The relation of breakfast and cereal consumption to nutrient intake and Body Mass Index

Objective To examine sex differences and longitudinal changes in ready-to-eat (RTE) cereal and breakfast consumption in the Dietary Intervention Study in Children, and the relationship between RTE cereal intake with nutrient intake, blood lipids, and body mass index (BMI). Design Secondary analyses based on data from Dietary Intervention Study in Children, a randomized, controlled, multicenter, clinical trial with five sets of three 24-hour recalls. Subjects/setting Children (n 660) from six clinics aged 8 to 10 years at study entry. Participants had serum lowdensity lipoprotein cholesterol levels between the 80th and 98th percentiles for age, and were followed for a mean of 7.5 years. Intervention Children were randomized to a total fatand saturated fat-modified dietary intervention or usual care. Statistical analyses Frequency of RTE cereal and breakfast consumption was examined by sex and age. Mixed models by sex were used to examine the relationship of RTE cereal consumption to average daily intake of nutrients, blood lipids, and BMI. Results For all children, RTE cereal and breakfast consumption declined with age. Boys consumed RTE cereal more often compared with girls. Except for energy, RTE cereal consumption was positively associated with all measures of nutrients for both sexes. In boys, higher RTE cereal consumption was associated with lower total and low-density lipoprotein cholesterol levels and lower BMI. Conclusions Food and nutrition professionals should continue to educate youth and their parents on the nutritional benefits of routinely eating RTE cereal. J Am Diet Assoc. 2009;109:1557-1565. Cereal consumption contributes to dietary quality in children and adolescents (1,2). Research has demonstrated an association between cereal intake and improved dietary macronutrient and micronutrient composition (1-4), reduced intake of total cholesterol (3-6), and increased consumption of milk (2,3,7), calcium (5-8), and dietary fiber (3,5,6,8). Children who consume cereal routinely are most likely to eat breakfast (4,8) and least likely to be at risk for overweight (4,5,9). Research documents a relationship between frequent breakfast consumption and lower prevalence of overweight, with cereal intake an important factor (4,5,9). This relationship is significant given the increased prevalence of pediatric obesity (10) and the associated increased likelihood of cardiovascular (CVD) risk factors (11-14). Diet plays a significant role in prevention of CVD risk factors among children (15), and cereal may be one component of a healthful dietary intake pattern (4,5) that may positively affect cardiovascular health (16). Children and adolescents who consume cereals more frequently have more favorable lipid profiles compared with those who consume cereal at lower levels (3). Moreover, cereals contain whole grain, fiber (16), and micronutrients such as folate (17) and calcium (18) that may protect against CVD risk factors. Thus, cereal may have benefits beyond improving diet quality. Longitudinal studies examining the relation between cereal intake and CVD risk factors, such as blood lipids, are lacking. The Dietary Intervention Study in Children (DISC) is one of the largest longitudinal food and nutrient databases among preadolescent children, with measurements of height, weight, and blood lipid levels to late adolescence. Thus, DISC provides an opportunity to examine patterns of cereal consumption in boys and girls A. M. Albertson is a senior nutrition research scientist, N. M. Holschuh is a principal statistician, and A. L. Eldridge is a manager, Nutrition Science, Bell Institute of Health and Nutrition, General Mills Inc, Minneapolis, MN. S. G. Affenito is an associate professor, Department of Nutrition, Saint Joseph College, West Hartford, CT; at the time of the study, she was a consultant to the Bell Institute of Health and Nutrition, General Mills, Inc, Minneapolis, MN, for this project. R. Bauserman is a research analyst, and B. A. Barton is president and chief executive officer, Maryland Medical Research Institute, Baltimore. Address correspondence to: Sandra G. Affenito, PhD, RD, Saint Joseph College, Department of Nutrition, 1678 Asylum Ave, West Hartford, CT 06117. E-mail: saffenito@sjc.edu Manuscript accepted: March 24, 2009. Copyright © 2009 by the American Dietetic Association. 0002-8223/09/10909-0005$36.00/0 doi: 10.1016/j.jada. 2009.06. 363 © 2009 by the American Dietetic Association Journal of the AMERICAN DIETETIC ASSOCIATION 1557 and their potential association with cardiovascular health indicators. This study reports the results of a secondary data analysis on ready-to-eat (RTE) cereal intake and breakfast consumption as participants in DISC aged from childhood through adolescence, and examines the relation between RTE cereal consumption and nutrient intake, blood lipids, and body mass index (BMI).