Abstract
ABSTRACTBackgroundObservational studies have shown that higher cereal fiber intake is associated with reduced type 2 diabetes risk. However, it remains uncertain whether this association is causal.ObjectiveThis study evaluated the feasibility of an intervention to increase cereal fiber intake in children using breakfast cereals.MethodsThe study was a 2-arm parallel group randomized controlled trial in 9–10-y-old children, who received free supplies of high-fiber breakfast cereals (>3.5 g/portion) or low-fiber breakfast cereals (<1.0 g/portion) to eat daily for 1 mo with behavioral support to promote adherence. Children provided baseline and 1-mo fasting blood samples, physical measurements, and 24-h dietary recalls. The primary outcome was the group difference in change in plasma total alkylresorcinol (AR) concentration; secondary outcomes were group differences in nutrient intakes and adiposity indices. Analyses (complete case and multiple imputation) were conducted by regressing the final AR concentration on baseline AR in models adjusted for sex, ethnicity, age, and school (random effect).ResultsTwo-hundred seventy-two children were randomly assigned (137 receiving a low-fiber and 135 a high-fiber diet) and 193 (71%) provided fasting blood samples at baseline and follow-up. Among randomized participants, median (IQR) of baseline AR was 43.1 (24.6–85.5) nmol/L and of cereal fiber intake was 4.5 (2.7–6.4) g; 87% of participants reported consuming the cereal on most or all days. Compared with changes in the low-fiber group, the high-fiber group had greater increases in AR (40.7 nmol/L; 95% CI: 21.7, 59.8 nmol/L, P < 0.0001) and in reported cereal fiber intake (2.9g/d; 95% CI: 2.0, 3.7 g; P < 0.0001). There were no appreciable differences in other secondary outcomes.ConclusionsWe have developed a simple and acceptable nutritional intervention that increases markers of daily cereal fiber intake in children. This intervention could be used to test whether increases in cereal fiber intake in children might reduce insulin resistance. This trial was registered at www.isrctn.com as ISRCTN33260236.
Highlights
Foods high in dietary fiber have long been considered an important component of human diets and beneficial for good health, gastrointestinal health
We have previously shown that children who consume highfiber breakfast cereals have lower insulin resistance than children who ate a low-fiber breakfast [19], suggesting that the association between cereal fiber and emerging type 2 diabetes risk may be apparent in childhood
AR and reported cereal fiber intakes were slightly higher at baseline in the group allocated to high-fiber cereals, whereas protein and fat intakes were higher at baseline in the low-fiber group
Summary
Foods high in dietary fiber have long been considered an important component of human diets and beneficial for good health, gastrointestinal health. Observational studies have shown that higher cereal fiber intake is associated with reduced type 2 diabetes risk. It remains uncertain whether this association is causal. Results: Two-hundred seventy-two children were randomly assigned (137 receiving a low-fiber and 135 a high-fiber diet) and 193 (71%) provided fasting blood samples at baseline and follow-up. Conclusions: We have developed a simple and acceptable nutritional intervention that increases markers of daily cereal fiber intake in children. This intervention could be used to test whether increases in cereal fiber intake in children might reduce insulin resistance.
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