April 2013

Association between Frequency of Ready-to-Eat Cereal Consumption, Nutrient Intakes, and Body Mass Index in Fourth-to-Six-Grade Low-Income Minority Children

Childhood obesity has reached epidemic proportions in the United States. One in three American children are overweight or obese and at risk for chronic diseases such as type 2 diabetes, metabolic syndrome, and cardiovascular disease. Childhood obesity is more common among minority children and children living in poverty. Among children aged 6 to 11 years, the combined prevalence of overweight and obesity was 40% for Mexican-American, 36% for African-American, and 26% for non-Hispanic white children.

Some studies have reported an inverse relationship between the frequency of breakfast consumption and BMI and/or weight status. The nutrient density of ready-to-eat cereals (RTECs), many of which are fortified with vitamins and minerals, can be important contributors to overall diet quality. Children who consume RTEC have increased intakes of calcium, iron, folate, zinc, vitamin A, thiamin, riboflavin, niacin, fiber, and decreased fat and cholesterol intakes. The dietary intake of Hispanic children has been shown to be deficient in essential nutrients such as calcium, potassium, magnesium, phosphorous, fiber and folate. The objectives of the study were to evaluate, in low-income minority children (mainly Hispanic), whether there is a relationship between the frequency of RTEC consumption and nutrient intakes and whether there was a relationship between the frequency of RTEC consumption and BMI.

This study was a secondary analysis of data collected for a primary study, Bienestar: A School-Based Type 2 Diabetes Prevention Program. Children provided information during three data collection periods: beginning of the fourth grade school year, end of the fifth grade school year, and the end of the sixth grade school year. During these data collection periods, children provided three 24-hour dietary recalls and had their height and weight measured for BMI calculations. For the purpose of the study, breakfast was considered the first meal of the morning consisting of any solid food, beverages, or both. RTEC was defined as a cereal that is processed to the point that it can be eaten without additional preparation.

Results showed that the frequency of children consuming 3 days of any type of breakfast (non-RTEC or RTEC) by grade level decreased from fourth (64%) to fifth (56%) to sixth grades (42%). The majority of the RTEC consumed contained added sugar and the most frequently consumed RTECs were Frosted Flakes, Cheerios, and Kix. RTEC consumption was associated with increased intakes of vitamins B-12, riboflavin, calcium, iron, zinc, and potassium. There was a significant decrease in cholesterol intake with increased days of RTEC consumption. Frequency of RTEC consumption significantly affected a child’s BMI with a decrease of 2 percentiles for every day of RTEC consumption.

RTEC consumption may be a marker of an overall healthy lifestyle. Breakfast consumption, specifically RTEC consumption, may indicate eating patterns that are more favorable for weight maintenance. It is possible that a breakfast including RTEC may provide satiety and prevent consumption of less nutrient-dense foods later in the day.

Frantzen, L.B., Trevino, R., Echon, R., Garcia-Dominic, O., & DiMarco, N. (2013). Association between      frequency of ready-to-eat cereal consumption, nutrient intakes, and body mass index in fourth- to sixth-grade low-income minority children. Journal of the Academy of Nutrition and   Dietetics, 113(4), 511-519.

Ready-to-Eat Cereal Consumption and the School Breakfast Program: Relationship to Nutrient Intake and Weight

I chose this article because many children rely on this program in order to receive breakfast. Currently, over  11 million US children participate in the School Breakfast Program, highlighting the importance of understanding the impact of breakfast and RTEC consumption in the school setting.

The target population of this study was students attending schools in School Food Authorities, which are school districts operating the NSLP in the US. The student analysis sample consisted of 2314 students who completed dietary intake interviews for at least one day and 666 of these students also completed intake interviews for a second day to estimate usual daily nutrient intakes. Each respondent was categorized in 1 of 5 “breakfast groups” based on day-1 SBP participation, breakfast consumption and cereal intake: (1) skipped breakfast, (2) SBP nonparticipants who consumed breakfast without cereal (3) SBP nonparticipants who consumed breakfast with cereal (4) SBP participants who consumed noncereal breakfast, or (5) SBP participants who consumed cereal breakfast.

Results indicated that students eating cereal breakfast consumed significantly more vitamin A, iron, dietary fiber, and whole grains on day 1 than students who ate noncereal breakfast regardless of whether they participated in the SBP. Among SBP nonparticipants, those who ate cereal breakfast had higher calcium intake than those who did not eat cereal. SBP participants who ate cereal breakfast had a lower cholesterol intake than any other group that consumed breakfast. In addition, breakfast skippers had significantly greater BMI-for-age z-scores than did students who ate noncereal breakfast, regardless of SBP participation.

Affenito, S., Thompson, D., Dorazio, A., Albertson, A., Loew, A., & Holschuh, N. (2013). Ready-to-eat cereal consumption and the school breakfast program: relationship to nutrient intake and    weight. Journal of School Health, 83(1), 28-35.