Replacing American Breakfast Foods with Ready-To-Eat (RTE) Cereals Increases Consumption of Key Food Groups and Nutrients among US Children and Adults: Results of an NHANES Modeling Study

Abstract

Replacing the typical American breakfast with ready-to-eat cereals (RTECs) may improve diet quality. Our goal was to assess the impact of RTECs on diet quality measures for different age groups, using substitution modeling. Dietary intakes came from the 2007–2010 National Health and Examination Surveys (NHANES; n = 18,112). All breakfast foods, excluding beverages, were replaced on a per calorie basis, with frequency-weighted and age/race specific RTECs. Model 1 replaced foods with RTECs alone; Model 2 replaced foods with RTECs and milk. Diet quality measures were based on desirable food groups and nutrients, Healthy Eating Index (HEI)-2010 scores, and estimated diet costs. Model 1 diets were significantly higher in whole grains (+84.6%), fiber (+14.3%), vitamin D (+14.0%), iron (+54.5%) and folic acid (+104.6%), as compared to observed diets. Model 2 diets were additionally higher in dairy (+15.8%), calcium (+11.3%) and potassium (+3.95%). In Model 1, added sugar increased (+5.0%), but solid fats declined (−10.9%). Energy from solid fats and added sugars declined (−3.2%) in both models. Model 2 offered higher diet quality (57.1 vs. 54.6, p-value < 0.01) at a lower cost ($6.70 vs. $6.92; p < 0.01), compared to observed diets. Substitution modeling of NHANES data can assess the nutritional and economic impact of dietary guidance.

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

“…Recently, Papanikolaou and Fulgoni [33] assessed the contribution of grain foods, including RTE cereal, to nutrient intakes in US adults; they found that RTE cereal provided 5-17% of fiber, folate, zinc, and B vitamins, although it contributed less than 3% of total energy. Using NHANES 2007-2010 dietary data, Rehm and Drewnowski [34] conducted a modeling study by replacing all non-RTE cereal breakfast food with RTE cereal on a per calorie basis and found that the modeled RTE cereal breakfast resulted in significantly higher intake of iron, folate, and many other vitamins and minerals, compared to reported breakfast foods.…”

Breakfast in the United States: Food and Nutrient Intakes in Relation to Diet Quality in National Health and Examination Survey 2011–2014. A Study from the International Breakfast Research Initiative

“…The Nutrient Rich Foods (NRF) index was the principal measure of nutrient density of the total diet [ 19 , 24 , 25 ]. Its development and validation, with respect to other measures of diet quality and long-term health outcomes, have been described in the literature [ 24 , 25 , 26 , 27 ].…”

“…The present NRF9.3 variant applied to total diets was based on 9 qualifying nutrients (NR) and 3 disqualifying nutrients (LIM). Reference daily values (DVs) were based on the US Food and Drug Administration (FDA) and other standards [ 19 , 24 ]. The qualifying nutrients and standard reference amounts were as follows: protein (50 g), fiber (28 g), vitamin A (900 RAE), vitamin C (90 mg), vitamin D (20 mcg), calcium (1300 mg), iron (18 mg), potassium (4700 mg) and magnesium (420 mg).…”

“…The rest exhibited as many as 12 breakfast “patterns” that typically included grain products, fruit juice, milk, whole fruit, sweets, meat and eggs and coffee or tea [ 4 ]. In some studies, the consumption of selected breakfast components (e.g., ready to eat or RTE cereals) was associated with higher-quality diets [ 16 , 17 , 18 , 19 ]. What food groups make for a healthy breakfast pattern across countries and consumer subgroups continues to be a topic of research interest [ 1 , 5 , 20 , 21 ].…”

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

“…Breakfast is extensively recognized as an important component of a healthy lifestyle and represents an important source of key nutrients in the diet for both adults and young population groups [ 1 , 2 , 3 , 4 , 5 ], showing several benefits of its consumption [ 2 , 3 , 4 ]. The International Breakfast Research Initiative (IBRI), developed in six countries, observed that there was a general breakfast pattern.…”