To the Editor

The objective of this study was to examine the association of breakfast, in particular ready to eat cereal (RTEC) consumption, with cardio‐metabolic health measures in adults 19–50 years (n=9292) using NHANES, 2001–2008. Using the first dietary recall, breakfast consumption was self‐defined by participants (n=6848) and any amount of RTEC for breakfast defined RTEC consumption (n=1148). Least square means ± SE were determined by regression analysis and odds ratios for risk factors were determined by logistic regression with adjustment for covariates. Compared to other breakfasts, RTEC breakfast was associated with a lower incidence (%±SE) of elevated BP (21±0.2 v 25±0.1, p<0.05), elevated blood glucose (27±0.2 v 34±0.1, p<0.003) and metabolic syndrome (20±0.1 v 25±0.1, p<0.007). RTEC breakfast was associated with lower LDL‐cholesterol (110.8±1.8 v 116.8±1.4, p<0.02) and lower fasting glucose (96.8±0.6 v 98.7±0.7, p<0.03) compared to breakfast skippers. RTEC breakfast consumers were also less likely to have elevated BP (OR=0.64; CI=0.50–0.82), elevated triglycerides (OR=0.69; CI=0.52–0.93), elevated fasting glucose (OR=0.57; CI=0.43–0.77), or metabolic syndrome (OR=0.50; CI=0.40–0.64). Consumers of other breakfasts showed a similar risk reduction, but odds ratios were slightly higher (0.70–0.85) than for RTEC (0.40–0.59). These data suggest breakfast consumption, particularly RTEC, is associated with improved markers of cardio‐metabolic health in adults. (Supported by Kellogg Company)

The purpose of these studies was to determine whether weight status, nutrient intake, and dietary adequacy were associated with breakfast consumption patterns. A representative sample of African American (AA) children and adolescents who participated in 1999-2002 National Health and Nutrition Examination Survey (NHANES) was used in a secondary data analysis. Participants were first grouped by age: 1-12 years of age (y) (n=1,389), 13-18 y (n = 988) and then by breakfast consumption category: breakfast skippers, ready-to-eat cereal (RTEC) consumers, and other breakfast consumers. A single multiple-pass 24-hour dietary recall was conducted using computer-assisted software to record dietary intake. To estimate dietary adequacy, the mean adequacy ratio (MAR) was calculated by expressing micronutrient intake as a percentage of the Estimated Average Requirement , truncated to no more than 100%, and averaged over 13 micronutrients: vitamins A, E, C, B1, B2, B6, B12; niacin; folate; phosphorus; magnesium; iron; and zinc. Sample-weighted data were used in all statistical analyses. In children, 7.4% of AA 1-5 y and 16.9% of AA 6-12 y, respectively, skipped breakfast while RTEC consumers included 45% and 38%, respectively. In AA 13-18 y, 36.8% skipped breakfast and 19.4% consumed RTEC at breakfast. Ready-to-eat cereal consumers 1-12 y had the lowest mean body mass index (BMI) (p≤0.05) and mean waist circumference (WC) (p≤0.05). They also had the highest mean intakes of vitamins A, B-6, and B-12; thiamin; riboflavin; niacin; folate; calcium; iron; and zinc; highest MAR (p≤0.05); and the highest intake of carbohydrates and total sugars, and the lowest intakes of total fat (p≤0.05). RTEC consumers 13-18 y had lower mean WC (p≤0.05) and BMI (p≤0.05) than breakfast skippers. Adolescent RTEC consumers and other breakfast consumers had higher mean energy intakes than breakfast skippers (p≤0.05) and had the highest MAR, while breakfast skippers had the lowest MAR (p<0.05). Adolescent RTEC breakfast consumers had higher intakes of vitamins A, B-6, B-12; thiamin; riboflavin, niacin; folate; and minerals calcium, phosphorus, magnesium, iron, zinc, and potassium than breakfast skippers and other breakfast consumers (p<0.05). Consuming an RTEC breakfast was associated with improved weight, nutrient intake, and dietary adequacy in AA children and adolescents.

The Relationship of Breakfast and Cereal Consumption to Nutrient Intake and Body Mass Index: The National Heart, Lung, and Blood Institute Growth and Health Study

The Relationship of Breakfast Skipping and Type of Breakfast Consumption with Nutrient Intake and Weight Status in Children and Adolescents: The National Health and Nutrition Examination Survey 1999-2006

Ready-to-eat cereal (RTEC) has been associated with improved nutrient intake and weight status, but intake has not been studied in Mexican-American (MA) children. The objective of this study was to assess whether nutrient intake, mean adequacy ratio (MAR), and weight were associated with classification of 3 breakfast consumption groups: breakfast skippers, RTEC breakfast consumers, and other breakfast (OB) consumers. Data on MA children (6–12 years; n = 1060) and adolescents (13–18 years; n = 1395) who participated in the 1999-2002 National Health and Nutrition Examination Survey (NHANES) were analyzed. One 24-hour diet recall was used to calculate nutrient intakes and MAR for micronutrients. Weight, body mass index, and waist circumference were evaluated. For statistical analyses, between-group differences in mean covariate-adjusted nutrient intake, unadjusted MAR, and unadjusted weights were examined. Nine percent of children and 28% of adolescents skipped breakfast; 34% and 22% of those age groups consumed RTEC breakfasts, respectively. Children who consumed an RTEC breakfast had higher intakes of thiamin, riboflavin, niacin, vitamin B6, folate, calcium, iron, and zinc than did children in the OB consumption group and breakfast skippers. Ready-to-eat cereal breakfast consumers also had a higher MAR and higher intakes of phosphorus, magnesium, and potassium than did breakfast skippers but not than OB consumers. Ready-to-eat cereal breakfast consumers had lower intakes of total fat, polyunsaturated fatty acid, and cholesterol than did OB consumers. In adolescents, compared with breakfast skippers or OB consumers, RTEC breakfast consumers had a higher MAR and higher intakes of vitamins A, B6, and B12; thiamin; riboflavin; niacin; folate; phosphorus; iron; and zinc. Carbohydrate intake was higher in RTEC breakfast consumers than in skippers or OB consumers. Children who consumed OB had lower mean body mass index and waist circumference than did those children who skipped breakfast. In MA children and adolescents, RTEC breakfast consumers had improved nutrient intake compared with breakfast skippers and OB consumers, and RTEC should be encouraged as a convenient, low-fat, nutrient-dense breakfast option.

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.

The Relationship of Ready-to-Eat Cereal Consumption to Nutrient Intake, Blood Lipids, and Body Mass Index of Children as They Age through Adolescence

Is Consumption of Breakfast Associated with Body Mass Index in US Adults?

Objective: The objective of this study was to investigate the relationship between breakfast type, energy intake and body mass index (BMI). We hypothesized not only that breakfast consumption itself is associated with BMI, but that the type of food eaten at breakfast also affects BMI.Methods: Data from the Third National Health and Nutrition Examination Survey (NHANES III), a large, population-based study conducted in the United States from 1988 to 1994, were analyzed for breakfast type, total daily energy intake, and BMI. The analyzed breakfast categories were “Skippers,” “Meat/eggs,” “Ready-to-eat cereal (RTEC),” “Cooked cereal,” “Breads,” “Quick Breads,” “Fruits/vegetables,” “Dairy,” “Fats/sweets,” and “Beverages.” Analysis of covariance was used to estimate adjusted mean body mass index (BMI) and energy intake (kcal) as dependent variables. Covariates included age, gender, race, smoking, alcohol intake, physical activity and poverty index ratio.Results: Subjects who ate RTEC, Cooked cereal, or Quick Breads for breakfast had significantly lower BMI compared to Skippers and Meat and Egg eaters (p ≤ 0.01). Breakfast skippers and fruit/vegetable eaters had the lowest daily energy intake. The Meat and Eggs eaters had the highest daily energy intake and one of the highest BMIs.Conclusions: This analysis provides evidence that skipping breakfast is not an effective way to manage weight. Eating cereal (ready-to-eat or cooked cereal) or quick breads for breakfast is associated with significantly lower body mass index compared to skipping breakfast or eating meats and/or eggs for breakfast.

Purpose: The aim of this study was to explore the relationship of ready-to-eat cereal (RTEC) consumption with nutrition and health status. Examination of health status for this project included obesity, abdominal obesity, hypertension, hypertriglyceridemia, hypercholesterolemia, low-HDL-cholesterolemia, diabetes, anemia, and metabolic syndrome. Methods: Two groups, RTEC consumers and those who did not consume RTEC, were identified using 24-hour dietary recall data from the 2012 Korea National Health and Nutrition Examination Survey (KNHANES). Nutritional intakes and risk factors of the two groups were compared using covariates-adjusted statistical procedures. Statistical analyses were performed using SAS survey procedures, and strata, cluster, and weight were considered. Subjects of analysis of nutritional intake were between the ages of 1 and 75, and those considered in the risk factor analysis were between the ages of 19 and 75. Results: Results showed that 3.8% of the Korean population was RTEC consumers. Compared to the subjects who did not intake RTEC, RTEC consumers exhibited significantly higher intakes of calcium, thiamin, riboflavin, and vitamin C. It was also discovered that the percentage of people whose intakes were less than EAR decreased with RTEC consumption. RTEC consumption showed significant association with decreased systolic blood pressure, diastolic blood pressure, serum triglyceride, and serum total cholesterol. Consequently, prevalence of hypertension among RTEC consumers was significantly lower than that among non-consumers, and the odds ratio for hypertension was 0.19 after adjusting the models for covariates. Conclusion: Results of this study clearly suggest an association of RTEC consumption with improved nutritional status and cardiometabolic risk profile in Korean adults. Conduct of additional studies will be necessary in order to determine the nature of these relationships.

The objective of the present study was to assess whether weight status, nutrient intake and dietary adequacy were associated with breakfast consumption patterns. A representative sample of the US population was used in a secondary analysis of nutrient intake/diet quality and weight status by breakfast consumption patterns. The 1999-2002 National Health and Nutrition Examination Survey (NHANES). The study sample included African-American (AA) children aged 1-12 years (n 1389). Forty-five per cent of children aged 1-5 years and 38 % of those aged 6-12 years consumed ready-to-eat cereal (RTEC) at breakfast; while 7.4 % and 16.9 % in those age groups skipped breakfast, respectively. The lowest mean BMI (P <or= 0.05) and mean waist circumference (P <or= 0.05) was found in children 1-12 years of age who consumed RTEC at breakfast compared with other consumption groups. RTEC breakfast consumers had the highest mean intakes of vitamins A, B6 and B12, thiamine, riboflavin, niacin, folate, Ca, Fe and Zn (P <or= 0.05) and the highest Mean Adequacy Ratio (P <or= 0.05). RTEC breakfast consumers also had the highest intake of carbohydrates and total sugars, and the lowest intakes of total fat (P <or= 0.05). Consuming RTEC at breakfast was associated with improved weight and nutrient adequacy in AA children. AA children in all breakfast categories still had mean intakes of most nutrients below recommended levels. The implications are that consuming a breakfast meal should be encouraged in these children, and that RTEC at breakfast provides important nutrients and may help promote a healthy weight.

Breakfast Consumption by African-American and White Adolescent Girls Correlates Positively with Calcium and Fiber Intake and Negatively with Body Mass Index

Ready-to-eat (RTE) cereal is a popular food among children. However, there are no recent data on the associations between RTE cereal consumption and dietary outcomes in the U.S. Therefore, we sought to investigate how RTE cereal was associated with nutrient and food group intakes and overall dietary quality among children aged 0.5 to 17 years using the latest data from the National Health and Nutrition Examination Survey (NHANES 2015–2016). Thirty-six percent of children reported consuming RTE cereal. RTE cereal eaters consumed the same number of calories as non-eaters but had higher intakes of total carbohydrates, total sugar, fiber, calcium, iron, magnesium, potassium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, and vitamin D, as well as lower intakes of total fat and saturated fat (p ≤ 0.0007). We also found that children who consumed RTE cereal had 29% higher total dairy intake (p < 0.0001) and 61% higher whole grain intake (p < 0.0001). Lastly, children who ate RTE cereal had higher diet quality than the children that did not eat RTE cereal, as shown by Healthy Eating Index 2015 total score (52.6 versus 47.7, p < 0.0001). Therefore, consumption of whole-grain fortified RTE cereals should be encouraged as part of healthy dietary patterns for children.

Consumption of breakfast cereal is associated with positive health outcomes: evidence from the National Heart, Lung, and Blood Institute Growth and Health Study

Breakfast consumption has been associated with an improved nutrient intake and diet quality in children and adolescents. Ready to eat cereal (RTEC) breakfast contributes to macro and micronutrient intake, because it is usually fortified with vitamins and minerals, and is low in fat and high in fiber content. The objective of this study was to examine the impact of RTEC consumption on nutrient intake and weight status in Hispanic-American (HA) children and adolescents using data from 1999 to 2002 The National Health and Nutrition Examination Survey (NHANES). Participants were categorized by breakfast skippers, RTEC breakfast, and other breakfast consumers. Hispanic-American children and adolescents consumed more other types of breakfast than an RTEC breakfast. Skipping breakfast was more common in HA adolescents than in children. Hispanic-American children and adolescents who consumed an RTEC breakfast had on average a lower intake of total fat and cholesterol than those who consumed other breakfast. Children between 1 to 5 years of age who consumed an RTEC breakfast had a higher mean energy intake from protein and a higher fiber intake than HA children who skipped breakfast. Hispanic-American in all age groups who consumed an RTEC breakfast had a better intake of vitamin B6, thiamin, riboflavin, niacin, folate, iron and zinc than those who consumed other breakfast and those who skipped breakfast. Children and adolescents met on average two thirds of the Recommended Dietary Allowance (RDA) for Vitamin C and K, but did not average of the two thirds of the RDA for vitamin E and fiber for any age regardless of the breakfast consumption pattern. Moreover, Adolescents who consumed an RTEC breakfast had a higher adequacy ratio (MAR) for shortfall nutrient intake than those who consumed others breakfast. Children between 6 to 12 years of age who skipped breakfast had a significantly higher mean of waist circumference than those who ate other breakfast; but this study found no significant association between the consumption of breakfast and skipped breakfast with the risk of overweight or being overweight in HA children and adolescent.