Influence of the intake of fortified breakfast cereals on dietary habits and nutritional status of Spanish schoolchildren

Breakfast: A Crucial Meal for Adolescents' Cognitive Performance According to Their Nutritional Status. The Cogni-Action Project

This study aimed to determine whether pupils who have breakfast just before a cognitive demand, do not regularly skip breakfast, and consume a high-quality breakfast present higher cognitive performance than those who do not; furthermore, to establish differences according to their nutritional status. In this study, 1181 Chilean adolescents aged 10–14 years participated. A global cognitive score was computed through eight tasks, and the body mass index z-score (BMIz) was calculated using a growth reference for school-aged adolescents. The characteristics of breakfast were self-reported. Analyses of covariance were performed to determine differences in cognitive performance according to BMIz groups adjusted to sex, peak height velocity, physical fitness global score, and their schools. A positive association was found in adolescents’ cognitive performance when they had breakfast just before cognitive tasks, did not regularly skip breakfast, presented at least two breakfast quality components, and included dairy products. No significant differences were found between breakfast components, including cereal/bread and fruits/fruit juice. Finally, pupils who were overweight/obese who declared that they skipped breakfast regularly presented a lower cognitive performance than their normal-BMIz peers. These findings suggest that adolescents who have breakfast just prior to a cognitive demand and regularly have a high quality breakfast have better cognitive performance than those who do not. Educative nutritional strategies should be prioritized, especially in “breakfast skippers” adolescents living with overweight/obesity.

Breakfast Characteristics and Its Association with Daily Micronutrients Intake in Children and Adolescents-A Systematic Review and Meta-Analysis

Breakfast is an important source of key nutrients in the diet. For this reason, the aim of this review was to investigate the associations between breakfast consumption and daily micronutrients intake in both children and adolescents (aged 2-18 years). A peer-reviewed systematic search was conducted in three datasets (PubMed, Scopus and Cochrane Library) in February 2020 in English and Spanish. Two independent reviewers evaluated 3188 studies considering the AXIS critical appraisal and PRISMA methodologies. Meta-analysis was carried out comparing results according to type of breakfast consumed (Ready to eat cereals (RTEC) breakfast or other types of breakfast) and breakfast skipping. Thirty-three articles were included in the systematic review (SR) and 7 in the meta-analysis. In the SR, we observed that those children and adolescents who usually consume RTEC at breakfast had a higher consumption of B-vitamins than those not consuming RTEC at breakfast. Breakfast consumers had a higher mineral intake (iron, calcium, magnesium, potassium, zinc, and iodine) than breakfast skippers. In the Meta-Analysis, RTEC consumers had significantly higher vitamin C intake than breakfast skippers (SMD, -4.12; 95% confidence intervals (CI): -5.09, -3.16). Furthermore, those children who usually consume breakfast had significantly higher daily intake of calcium than breakfast skippers (SMD, -7.03; 95%CI: -9.02, -5.04). Our review proposes that breakfast consumption seems to be associated with higher daily micronutrients intake than breakfast skippers.

Breakfast Characteristics and Their Association with Energy, Macronutrients, and Food Intake in Children and Adolescents: A Systematic Review and Meta-Analysis

Breakfast plays an important role in health because it has been associated with overall health, which includes a high daily nutrient intake and a low risk of chronic diseases. For this reason, we investigated the associations between breakfast consumption and daily energy, macronutrients, and food and beverage consumption. We systematically searched peer-reviewed articles in three datasets (Pubmed, Scopus, and Cochrane). Two independent reviewers evaluated 3188 studies against the inclusion criteria using the Appraisal tool for Cross-Sectional Studies (AXIS) critical appraisal and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodologies. The meta-analysis was performed by comparing results based on type of breakfast consumed (ready to eat cereal breakfasts or other types of breakfasts). Ultimately, 38 studies were included in the review and 7 of them in the energy and macronutrients intake meta-analysis. In the Systematic Review, breakfast consumers had higher energy intake (EI), fibre intake, and higher consumption of fruits and vegetables and lower consumption of soft drinks than breakfast skippers. In the Meta-Analysis, breakfast consumers had a higher carbohydrates intake (MD, -8.21; 95%CI: -11.37, -5.05) and fibre intake (MD, -8.43; 95%CI: -12.63, -4.23) than breakfast skippers. However, breakfast consumers had a lower fat intake (MD, 4.59; 95%CI: 2.04, 7.15). Our review suggests that breakfast consumption is associated with better macronutrient intake and healthier food and beverage consumption.

Fortification of staple foods with vitamin A for vitamin A deficiency

BACKGROUND

Vitamin A deficiency is a significant public health problem in many low- and middle-income countries, especially affecting young children, women of reproductive age, and pregnant women. Fortification of staple foods with vitamin A has been used to increase vitamin A consumption among these groups.

OBJECTIVES

To assess the effects of fortifying staple foods with vitamin A for reducing vitamin A deficiency and improving health-related outcomes in the general population older than two years of age.

SEARCH METHODS

We searched the following international databases with no language or date restrictions: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library; MEDLINE and MEDLINE In Process OVID; Embase OVID; CINAHL Ebsco; Web of Science (ISI) SCI, SSCI, CPCI-exp and CPCI-SSH; BIOSIS (ISI); POPLINE; Bibliomap; TRoPHI; ASSIA (Proquest); IBECS; SCIELO; Global Index Medicus - AFRO and EMRO; LILACS; PAHO; WHOLIS; WPRO; IMSEAR; IndMED; and Native Health Research Database. We also searched clinicaltrials.gov and the International Clinical Trials Registry Platform to identify ongoing and unpublished studies. The date of the last search was 19 July 2018.

SELECTION CRITERIA

We included individually or cluster-randomised controlled trials (RCTs) in this review. The intervention included fortification of staple foods (sugar, edible oils, edible fats, maize flour or corn meal, wheat flour, milk and dairy products, and condiments and seasonings) with vitamin A alone or in combination with other vitamins and minerals. We included the general population older than two years of age (including pregnant and lactating women) from any country.

DATA COLLECTION AND ANALYSIS

Two authors independently screened and assessed eligibility of studies for inclusion, extracted data from included studies and assessed their risk of bias. We used standard Cochrane methodology to carry out the review.

MAIN RESULTS

We included 10 randomised controlled trials involving 4455 participants. All the studies were conducted in low- and upper-middle income countries where vitamin A deficiency was a public health issue. One of the included trials did not contribute data to the outcomes of interest.Three trials compared provision of staple foods fortified with vitamin A versus unfortified staple food, five trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus unfortified staple foods, and two trials compared provision of staple foods fortified with vitamin A plus other micronutrients versus no intervention. No studies compared staple foods fortified with vitamin A alone versus no intervention.The duration of interventions ranged from three to nine months. We assessed six studies at high risk of bias overall. Government organisations, non-governmental organisations, the private sector, and academic institutions funded the included studies; funding source does not appear to have distorted the results.Staple food fortified with vitamin A versus unfortified staple food We are uncertain whether fortifying staple foods with vitamin A alone makes little or no difference for serum retinol concentration (mean difference (MD) 0.03 μmol/L, 95% CI -0.06 to 0.12; 3 studies, 1829 participants; I² = 90%, very low-certainty evidence). It is uncertain whether vitamin A alone reduces the risk of subclinical vitamin A deficiency (risk ratio (RR) 0.45, 95% CI 0.19 to 1.05; 2 studies; 993 participants; I² = 33%, very low-certainty evidence). The certainty of the evidence was mainly affected by risk of bias, imprecision and inconsistency.It is uncertain whether vitamin A fortification reduces clinical vitamin A deficiency, defined as night blindness (RR 0.11, 95% CI 0.01 to 1.98; 1 study, 581 participants, very low-certainty evidence). The certainty of the evidence was mainly affected by imprecision, inconsistency, and risk of bias.Staple foods fortified with vitamin A versus no intervention No studies provided data for this comparison.Staple foods fortified with vitamin A plus other micronutrients versus same unfortified staple foods Fortifying staple foods with vitamin A plus other micronutrients may not increase the serum retinol concentration (MD 0.08 μmol/L, 95% CI -0.06 to 0.22; 4 studies; 1009 participants; I² = 95%, low-certainty evidence). The certainty of the evidence was mainly affected by serious inconsistency and risk of bias.In comparison to unfortified staple foods, fortification with vitamin A plus other micronutrients probably reduces the risk of subclinical vitamin A deficiency (RR 0.27, 95% CI 0.16 to 0.49; 3 studies; 923 participants; I² = 0%; moderate-certainty evidence). The certainty of the evidence was mainly affected by serious risk of bias.Staple foods fortified with vitamin A plus other micronutrients versus no interventionFortification of staple foods with vitamin A plus other micronutrients may increase serum retinol concentration (MD 0.22 μmol/L, 95% CI 0.15 to 0.30; 2 studies; 318 participants; I² = 0%; low-certainty evidence). When compared to no intervention, it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency (RR 0.71, 95% CI 0.52 to 0.98; 2 studies; 318 participants; I² = 0%; very low-certainty evidence) . The certainty of the evidence was affected mainly by serious imprecision and risk of bias.No trials reported on the outcomes of all-cause morbidity, all-cause mortality, adverse effects, food intake, congenital anomalies (for pregnant women), or breast milk concentration (for lactating women).

AUTHORS' CONCLUSIONS

Fortifying staple foods with vitamin A alone may make little or no difference to serum retinol concentrations or the risk of subclinical vitamin A deficiency. In comparison with provision of unfortified foods, provision of staple foods fortified with vitamin A plus other micronutrients may not increase serum retinol concentration but probably reduces the risk of subclinical vitamin A deficiency.Compared to no intervention, staple foods fortified with vitamin A plus other micronutrients may increase serum retinol concentration, although it is uncertain whether the intervention reduces the risk of subclinical vitamin A deficiency as the certainty of the evidence has been assessed as very low.It was not possible to estimate the effect of staple food fortification on outcomes such as mortality, morbidity, adverse effects, congenital anomalies, or breast milk vitamin A, as no trials included these outcomes.The type of funding source for the studies did not appear to distort the results from the analysis.

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.

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.

The combination of daily breakfast consumption and optimal breakfast choices in childhood is an important public health message

The aim of this study was to investigate the association of breakfast consumption with children's diet quality and cardiometabolic risk factors. Study sample consisted of 1558 children aged 4-8 years from Cyprus. Breakfast frequency was assessed through a parental questionnaire. Body mass index (BMI), BMI z-scores, waist circumference, blood lipid profile and blood pressure were examined in relation to breakfast frequency consumption. Habitual breakfast consumers' daily nutrient intake was assessed through a 24-Hour Dietary Recall, according to their breakfast choices. Girls who have breakfast on a daily basis had lower mean BMI and BMI z-score; they were also less likely of having abnormal levels of serum triglycerides, atheromatic index (total cholesterol to high density lipoprotein-cholesterol ratio) and diastolic blood pressure after controlling for several confounding factors. Within regular breakfast consumers, of both boys and girls, those having ready to eat cereals had a superior nutrient intake profile. Daily breakfast consumption along with good breakfast choices is an important public health message for Cypriot children.

The impact of voluntary food fortification on micronutrient intakes and status in European countries: a review

This review aims to assess the efficacy and safety of voluntary fortification as an option to address the occurrence of inadequate micronutrient intakes in population subgroups in Europe. Although legislation is harmonised across the European Union, fortification practices and patterns of consumption of fortified foods vary considerably between countries. While the proportion of children consuming fortified foods is greater than adults, the proportion of dietary energy obtained from fortified foods is generally low (<10% in Ireland, where fortified foods are widely consumed). There are a few systematic studies on the overall nutritional impact of voluntary fortification, but there are several studies on the impact of fortified ready-to-eat breakfast cereals. The available evidence indicates that voluntary fortification can reduce the risk of sub-optimal intakes of a range of micronutrients at a population level and can also improve status for selected micronutrients (e.g. folate, vitamin D and riboflavin) in children and adults. Although concerns have been raised regarding the potential of food fortification to lead to unacceptably high micronutrient intakes, particularly for those consuming higher amounts of fortified foods, data from national surveys on total micronutrient intakes (including fortified foods) in Europe show that small proportions of the population, particularly children, may exceed the upper intake level (UL) for some micronutrients. The risk of adverse effects occurring in these individuals exceeding the UL by modest amounts is low. In conclusion, voluntary fortification practices have been shown to improve intake and status of key micronutrients in European Union population groups and do not contribute appreciably to risk of adverse effects.

Breakfast and the diets of Australian children and adolescents: an analysis of data from the 1995 National Nutrition Survey

The aim of this study was to describe the nutrients provided to Australian children and adolescents by the breakfast meal and compare the food and nutrient intakes and health of regular breakfast eaters (those who ate breakfast 5 days or more a week) and skippers (who are breakfast rarely or never). The Australian Bureau of Statistics was commissioned to undertake additional analysis of data collected in the 1995 Australian National Nutrition Survey. The survey included 24-h recalls, physical measurements and a food-habits questionnaire collected during the period February 1995-March 1996, with a nationally representative sample of 3,007 Australians aged between 2 and 18 years. The median nutrient intakes at breakfast and the proportion of the daily total contributed by breakfast were calculated. Differences between regular breakfast eaters and breakfast skippers in terms of nutrient intake, body mass index and health status were compared using student t-tests. The findings show the typical breakfast consumed by young Australians was low in fat, high in carbohydrate and a good source of thiamin, riboflavin, niacin, calcium and magnesium. Those who did not eat breakfast cereal were much more likely to have inadequate nutrient intakes, especially of thiamin, riboflavin, calcium, magnesium and iron. There was no difference between the fat intake and the body mass index of regular breakfast eaters compared with breakfast skippers. Regular breakfast consumption is associated with better diets for children and adolescents.

Benefits of Breakfast for Children and Adolescents: Update and Recommendations for Practitioners

A number of studies report health benefits for children and adolescents who consume breakfast. Breakfast skipping is fairly common in children and adolescents and increases as children age. Breakfast can enhance children's diets by positively contributing to daily nutrient intake, augmenting intake of key nutrients such as fiber and calcium, and provides an opportunity to help meet the recommendations of the Dietary Guidelines for Americans. Breakfast also is associated with more healthful food choices. Cross-sectional studies support that eating breakfast more often may help children and adolescents maintain a healthful weight. However, the results from longitudinal studies are inconclusive and suggest that more research is needed to clarify this relationship, including understanding the mediating effects of initial weight status, dieting behavior, and physical activity levels. Breakfast consumption may provide some benefit toward cognitive function and academic achievement, but more research is needed. Breakfast is one facet of a healthy lifestyle that may help contribute to the short- and long-term health and well-being of children and adolescents. Health practitioners can promote healthy breakfast consumption in children and adolescents by addressing barriers to eating breakfast and focusing on individuals who may be more likely to skip breakfast on a regular basis.

Analysis of the impact of fortified food consumption on overall dietary quality in Irish adults

The aim of the present study was to assess the impact of fortified food (FF) consumption on overall dietary quality in Irish adults. Data for this analysis was based on the North/South Ireland Food Consumption Survey w7/15/2008hich used a 7 d food diary to collect food and beverage intake data in a representative sample of 1379 Irish adults (662 men and 717 women) aged 18–64 years. Foods contained in the database that are fortified were identified from the presence of vitamins and/or minerals in the ingredient list on the label. The results showed that an increased level of FF consumption was associated with lower intakes (percentage food energy) of total fat and saturated fat (women only) and higher intakes of total carbohydrate, total sugars (but not added sugars) and starch. Increased consumption was associated with a more micronutrient-dense diet and a reduced prevalence of dietary inadequacies of Ca, Fe, riboflavin and folate, particularly in women. Higher FF consumption was associated with higher intakes of fruit, lower intakes of alcohol and a lower likelihood of smoking in men and women. Thus it appears that FF consumption is a marker of both better dietary quality and healthy lifestyle behaviours.

Breakfast eating and weight change in a 5-year prospective analysis of adolescents: Project EAT (Eating Among Teens)

OBJECTIVE

Breakfast-eating frequency declines through adolescence and has been inversely associated with body weight in cross-sectional studies, with few prospective studies on this topic. This study was conducted to examine the association between breakfast frequency and 5-year body weight change in 2216 adolescents.

PATIENTS AND METHODS

Project EAT (Eating Among Teens) was a 5-year longitudinal study of eating patterns and weight concerns among adolescents. Surveys were completed in 1998-1999 (time 1) and 2003-2004 (time 2). Multivariable linear regression was used to examine the association between breakfast frequency and change in BMI, with adjustment for age, socioeconomic status, race, physical activity, time 1 BMI and breakfast category, and time 1 dietary and weight-related variables.

RESULTS

At time 1, frequency of breakfast was directly associated with intake of carbohydrate and fiber, socioeconomic status, white race, and physical activity and inversely associated with smoking and alcohol consumption and dieting and weight-control behaviors. In cross-sectional analyses at times 1 and 2, inverse associations between breakfast frequency and BMI remained largely independent of all of the confounding and dietary factors. Weight-related factors (concerns, behaviors, and pressures) explained little of the breakfast-BMI association. In prospective analyses, frequency of breakfast was inversely associated with BMI in a dose-response manner. Further adjustment for confounding and dietary factors did not seem to explain the association, but adjustment for weight-related variables seemed to partly explain this finding.

CONCLUSIONS

Although experimental studies are needed to verify whether the association between breakfast and body weight is of a causal nature, our findings support the importance of promoting regular breakfast consumption among adolescents. Future studies should further examine the role of breakfast habits among youth who are particularly concerned about their weight.

The impact of voluntary fortification of foods on micronutrient intakes in Irish adults

The objective of this work was to quantify the impact of the voluntary fortification of foods on dietary intakes of vitamins and minerals of Irish adults. Foods that were voluntarily fortified were identified and pre- and post-fortification levels of micronutrients were determined from data supplied by manufacturers and food composition tables. Using food consumption data in 1379 adults aged 18–64 years, estimated using a 7-d food diary during the North/South Ireland Food Consumption Survey, intakes of micronutrients were determined, both including and excluding the fortification component in foods. Of approximately 3000 foods recorded as consumed, 1·9 % were fortified, mainly breakfast cereals and beverages. Median micronutrient content of fortified foods (FF) ranged from 18–33 % EC RDA per typical serving. Among consumers (65 % of men, 68 % of women), FF contributed, on average, 3·9 % (men) and 5·0 % (women) to mean daily intake (MDI) of energy. Relative to their contribution to MDI of energy, FF contribute a greater % MDI for Fe (men 16, women 19), folate (men 18, women 21), vitamins B1(men 14, women 16), B2(men 16, women 18), B6(men 12, women 15), D (men 5, women 11), B12(men 5, women 7) and niacin (men 10, women 12). Fortification significantly improved the adequacy of intake of some micronutrients, particularly of riboflavin, folate, vitamin D and Fe in women and did not contribute to an increased risk of adverse effects from excessive intake of any micronutrient.

The Contribution of Ready-to-Eat Cereals to Daily Nutrient Intake and Breakfast Quality in a Mediterranean Setting

OBJECTIVES

To examine if and how ready-to-eat cereals (RTEC) contribute to the quality of the diet of children, adolescents and young adults in a Mediterranean setting.

METHODS

A random sample of 3534 subjects aged 2 to 24 years in Spain was studied. Food and nutrient intakes were determined by a 24 hour recall. RTEC consumption was assessed by a quantitative food frequency questionnaire. Additional questions on socioeconomic level and nutritional knowledge were administered. Cereal consumption was classified into non-consumers and daily intakes between 1 and 20g, 21 and 40g, and more than 40g. After excluding the underreporters the final sample consisted of 2852 individuals.

RESULTS

About half of the population (49.8%) reported eating RTEC. Macronutrient profile improved with increasing cereal consumption. Intakes of thiamine, riboflavin and vitamin B6 increased significantly with increasing consumption of RTEC in all age-sex groups, whereas niacin and folate intake improved in almost all groups and calcium, iron and vitamin D in at least half of the groups. Except for magnesium, vitamin B12 and vitamin E in males, consumption of RTEC was significantly associated with increased coverage of the daily nutrient requirements for all micronutrients studied. Higher levels of RTEC consumption was associated with a greater consumption of dairy products, and related to better breakfast quality.

CONCLUSIONS

Level of RTEC consumption is associated with a better nutritional profile in the diets of Spanish children, adolescents and young adults and a lower risk for inadequate micronutrient intakes. RTEC consumers have better quality breakfasts, in terms of both food choices as well as energy and nutrient content.

Public health aspects of food fortification: a question of balance

Micronutrient malnutrition is widespread throughout the world, with important health and economic consequences. Tools to address this situation include food fortification, supplementation and dietary diversification, each having different and complementary roles. Fortification (mandatory and voluntary) has been practised over several decades in Western countries as well as in developing countries. Iodised salt was introduced in the USA in 1924 to reduce severe I deficiency. In 1938 voluntary enrichment of flours and breads with niacin and Fe was initiated to reduce the incidence of pellagra and Fe-deficiency anaemia respectively. Micronutrient intakes in European countries appear to be generally adequate for most nutrients. However, a number of population subgroups are at higher risk of suboptimal intakes (below the lower reference nutrient intake) for some micronutrients, e.g. folate, Fe, Zn and Ca in children, adolescents and young women. Dietary surveys indicate that fortified foods play a role in mitigating such risks for several important nutrients. The number of foods suited to fortification are considerably limited by several factors, including technological properties (notably moisture, pH and O2 permeability), leading to unacceptable taste and appearance, as well as cost and consumer expectations. In countries in which voluntary fortification is widely practised micronutrient intakes are considerably below tolerable upper intake levels. Concerns about safety are addressed in relation to the potentially increased level or proportion of fortified foods (e.g. following potential EU legislation), for nutrients with relatively low tolerable upper intake levels and where the potential benefit and risks are in different subpopulations (e.g. folic acid). Recent models for assessing these issues are discussed.

Consumption of Ready-to-Eat Cereals in Relation to Health and Diet Indicators among School Adolescents in Crete, Greece

BACKGROUND/AIMS

We aimed at examining the intake of ready-to-eat cereals (RTEC) among adolescents in Crete, Greece, and investigate relationships with health and diet indicators.

METHODS

A sample of 392 adolescents (183 boys, 209 girls) aged 15 +/- 0.4 years, attending high schools of two major counties in Crete, was studied to determine consumption of RTEC using a frequency questionnaire. Anthropometric measurements were performed and blood was drawn for analysis of serum lipoproteins and blood glucose (BG). The physical fitness was assessed with the 20-meter shuttle run test (SRT) and the amount of time watching television was estimated. Nutrient intakes were calculated through 24-hour dietary recalls.

RESULTS

42% (n = 77) of boys and 43% (n = 90) of girls reported consumption of RTEC at least once per week. Approximately 40% of the male and 47% of the female consumers reported eating RTEC only at meals other than breakfast. RTEC consumption was inversely related to the obesity indices and BG levels, and positively related to the SRT (p < 0.05 in all analyses). RTEC consumers had significantly higher intakes of fibre, magnesium, calcium, iron, folate, and vitamins A, B2 and B6 (p < 0.05 in all analyses).

CONCLUSION

Our results demonstrated favourable associations between RTEC intake and health and diet indicators in Greek adolescents, with potential implications for improved health status and chronic disease risk reduction.

Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents

Breakfast has been labeled the most important meal of the day, but are there data to support this claim? We summarized the results of 47 studies examining the association of breakfast consumption with nutritional adequacy (nine studies), body weight (16 studies), and academic performance (22 studies) in children and adolescents. Breakfast skipping is highly prevalent in the United States and Europe (10% to 30%), depending on age group, population, and definition. Although the quality of breakfast was variable within and between studies, children who reported eating breakfast on a consistent basis tended to have superior nutritional profiles than their breakfast-skipping peers. Breakfast eaters generally consumed more daily calories yet were less likely to be overweight, although not all studies associated breakfast skipping with overweight. Evidence suggests that breakfast consumption may improve cognitive function related to memory, test grades, and school attendance. Breakfast as part of a healthful diet and lifestyle can positively impact children's health and well-being. Parents should be encouraged to provide breakfast for their children or explore the availability of a school breakfast program. We advocate consumption of a healthful breakfast on a daily basis consisting of a variety of foods, especially high-fiber and nutrient-rich whole grains, fruits, and dairy products.

Micronutrient intakes, micronutrient status and lipid profiles among young people consuming different amounts of breakfast cereals: further analysis of data from the National Diet and Nutrition Survey of Young People aged 4 to 18 years

OBJECTIVE

To examine associations between breakfast cereal consumption and the dietary habits, nutrient intakes and nutritional status of young people, considering both nutrient adequacy and safety issues (fortification).

METHODS

Using archived data from 1688 children in the (British) National Diet and Nutrition Survey of Young People aged 4 to 18 years, nutrient intakes and status were compared across thirds of breakfast cereal consumption (T1 to T3), adjusted for age and energy intake. Cereals provided on average 2%, 6% and 12% of energy in T1, T2 and T3, respectively, for boys; 1%, 4% and 10%, respectively, for girls.

RESULTS

Intakes of iron, B vitamins and vitamin D were around 20-60% higher in T3 compared with T1, with significant linear relationships observed for iron, thiamin, riboflavin and folate (T1<T2<T3). After excluding low energy reporters and the unwell, 14% of girls had iron intakes below the Lower Reference Nutrient Intake and this varied fivefold between T1 and T3 (27%, 12% and 5%; P=0.0001). High consumers of breakfast cereals (T3) had better folate, vitamin B12 and riboflavin status and lower total and low-density lipoprotein cholesterol. There was also an association with thiamin and vitamin B6 status in girls. However, iron status (haemoglobin, ferritin and transferrin saturation) was not significantly different between groups, possibly due to lower meat intakes in T3. Total iron intakes were within tolerable levels (maximum of 32 mg day(-1) in one girl taking supplements).

CONCLUSIONS

The nutritional benefits of breakfast cereals are demonstrated in status measurements as well as in nutrient intakes in this study. Concerns about excessive iron intakes from fortification appear unjustified.

Relationship between habitual breakfast and intellectual performance (logical reasoning) in well-nourished schoolchildren of Madrid (Spain)

OBJECTIVE

To determine the relationships between habitual breakfast habits and performance in verbal aptitude, logical reasoning and mathematical tests in a group of well-nourished scholars from Madrid.

DESIGN

The study subjects were 180 children between 9 and 13 y of age. A dietetic study was undertaken using a 7-day food record. Scholastic aptitude was examined using the scholastic aptitude test (SAT-1) test.

RESULTS

Breakfast made up 19.1% of total daily intake. No differences were found between subjects in terms of personal data or total diet with respect to whether they habitually took adequate breakfasts (AB) (ie, more than 20% of daily energy being provided by this meal) or inadequate breakfasts (IB) (less than 20%). However, AB subjects achieved better reasoning scores in the SAT-1 test.

CONCLUSIONS

The normal breakfast habits of schoolchildren should be taken into account when studying diet-mental function relationships, even when studying well-nourished populations.

Impact of ready-to-eat breakfast cereal (RTEBC) consumption on adequacy of micronutrient intakes and compliance with dietary recommendations in Irish adults

OBJECTIVE

To describe the consumption of ready-to-eat-breakfast cereals (RTEBCs) in Irish adults and its impact on adequacy and safety of micronutrient intakes and compliance with dietary recommendations.

DESIGN

Analysis for this paper used data from the North/South Ireland Food Consumption Survey that estimated habitual food intake using a 7-day food diary in a representative sample of adults aged 18-64 years ( 662 men, 717 women).

RESULTS

Despite the small quantity consumed (mean 28.6 g day-1 or 4.7% of total energy intake), RTEBCs made an important contribution to the mean daily intake of carbohydrate (8.1%), starch (10.8%), dietary fibre (9.8%) and non-starch polysaccharides (NSP) (10.8%) in consumers. Increased consumption was associated with a more fibre-dense diet and with greater compliance with dietary recommendations for fat, carbohydrate and NSP. Fortified RTEBCs contributed significantly to mean daily intakes of iron (18%), thiamin (14%), riboflavin (17%), niacin (15%), vitamin B6 (13%), total folate (18%) and vitamin D (10%) and most of the contribution was from micronutrients added to RTEBCs. Increased consumption of fortified RTEBCs was associated with an increased nutrient density for a number of micronutrients and with a lower prevalence of dietary inadequacy of calcium, iron, riboflavin and folate, particularly in women. However, it was not associated with intakes in excess of the Tolerable Upper Intake Level for any micronutrient.

CONCLUSIONS

The consumption of RTEBCs is associated with improved compliance with dietary recommendations for fat, carbohydrate and fibre, with a more micronutrient-dense diet and a reduced risk of dietary inadequacy for calcium, iron, riboflavin and folate, without increasing the risk of excessive intakes of micronutrients.

Breakfast consumption in Spanish children and young people

BACKGROUND AND OBJECTIVES

Breakfast consumption is important for nutritional balance in all population groups. The objective of this paper is to describe breakfast consumption patterns in Spanish children and young people.

DESIGN

Random population cross-sectional nutritional survey.

METHODS

A random sample of 3534 people aged 2 to 24 years were interviewed by a team of 43 dietitians. The protocol included 24-hour recalls (a second 24-hour recall in 30% of the sample), a food-frequency questionnaire and other questions including lifestyles, knowledge and food preferences.

RESULTS

Participation rate in the survey was 68%. Of the boys, 91.2% and 92.2% of the girls in the sample usually had breakfast. Males aged 18 years and above and 14-17-year-old girls showed the lowest consumption rates. Some 4.1% of the sample did not have any food at all before lunch. Main sources of energy with breakfast were milk and dairy products (34%) and buns, cookies, croissants, etc. (24.6%). Some 44.7% of the sample was classified in the poor-quality breakfast group. Subjects from a low socio-economic background and low educated parents had lower Quality Breakfast Score.

CONCLUSIONS

The proportion of children having breakfast before attending school has increased in Spain in recent decades. However, intake of breakfast is not adequate in a large proportion of this population and a number of children and young people still do not eat anything before lunch. School-based nutrition education involving families, teachers and health professionals, supported by community actions, can contribute to improve this situation.

Vitamin and mineral intakes in European children. Is food fortification needed?

OBJECTIVE

To provide an overview of vitamin and mineral intakes among children and adolescents in European countries and to present results from studies showing the impact of food fortification.

DESIGN

Comparative analysis of a number of nutritional studies among children and adolescents performed during the last decade in certain European countries.

SETTING

Spain, France, UK, North Ireland, Portugal, Germany.

SUBJECTS

Europeans aged 6 to 18.

RESULTS

Dietary surveys across Europe showed that varying levels of nutrient adequacy existed from one country to another, and that even within the same country, there were important nutritional gaps between different regions. In general, studies are difficult to compare, and information for many countries was missing. The results suggest that children and adolescents are the population group most likely to have higher risk of nutritional deficiencies, particularly for iron, vitamins C, E, B(6) and folates. In France, Ireland, UK and Spain, food fortification, and particularly of breakfast cereals, has positively contributed to increasing vitamin and mineral intakes in childhood and adolescence.

CONCLUSIONS

Information on vitamin and mineral intakes in European children is less available than in adults. Fortified foods may contribute to reducing nutrient inadequacy in European children and adolescents, but should not replace nutrition education.

The importance of breakfast in meeting daily recommended calcium intake in a group of schoolchildren

OBJECTIVE

To evaluate the breakfast intake of calcium and milk products and to determine whether these correlate with total intake of both calcium and milk products.

METHODS

Food taken at breakfast and throughout the day was recorded using a 7 consecutive day food record in 200 schoolchildren aged between 9 and 13 years.

RESULTS

65.3% of boys and 80.5% of girls showed intakes of calcium which were lower than recommended. Milk products were the foods most frequently included in breakfast (95.5% of subjects included them in this meal). A relationship was seen between energy provided by breakfast and the quantities of milk products (r = 0.5735) and calcium (r = 0.6908) taken at this meal. A relationship was also seen between energy provided by breakfast and daily intake of milk products (r = 0.4633) and calcium (r = 0.4954). The percentage of intakes of calcium lower than those recommended decreased when breakfast provided > or = 20% of total energy intake, and when the consumption of milk products at breakfast was greater than the 50th percentile (200 ml). Subjects with breakfast milk product intakes > or = 200 ml showed higher intakes of the same over the rest of the day (233.3 +/-140.4 g) than did those who took lesser quantities of these foods at breakfast (161.5 +/- 100.6 g). Further, those who took > or = 25% of the recommended intake of calcium at breakfast showed greater intakes of the same over the rest of the day (600.4 +/- 213.8 mg compared to 510.8 +/- 200.7 mg in subjects with lower calcium intakes).

CONCLUSIONS

The intake of milk products (r = 0.7587) and calcium (r = 0.7223) at breakfast correlates with the consumption of these foods in the whole diet. However, the total daily intake of milk products and calcium does not depend solely on breakfast intake. Subjects with the greatest intakes at breakfast also showed greater intakes over the rest of the day (r = 0.3953 for milk products and r = 0.4122 for calcium).