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. 2017 Sep 13;9(9):1010.
doi: 10.3390/nu9091010.

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

Colin D Rehm  1 , Adam Drewnowski  2
Affiliations

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

Colin D Rehm et al. Nutrients. .

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.

Keywords: breakfast; diet cost; diet quality; modeling; nutrient density.

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Conflict of interest statement

Funding for this research was provided to the University of Washington Center for Public Health Nutrition from the General Mills Bell Institute of Health and Nutrition. The funder approved the study proposal, but played no role in the data analysis, interpretation, or decision to submit this research for publication. Adam Drewnowski has received grants, contracts, honoraria, and consulting fees from numerous food and beverage companies and other commercial and nonprofit entities with interests in diet quality and health. The University of Washington has received grants, donations, and contracts from both the public and the private sector. Colin D. Rehm has no financial relationships relevant to this article to disclose.

Figures

Figure 1
Figure 1
Whole grains (A) and refined grains (B) observed and in replacement models using ready-to-eat cereal (RTEC) alone (Model 1) and RTEC plus milk (Model 2). Model 1 represents substitution with ready-to-eat-cereals (RTEC) and Model 2 represents substitution with RTEC and milk. The p-values of the differences between each model and observed values are indicated by asterisk (*** p < 0.001). Error bars are 95% confidence intervals. WIC stands for Women, Infants and Children and indicates participation in this supplemental nutrition program.
Figure 2
Figure 2
Total dairy in observed diets and in replacement models using RTEC alone (Model 1) and RTEC plus milk (Model 2). Model 1 represents substitution with ready-to-eat-cereals (RTEC) and Model 2 represents substitution with RTEC and milk. The p-values of the differences between each model and observed values are indicated by asterisk (*** p < 0.001; ** 0.001 < p-value < 0.01; * 0.05 < p < 0.01). WIC stands for Women, Infants and Children and indicates participation in this supplemental nutrition program.
Figure 3
Figure 3
Energy from solid fats and added sugars (A), grams of solid fat (B) and teaspoons of added sugars (C) in observed diets and in replacement models using RTEC alone (Model 1) and RTEC plus milk (Model 2). Model 1 represents substitution with ready-to-eat-cereals (RTEC) and Model 2 represents substitution with RTEC and milk. The p-values of the differences between each model and observed values are indicated by asterisk (*** p < 0.001; ** 0.001 < p-value < 0.01; * 0.05 < p < 0.01). WIC stands for Women, Infants and Children and indicates participation in this supplemental nutrition program.
Figure 4
Figure 4
Dietary fiber (A), vitamin D (B), potassium (C) and calcium (D) in observed diets and in replacement models using RTEC alone (Model 1) and RTEC plus milk (Model 2). Model 1 represents substitution with ready-to-eat-cereals (RTEC) and Model 2 represents substitution with RTEC and milk. The p-values of the differences between each model to observed values are indicated by asterisk (*** p < 0.001; ** 0.001 < p-value < 0.01; * 0.05 < p < 0.01). WIC stands for Women, Infants and Children and indicates participation in this supplemental nutrition program.
Figure 4
Figure 4
Dietary fiber (A), vitamin D (B), potassium (C) and calcium (D) in observed diets and in replacement models using RTEC alone (Model 1) and RTEC plus milk (Model 2). Model 1 represents substitution with ready-to-eat-cereals (RTEC) and Model 2 represents substitution with RTEC and milk. The p-values of the differences between each model to observed values are indicated by asterisk (*** p < 0.001; ** 0.001 < p-value < 0.01; * 0.05 < p < 0.01). WIC stands for Women, Infants and Children and indicates participation in this supplemental nutrition program.
Figure 5
Figure 5
Magnesium (A), iron (B) and folic acid (C) in observed diets and in replacement models using RTEC alone (Model 1) and RTEC plus milk (Model 2). Model 1 represents substitution with ready-to-eat-cereals (RTEC) and Model 2 represents substitution with RTEC and milk. The p-values of the differences between each model and observed values are indicated by asterisk (*** p < 0.001; ** 0.001 < p-value < 0.01; * 0.05 < p < 0.01). WIC stands for Women, Infants and Children and indicates participation in this supplemental nutrition program.
Figure 6
Figure 6
HEI-2010 a component scores under different modeling scenarios in the US population, 2007–2010. a The HEI-2010 is a 100-point score ranging from 0 to 100, which measures adherence to the 2010 Dietary Guidelines for Americans. A score of 100 indicates perfect adherence to the 2010 Dietary Guidelines for Americans. Higher scores indicate higher quality diets. The values in parentheses are the maximum values for each HEI-2010 component. SOFAAS stands for solid fats, alcohol and added sugars, and is a summary measure of empty calories.
Figure 7
Figure 7
Diet cost as observed and in replacement models using RTEC alone (Model 1) and RTEC plus milk (Model 2). Model 1 represents substitution with ready-to-eat-cereals (RTECs) and Model 2 represents substitution with RTECs and milk. The p-Values of the differences between each model and observed values are indicated by asterisk (** 0.001 < p-value < 0.01; * 0.05 < p < 0.01). WIC stands for Women, Infants and Children and indicates participation in this supplemental nutrition program.
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