To the Editor
2008; Elsevier BV; Volume: 108; Issue: 10 Linguagem: Inglês
10.1016/j.jada.2008.08.004
ISSN1878-3570
AutoresCeleste A Clark, Susan J. Crockett,
Tópico(s)Nutritional Studies and Diet
ResumoThe article “Examining the Nutritional Quality of Breakfast Cereals Marketed to Children” in the April 2008 issue of the Journal (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) overlooked several key elements in the assessment of the nutritional quality of the ready-to-eat cereal (RTEC).The RTEC category described by Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) failed to reflect the current nutritional profile of the RTECs available in the marketplace. The researchers collected 161 RTECs available from four leading cereal companies between January and February 2006. Subsequent to this time, there has been significant reformulation of the RTEC category to further “improve” the nutritional profiles of many leading brands. For example, General Mills, Inc reduced sugar content in 11 brands and introduced 10 new RTECs with low to moderate sugar (2 to 10 g/serving). Similarly, Kellogg Company reduced sugar content in seven brands and introduced 12 brands with low to moderate sugar (1 to 12 g/serving).Previous research has documented many positive effects of RTEC consumption on a variety of health outcomes in children. For example, children who consume cereal, relative to other breakfast foods, are less likely to be overweight or obese and evidence lower body mass index (2Albertson A.M. Anderson G.H. Crockett S.J. Goebel M.T. Ready-to-eat cereal consumption its relationship with BMI and nutrient intake of children aged 4 to 12 years.J Am Diet Assoc. 2003; 103: 1613-1619Google Scholar, 3Cho S. Dietrich M. Brown C.J. Clark C.A. Block G. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III).J Am Coll Nutr. 2003; 22: 296-302Google Scholar, 4Kosti R.I. Panagiotakos D.B. Zampelas A. Mihas C. Alevizos A. Leonard C. Tountas Y. Mariolis A. The association between consumption of breakfast cereals and BMI in schoolchildren aged 12-17 years: The VYRONAS study.Public Health Nut. 2007; 20: 1-7Google Scholar, 5Nicklas T.A. O'Neil C.E. Berenson G.S. Nutrient contribution of breakfast, secular trends, and the role of ready-to-eat cereals: A review of data from the Bogalusa Heart Study.Am J Clin Nutr. 1998; 67: 757S-763SGoogle Scholar, 6Sampson A.E. Dixit S. Meyers A.F. Houser Jr, R. The nutritional impact of breakfast consumption on the diets of inner-city African-American elementary school children.J Natl Med Assoc. 1995; 87: 195-202Google Scholar, 7Williams P. Breakfast and the diets of Australian children and adolescents: An analysis of data from the 1995 National Nutrition Survey.Int J Food Sci. 2007; 58: 210-216Google Scholar, 8Barton B.A. Eldridge A.L. Thompson D. Affenito S.G. Striegel-Moore R.H. Franko D.L. Albertson A.M. Crockett S.J. 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.J Am Diet Assoc. 2005; 105: 1383-1389Google Scholar). In addition, cereal consumption was related to increased intake of fiber, calcium, iron, folic acid, vitamin C, and zinc and decreased intake of fat and cholesterol (2Albertson A.M. Anderson G.H. Crockett S.J. Goebel M.T. Ready-to-eat cereal consumption its relationship with BMI and nutrient intake of children aged 4 to 12 years.J Am Diet Assoc. 2003; 103: 1613-1619Google Scholar, 5Nicklas T.A. O'Neil C.E. Berenson G.S. Nutrient contribution of breakfast, secular trends, and the role of ready-to-eat cereals: A review of data from the Bogalusa Heart Study.Am J Clin Nutr. 1998; 67: 757S-763SGoogle Scholar, 8Barton B.A. Eldridge A.L. Thompson D. Affenito S.G. Striegel-Moore R.H. Franko D.L. Albertson A.M. Crockett S.J. 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.J Am Diet Assoc. 2005; 105: 1383-1389Google Scholar).Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) also failed to acknowledge the relatively small amount of total and added sugar that RTEC contributes to the total daily sugar intake of children. Analysis of National Health and Nutrition Examination Survey 2003-2004 data (9National Center for Health StatisticsNational Health and Nutrition Examination Survey 2003-2004.http://www.cdc.gov/nchs/about/major/nhanes/nhanes2003-2004/nhanes03_04.htmGoogle Scholar) shows that RTECs contribute, on average, only 5% of the total sugar in children's diets and only 3% of added sugar (as defined by the US Department of Agriculture Pyramids Serving Data Base Version 1.0) (10Friday J.E. Bowman S.A. MyPyramid Equivalents Database for USDA Survey Food Codes, 1994-2002, version 1.0.http://www.ars.usda.gov/Services/docs.htm?docid=8503Google Scholar).The 2005 US Dietary Guidelines state, “Sugars can improve the palatability of foods and beverages that otherwise might not be consumed” (11US Department of Health and Human ServicesUS Department of AgricultureDietary Guidelines for Americans, 2005.http://www.health.gov/dietaryguidelines/dga2005/document/Google Scholar). Children like the taste of RTEC and therefore are more likely to eat breakfast. The literature documenting the benefits of consuming breakfast is vast. Breakfast consumption is associated with maintenance of a healthful body weight, improved nutrient intake, and improved cognitive performance (12Rampersaud G.C. Pereira M.A. Girard B.L. Adams J. Metzl J.D. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents.J Am Diet Assoc. 2005; 105: 743-760Google Scholar). Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) overlooked these benefits and provided no scientific support for the assertion that there are negative implications of added sugars in RTECs, especially with regard to weight management.RTECs, regardless of sugar content, provide significant levels of vitamins and minerals essential for children's health and are superior in nutritional quality compared to many other common breakfast options. The nutrients reported by Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) were limited to those required on the Nutrition Facts panel. The authors disregarded the contribution of important nutrients that are higher in the diets of RTEC breakfast consumers, including calcium, folic acid, iron, and zinc (2Albertson A.M. Anderson G.H. Crockett S.J. Goebel M.T. Ready-to-eat cereal consumption its relationship with BMI and nutrient intake of children aged 4 to 12 years.J Am Diet Assoc. 2003; 103: 1613-1619Google Scholar, 3Cho S. Dietrich M. Brown C.J. Clark C.A. Block G. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III).J Am Coll Nutr. 2003; 22: 296-302Google Scholar, 5Nicklas T.A. O'Neil C.E. Berenson G.S. Nutrient contribution of breakfast, secular trends, and the role of ready-to-eat cereals: A review of data from the Bogalusa Heart Study.Am J Clin Nutr. 1998; 67: 757S-763SGoogle Scholar, 6Sampson A.E. Dixit S. Meyers A.F. Houser Jr, R. The nutritional impact of breakfast consumption on the diets of inner-city African-American elementary school children.J Natl Med Assoc. 1995; 87: 195-202Google Scholar, 8Barton B.A. Eldridge A.L. Thompson D. Affenito S.G. Striegel-Moore R.H. Franko D.L. Albertson A.M. Crockett S.J. 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.J Am Diet Assoc. 2005; 105: 1383-1389Google Scholar) in their determination of nutritional quality of RTECs. This highlights the need for standardized calculations of nutrient-density and/or nutrient quality of foods. Fortified RTECs are indeed a nutrient-dense food based on the level of micronutrients provided per calories delivered.The cereal category reflects a wide variety of choices with varying densities. Industry research indicates consumers select serving size based on volume rather than serving weight. RTECs are labeled as such on the Nutrition Facts panel. Gram weight, which was selected by the authors as the basis of their analysis, is not an accurate portrayal of cereal usage. Analysis by recommended serving size (which more accurately reflects amount typically consumed), would not support the conclusions put forth by Schwartz and colleagues.Finally, children will not forgo taste for the promise that a food is “good for you.” The authors overlooked this key element in the discussion of optimal dietary intake for children. Consumer insights, especially around hedonic qualities, are imperative if true improvements in dietary quality for children are to be accomplished.Scientific research has determined that RTEC provides the well-established benefits of increased breakfast consumption, including better nutritional intake, improved cognitive performance, and a healthful body weight. Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) have provided an unbalanced view of the health implications of RTEC consumption in children. The article “Examining the Nutritional Quality of Breakfast Cereals Marketed to Children” in the April 2008 issue of the Journal (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) overlooked several key elements in the assessment of the nutritional quality of the ready-to-eat cereal (RTEC). The RTEC category described by Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) failed to reflect the current nutritional profile of the RTECs available in the marketplace. The researchers collected 161 RTECs available from four leading cereal companies between January and February 2006. Subsequent to this time, there has been significant reformulation of the RTEC category to further “improve” the nutritional profiles of many leading brands. For example, General Mills, Inc reduced sugar content in 11 brands and introduced 10 new RTECs with low to moderate sugar (2 to 10 g/serving). Similarly, Kellogg Company reduced sugar content in seven brands and introduced 12 brands with low to moderate sugar (1 to 12 g/serving). Previous research has documented many positive effects of RTEC consumption on a variety of health outcomes in children. For example, children who consume cereal, relative to other breakfast foods, are less likely to be overweight or obese and evidence lower body mass index (2Albertson A.M. Anderson G.H. Crockett S.J. Goebel M.T. Ready-to-eat cereal consumption its relationship with BMI and nutrient intake of children aged 4 to 12 years.J Am Diet Assoc. 2003; 103: 1613-1619Google Scholar, 3Cho S. Dietrich M. Brown C.J. Clark C.A. Block G. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III).J Am Coll Nutr. 2003; 22: 296-302Google Scholar, 4Kosti R.I. Panagiotakos D.B. Zampelas A. Mihas C. Alevizos A. Leonard C. Tountas Y. Mariolis A. The association between consumption of breakfast cereals and BMI in schoolchildren aged 12-17 years: The VYRONAS study.Public Health Nut. 2007; 20: 1-7Google Scholar, 5Nicklas T.A. O'Neil C.E. Berenson G.S. Nutrient contribution of breakfast, secular trends, and the role of ready-to-eat cereals: A review of data from the Bogalusa Heart Study.Am J Clin Nutr. 1998; 67: 757S-763SGoogle Scholar, 6Sampson A.E. Dixit S. Meyers A.F. Houser Jr, R. The nutritional impact of breakfast consumption on the diets of inner-city African-American elementary school children.J Natl Med Assoc. 1995; 87: 195-202Google Scholar, 7Williams P. Breakfast and the diets of Australian children and adolescents: An analysis of data from the 1995 National Nutrition Survey.Int J Food Sci. 2007; 58: 210-216Google Scholar, 8Barton B.A. Eldridge A.L. Thompson D. Affenito S.G. Striegel-Moore R.H. Franko D.L. Albertson A.M. Crockett S.J. 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.J Am Diet Assoc. 2005; 105: 1383-1389Google Scholar). In addition, cereal consumption was related to increased intake of fiber, calcium, iron, folic acid, vitamin C, and zinc and decreased intake of fat and cholesterol (2Albertson A.M. Anderson G.H. Crockett S.J. Goebel M.T. Ready-to-eat cereal consumption its relationship with BMI and nutrient intake of children aged 4 to 12 years.J Am Diet Assoc. 2003; 103: 1613-1619Google Scholar, 5Nicklas T.A. O'Neil C.E. Berenson G.S. Nutrient contribution of breakfast, secular trends, and the role of ready-to-eat cereals: A review of data from the Bogalusa Heart Study.Am J Clin Nutr. 1998; 67: 757S-763SGoogle Scholar, 8Barton B.A. Eldridge A.L. Thompson D. Affenito S.G. Striegel-Moore R.H. Franko D.L. Albertson A.M. Crockett S.J. 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.J Am Diet Assoc. 2005; 105: 1383-1389Google Scholar). Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) also failed to acknowledge the relatively small amount of total and added sugar that RTEC contributes to the total daily sugar intake of children. Analysis of National Health and Nutrition Examination Survey 2003-2004 data (9National Center for Health StatisticsNational Health and Nutrition Examination Survey 2003-2004.http://www.cdc.gov/nchs/about/major/nhanes/nhanes2003-2004/nhanes03_04.htmGoogle Scholar) shows that RTECs contribute, on average, only 5% of the total sugar in children's diets and only 3% of added sugar (as defined by the US Department of Agriculture Pyramids Serving Data Base Version 1.0) (10Friday J.E. Bowman S.A. MyPyramid Equivalents Database for USDA Survey Food Codes, 1994-2002, version 1.0.http://www.ars.usda.gov/Services/docs.htm?docid=8503Google Scholar). The 2005 US Dietary Guidelines state, “Sugars can improve the palatability of foods and beverages that otherwise might not be consumed” (11US Department of Health and Human ServicesUS Department of AgricultureDietary Guidelines for Americans, 2005.http://www.health.gov/dietaryguidelines/dga2005/document/Google Scholar). Children like the taste of RTEC and therefore are more likely to eat breakfast. The literature documenting the benefits of consuming breakfast is vast. Breakfast consumption is associated with maintenance of a healthful body weight, improved nutrient intake, and improved cognitive performance (12Rampersaud G.C. Pereira M.A. Girard B.L. Adams J. Metzl J.D. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents.J Am Diet Assoc. 2005; 105: 743-760Google Scholar). Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) overlooked these benefits and provided no scientific support for the assertion that there are negative implications of added sugars in RTECs, especially with regard to weight management. RTECs, regardless of sugar content, provide significant levels of vitamins and minerals essential for children's health and are superior in nutritional quality compared to many other common breakfast options. The nutrients reported by Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) were limited to those required on the Nutrition Facts panel. The authors disregarded the contribution of important nutrients that are higher in the diets of RTEC breakfast consumers, including calcium, folic acid, iron, and zinc (2Albertson A.M. Anderson G.H. Crockett S.J. Goebel M.T. Ready-to-eat cereal consumption its relationship with BMI and nutrient intake of children aged 4 to 12 years.J Am Diet Assoc. 2003; 103: 1613-1619Google Scholar, 3Cho S. Dietrich M. Brown C.J. Clark C.A. Block G. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III).J Am Coll Nutr. 2003; 22: 296-302Google Scholar, 5Nicklas T.A. O'Neil C.E. Berenson G.S. Nutrient contribution of breakfast, secular trends, and the role of ready-to-eat cereals: A review of data from the Bogalusa Heart Study.Am J Clin Nutr. 1998; 67: 757S-763SGoogle Scholar, 6Sampson A.E. Dixit S. Meyers A.F. Houser Jr, R. The nutritional impact of breakfast consumption on the diets of inner-city African-American elementary school children.J Natl Med Assoc. 1995; 87: 195-202Google Scholar, 8Barton B.A. Eldridge A.L. Thompson D. Affenito S.G. Striegel-Moore R.H. Franko D.L. Albertson A.M. Crockett S.J. 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.J Am Diet Assoc. 2005; 105: 1383-1389Google Scholar) in their determination of nutritional quality of RTECs. This highlights the need for standardized calculations of nutrient-density and/or nutrient quality of foods. Fortified RTECs are indeed a nutrient-dense food based on the level of micronutrients provided per calories delivered. The cereal category reflects a wide variety of choices with varying densities. Industry research indicates consumers select serving size based on volume rather than serving weight. RTECs are labeled as such on the Nutrition Facts panel. Gram weight, which was selected by the authors as the basis of their analysis, is not an accurate portrayal of cereal usage. Analysis by recommended serving size (which more accurately reflects amount typically consumed), would not support the conclusions put forth by Schwartz and colleagues. Finally, children will not forgo taste for the promise that a food is “good for you.” The authors overlooked this key element in the discussion of optimal dietary intake for children. Consumer insights, especially around hedonic qualities, are imperative if true improvements in dietary quality for children are to be accomplished. Scientific research has determined that RTEC provides the well-established benefits of increased breakfast consumption, including better nutritional intake, improved cognitive performance, and a healthful body weight. Schwartz and colleagues (1Schwartz M.B. Vartanian L.R. Wharton C.M. Brownell K.D. Examining the nutritional quality of breakfast cereals marketed to children.J Am Diet Assoc. 2008; 108: 702-705Google Scholar) have provided an unbalanced view of the health implications of RTEC consumption in children. Examining the Nutritional Quality of Breakfast Cereals Marketed to ChildrenJournal of the American Dietetic AssociationVol. 108Issue 4PreviewThere are both public health and food industry initiatives aimed at increasing breakfast consumption among children, particularly the consumption of ready-to-eat cereals. The purpose of this study was to determine whether there were identifiable differences in nutritional quality between cereals that are primarily marketed to children and cereals that are not marketed to children. Of the 161 cereals identified between January and February 2006, 46% were classified as being marketed to children (eg, packaging contained a licensed character or contained an activity directed at children). Full-Text PDF Authors' ResponseJournal of the American Dietetic AssociationVol. 108Issue 10PreviewIn response to our paper addressing the nutritional quality of children's cereals (1), several people wrote and raised important points. One of the issues raised was the importance of assessing ready-to-eat cereals (RTECs) “dispassionately and objectively in examining decades of scholarly research.” We agree that an objective review of this literature is needed, and it is critical to have a review conducted by researchers not funded by the cereal industry (2,3). There is evidence that industry-funded research tends to report findings favorable to that industry [for examples, see reviews on tobacco (4), pharmaceutical (5), and beverage research (6,7)]. Full-Text PDF
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