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When Given Low-Sugar Cereals, Children Will Eat More Fresh Fruit

Medical News Today 13 Dec 2010 

If you give children low-sugar cereals and place some fresh fruit and sugar on the table, most of them will add a good portion of fresh fruit, researchers from the Rudd Center for Food Policy and Obesity, Yale University, wrote in the medical journal Pediatrics. The study provides encouraging evidence that despite heavy marketing of sugar-laden cereals aimed at children, kids can and will make sensible nutritional decisions on their own if given the chance.

Although breakfast is widely accepted as a crucial meal which should not be skipped, ready-to-eat breakfast cereals contribute significantly to a child's daily intake of added sweeteners. Studies have shown that cereals specifically targeted at children have considerably more sugar added than other breakfast cereals, the authors explained. Not only is breakfast nutritionally important for a child's health, it is also vital for good academic performance.

Because of these factors, children tend to consume much more refined sugar than they should.

Parents get mixed signals from messages via the media, many supposedly coming from experts. While some report that only low-sugar cereals should be made available for kids, others stress that compared to no breakfast at all, serving high-sugar cereals is better.

Jennifer L. Harris, PhD, MBA, and team carried out a randomized study involving 90 children, aged 5 to 12 years, who were attending summer day camp. They wanted to find out whether kids will eat low-sugar ready-to-eat cereals, and what effect serving high vs. low sugar cereals might have on how much fruit, refined sugar, and milk they consumed.

The children were assigned to two groups: 

Low-Sugar Cereal Group - they could chose from Corn Flakes, Rice Krispies or Cheerios -- Cereals that have from 1g to 4g of sugar per serving. 

High-Sugar Cereal Group - they could chose from Frosted Flakes, Cocoa Pebbles or Froot Loops. Cereals which contain from 11g to 12g of sugar per serving.

In front of each child there was a 8 ounce container of milk (1% fat), bowls of banana sections and chopped up strawberries, and a small cup of orange juice. Individual sugar packets, more milk, and more juice were placed in the middle of the table which children were free to use. They were told to eat at will.

At the end of their meal the kids filled out a questionnaire which asked whether they added sugar, ate any fruit, and how much they liked their breakfast.

The researchers found that the children in the Low-Sugar Cereal Group consumed approximately 12.5g of refined sugar during breakfast compared to 24.4g in the High-Sugar Cereal Group. They also reveal that 54% of the Low-Sugar Cereal Group added fresh fruit to their breakfast, compared to 8% in the High-Sugar Cereal Group.

90% of all the children said they liked or loved their breakfast. The average breakfast rating in the Low-Cereal Group was 4.5, and 4.6 in the High-Cereal Groups (out of a maximum rating of 5 and minimum of 0).

The Low-Sugar Group had an average of just one cereal serving; compared to nearly two servings in the High-Sugar Group.

Although the kids in the Low-Sugar Group added more sugar to their breakfast cereal, their total refined sugar intake, at 0.7 teaspoons, was considerably lower than for those in the High-Sugar Group, who had 5.7 teaspoons.

Orange juice and milk intake was the same in both groups.

14% of calories came from refined sugar and 18% from fruit in the Low-Sugar Group, compared to 25% from refined sugar and 12% from fruit in the other group, the authors revealed.

The researchers added that repeatedly giving children high-sugar breakfast cereals will eventually give them a much sweeter palate - they will go for sweeter foods in general.

The authors concluded:

"Compared with serving low-sugar cereals, high-sugar cereals increase children's total sugar consumption and reduce the overall nutritional quality of their breakfast. Children will consume low-sugar cereals when offered, and they provide a superior breakfast option." 

As the study was extremely short - children were observed for just one meal - the scientists stress that longer and larger trials would be required to confirm their findings. They add that the participants were mainly children of low-income households.

Effects of Serving High-Sugar Cereals on Children's Breakfast-Eating Behavior

Pediatrics Dec 2010; doi:10.1542/peds.2010-0864

Jennifer L. Harris, PhD, MBAa,Marlene B. Schwartz, PhDa,Amy Ustjanauskas, BAa,Punam Ohri-Vachaspati, PhD, RDb,Kelly D. Brownell, PhD

Rudd Center for Food Policy and Obesity, Yale University, New Haven, Connecticut; and bRobert Wood Johnson Foundation, Princeton, New Jersey 

OBJECTIVES To test (1) whether children will consume low-sugar ready-to-eat (RTE) cereals and (2) the effects of serving high- versus low-sugarcereals on the consumption of cereal, refined sugar, fresh fruit, and milk. 

PARTICIPANTS AND METHODS Using an experimental design, we randomly assigned children(n = 91) who were attending summer day camp to receive a breakfast that included either the choice of 1 of 3 high-sugar cereals (high-sugar condition) or low-sugar cereals (low-sugar condition), as well as low-fat milk, orange juice, bananas, strawberries, and sugar packets. Participants served themselves and completed a background questionnaire after eating. Researchers measured the amount and calories consumed of each food. 

RESULTS In both conditions, children reported "liking" or "loving" the cereal they chose. Children in the low-sugar cereal condition consumed, on average, slightly more than 1 serving of cereal (35 g), whereas children in the high-sugar condition consumed significantly more (61 g) and almost twice the amount of refined sugar in total (24.4 vs 12.5 g). Milk and total calories consumed did not differ significantly between conditions, but children in the low-sugar condition were more likely to put fruit on their cereal (54% vs 8%) and consumed a greater portion of total calories from fresh fruit (20% vs 13%). 

CONCLUSIONS Compared with serving low-sugar cereals, high-sugar cereals increase children's total sugar consumption and reduce the overall nutritional quality of their breakfast. Children will consume low-sugar cereals when offered, and they provide a superior breakfast option.

Is There a Relationship Between Dietary Fat and Stature or Growth in Children Three to Five Years of Age?

PEDIATRICS Vol. 92 No. 4 October 1993, pp. 579-586

Steven Shea MD1, Charles E. Basch PhD2, Aryeh D. Stein PhD3, Isobel R. Contento PhD2, Matilde Irigoyen MD4, , Patricia Zybert PhD2

1 The Division of General Medicine, Department of Medicine., Division of Epidemiology, Columbia University School of Public Health
2 Department of Health and Nutrition Education and Center for Health Promotion, Teachers College, Columbia University, New York, NY.
3 Division of Epidemiology, Columbia University School of Public Health
4 Department of Pediatrics, Columbia University College of Physicians & Surgeons

Study objective. To determine whether a moderately reducedfat diet affects the stature or growth of healthy preschoolchildren.

Design. Cohort study with mean of 25 months of follow-up.

Setting. Primary care pediatrics practice at a large urban medical center.

Subjects. A predominately Hispanic group of 215 children aged 3 to 4 years at baseline.

Measurements and main results. The children's diet was assessed using four 24-hour recalls and three Willett semiquantitative food-frequency questionnaires administered to the children's mothers over a 1-year baseline period. Stature was defined in terms of height, weight, and body mass index at baseline. Growth was defined in terms of change during follow-up in height, weight, and body mass index. Total fat provided a mean of 27.1% of caloric intake in the lowest quintile of intake compared with 38.4% in the highest quintile. There were no differences in stature or growth across quintiles of children defined by consumption of total fat, saturated fat, or cholesterol. These findings were consistent across the two methods of diet assessment. Children who consumed a smaller percentage of total calories from fat consumed significantly less total calories, saturated fat, cholesterol, calcium, and phosphorus, as well as more carbohydrates, iron, thiamine, niacin, vitamin A, and vitamin C.

Conclusions. These data support the safety of a moderately reduced fat diet in healthy preschool children. Maintenance of calcium and phosphorus intake should be part of any program of dietary fat reduction. Substitution of low-fat milk for whole milk, rather than elimination of whole milk, is one such strategy.

Relationships of dietary fat consumption to serum total and low-density lipoprotein cholesterol in hispanic preschool children

Preventive medicine 1991 Mar 20(2):237-49

Shea S, Basch CE, Irigoyen M, Zybert P, Rips JL, Contento I, Gutin B.

Department of Medicine, Columbia University, New York, NY 10032


BACKGROUND: Studies of the relationship between dietary fat intake and serum lipids in young children have yielded inconclusive results. We studied this relationship in 108 Hispanic children ages 4-5 years.

METHODS: Four 24-hr recalls approximately 3 months apart and two Willett semiquantitative food frequency questionnaires approximately 6 months apart were obtained by interviewing the children's mothers. Diet measures were averaged for the multiple administrations of each of these instruments.

RESULTS: Based on the 24-hr recalls, children in the highest tertile of total fat consumption (36.2% of total calories) compared with the lowest tertile (30.2% of total calories) had mean total serum cholesterol of 4.32 mmol/liter (167 mg/dl) vs 3.91 mmol/liter (151 mg/d) (test for linear trend across tertiles, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.74 mmol/liter (106 mg/dl) vs 2.29 mmol/liter (89 mg/dl) (test for linear trend, P less than 0.01). Children in the highest tertile of saturated fat consumption (14.6% of total calories) compared with the lowest tertile (11.2% of total calories) had mean total serum cholesterol of 4.39 mmol/liter (170 mg/dl) vs 3.97 mmol/liter (154 mg/dl) (test for linear trend, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.80 mmol/liter (108 mg/dl) vs 2.35 mmol/liter (91 mg/dl) (test for linear trend, P less than 0.01). These relationships remained significant when calorie-adjusted nutrient intakes were examined and after adjustment in multiple linear regression models for age, sex, and body mass index, with the exception of the association of calorie-adjusted total fat with total serum cholesterol level (P = 0.07). Similar results were obtained using the Willett questionnaires.

CONCLUSIONS: These findings indicate that dietary fat, particularly saturated fat consumption, is an important correlate of blood lipid levels in preschool children. These are also the first reported data indicating that the Willett questionnaire, as a method for measuring the atherogenic components of diet, has criterion-related validity in young children. 

Nutrient Adequacy of Low Fat Intakes for Children: The Bogalusa Heart Study
PEDIATRICS Vol. 89 No. 2 February 1992, pp. 221-228

Theresa A. Nicklas Dr PH, LDN1, Larry S. Webber PhD2, Mary Lynn Koschak MPH, RD1, , Gerald S. Berenson MD1

1 From the Department of Medicine, Louisiana State University Medical Center, New Orleans, Louisiana
2 From the Biometry and Human Genetics, Louisiana State University Medical Center, New Orleans, Louisiana

Nutritional adequacy is important when diets and dietary alterations are recommended for children. Concern is expressed that low fat intakes may have deleterious effects on growth and development and may be deficient in total calories and essential nutrients. In a study of the effect of variation in percent fat in the diet, a sample of 871 ten-year-olds was stratified according to four different fat intakes: <30% of total kilocalories (kcal), 30% to 35% kcal, 35% to 40% kcal, and >40% kcal. The race/sex distribution was similar within each fat intake group. Fourteen percent of the sample had fat intakes less than 30% of total calories. The amount of calories from breakfast, dinner, and snacks was higher in the children with fat intakes >40% of total calories than those with lower fat intakes. The energy intake of all race/sex groups fell within the recommended range. The low fat intake group was eating 25% less calories than the high fat intake group (1800 kcal vs 2400 kcal). The percentage of calories from carbohydrate, specifically sugar, was greater in the low fat intake group compared with the high fat intake group. Percentage of calories from protein was approximately 13% for all groups. Fiber and starch were the same across allfat intakes. The major fat sources (percentage of total calories), in rank order, in the high fat intake group (>40% kcal) were meats (31%), dairy (16%), fats and oils (10%), and prepared vegetables (10%); whereas in the low fat intake group (<30% kcal) they were dairy (23%), meats (16%), breads (13%), and desserts (12%). Percentage of calories from saturated fat was higher in the high fat intake group (18%) than in the low fat intake group (11%). Interestingly, mean intake of sugar was greater in the low fat intake group (160 g) than in the high fat intake group (129 g). Percentage of total sugar intake in the low and high fat intake groups came from candy (29% vs 21%), beverages (25% vs 19%), and desserts (11% vs 14%). Based on the differences in total caloric intakes, the following is acomparison of the percentage of the high fat intake group vs the percentage of the low fat intake group not meeting the Recommended Dietary Allowances for the following nutrients: vitamins B6 (69% vs 77%), B12 (36% vs 70%), and E (23% vs 55%); thiamin (40% vs 58%), riboflavin (25% vs 45%), and niacin (41% vs 64%). Differences were less dramatic for folacin and iron. Obviously, attention has to be given to overall nutrient adequacy when dietary fat recommendations are made. 

Nutrient intake and food group consumption of 10-year-olds by sugar intake level: the Bogalusa Heart Study
Journal of the American College of Nutrition 1998 Dec 17(6):579-85

Farris RPNicklas TAMyers LBerenson GS.

Tulane Center for Cardiovascular Health, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112-2824


OBJECTIVE: The effect of total sugar intake on nutrient intake and food group consumption was examined in children.

METHODS: Twenty-four hour dietary recalls were collected on a sample of 568 ten-year-olds from two cross-sectional surveys. The population was stratified according to total sugar intake quartiles: < or = 25th (46 g/1000 kcal), 25-50th (67 g/1000 kcal), 50-75th (81 g/1000 kcal) and > or = 75th (106 g/1000 kcal).

RESULTS: No significant difference was shown in energy intakes across the quartiles and no significant race or gender differences were observed in mean total sugar intakes. However, with increasing total sugar intake, there was a significant linear decrease in mean intakes of protein, fat, saturated fat, starch, cholesterol, sodium, vitamins B6 and E, thiamin, niacin, iron, and zinc; and a significant linear increase in mean intakes of carbohydrate, fructose, lactose, sucrose, vitamin D, and calcium. Eating patterns reflected the differing nutrient intakes, with high sugar consumers having significantly higher intakes of total g of candy, beverages and milk and lower intakes of total g of meats, and cheese than lower sugar consumers. The nutritional quality of children's diets high in total sugar appear to be adequate regarding vitamin and mineral intakes and are closer to meeting current dietary fat recommendations.