Comparison of dietary intakes according to breakfast choice in Australian boys

The effect of breakfast on childhood obesity: a systematic review and meta-analysis

Objective

Previous cohort trials have shown that skipping breakfast increases the risk of obesity or overweight in children. However, this finding remains controversial. Through a meta-analysis, this study systematically evaluated the effect of skipping breakfast on the prevalence of obesity or overweight in children.

Methods

We performed a literature search for studies published until March 19, 2023. using the Cochrane, PubMed, and Embase databases. Based on the inclusion and exclusion criteria, observational studies on the relationship between skipping breakfast and overweight/obesity in children and adolescents were analyzed. Three investigators independently screened the relevant literature, extracted the data, and assessed the risk of bias. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects model was used. The odds ratio (OR) with its 95% confidence interval (CI) was used to indicate the effect size.

Results

A total of 40 retrospective studies with 323,244 children ranging in age from 2 to 20 years were included in this study. The results of this meta-analysis showed that children and adolescents who skipped breakfast had a significantly higher prevalence of obesity or overweight than those who ate breakfast (OR, 1.59; 95% CI, 1.33-1.90; P < 0.001). Skipping breakfast was positively associated with overweight in children and adolescents (OR, 1.37; 95% CI, 1.23-1.54; P < 0.001). Similarly, skipping breakfast was positively associated with obesity in children and adolescents (OR, 1.51; 95% CI, 1.30-1.76; P < 0.001). The effect was also different by sex, with girls being the most affected (OR, 1.47; 95% CI, 1.23-1.76; P < 0.001). There was also a correlation between skipping breakfast and abdominal obesity in children (OR, 0.65; 95% CI, 0.55-0.77; P < 0.001).

Conclusion

This meta-analysis suggested that skipping breakfast is associated with an increased risk of overweight/obesity in children and adolescents. The findings provide support for a possible protective role of breakfast against excessive weight gain in children and adolescents. However, more rigorous study designs with validated and standardized measures of relevant variables are needed.

Breakfast consumption trends among young Australian children aged up to 5 years: results from InFANT program

Breakfast is considered a healthy dietary habit which can track over time from childhood to adulthood. The breakfast meal has the potential to improve daily dietary quality, particularly if it includes a range of food groups and adequate nutrient intakes. However, research on breakfast consumption trends among young Australian children aged up to 5 years is currently limited. This study assessed children's usual breakfast food group and nutrient intakes at ages 1.5 (n = 369), 3.5 (n = 242), and 5.0 (n =240) years using three 24-hour dietary recalls from the Melbourne InFANT program. Tracking of food groups at breakfast across the three ages was assessed by Pearson correlation of energy-adjusted food intake residuals. The main food groups consumed at breakfast were grains, milk/alternatives and discretionary items, with vegetables rarely consumed at any age. Our study found that while breakfast contributed about 20% of total daily energy, this provided 20%-29.1% of total daily intake across all ages for carbohydrates, total sugars, calcium and potassium. For the contribution to daily recommendations, breakfast contributed more than about a third of daily recommended intakes for some micronutrients (e.g., iron, calcium and zinc), and a large proportion (over 40%) of sodium intake. Children consumed 11.9% -15.2% of their energy at breakfast from saturated fat, which is higher than the recommended total energy contribution of saturated fat (no more than 10% from saturated fat). For tracking of most food groups and nutrients, tracking was found to be low or moderate over time. Given the contribution that breakfast can make to ensure children achieve their daily dietary intakes, early interventions for young Australian children should focus on practical strategies to increase vegetable intake while reducing sodium and saturated fat intake at breakfast.

Breakfast Consumption and Diet Quality of Teens in Southwestern Ontario

Background

Breakfast skipping has previously been associated with worse diet quality among adolescents; the latter increases the risk of chronic disease. However, many studies do not consider diet quality as a function of calories, which is problematic as skippers tend to consume less energy than consumers. Additionally, due to the lack of one accepted definition of both breakfast skipping and diet quality, it is unclear how differences found may change when using varying definitions.

Objectives

We aimed to compare the Healthy Eating Index-2015 (HEI-2015) scores and nutrient intakes of teen breakfast skippers and consumers in Southwestern Ontario, Canada.

Methods

Cross-sectional, baseline data were used from SmartAPPetite, an ongoing nutrition intervention study. Singular 24-h dietary recalls and sociodemographic data from 512 adolescents aged 13-19 y were used to compare HEI-2015 scores and nutrient intakes via multivariable linear regression.

Results

Previous day breakfast skippers had significantly lower HEI-2015 scores (-4.4; 95% CI: -8.4, -0.4) and significantly lower intakes of calories, saturated fat, and vitamin C, as well as significantly higher intake of sodium and total fat.

Conclusions

Previous day breakfast consumers had significantly higher diet quality scores and better nutrient intakes than breakfast skippers, although, on average, both had poor diet quality. Consequently, it is unlikely that simply advising teens to consume breakfast will result in meaningful change in diet quality, and more effort should be placed on promoting nutritious breakfasts.

Breakfast Habits of a Representative Sample of the Spanish Child and Adolescent Population (The ENALIA Study): Association with Diet Quality

The association between breakfast quality and total diet quality of children and adolescents ((1-17.9 years (n = 1570)) from the National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) was analyzed. Dietary information was collected using two non-consecutive one-day food diaries (1-10 years old) or two 24 h dietary recalls (>10 years). Breakfast quality index (BQI) and a variant of Nutrient Rich Foods index (NRF9.3) were calculated to assess the total diet quality. Children and adolescents who had breakfast on at least one day (n = 1561) were divided into two groups according to BQI: Worse Quality Breakfast (WQB) (BQI < 4 points (P66), n = 781) and Good Quality Breakfast (GQB) (BQI ≥ 4, n = 780). Younger children and those whose parents have university education presented higher BQI. GQB group had significantly higher intakes of micronutrients (vitamins A, D, C, B1, B2, B6, niacin, folate, calcium, potassium, magnesium). Fewer GQB children exceeded the Acceptable Macronutrient Distribution Range for fat and had folate and calcium intakes below their estimated average requirement. Daily NRF9.3 was 496.2 ± 54.0, being higher in GQB (503.8 ± 50.6 vs. 488.6 ± 56.2, p < 0.001). Increasing the quality of breakfast increased the possibility of having a NRF9.3 higher than P50 (OR: 1.893, CI: 1.549-2.315, p < 0.0001). Breakfasts have room for quality improvement in a high percentage of children. A higher quality breakfast is associated with a benefit in the quality of the total diet.

Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality among Infants, Toddlers, and Children in the National Health and Nutrition Examination Survey 2015-2016

Ready-to-eat (RTE) cereal is a popular food among children. However, there are no recent data on the associations between RTE cereal consumption and dietary outcomes in the U.S. Therefore, we sought to investigate how RTE cereal was associated with nutrient and food group intakes and overall dietary quality among children aged 0.5 to 17 years using the latest data from the National Health and Nutrition Examination Survey (NHANES 2015-2016). Thirty-six percent of children reported consuming RTE cereal. RTE cereal eaters consumed the same number of calories as non-eaters but had higher intakes of total carbohydrates, total sugar, fiber, calcium, iron, magnesium, potassium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, and vitamin D, as well as lower intakes of total fat and saturated fat (p ≤ 0.0007). We also found that children who consumed RTE cereal had 29% higher total dairy intake (p < 0.0001) and 61% higher whole grain intake (p < 0.0001). Lastly, children who ate RTE cereal had higher diet quality than the children that did not eat RTE cereal, as shown by Healthy Eating Index 2015 total score (52.6 versus 47.7, p < 0.0001). Therefore, consumption of whole-grain fortified RTE cereals should be encouraged as part of healthy dietary patterns for children.

Breakfast Choice Is Associated with Nutrient, Food Group and Discretionary Intakes in Australian Adults at Both Breakfast and the Rest of the Day

Breakfast choice is correlated with daily nutrient intakes, but this association may not be solely explained by the breakfast meal. We profiled breakfast consumer groups among Australian adults and compared the role that breakfast versus the rest of the day had on daily intakes of the Five Food Groups, discretionary foods, and nutrients. Breakfast groups were breakfast cereal consumers, non-cereal breakfast consumers, and breakfast skippers. One-day dietary recall data from the 2011⁻2012 National Nutrition and Physical Activity Survey were analysed (n = 9341, ≥19 years), as well as socio-demographic and anthropometric measures. Twelve per cent of adults were breakfast skippers, 41% were breakfast cereal consumers, and 47% were non-cereal breakfast consumers. Females were more likely to have a non-cereal breakfast than males, and the non-cereal breakfast was predominantly bread-based. Breakfast skipping decreased with age (p < 0.001), while breakfast cereal consumption increased with age (p < 0.001). Breakfast skippers were more likely to be male, had a lower socio-economic status, and lower physical activity levels (p < 0.001). Breakfast skippers had the highest mean body mass index (BMI) and waist circumference (p < 0.001), the lowest intake of wholegrain foods, fruits and vegetables, and the highest intake of discretionary foods (p < 0.001). Breakfast cereal consumers had the lowest mean BMI and waist circumference (p < 0.001) and had healthier diets at both breakfast and throughout the rest of the day. They were the most likely to meet the daily recommended serves for grain foods, fruit, dairy, and vegetables, had the highest wholegrain food intake, and the lowest discretionary intake (p < 0.001). Additionally, breakfast cereal consumers had the most favourable daily nutrient intakes, including the lowest added sugars intakes. Differences in daily diet between breakfast groups were attributed to differences in food choices both at breakfast and throughout the rest of the day.

Dietary Fibre Intake in Australia. Paper I: Associations with Demographic, Socio-Economic, and Anthropometric Factors

Dietary fibre is important for regular laxation and reduces chronic disease risk. The National Health and Medical Research Council outlines daily fibre intake targets, yet the proportion of the population that meets these targets is unknown. Using the 2011⁻2012 National Nutrition and Physical Activity Survey, we profiled fibre intake among Australian children and adults. Data from one-day dietary recalls were analysed (n = 12,153, ≥2 years) as well as demographic and anthropometric factors. The median fibre intake was 18.2 g (interquartile range [IQR] 13.2⁻25.0) in children and 20.7 g (IQR 14.3⁻28.7) in adults. We found that 42.3% (95% CI 40.5⁻44.1%) of children and 28.2% (95% CI 27.3⁻29.1%) of adults met the Adequate Intake (AI), and less than 20% of adults met the Suggested Dietary Target (SDT) to reduce the risk of chronic disease. Older children (aged 14⁻18 years), girls, young adults (19⁻30 years), males, and those of lower socio-economic status were less likely to meet the AI (p < 0.001). Those with a higher energy intake were more likely to meet the AI. Anthropometric measures were not associated with fibre intake or the likelihood of meeting the AI. Fibre is a nutrient of concern in Australian diets, with most children and adults falling short of recommendations. Adolescents, girls, young adults, men, and those of lower socio-economic status were less likely to meet the recommendations and may benefit most from public health interventions.

Cereal fibre intake in Australia: a cross-sectional analysis of the 2011-12 National Nutrition and Physical Activity Survey

Extensive evidence supports health benefits of cereal fibre, however globally no national intake data exists. This study aimed to determine estimates of intake and food sources of cereal fibre, and relationships to dietary fibre intake in an Australian sample population. A cereal fibre database was applied to dietary intake data from the 2011-12 National Nutrition and Physical Activity Survey (n = 12,153). Usual intake based on 2-day intake data was weighted to infer population results. Median daily cereal fibre intake was 6.4 g/d (9.7 g/10 MJ/d) for adults (19-85 years) and 6.2 g/d (10.2 g/10 MJ/d) for children/adolescents (2-18 years). Individuals with the highest cereal fibre intake were more likely to meet dietary fibre recommendations than those with the lowest intake (males Q4: 17.1% Q1: 3.9%; females Q4: 20.3% Q1: 6.6%). Breakfast cereals, bread and bread rolls provided the most cereal fibre. This study provides first quantification of cereal fibre from all sources in an Australian national sample.

Breakfast and Breakfast Cereal Choice and Its Impact on Nutrient and Sugar Intakes and Anthropometric Measures among a Nationally Representative Sample of Australian Children and Adolescents

There is limited evidence in Australia that compares the nutritional impact of a breakfast cereal breakfast to a non-cereal breakfast, and includes the type of cereal. This study investigated the impact of breakfast choice and the total sugar content of breakfast cereal on nutrient intakes and anthropometric measures among Australian children and adolescents. Data from 2 to 18-year-old in the 2011–2012 National Nutrition and Physical Activity Survey were used (n = 2821). Participants were classified as breakfast cereal consumers (minimally pre-sweetened (MPS) or pre-sweetened (PS)), non-cereal breakfast consumers, or breakfast skippers. Foods consumed for breakfast, foods added to the cereal bowl, and the impact of breakfast choice on daily nutrient intakes and anthropometric measures were determined. Although only 9% of children skipped breakfast, 61% of skippers were aged 14–18 years. Among breakfast consumers, 49% had breakfast cereal, and 62% of these exclusively consumed MPS cereal. Breakfast skippers had a higher saturated fat intake than breakfast cereal consumers, and lower intakes of dietary fibre and most micronutrients (p < 0.001). Compared with non-cereal breakfast consumers, breakfast cereal consumers had similar added and free sugars intakes, lower sodium, and higher total sugars, carbohydrate, dietary fibre, and almost all other micronutrients (p < 0.001). The only difference in nutrient intakes between MPS and PS cereal consumers was higher folate among PS consumers. No associations between anthropometric measures and breakfast or breakfast cereal choice were found. The highest prevalence of breakfast skipping was among 14–18-year old. Breakfast cereal consumers had higher intakes of dietary fibre and most micronutrients compared with non-cereal breakfast consumers and skippers, and almost no differences were found between MPS and PS cereal consumers.

The nutritional quality of New Zealand breakfast cereals: an update

Objective

To compare the nutritional quality of New Zealand breakfast cereals in 2013 and 2017.

Design

Nutrition Information Panel data were collected from all cereals available from two large supermarket chains in 2017 and compared with earlier published data collected in 2013.

Setting

Urban New Zealand supermarkets.

Subjects

The nutritional content of breakfast cereals (‘biscuits and bites’, ‘brans’, ‘bubbles, flakes and puffs’, ‘children’s cereals’, ‘muesli’ and ‘oats’) was analysed for total energy, protein, fat (total and saturated), carbohydrate, sugar, fibre and Na. The Nutrient Profile Scoring Criterion (NPSC) for each cereal was calculated to determine the proportion of ‘less healthy’ cereals (NPSC≥4) in each product category.

Results

The energy and fat content of bubbles, flakes and puffs, muesli and oats were significantly higher in 2017 compared with 2013 (all P≤0·01). However, there was a small reduction in Na overall in 2017 (P<0·05). There was no change between 2013 and 2017 in the proportion of ‘healthy’ or ‘less healthy’ breakfast cereals available.

Conclusions

The nutrient profile of breakfast cereals has not improved since 2013, suggesting that industry self-regulation of the nutritional composition of cereals in New Zealand is not working and needs urgent reconsideration.

Breakfast consumption and nutrient intakes in 4-18-year-olds: UK National Diet and Nutrition Survey Rolling Programme (2008-2012)

Although breakfast consumption is widely considered to be an important component of a healthy lifestyle, few UK studies have examined differences in nutrient intakes between breakfast consumers and breakfast skippers among children and adolescents. We investigated associations between breakfast skipping in 4-18-year-olds and their nutrient intakes using data from the UK's National Diet and Nutrition Survey Rolling Programme. Dietary data were derived from 4-d estimated food diaries of 802 children aged 4-10 years and 884 children aged 11-18 years (1686 in total). Daily nutrient intakes of children with different breakfast habits were compared by one-way ANCOVA adjusting for relevant covariates (sex, age, ethnicity, equivalised household income and BMI). Within-person analysis was carried out on children with an irregular breakfast habit (n 879) comparing nutrient intakes on breakfast days with those on non-breakfast days using repeated measures ANCOVA. We observed that the overall nutritional profile of the children in terms of fibre and micronutrient intake was superior in frequent breakfast consumers (micronutrients: folate, Ca, Fe and I (P<0·01)) and, for the 4-10 years age group, on breakfast days (micronutrients: folate, vitamin C, Ca and I (P<0·01)). Also, significantly higher proportions of breakfast-consuming children met their reference nutrient intakes of folate, vitamin C, Ca, Fe and I compared with breakfast skippers (χ 2 analysis, P<0·001). Our study adds to the body of data linking breakfast consumption with higher quality dietary intake in school-age children, supporting the promotion of breakfast as an important element of a healthy dietary pattern in children.

Whole grain intake of Australians estimated from a cross-sectional analysis of dietary intake data from the 2011–13 Australian Health Survey

Objective

The Australian Dietary Guidelines recommend Australians choose mostly whole-grain and/or high-fibre varieties within the grains (cereal) foods category, with other groups specifying a whole grain Daily Target Intake of 48 g for Australians aged 9 years or above. The USA and UK report estimates of whole grain intake that are low and declining, and no comprehensive studies on whole grain intake in the Australian population are available. The present study aimed to determine national estimates of whole grain intake, compared with current recommendations.

Design

A recently updated whole grain database was applied to the most current population dietary intake data. Single 24 h dietary recall intake data were reviewed against age group, sex, relative to energy intake and whole grain recommendations.

Setting

Australia.

Subjects

Australians (2–85 years) participating in the 2011–13 Australian Health Survey (n 12 153).

Results

The median daily whole grain intake was 21 g for adults (19–85 years) and 17 g for children/adolescents (2–18 years), or 28 and 23 g/10 MJ per d, respectively. Approximately 30 % of children/adolescents consumed no whole grains on the day of the survey. Whole grain intake was lowest for the age group 14–18 years (8·7 g/d). Of all participants aged ≥9 years, 73 % did not reach the recommended Daily Target Intake of 48 g.

Conclusions

Whole grain intake in Australia is below recommendations in all age groups. Adolescents may be a key target for campaigns to increase whole grain consumption. This study provides the first quantification of absolute whole grain intake from all food sources in a national sample of Australians.

Salt and sugars content of breakfast cereals in the UK from 1992 to 2015

OBJECTIVE

To study the salt and sugars content of breakfast cereals sold in the UK between 1992 and 2015.

DESIGN

Cross-sectional surveys on salt and sugars content collected from the nutrition information panel of breakfast cereals in 1992, 2004, 2006, 2009, 2012 and 2015.

SETTING

All major UK retailers operating at that moment in time (approximately ten).

SUBJECTS

The salt and sugars content was collected from product packaging and the nutrition information panels.

RESULTS

Cereals consistently surveyed across all five years (n22) showed a significant reduction in salt content of 47 % (P<0·001). Sugars content of breakfast cereals (n 15), however, did not show a significant change; 25·65 g/100 g in 1992 and 22·45 g/100 g in 2015 (P=0·170). There was a large variation in salt and sugars content between different categories and within the same type of category.

CONCLUSIONS

The study shows the progressive reduction in salt content of breakfast cereals in the UK since 2004 as a result of the successful salt reduction programme, particularly the setting of incremental salt targets. Further reductions in salt content need to be made as cereals remain a major contributor to salt intake. Sugars content, however, has been consistently high due to the lack of a sugar reduction strategy. The research demonstrates that the sugars content of breakfast cereals in the UK is of concern, particularly in children's breakfast cereals, with a typical serving (30 g) containing a third of a 4-6-year-old's maximum daily recommendation (19 g/d) for free sugars intake in the UK. More can and should be done to reformulate, with an urgent need to set incremental sugar reduction targets.

Effects of Ready-to-Eat-Cereals on Key Nutritional and Health Outcomes: A Systematic Review

BACKGROUND

In many countries breakfast cereals are an important component of breakfast. This systematic review assesses the contribution of consumption of ready-to eat cereal (RTEC) to the recommended nutrient intake. Furthermore, the effects of RTEC consumption on key health parameters are investigated as well as health promoting properties of RTEC.

METHOD

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL have been searched up till 16th of June 2015. Randomized controlled trials were excluded if RTEC were used during hypocaloric diets, if RTEC were eaten at other times than breakfast and if breakfasts included other products than RTEC, milk and fruit. Observational studies were excluded when "breakfast cereals" were not defined or their definition included cooked cereals. From cross-sectional studies only data concerning energy and nutrient intake as well as micronutrient status were used.

RESULTS

From 4727 identified citations 64 publications met the inclusion criteria of which 32 were cross-sectional studies, eight prospective studies and 24 randomized controlled trials. Consumption of RTEC is associated with a healthier dietary pattern, concerning intake of carbohydrates, dietary fiber, fat and micronutrients, however total sugar intake is higher. Persons consuming RTEC frequently (≥ 5 times/week) have a lower risk of inadequate micronutrient intake especially for vitamin A, calcium, folate, vitamin B 6, magnesium and zinc. Evidence from prospective studies suggests that whole grain RTEC may have beneficial effects on hypertension and type 2 diabetes. Consumption of RTEC with soluble fiber helps to reduce LDL cholesterol in hypercholesterolemic men and RTEC fortified with folate can reduce plasma homocysteine.

DISCUSSION

One of the review's strengths is its thorough ex/inclusion of studies. Limitations are that results of observational studies were based on self-reported data and that many studies were funded by food-industry.

CONCLUSION

Consumption of RTEC, especially of fiber-rich or whole grain RTEC, is implicated with several beneficial nutritional and health outcomes. The effect on body weight, intestinal health and cognitive function needs further evaluation. Of concern is the higher total sugar intake associated with frequent RTEC consumption.

Impact of Breakfast Skipping and Breakfast Choice on the Nutrient Intake and Body Mass Index of Australian Children

Recent data on breakfast consumption among Australian children are limited. This study examined the impact of breakfast skipping and breakfast type (cereal or non-cereal) on nutrient intakes, likelihood of meeting nutrient targets and anthropometric measures. A secondary analysis of two 24-h recall data from the 2007 Australian National Children’s Nutrition and Physical Activity Survey was conducted (2–16 years; n = 4487) to identify (a) breakfast skippers and (b) breakfast consumers, with breakfast consumers further sub-divided into (i) non-cereal and (ii) cereal consumers. Only 4% skipped breakfast and 59% of skippers were 14–16 years. Breakfast consumers had significantly higher intakes of calcium and folate, and significantly lower intakes of total fat than breakfast skippers. Cereal consumers were more likely to meet targets and consume significantly higher fibre, calcium, iron, had significantly higher intakes of folate, total sugars and carbohydrate, and significantly lower intakes of total fat and sodium than non-cereal consumers. The prevalence of overweight was lower among breakfast consumers compared to skippers, and among cereal consumers compared to-cereal consumers (p < 0.001), while no significant differences were observed for mean body mass index (BMI), BMI z-score, waist circumference and physical activity level across the categories. Breakfast and particularly breakfast cereal consumption contributes important nutrients to children’s diets.

The Effect of Breakfast Type on Total Daily Energy Intake and Body Mass Index Among Thai School Children

The study investigated the association between breakfast types consumed, daily energy intake, and body mass index for age Z-score (BAZ). Cross-sectional data from 1258 children aged 7 to 12.9 years were analyzed for breakfast type, nutrient intakes, BAZ, and proportion of overweight or obesity. Analysis of covariance was used to compare energy and nutrient intakes, BAZ, and proportion of overweight/obese children between breakfast groups. Only 19% of children had adequate energy intake from breakfast. Those consuming snacks had a significantly lower BAZ (Z = -0.73), with 5% of them being overweight/obese. Those consuming beverages and desserts had the lowest total daily energy intake (1314 kcal) and lowest protein intake (8.4 g). The results suggest that breakfast type is associated with daily energy intake and BAZ. Most breakfasts are not adequate. School-based nutrition education programs involving families, teachers, and health professionals can contribute to improve this situation.

The Contribution of Fortified Ready-to-Eat Cereal to Vitamin and Mineral Intake in the U.S. Population, NHANES 2007-2010

Micronutrients play a pivotal role in achieving and maintaining optimum health across all life stages. Much of the U.S. population fails to meet Estimated Average Requirements (EARs) for key nutrients. This analysis aims to assess the contribution of fortified ready-to-eat cereals (RTEC) to micronutrient intake for U.S. residents aged 2–18, 19–99, and 2–99 years of age according to National Health and Nutrition Examination Survey (NHANES) 2007–2010 data. We used the National Cancer Institute (NCI) method to assess usual intake of 21 micronutrients and the percentage of the population under EARs and above Tolerable Upper Intake Levels (UL). Without fortification of RTECs, the percentage of those aged 2–18 years that were below EARs increased by 155%, 163%, 113%, and 35% for niacin, iron, thiamin, and vitamin A, respectively. For vitamins B6 and zinc, the respective numbers were 118% and 60%. Adults aged 19–99 and 2–99 had lower percentages but similar outcomes. RTECs are associated with improved nutrient adequacy and do not widely affect prevalence above the UL. The data indicate that large proportions of the population fail to achieve micronutrient sufficiency without fortification, and that its use can help Americans reach national nutrient intake goals.

Ready-to-eat cereals improve nutrient, milk and fruit intake at breakfast in European adolescents

Purpose

Breakfast consumption has been recommended as part of a healthy diet. Recently, ready-to-eat cereals (RTEC) became more popular as a breakfast item. Our aim was to analyse the dietary characteristics of an RTEC breakfast in European adolescents and to compare them with other breakfast options.

Methods

From the European multi-centre HELENA study, two 24-h dietary recalls of 3137 adolescents were available. Food items (RTEC or bread, milk/yoghurt, fruit) and macro- and micronutrient intakes at breakfast were calculated. Cross-sectional regression analyses were adjusted for gender, age, socio-economic status and city.

Results

Compared to bread breakfasts (39 %) and all other breakfasts (41.5 %), RTEC breakfast (19.5 %) was associated with improved nutrient intake (less fat and less sucrose; more fibre, protein and some micronutrients like vitamin B, calcium, magnesium and phosphorus) at the breakfast occasion. Exceptions were more simple sugars in RTEC breakfast consumers: more lactose and galactose due to increased milk consumption, but also higher glucose and fructose than bread consumers. RTEC consumers had a significantly higher frequency (92.5 vs. 50.4 and 60.2 %) and quantity of milk/yoghurt intake and a slightly higher frequency of fruit intake (13.4 vs. 10.9 and 8.0 %) at breakfast.

Conclusions

Among European adolescents, RTEC consumers showed a more favourable nutrient intake than consumers of bread or other breakfasts, except for simple sugars. Therefore, RTEC may be regarded as a good breakfast option as part of a varied and balanced diet. Nevertheless, more research is warranted concerning the role of different RTEC types in nutrient intake, especially for simple sugars.

Performance of a five category front-of-pack labelling system - the 5-colour nutrition label - to differentiate nutritional quality of breakfast cereals in France

BACKGROUND

Breakfast cereals exhibit a wide variability in nutritional quality, and differences are not easily grasped by consumers. A simplified nutritional information system might contribute to help consumers make healthier food choices. A five-category colour label based on the Food Standards Agency Nutrient profiling system (FSA score) has been proposed in France to be implemented on the front-of-pack of foods (the five-colour nutrition label - 5-CNL). Objectives were to evaluate the ability of the 5-CNL to discriminate nutritional quality between types of breakfast cereals, within a category and in equivalent products, as well as its ability to change through product reformulation.

METHODS

Nutritional information was collected through an Internet and supermarket research for N = 433 breakfast cereals (N = 380 complete data included in the analyses). Breakfast cereals were categorized according to common attributes in terms of processing and/or ingredients used. The FSA score and 5-CNL category allocation were computed for each cereal. Nutrient content and FSA score were compared across types of cereals. Distribution within the 5-CNL categories was assessed across types of cereals and for equivalent products. Impact of reformulation (reduction of 5 and 10% in simple sugar, saturated fat and sodium) on the 5-CNL category allocation was compared to original allocation with Bapkhar's tests of homogeneity of marginal distribution.

RESULTS

Variability in nutritional quality of breakfast cereals was high, as reflected by the FSA score (range -7- 22 for a theoretical range of -15-40) and the 5-CNL (all five categories represented). The 5-CNL allowed for discrimination across types of cereals, within categories of breakfast cereals and for equivalent products (at least 3 categories of the 5-CNL represented). Reformulation scenarios allowed for significant change in 5-CNL allocation: 5% reduction in sugar lead to a modification of the label for 4.21% of products while a reduction of 10% of sugar, saturated fat and sodium lead to a modification of the label for 19.2% of products.

CONCLUSION

The 5-CNL adequately discriminates between breakfast cereals. It would therefore be an adequate tool for consumer information on nutritional quality of foods in the French context.

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.

Breakfast consumption is positively associated with nutrient adequacy in Canadian children and adolescents

Although breakfast is associated with more favourable nutrient intake profiles in children, limited data exist on the impact of breakfast on nutrient adequacy and the potential risk of excessive intakes. Accordingly, we assessed differences in nutrient intake and adequacy among breakfast non-consumers, consumers of breakfasts with ready-to-eat cereal (RTEC) and consumers of other types of breakfasts. We used cross-sectional data from 12,281 children and adolescents aged 4-18 years who took part in the nationally representative Canadian Community Health Survey, 2004. Mean nutrient intakes (obtained using a multiple-pass 24 h recall method) were compared among the breakfast groups using covariate-adjusted regression analysis. Usual nutrient intake distributions, generated using the National Cancer Institute method, were used to determine the prevalence of nutrient inadequacy or the potential risk of excessive intakes from food sources alone and from the combination of food plus supplements. Of these Canadian children, 10% were breakfast non-consumers, 33% were consumers of RTEC breakfasts and 57% were consumers of other types of breakfasts. Non-consumption of breakfast increased with age (4-8 years: 2%; 9-13 years: 9%; 14-18 years: 18%). Breakfast consumers had higher covariate-adjusted intakes of energy, many nutrients and fibre, and lower fat intakes. The prevalence of nutrient inadequacy for vitamin D, Ca, Fe and Mg (from food alone or from the combination of food plus supplements) was highest in breakfast non-consumers, intermediate in consumers of other types of breakfasts and lowest in consumers of RTEC breakfast. For vitamin A, P and Zn, breakfast non-consumers had a higher prevalence of nutrient inadequacy than both breakfast groups. The potential risk of excessive nutrient intakes was low in all groups. Efforts to encourage and maintain breakfast consumption in children and adolescents are warranted.

Dairy food at the first occasion of eating is important for total dairy food intake for Australian children

The cross-sectional 2007 Australian National Children’s Nutrition and Physical Activity Survey collected detailed dietary information from a representative sample of more than 4400 children by 24-h dietary recall. Dairy food intake by Australian children is substantially lower than recommendations, and decreases as a percentage of energy intake as children grow older. Children aged 2 to 16 years are, on average, 2.3 times more likely to have a dairy food at the first daily occasion of eating, than at the second occasion. For children who consumed any dairy food at the first occasion of eating, the total daily intake of dairy foods was 129% (95% CI 120%–138%) greater than for children who did not consume a dairy food at the first occasion of eating. Their dairy food intake for the rest of the day following the first occasion of eating was also greater by 29% (95% CI 21%–37%). Younger age group, male sex, location of eating being at home or in a residence and starting the first occasion of eating from 6 a.m. to 9 a.m. are all jointly associated with having a dairy food at the first occasion of eating. A simple strategy to increase Australian children’s intake from the dairy and alternatives food group may be to make sure that the first occasion of eating each day includes a dairy food or a nutritional equivalent.

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.

Total dietary fiber intakes in the US population are related to whole grain consumption: results from the National Health and Nutrition Examination Survey 2009 to 2010

Whole grain (WG) foods have been shown to reduce chronic disease risk and overweight. Total dietary fiber is associated with WG and its health benefits. The purpose was to determine whether associations exist between WG intake (no-WG intake, 0 ounce equivalent [oz eq]; low, >0-<3 oz eq; high, ≥3 oz eq) and total dietary fiber intake among Americans 2 years and older. One-day food intake data from the US National Health and Nutrition Examination Survey 2009 to 2010 (n = 9042) showed that only 2.9% and 7.7% of children/adolescents (2-18 years) and adults (≥19 years) consumed at least 3 WG oz eq/d, respectively. For children/adolescents and adults, individuals in the high WG intake group were 59 and 76 times more likely to fall in the third fiber tertile, respectively, compared with those with no-WG intake. Total dietary fiber intake from food sources varied by WG intake group for children/adolescents and adults with more total dietary fiber consumed from ready-to-eat (RTE) and hot cereals and yeast breads/rolls in the high WG intake group compared with the no-WG intake group. Major WG sources for children/adolescents and adults included yeast bread/rolls (24% and 27%, respectively), RTE cereals (25% and 20%, respectively), and oatmeal (12% and 21%, respectively). Among those with the highest WG intake, WG RTE cereal with no added bran was the greatest contributor to total dietary fiber compared with other RTE cereal types. Whole grain foods make a substantial contribution to total dietary fiber intake and should be promoted to meet recommendations.

Consumption of breakfast and the type of breakfast consumed are positively associated with nutrient intakes and adequacy of Canadian adults

Few studies have assessed the associations between breakfast intake and nutrient adequacy [where inadequacy reflects prevalence of usual intakes below the estimated average requirement (EAR) and potential excess reflects the prevalence above the tolerable upper intake level (UL)]. This study examined associations among breakfast, nutrient intakes, and nutrient adequacy in Canadian adults. Respondents aged ≥19 y in the Canadian Community Health Survey 2.2 (n = 19,913) were classified as breakfast nonconsumers (11%), ready-to-eat cereal (RTEC) breakfast consumers (20%), or other breakfast consumers (69%). Nutrient intakes from food (24-h recall) and the prevalence of usual intakes below the EAR and above the UL from food alone and from food plus supplements were compared by breakfast group. Usual intake distributions were estimated using the National Cancer Institute method. Breakfast consumers, and to a greater extent RTEC breakfast consumers, had significantly higher intakes of fiber and several vitamins and minerals than breakfast nonconsumers. Compared with nonconsumers, RTEC and other breakfast consumers had significantly lower prevalences below the EARs for vitamin A and magnesium. The prevalences below the EARs of these nutrients and calcium, thiamin, vitamin D, and iron were significantly lower with RTEC breakfasts than with other breakfasts. Similar patterns were observed from food alone compared with food plus supplements. Breakfast consumption did not affect prevalence above the UL based on food sources, although based on food plus supplements, breakfast consumers had slightly higher proportions that were above the UL than nonconsumers for several nutrients. Breakfast, especially an RTEC breakfast, is associated with improved nutrient adequacy and does not meaningfully affect prevalence above the UL.