agenda 2 what is cereal? importance of breakfast to overall health nutrient contributions of a...

Agenda 2 What is Cereal? Importance of Breakfast to Overall Health Nutrient Contributions of a Cereal Breakfast Perceived Barriers to Consumption of Ready-To-Eat Cereal How to Incorporate Cereal into the Modern Diet

What is Cereal? 3

In the most basic form, cereal is any food derived from a plant in the grass family that yields edible grain or seed Barley, corn, oats, rice, rye and wheat are among the most popular grains Breakfast cereal categories include ready-to-eat cereal and cooked cereal 4

Brief History of Breakfast Cereal Typical 19 th century breakfasts were heavy on meat, light on grains In 1863, Granula was one of the 1 st attempts at a healthier breakfast; its bran nuggets had to be soaked overnight, making it rather unpopular Creation of flaked cereal in 1894 revolutionized breakfast by offering a more convenient breakfast option that was quick to prepare Corn flakes, the first commercially available cereal, was introduced in 1906, bringing a convenient, affordable breakfast option to the table 5

Brief History of Breakfast Cereal Bran flake cereal introduced in 1915 In early 30s, companies began printing nutrition messages, recipes and product information on the back and side panels of cereal packages First fortified cereal was introduced in 1938 First high-protein cereal was introduced in 1955 Guideline Daily Amounts (GDA), or front-of-pack labeling, introduced in 2005 to help consumers evaluate a products nutrition 6

Importance of Breakfast to Overall Health 7

Getting a Boost from Breakfast After 8-12 hours of fasting, the body and brain need to refuel Eating breakfast helps improve mental alertness and physical performance Eating breakfast is positively associated with improvements in short-term memory 8

Breakfast and Academic Performance A review of 22 studies published in the Journal of the American Dietetic Association suggests that eating breakfast may help children do better in school by improving: 1 Memory Test grades School attendance Psycho-social function Mood 9 1 Rampersaud et al. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc. 2005;105:743-760.

Breakfast and Cognitive Function/Memory A study of 319 adolescents published in the Journal of Adolescent Health suggests: 2 High energy intake from breakfast had a beneficial effect on immediate recall in short-term memory A study published in the American Journal of Clinical Nutrition found eating breakfast had beneficial effects on cognitive function in previously undernourished children 3 10 2 Michaud C et al. Effects of breakfast-size on short-term memory, concentration, mood and blood glucose. J Adolesc Health. 1991;12:53-57. 3 Simeon DT et al. Effects of missing breakfast on the cognitive functions of school children of differing nutritional status. Am J Clin Nutr. 1989;49:646-53.

Calories at Breakfast and Performance Breakfast should provide approximately 20% of your daily energy intake and nutrient needs Study of 195 children published in the International Journal of Food Science showed that when children consumed 20% of daily calories at breakfast their physical endurance and performance on a creativity test were much better than when they consumed less than 10% of their recommended calories at breakfast 4 11 4 Wyon DP et al. An experimental study of the effects of energy intake at breakfast on test performance of 10-year-old children in school. Int J Food Sci Nutr. 1997;48:5-12.

Breakfast Eaters and Nutrient Intake A study of 467 U.S. children published in the Journal of the American Dietetic Association found: 5 Those who ate breakfast had higher intakes of vitamins A and E, iron and the B vitamins Higher percentage of breakfast skippers (16% of participants) were less likely to achieve even 2/3 of their recommended daily intake for vitamins and minerals 12 5 Nicklas TA et al. Breakfast consumption affects adequacy of total daily intake in children. J Am Diet Assoc. 1993;93(8):886-891.

Breakfast Consumption is Declining Today, people in the U.S. are eating breakfast 10% less than before 6 Recent data indicates that U.S. children tend to eat breakfast less often as they get older 7 96% of males 95% of females Eat breakfast 87% of males 86% of females Eat breakfast 69% of males 70% of females Eat breakfast 2-5 year olds 6-11 year olds 12-19 year olds 13 6 International Food Information Council, IFIC Review: Breakfast and Health. 2008;12. 7 What We Eat America, NHANES, 2001-2002. Table 5: Percentage of Americans eating breakfast on any given day and location where eaten. US Department of Agriculture, Agricultural Research Service website.

Nutrient Contributions of a Cereal Breakfast 14

Cereal is a Great Way to Start the Day Cereal is a typically low-fat, nutrient- dense, cholesterol-free food that encourages breakfast consumption Variety of flavors and textures Breakfast cereal is convenient Research suggests that people who regularly consume ready-to-eat cereal for breakfast have higher nutrient intakes 15

Cereal Provides Key Nutrients for Children 16 8 Centers for Disease Control and Prevention National Center for Health Statistics NHANES 2005-2006.

Cereal as Part of a Balanced Breakfast Cereal with milk is an excellent centerpiece for a balanced breakfast Ready-to-eat cereal and milk is the leading source of 10 nutrients in childrens diets (vitamins A, B6, B12, riboflavin, niacin, folate, iron, zinc, thiamin and vitamin D) 9 Its unlikely that any other two foods contribute so much to the diet 9 17 9 NHANES, 2003-2006.

Cereal and Nutrient Intake Worldwide If essential nutrients are missed at breakfast, people dont compensate for the loss at other meals during the day A study of French children, adolescents and adults published in the Journal of the American College of Nutrition suggests: 10 Children and adolescents who ate a breakfast of cereal had higher dietary intakes of calcium, phosphorous, iron and vitamins B1 and B2 Adults who ate cereal had higher intakes of calcium and phosphorous, vitamins B1 and B2, vitamins A and C and folic acid Analysis of data from the U.K. shows that children age 4-18 who typically consume 30-40 grams of breakfast cereal daily have: 11 20-60% higher intake of iron, B vitamins and vitamin D Better folate, riboflavin and vitamin B12 levels 18 10 Preziosi P et al. Breakfast type, daily nutrient intakes and vitamin and mineral status of French children, adolescents and adults. J Am Coll Nutr. 1999;18:171-78. 11 Gibson. Public Health Nutr. 2003;6:815-820.

Cereal Helps Meet Specific Nutrition Needs For Digestive Health For Weight Management For Heart Health 19

Cereals Role in Digestive Health Consistent, strong evidence supports role of fiber- containing foods in improving digestive health Some ready-to-eat cereals are a good (3 grams) or excellent (5 grams) source of fiber Bran cereals Shredded wheat Wheat flake cereals Fiber-added cereals Fiber is an important nutrient; however 90% of Americans fall short of meeting adequate intakes 12 20 12 Food and Nutrition Board, Institutes of Medicine of the National Academies. Dietary reference intakes for energy, carbohydrates, fiber, fat, fatty acids, cholesterol, protein and amino acids. Washington, DC: The National Academies Press; 2002.

Digestive Health Benefits of Fiber Fiber helps keep food moving through the digestive system and plays a bulking role so undigested food can be more easily eliminated 13 Increasing the intake of fiber (particularly wheat bran) prevents food from lingering in the digestive system (which can cause a bloated, uncomfortable feeling) Fibers help to absorb water and create bulk, which speeds up the passage of food through the digestive system, helping prevent constipation 21 13 Jefferson A. Diet and Digestive Health Primary Healthcare. 2005;15:27-31.

Cereals Role in Weight Management Regular cereal eaters, regardless of the type of cereal they eat, tend to have lower body mass indexes and are less likely to be overweight 22

Cereal and Healthier Body Weights 14 23 14 Albertson AM et al. ready-to-eat cereals consumption: its relationship with BMI and nutrient intake of children aged 4 to 12 years. J Am Diet Assoc. 2003;103:1613-1619.

Cereal Consumption and BMI in Adults Analysis of data from the National Health and Nutrition Examination Survey, 1999- 2000, published in the Journal of the American Dietetic Association, found an inverse relationship between breakfast consumption and BMI in women 15 Relationship between ready-to-eat cereal consumption and BMI in women was especially noted 24 15 Song WO, et al. Is consumption of breakfast associated with body mass index in US adults? J Am Diet Assoc. 2005; 105:1373-82.

Cereal Consumption and BMI in Girls A study of 2,000 girls over a 10-year period published in the Journal of the American Dietetic Association found that girls who regularly ate cereal had healthier body weights and lower BMI and higher nutrient intakes than those who did not 16 41% of the cereals consumed by girls in the study were kids cereals, yet it was the number of days cereal was eaten that was predictive of lower BMI and higher nutrient intakes 25 16 Barton BA, et al. The relationship between breakfast and cereal consumption to nutrient intake and body mass index: The National Heart, Lung, and Blood Institute Growth and Health Study. J Am Diet Assoc. 2005; 105:1383-1389.

Cereal Consumption and Heart Health Studies have shown that breakfast skippers have higher blood cholesterol levels than breakfast eaters, especially those who eat breakfast cereal 17, 18 Eating breakfast is associated with heart- protective eating patterns such as lower fat intakes in adults and higher fiber intakes in adults, children and adolescents 19 26 17 Stanton JL, et al. Serum cholesterol, fat intake, and breakfast consumption in the United States adult population. J Am Coll Nutr. 1989; 8:567-572. 18 Resnicow K. The relationship between breakfast habits and plasma cholesterol levels in schoolchildren. J Sch Health. 1991; 61:81-85. 19 Ruxton CH, et al. Breakfast: a review of associations with measures of dietary intake, physiology and biochemistry. Br J Nutr. 1997; 78:199-213.

Important Nutrition for Every Life Stage Children Women of child-bearing age Elderly people Valuable nutrients they might otherwise miss Necessary iron, calcium, fiber and folic acid Women of child-bearing age Children Elderly people Important nutrients for relatively few calories 27

Perceived Barriers to Consumption of Ready-To-Eat Cereal 28

Perceived Barriers to Cereal Consumption 29 Processed Food Confusion About Fiber Sugar Obesity Sodium Many of the media reports around breakfast cereals are inaccurate and misleading, only leading to confusion among consumers. Breakfast cereals can provide a healthy start to the day for adults and children alike. C.S. Williamson, British Nutrition Foundation Nutrition Bulletin, 2010

Cereal Begins with Simple Grains 30 Wheat Berries Rice Corn Grain-Based Doughs

Importance of Fiber-Rich Foods Fiber is an important nutrient lacking in 90% of American diets Fiber helps contribute to overall health Consistent, strong evidence supports role of fiber- containing foods to help: 20 Improve digestive health Lower cholesterol, important in prevention of heart disease Protect against chronic disease, such as obesity, diabetes and certain cancers 31 20 International Food Information Council. Fiber Fact Sheet. 2008; see www.IFIC.org.

Confusion About Where to Find Fiber In a recent study, 75% of U.S. consumers surveyed said they expect products made with whole grain to also be at least a good source of fiber. 21 While whole grain provides micronutrients, not all whole-grain foods are a good source of fiber. The fiber content of whole-grain foods varies greatly and some whole-grain foods contain very little fiber. 22 This confusion about whole grain and fiber may have unintended consequences leading to the exacerbation of the fiber deficit. 22 32 21 Kellogg Companys Whole Grains & Fiber Omnibus Survey. 2009. 22 Kellogg Companys Every Gram Counts: Eating Away at the Fiber Deficit. 2009.

Putting Sugar Into Perspective 33 23 NHANES, 2003-2006. 100% Orange Juice NUTRITION FACTS Serving Size 8-ounces __________________________ Amount Per Serving Calories 110 __________________________ Total Fat 0 g Sodium 15 mg Potassium 450 mg Total Carbohydrate 27 g Sugars 24 g Protein 2 g __________________________ Fruit on the Bottom Yogurt NUTRITION FACTS Serving Size 6-ounces __________________________ Amount Per Serving Calories 150 __________________________ Total Fat 15 g Sodium 120 mg Potassium 290 mg Total Carbohydrate 27 g Sugars 27 g Protein 6 g __________________________ Kelloggs Frosted Mini- Wheats Original Bite Size NUTRITION FACTS Serving Size About 24 biscuits (59 g) __________________________ Amount Per Serving Calories 200 __________________________ Total Fat 1 g Sodium 5 mg Potassium 200 mg Total Carbohydrate 48 g Dietary Fiber 6 g Sugars 12 g Protein 6 g __________________________ Sugar in cereal is less than 5-7% of kids daily sugar intake in the U.S. 23 Other popular breakfast items have more sugar than ready-to-eat cereal

Obesity as an Effect of Calorie Imbalance CALORIES CONSUMED vs. PERCENT OBESE 24, 25 2,500 2,000 1,500 1,000 500 0 1974 1994 20002004 2006 Calories Consumed Percent Obese 30% 20% 15% 10% 5% 0 25% Boys Girls Obese 34 24 NHANES, 1971-2006; in boys and girls age 6-11 years of age. 25 CDC/NCHS, National Health Examination Survey and National Health and Nutrition Examination Survey. 2008

Sodium in Cereal Sodium from cereal contributes about 2% of the sodium in the U.S. diet 26 Cereal contains less than half the sodium of many popular breakfast items 27 35 26 NHANES, 2003-2006. 27 US Department of Agriculture, Agricultural Research Service. 2009. USDA Nutrient Database for Standard Reference Release 22. Nutrient Data Laboratory website http://www.usda.gov/nutrient data.

Reducing Sodium in Cereals Finding adequate replacements for sodium in cereals while maintaining taste is a challenge Consumers often equate reduced sodium with reduced taste The industry has been silently lowering sodium content in cereal for more than 10 years. In the U.S.: Kelloggs All-Bran 70% reduction Kelloggs Corn Flakes 39% reduction Kelloggs Rice Krispies 37% reduction Kelloggs Frosted Flakes 30% reduction Kelloggs Raisin Bran 29% reduction 36

How to Incorporate Cereal into the Modern Diet 37

How is Cereal Still Relevant Today? Cereal is the preferred breakfast in the U.S. Cereal is an effective carrier to help meet nutrient shortfalls of important and often lacking vitamins, minerals and nutrients 82% of women 79% of men Start their day with a cereal breakfast 38

Cereal Delivers Nutrition People Need Cereal is nutrient-dense, relatively low in calories and cholesterol-free People like cereal When they eat the food they like, they also get the nutrition they need Affordable way of providing nutrients A serving of cereal with milk in the U.S. costs an average of 50 cents 39

Cereal Fits Into Our Busy Lives Quick to the table Almost everyone in the family can make a bowl of cereal and milk Can be eaten on the go Makes a tasty snack Long shelf-life 40

What Can I Do? 41

Making a Nutritious Breakfast Relevant for Patients/Clients Educate patients/clients about getting ample nutrients at breakfast Highlight where to look for their individual nutrition needs Educate patients/clients about importance of fiber in the diet Good source = at least 3 grams Calories Vitamins Sodium Fiber 42

Tools for the Professional American Dietetic Association website www.eatright.org www.KelloggsNutrition.com Printable materials and ready-to-use presentations on breakfast, fiber, diabetes and more Helpful tools including a Fiber Tracker interactive database 43

THANK YOU! 44

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