Thursday, March 11, 2010

Ready-to-eat Cereal Breakfasts are Associated with Improved Nutrient Intake and Dietary Adequacy but Not Body Mass Index in Black Adolescents

From American Journal of Lifestyle Medicine

Improved Nutrient Intake and Dietary Adequacy but Not Body Mass Index
Brandy M. Williams; Carol E. O'Neil, PhD, MPH, LDN, RD; Debra R. Keast, PhD; Susan Cho, PhD; Theresa A. Nicklas, DrPH

Posted: 02/23/2010; Am J Lifestyle Med. 2009;3(6):500-8.

The goal of this study was to determine whether nutrient intake, dietary adequacy, and weight status were associated with type of breakfast consumption: skipping breakfast, consuming ready-to-eat cereal (RTEC) at breakfast, or consuming other types of foods at breakfast.

Data from black adolescents 13 to 18 years of age (n = 988) participating in the 1999–2002 National Health and Nutrition Examination Survey were used in a secondary data analysis. Thirty-seven percent of black adolescents skipped breakfast, 19% consumed RTEC at breakfast, and 44% consumed other breakfasts. RTEC breakfast and other breakfast consumers had higher mean energy intakes than breakfast skippers (P ≤ .05).

After adjusting for gender and energy intake, RTEC breakfast consumers had higher intakes of thiamin, riboflavin, niacin, folate, calcium, phosphorus, magnesium, iron, zinc, potassium, and vitamins A, B6, and B12 than breakfast skippers and other breakfast consumers (P ≤ .05). RTEC breakfast consumers had the highest mean adequacy ratio, followed by other breakfast consumers, then breakfast skippers (P ≤ .05). Those consuming RTEC at breakfast had lower mean body mass index (P ≤ .05) and waist circumference (P ≤ .05) than breakfast skippers; however, there was no difference between those consuming RTEC and other breakfasts.

If confirmed in prospective studies, consuming a breakfast meal with RTEC may be a useful strategy to encourage in black adolescents as a way to improve nutrient intake and dietary adequacy without increasing weight.


Adolescence is a time of rapid growth and development, making this a period of nutritional vulnerability. At the same time, adolescents demonstrate increasing control over their own food choices[1,2] and may make poor dietary choices.[3,4] Discretionary fat and added sugars make up more than 40% of total energy intake in the diet of adolescents.[3] Black adolescents may be especially vulnerable to poor diets because they are less likely than white adolescents to meet dietary recommendations for several essential nutrients.[5–7]

Skipping breakfast is an example of a poor dietary practice commonly seen in adolescents.[8] Although breakfast has been called the most important meal of the day, it is the meal that is skipped most frequently.[9,10]

Black adolescents tend to skip breakfast more often than their white counterparts.[11–13] The importance of breakfast is underscored because regular consumption of breakfast is associated with improved cognition[14] and nutrient intake in adolescents.
Skipping breakfast may result in inadequate nutrient intake that is not compensated for at other times during the day.[15] Skipping breakfast is also associated with lower energy intake but higher body mass index (BMI).[8,9,16,17]

The prevalence of overweight in adolescents increased markedly from 1999 to 2002[18] and from 2003 to 2006,[19] with the prevalence of overweight and obesity higher and increasing more rapidly in black adolescents compared to their white counterparts.[18] Overweight is a leading indicator of health status[20] and is associated with elevated blood pressure, dyslipidemia, metabolic syndrome, type 2 diabetes mellitus, and reduced insulin sensitivity.[21]

Childhood overweight tracks into young adulthood,[22] and tracking may show racial differences.
Eighty-four percent of overweight black girls and 82% of overweight black boys will be obese adults; these rates are higher than their white counterparts,[23] suggesting it is important to assess factors associated with overweight in black children and adolescents. Increases in overweight adolescents will increase the burden of adult diseases associated with unhealthy weight status.[24]

Consumption of ready-to-eat cereals (RTECs) at breakfast may help adolescents maintain a healthy weight and improve nutrient intake. RTECs are those cereals that can be consumed without further preparation, so they are convenient; furthermore, most are low fat, and more than 90% of RTECs are fortified with essential micronutrients.[25,26] In the United States, RTECs are often fortified with vitamins B6 and B12, thiamin, niacin, folate, and iron. Consumption of RTECs has been associated with higher intakes of iron, folic acid, vitamin C, and zinc and with lower intakes of total fat and cholesterol.[7,27] Adolescents who consume RTECs for breakfast also have increased intakes of milk and calcium.[28] Breakfasts that include RTECs have been associated with lower BMI in individuals 9 to 19 years of age.[8,17,18] Thus, RTECs may be an excellent food choice for adolescents.

Recently, the importance of consuming RTECs for nutrient intake and dietary adequacy at breakfast in the diets of black children was demonstrated;[29] however, the association of breakfast consumption patterns of black adolescents with diet and weight status has been understudied. The objectives of this study were to examine nutrient intake, dietary adequacy, and weight status in a nationally representative sample of black adolescents who skipped breakfast, consumed a breakfast that included RTECs, or consumed other foods at breakfast.

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