready-to-eat cereals was a negative predictor while vegetables were a positive predictor of overweight/obesity and abdominal obesity. Active boys had lower odds of abdominal obesity compared with inactive boys. Boys whose mother showed a low education level had higher odds of abdominal obesity compared with boys whose mother presented a high education level. Concerning girls, higher intake of sweets and pastries was a negative predictor of overweight/obesity and abdominal obesity. Girls in tertile 2 of milk intake had lower odds of abdominal obesity than those in tertile 1. Girls whose father had no relationship with employment displayed higher odds of abdominal obesity compared with girls whose father had high employment status.

CONCLUSIONS

We have found that different measures of obesity have distinct associations with food group intakes, physical activity and socio-economic status.

Ready-to-eat cereal consumption and the School Breakfast Program: relationship to nutrient intake and weight

BACKGROUND

Children in the United States exhibit high rates of nutrient inadequacy and overweight/obesity; other international studies report similar associations. The School Breakfast Program (SBP) may help alleviate these conditions for youth in the United States. This research examined the association of ready-to-eat (RTE) breakfast cereal consumption with students' (SBP participants and nonparticipants) dietary nutrient intake and weight status.

METHODS

Data were from the third School Nutrition Dietary Assessment Study (SNDA-III), conducted in 2004-2005. Analyses included all 2298 SNDA-III participants (ages 5-18 years), who completed a dietary recall and whose parents completed an interview. Students were categorized as skipping versus eating breakfast; students eating breakfast were categorized by SBP participation (SBP participant vs nonparticipant) and breakfast type (with vs without RTE cereal). Analyses estimated the association of these categorizations with total daily nutrient intake and weight-related measures, after adjusting for covariates.

RESULTS

RTE cereal breakfast consumers (regardless of SBP participation) had greater intake of vitamin A, iron, and whole grain, compared with noncereal breakfast eaters. Breakfast consumers (regardless of SBP participation and type) had greater intake of vitamins A and C, calcium, iron, dietary fiber, and whole grain, relative to breakfast skippers.

CONCLUSIONS

The SBP increases opportunity for improved nutrient intake and healthier body weight through breakfast consumption, especially whole grain RTE cereals, as recommended by the Dietary Guidelines 2010.

Ready-to-eat cereals and the burden of obesity in the context of their nutritional contribution: are all ready-to-eat cereals equally healthy? A systematic review

A significant increase in the prevalence of obesity has occurred worldwide and the importance of considering the role of diet in the prevention and treatment of obesity is widely acknowledged. A growing body of evidence encourages the consumption of ready-to-eat cereals (RTEC) as part of a healthful diet. Research has shown an inverse association between the consumption of RTEC and the rate of obesity. However, other findings claim that this association was only attributed to the consumption of whole-grain cereals and not the refined-grain ones. Although meta-analyses of clinical trials support the use of a low-glycaemic index diet on weight loss, findings from other studies on the effect of the dietary glycaemic index on body weight have not been consistent. Thus, further research into the role of glycaemic index in the prevention and management of obesity and chronic disease is needed. Moreover, significant differences have been observed in composition among the marketed RTEC. In light of the revealing protective role of whole-grain, fibre-rich, low-energy-dense and low-glycaemic index/glycaemic load foods against obesity, public health professionals could drive their efforts towards the promotion of even more healthier RTEC when issuing advice on weight management. It seems, however, that despite any differences in their composition, the frequent consumption of RTEC due to their nutritional contribution is recommended in moderation and under the current recommendations in the context of a healthy balanced diet.

Cereal consumption and indicators of cardiovascular risk in adolescent girls

OBJECTIVE

To examine the association between cereal consumption and cardiovascular risk factors including waist, height, total cholesterol, LDL cholesterol and HDL cholesterol in a sample of adolescent girls.

DESIGN

Longitudinal study.

SETTING

The study was conducted from 1987 to 1997 and data were collected at three study sites (University of California at Berkeley, University of Cincinnati and Westat Inc., Rockville, MD, USA). Mixed models were used to estimate the association between the number of days of eating cereal and these four outcome variables.

SUBJECTS

Girls (n 2371) who participated in the 10-year National Heart, Lung, and Blood Growth and Health Study (NGHS) and completed a 3 d food diary in years 1-5 and 7, 8 and 10.

RESULTS

Adolescent girls who ate cereal more often had lower waist-to-height ratio (P<0.005), lower total cholesterol (P<0.05) and lower LDL cholesterol (P<0.05), taking into account sociodemographic variables, physical activity levels and total energy intake.

CONCLUSIONS

Findings suggest that cereal consumption is associated with markers of cardiovascular risk and that childhood patterns of consumption may influence the development of risk factors later in adolescence.