Ready-to-eat cereal consumption is associated with improved nutrient intakes and diet quality in Canadian adults and children across income levels

Background

Results from observational studies suggest ready-to-eat cereal (RTEC) consumption is associated with higher diet quality. In the United States, studies have shown that RTEC is an important contributor to nutrient intakes across income levels. However, it is unknown if this association varies by income level in the Canadian population. Given its affordability, RTEC may represent an important source of nutrients for lower-income individuals.

Objective

This study evaluated the association of RTEC consumption with nutrient intakes and diet quality across household income levels in Canadian adults and children.

Methods

Income and dietary data from 24 h dietary recalls were obtained from the 2015 Canadian Community Health Survey (CCHS)-Nutrition in 6,181 children (2-18 years) and 13,908 adults (19+ years). Diet quality was assessed with a modified Nutrient Rich Food Index (NRF) 9.3. Income levels were stratified into low, middle, and high based on family size, and data were analyzed by RTEC consumption and income level using multivariate linear regression adjusted for energy, age, and sex.

Results

Diet quality was greater in adult and child RTEC consumers across all household income levels. Children and adults consuming RTEC also had higher nutrient intakes, including shortfall nutrients such as calcium, dietary fiber, iron, magnesium, and vitamin D. RTEC provided <10% of energy intake, <4% of saturated fat intake, and <9% of total sugar intake across all ages and income levels, while also providing one-third of daily iron intake and at least 10% of daily intake of dietary fiber, thiamin, folate, and vitamin B6.

Conclusion

RTEC consumption was associated with improved nutrient intakes and diet quality in adults and children across household income levels. Nutrient dense and affordable food choices, such as RTEC, may be a helpful strategy to improve the diet quality of Canadians, particularly those with a lower household income.

Ready-to-eat cereal is an affordable breakfast option associated with better nutrient intake and diet quality in the US population

Background

Results from observational studies have reported ready-to-eat cereal (RTEC) consumers have higher dietary quality and nutrient intake compared to consumers of non-RTEC breakfasts or those who do not eat breakfast. Yet, there have been few investigations on the relationship of RTEC to meal costs at breakfast and across the day, which may be one reason some consumers choose to not consume breakfast.

Objective

The objective of this study is to evaluate the contribution of RTEC consumed at breakfast to nutrient intake and adequacy, diet quality and meal costs in a nationally representative sample of children and adults in the US.

Methods

Dietary data from 2,259 children (2-18 years) and 4,776 adults (≥19 years) in the National Health and Nutrition Examination Survey (NHANES) 2017-2018 were evaluated to compare nutrient intake, adequacy, dietary quality, and food costs in RTEC breakfast consumers, non-RTEC breakfast consumers and those who did not consume breakfast.

Results

RTEC breakfast consumers made up 28% of children and 12% of adults. Children and adults consuming RTEC for breakfast had higher intakes of carbohydrate, dietary fiber, calcium, magnesium, iron, zinc, phosphorus, potassium, B vitamins, vitamins A and D, whole grains, and total dairy compared to consumers of non-RTEC breakfast or no breakfast. There were no differences by breakfast status for sodium, saturated fat, or added sugar, except adults consuming RTEC had lower added sugar intake compared to those who did not consume breakfast. RTEC breakfast consumers were also more likely to meet estimated average requirements (EAR) for intake of several nutrients and had overall higher dietary quality. For children, breakfast meal costs were less for RTEC breakfast compared to non-RTEC breakfast, but total daily meal costs were similar for consumers of RTEC and non-RTEC breakfasts.

Conclusion

RTEC breakfasts may contribute to greater nutrient intake and diet quality in children and adults in the US without increasing total daily meal costs.

Associations of Ready-to-Eat Cereal Consumption and Income With Dietary Outcomes: Results From the National Health and Nutrition Examination Survey 2015–2018

Background

Ready-to-eat (RTE) cereal has been associated with higher diet quality but it is not known if this association differs by income.

Objective

To investigate the association of RTE cereal with dietary outcomes in a US population stratified by income [measured using the poverty-to-income ratio (PIR)].

Methods

Data from children 2–18 years (n = 5,028) and adults 19 years and older (n = 9,813) with 24-h dietary recalls from the cross-sectional, US nationally-representative 2015–2016 and 2017–2018 National Health and Nutrition Examination Surveys (NHANES) were used in a multivariable linear model that included cereal eating status (based on day 1 24 h dietary recall), PIR category (Low-PIR &lt;1.85; Mid-PIR 1.85–3.50; High-PIR &gt;3.50) and their interaction. PIR is based on the ratio of the family household income to the poverty level set by the US Department of Health and Human Services and higher PIR values indicate higher household income.

Results

For children, there were positive associations between RTE cereal consumption and nutrient (e.g., iron, calcium, fiber, potassium and vitamin D, p &lt; 0.001) and food group (e.g., whole grain and dairy, p &lt; 0.001) intake and 2015-HEI (p &lt; 0.0001) but no association with PIR or RTE cereal-PIR interaction. For adults, PIR category was positively associated with the intake of nutrients (e.g., fiber, magnesium, potassium, and vitamin C, p &lt; 0.001) as was RTE cereal consumption (e.g., fiber, calcium, vitamin D, potassium, vitamin B12, among others, p &lt; 0.001). Both PIR and RTE cereal were positively associated with whole grain, dairy, and fruit (p &lt; 0.001) and 2015-HEI (p &lt; 0.0001) for adults. We also found a significant interaction between PIR and RTE cereal for adults for iron, phosphorus, B vitamins, and dairy (p &lt; 0.001). RTE cereal contributed to one quarter or more of daily intake, across all age and PIR groups, for several B vitamins, iron, zinc, and whole grains. Added sugar intake was not associated with RTE cereal consumption in either children or adults.

Conclusion

RTE cereal was associated with improved dietary outcomes, including increased intake of under-consumed nutrients, increased intake of recommended food groups, and higher diet quality, at all income levels. This work can help inform future dietary recommendations.

Association between whole grain food intake in Canada and nutrient intake, food group intake and diet quality: Findings from the 2015 Canadian Community Health Survey

Whole grains have been associated with numerous beneficial health outcomes and are recommended in Canada's Food Guide; however, there is little research on whole grains specific to Canada. Therefore, the objective of this study was to characterize the association between Canadians' WG intake and nutrients, food groups and diet quality and to understand top sources of WG in the diets of Canadians. We used data from the Canadian Community Health Survey 2015: a cross-sectional survey that collected information on diet (using a 24-hour recall) and health from 20,487 Canadians 1 year and older. We classified study participants according to their WG intake: non-WG (n = 10,883) and three groups based on age-specific tertiles of WG intake, low-WG (n = 3,322), mid-WG (n = 3,180), and high-WG (n = 3,102). Results were analyzed using population-based survey methods and were adjusted for energy, age, gender, overweight/obesity, income, and supplement use. We found differences in nutrients and food groups by WG group: there was a significant linear trend across groups of increasing WG for increased fiber (children and adults), vitamin B6 (children), thiamin (adults), potassium (children and adults), zinc (adults), calcium (children and adults), iron (children and adults), magnesium (children and adults), fruit (adults), and legumes, nuts and seeds (adults); and decreased total fat (adults), saturated fat (adults), folate (children and adults), refined grains (adults and children), and meat and poultry (adults) intake. We found that there were no differences in total sugar or sodium intake across WG intake groups. The high WG intake group for both children and adults had higher diet quality, measured by the Nutrient Rich Food Index 9.3, compared to non-WG eaters. The top 2 food sources of WG across WG intake groups for children and adults were whole grain oat and high fiber breakfast cereal and whole grain and whole wheat bread. Other top sources of WG included rice, bread products, other breakfast cereals, salty snacks, cereal grains and flours, pasta, and sweet snacks. This research supports recommendations to increase WG foods intake as a means to improve diet quality of Canadians.

Association Between Ready-to-Eat Cereal Consumption and Serum Level of 25-hydroxyvitamin D in US Children and Adults, NHANES 2013–2014

Objectives

Previous studies have shown that consumption of ready-to-eat (RTE) cereal is associated with higher dietary intake of vitamin D; however, little is known about the association between RTE cereal consumption and vitamin D status measured by the serum biomarker, 25-hydroxyvitamin D. The study was conducted to examine association between consumption of RTE cereal and serum level of 25-hydroxyvitamin D, the clinical biomarker for vitamin D status in children and adults in the United States.

Methods

Children aged 1–18 years old (N = 2553) and adults aged 19 years or older (N = 4901) from the National Health and Nutrition Examination Survey 2013–2014 were included in the study. Day 1 dietary data were used to classify participants by RTE cereal consumption status. Vitamin D deficiency and inadequacy were assessed by serum levels of 25-hydroxyvitaminD using cut-off values recommended by the National Academy of Medicine. Adjusted odds ratio (aOR) and 95% confidence intervals (CI) were calculated using survey logistic regression for associations between RTEC consumption and vitamin D status in children and adults.

Results

Both children and adults who reported RTE cereal consumption had a significantly higher level of serum 25-hydroxyitamin D than children and adults who did not consume RTE cereal (P &lt; 0.05). Adjusting for age, gender, race/ethnicity, family income to poverty ratio, season of data collection, and use of vitamin D containing supplements, children who consumed RTE cereal were less likely to have vitamin D inadequacy than non-eaters (aOR = 0.48, 95% CI = [0.34, 0.68]). In adults, RTEC eaters were less likely to have vitamin D deficiency than non-eaters (aOR = 0.52, 95% CI = [0.28, 0.97]).

Conclusions

Consumption of RTE cereal is associated with better vitamin D status in both children and adults in the United States.

Funding Sources

The study was funded by the Bell Institute of Health and Nutrition, General Mills, Inc.

Association of Ready-to-Eat Cereal Consumption with Nutrient and Food Group Intake and Diet Quality by Income Status Among Children, NHANES 2013–2016

Objectives

Ready-to-eat (RTE) cereal is an important source of nutrients and whole grains in the diet of children and is associated with higher diet quality. Socioeconomic status is also strongly associated with nutrient intake and diet quality in the US. The objective of this study was to characterize the association between RTE cereal consumption and nutrient and food group intake and diet quality in US children ages 2 to 18 years stratified by their household income status.

Methods

Children age 2 to 18 years (N = 5658) in two cycles (2013–2014 and 2015–2016) of the National Health and Nutrition Examination Survey, a US nationally representative cross-sectional study, were categorized as RTE cereal eaters or non-eaters based on one day 24-hour dietary recall. Children were further stratified by their household income status according to the poverty-to-income ratio (PIR), as low-income (PIR ≤ 1.85), mid-income (PIR &gt; 1.85 to &lt;3.50) or high-income (PIR ≥ 3.50). Nutrient intakes, food group intake, and diet quality were compared between RTE cereal eaters and non-eaters in each income category using t-tests.

Results

More children in the low-income group were RTE cereal eaters (52%) compared to children in the mid-income (24%) and high-income (23%) groups. RTE cereal eaters, compared to non-eaters, in the low-income group had higher intakes of calcium (23% higher), vitamin D (85%), potassium (9%), fiber (12%), iron (71%), magnesium (11%), vitamin A (66%), and vitamin C (21%) (P &lt; 0.05 for all). Conversely, only intakes of vitamin D (59% higher), iron (56%) and vitamin A (39%) were significantly higher in RTE cereal eaters than non-eaters from the high-income group (P &lt; 0.05 for all). Cereal eaters also had higher intake of several key food groups including total dairy, fluid milk, and whole grains in all groups (P &lt; 0.05 for all). Lastly, diet quality was significantly higher among RTE cereal eaters, compared to non-eaters, in the low- and mid-income groups (P &lt; 0.05 for both) but not the high-income group.

Conclusions

RTE cereal is a popular, affordable food that provides under-consumed nutrients and food groups and is associated with increased diet quality particularly among low-income children.

Funding Sources

This study was funded by the Bell Institute of Health and Nutrition, General Mills, Inc.

Frequency of Yogurt Consumption and Its Association with Dietary Intake and Diet Quality in UK Children and Adults, National Diet and Nutrition Survey 2014–2017

Objectives

Yogurt is a popular food in the United Kingdom. It has been reported that yogurt consumption is associated with improved nutrient intake and diet quality in other countries. The objective of this study was to examine frequency of yogurt consumption and its association with dietary intake and diet quality in children and adults in the United Kingdom.

Methods

Children aged 1.5–18 years old (N = 1912) and adults aged 19 years or older (N = 2064) from the National Diet and Nutrition Survey year 7 to year 9 (2014/15–2016/17) were included in the study. Four-day diet diary data were used to classify participants by frequency of yogurt consumption based on the number of days with yogurt consumption (non-eaters, 0 day; occasional eaters, 1–2 days; regular eaters, 3–4 days). Dietary intake was calculated as the average intake across 4 days for each participant. Associations between frequency of yogurt consumption and dietary intake were assessed by survey multiple linear regression, adjusted for age, gender, equivalized family income levels, and calorie intake. Diet quality was assessed using a modified version of the Nutrient Rich Food Index 9.3.

Results

Thirty-six % of children and 25% of adults were occasional yogurt eaters and 16% of children and 14% of adults were regular eaters. In children, regular yogurt eaters had significantly higher intake of total energy, total sugar, vitamin A, thiamin, riboflavin, folate, vitamin C, vitamin D, potassium, calcium, magnesium, phosphorus, zinc, iodine, with lower intake of fat, than non-eaters and/or occasional eaters (P &lt; 0.05 for all). Similar results were found in adults except that intake of fat and vitamin A was not different, whereas intake of protein, carbohydrate, vitamin B6, vitamin E, iron, selenium and manganese was also significantly higher, together with significantly lower intake of sodium, in regular yogurt eaters, compare to non-eaters and/or occasional eaters (P &lt; 0.05 for all). Diet quality was positively associated with frequency of yogurt consumption in both children and adults (P &lt; 0.05 for both).

Conclusions

Frequent yogurt consumption is associated with better dietary intake and diet quality in children and adults in the United Kingdom.

Funding Sources

The study was funded by the Bell Institute of Health and Nutrition, General Mills, Inc.

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.

Within-subject Comparison of Dietary Intake and Diet Quality on Days with and Without Ready to Eat Cereal Consumption (P18-053-19)

Objectives

Studies have shown ready to eat cereal (RTEC) eaters had better dietary intake than non-eaters, however, little is known about within-subject differences by RTEC consumption. The study was conducted to compare differences in dietary intake and diet quality between the day with and without RTEC consumption in adults from the United States.

Methods

Data from the National Health and Nutrition Examination Survey 2013–2014 and 2015–2016 were used in the study. The sample comprised of 1818 adults aged 18 years or older who reported consumption of RTEC in one day but not the other day based on two 24-hour dietary recalls. Energy and nutrient intake were obtained from the dietary data, whereas intake of whole grains and added sugar were estimated using Food Patterns Equivalent Database. Diet quality was measured by Healthy Eating Index 2015 (HEI-2015). Multiple linear regression analyses for surveys were conducted to estimate within-subject differences in each outcome by RTEC consumption while adjusting for recall day, recall method, as well as a separate fixed effect of each person to control for demographic characteristics.

Results

Subjects had significantly higher intake of vitamin A, vitamin D, vitamin B12, vitamin B6, thiamin, riboflavin, niacin, folate, calcium, magnesium, iron, zinc, potassium, phosphorus, carbohydrate, as well as dietary fiber and whole grains, together with significantly lower intake of total fat and sodium, on the day when they consumed RTEC than the day when RTEC was not consumed (P < 0.05 for all). Total energy intake, intake of protein and total sugar as well as added sugar did not differ significantly between the day with and without RTEC consumption. On days when RTEC was consumed, HEI-2015 total score, as well as sub scores for adequacy components including whole fruits, whole grains, dairy, and moderation components including saturated fat, added sugar, and sodium, were significantly higher (P < 0.05 for all).

Conclusions

When adults consumed RTEC on a given day, they had a healthier diet with higher daily intake of dietary fiber, whole grains, as well as many key vitamins and minerals than the day when they did not consume RTEC. RTEC consumption is not associated with total energy intake and intake of total sugar or added sugar.

Funding Sources

The study was funded by General Mills, Inc.

Associations Between Consumption of Ready to Eat Cereal and Dietary Intake and Diet Quality in Hispanics (P18-052-19)

Objectives

To understand consumption pattern of ready to eat cereal (RTEC) in the Hispanic population in the United States and investigate associations between RTEC consumption and dietary intake as well as diet quality in this population.

Methods

Children aged between 2–17 years old (N = 899) and adults aged 18 years or older (N = 1593) who were Mexican American or other Hispanics from the National Health and Nutrition Examination Survey 2015–2016 were included in the study. Day 1 dietary data were used to determine RTEC consumption status, energy intake, nutrient and food group intake. Diet quality was measured as the Healthy Eating Index 2015 (HEI-2015). Multiple linear regression analyses for surveys were conducted to estimate covariates-adjusted associations between RTEC consumption and dietary intake, as well as diet quality.

Results

About 40% of Hispanic children reported RTEC consumption whereas only 14% of Hispanic adults were RTEC eaters. RTEC eaters were more likely from lower income families. Compared to non-eaters, both children and adults who reported RTEC consumption had significantly higher intake of whole grains, dairy products, and vitamins and minerals such as calcium, iron, zinc, folate, thiamin, riboflavin, niacin, vitamin B12, vitamin B6, vitamin A, vitamin D; as well as significantly lower intake of sodium and dietary cholesterol (P < 0.05 for all). Total energy intake and added sugar intake did not differ by RTEC consumption status in both age groups. HEI-2015 total score was significantly higher in RTEC eaters than non-eaters in both Hispanic children and adults (P < 0.05 for both).

Conclusions

Consumption of RTEC is associated with improved diet quality including higher intake of whole grain and dairy products, as well as several vitamins and minerals in both Hispanic children and adults. Consumption of RTEC is not associated with total energy intake or added sugar in the Hispanic population.

Funding Sources

The study was funded by General Mills, Inc.

Yogurt Consumption Is Associated with Better Dietary Intake and Diet Quality in School-aged Children (P18-112-19)

Objectives

To assess associations between yogurt consumption and dietary intake as well as diet quality in school-aged children in the United States.

Methods

A total of 3709 children aged 6–12 years from the National Health and Nutrition Examination Survey 2011–2012, 2013–2014 and 2015–2016 were included in the study. Day 1 dietary data were used to determine yogurt consumption status, energy and nutrient intake. Healthy Eating Index 2015 (HEI-2015) was used as a measure of diet quality. Multiple linear regression analyses for surveys were conducted to estimate associations between yogurt consumption and dietary intake, as well as diet quality, adjusting for sociodemographic characteristics.

Results

About 9% of children aged 6–12 years were yogurt eaters. Compared to non-eaters, children who reported yogurt consumption had significantly higher intake of calcium, magnesium, phosphorus, potassium, total sugar and carbohydrate, as well as significantly less intake of total fat and sodium (P < 0.05 for all). There were no significant differences on intake of added sugar and total energy intake. HEI-2015 total score, as well as sub scores for greens and beans, whole fruit, dairy, and sodium were significantly higher in yogurt eaters than non-eaters (P < 0.05 for all).

Conclusions

Consumption of yogurt is associated with increased intake of several key vitamins and minerals, including nutrients of public health concern such as calcium and potassium, in school-aged children. Yogurt consumption is also associated with better diet quality in this population.

Funding Sources

The study was funded by General Mills, Inc.

Whole grain consumption and body mass index in adult women: an analysis of NHANES 1999-2000 and the USDA pyramid servings database

OBJECTIVE

To examine the relationship between whole grain consumption and body mass index (BMI) in a sample of American adult women.

METHODS

Dietary intake data from the National Health and Nutrition Examination Survey 1999-2000 were linked to the USDA Pyramid Servings Database. Women 19 years of age and older (n = 2,092) were classified into groups based on their average whole grain (WG) intake: 0 servings, more than 0 but less than 1 serving, and > or =1 servings per day. Within these classifications, mean BMI, mean waist circumference and percent overweight/obese (BMI > or = 25) were identified as primary dependent variables. Regression and logistic regression analyses were used to assess associations between BMI, waist circumference and percent of the population overweight/obese (BMI > or =25) and WG consumption.

RESULTS

Women consuming at least one serving of WG had a significantly lower mean BMI and waist circumference than women with no WG consumption (p < 0.05). Multiple regression analysis showed a significant inverse relationship between BMI and whole grain intake after adjustment for age, energy intake, dietary fiber and alcohol intake (p = 0.004). This effect was mildly attenuated but remained significant after further adjustment for level of physical activity, smoking status, ethnicity and education (p = 0.018). The odds ratio for having a BMI > or = 25 was 1.47 (95% CI 1.12-1.94; p for trend 0.013) for women consuming no WG compared to those consuming at least one serving, after adjustment for all covariates.

CONCLUSIONS

These data support other research suggesting increased WG intake may contribute to a healthy body weight in adult women.