European Journal of Clinical Nutrition (2012) 66, 10–17
& 2012 Macmillan Publishers Limited All rights reserved 0954-3007/12
www.nature.com/ejcn
ORIGINAL ARTICLE
The contribution of breakfast cereals to the
nutritional intake of the materially deprived
UK population
BA Holmes1, N Kaffa, K Campbell and TAB Sanders
King’s College London, Diabetes & Nutritional Sciences Division, School of Medicine, London, UK
Background/Objectives: Breakfast is an important source of micronutrients in the diet and its consumption has been linked to
positive health outcomes. The present analysis investigated the contribution that breakfast cereals make to the nutrient intakes
of the materially deprived (low income) UK population.
Subjects/Methods: Data for 3728 respondents aged 2 years and over from the UK Low Income Diet and Nutrition Survey
(2003–2005) were analysed. Nutrient intakes of consumers and non-consumers of breakfast cereal were compared.
Results: Breakfast cereals were consumed by 49% of men, 58% of women, 80% of boys and 80% of girls, and median intakes
were: 35, 25, 29 and 21 g/d, respectively. Consumers of breakfast cereals had higher intakes of thiamin, riboflavin, niacin, biotin,
folate, vitamin B6, vitamin B12, iron and zinc than non-consumers. Breakfast cereal consumption was also related to higher
intakes of calcium, attributable to higher milk consumption. The intake of wholegrain and high-fibre breakfast cereals was
associated with a higher intake of non-starch polysaccharides. Intakes of niacin, biotin, calcium and zinc were higher but that of
vitamin B6 was lower among consumers of exclusively wholegrain and high-fibre breakfast cereals compared with consumers
of other breakfast cereals. There were no significant differences observed in intakes of non-milk extrinsic sugars according to type
of breakfast cereal consumed.
Conclusions: Breakfast cereals make a significant contribution to the micronutrient intake of the low-income UK population.
European Journal of Clinical Nutrition (2012) 66, 10 – 17; doi:10.1038/ejcn.2011.143; published online 10 August 2011
Keywords: breakfast cereal; fibre; low income; UK
Introduction
Breakfast consumption, in particular breakfast cereal consumption, has been linked to higher micronutrient intakes
and positive health outcomes (Nicklas et al., 2004; Song
et al., 2006; Van den Boom et al., 2006; Wilson et al., 2006;
Williams, 2007; Albertson et al., 2008). There is evidence to
suggest that lower-income or disadvantaged populations
may be less likely to consume breakfast (Keski-Rahkonen
et al., 2003), particularly children and adolescents
Correspondence: Dr BA Holmes, Danone Research, Global Nutrition
Department, RD 128, Palaiseau Cedex 91767, France.
E-mail: [email protected]
1
Current address: Danone Research, Global Nutrition Department, Palaiseau
Cedex, France.
Contributors: BH was involved in all stages of LIDNS, the analysis and the
manuscript. TS was involved in the scientific report carried out at Kings
College London, the analysis and the manuscript. NK and KC were involved in
the scientific report and commented on the manuscript.
Received 19 April 2010; revised 27 June 2011; accepted 28 June 2011;
published online 10 August 2011
(O’Dea and Caputi, 2001; Moore et al., 2007; Timlin et al.,
2008; Merten et al., 2009; Deshmukh-Taskar et al., 2010). It
has also been suggested that they are more likely to consume
less healthful breakfasts that do not include fruits or cereals
(Moore et al., 2007).
Cereal grains, especially wholegrains, are a rich source of
B-complex vitamins, and breakfast cereals in the United
Kingdom (UK) are also often fortified with vitamin D, folic
acid, vitamin B12, iron and zinc (Williamson, 2010). Several
reports have indicated that consumers of breakfast cereal
have higher micronutrient intakes compared with nonconsumers, and are thus more likely to meet micronutrient
recommendations especially for riboflavin, folate, vitamin
B6, calcium, zinc and iron (Crawley, 1993; Nicklas et al.,
1998, 2004; Galvin et al., 2002; Van den Boom et al., 2006).
However, breakfast cereals are usually consumed with milk,
which is a significant source of calcium and riboflavin, and
this is likely to be an important determinant of the higher
calcium and riboflavin intake reported among consumers.
Consumption of breakfast cereals is associated with higher
Contribution of breakfast cereals to low-income diets
BA Holmes et al
11
intakes of several micronutrients in preschool children
(Ruxton and Kirk, 1997), school children and adolescents
(Crawley, 1993; Nicklas et al., 1993, 1995; Gibson and
O’Sullivan, 1995; Ruxton et al., 1996; Van den Boom et al.,
2006; Williams, 2007; Deshmukh-Taskar et al., 2010), and
adults (McNulty et al., 1994). Breakfast consumption is also
associated with higher intakes of fibre (Ruxton and Kirk,
1997; Barton et al., 2005; Rampersaud et al., 2005; Van den
Boom et al., 2006).
The Low Income Diet and Nutrition Survey (LIDNS), a
national survey of materially deprived (low-income)
individuals in the UK, showed that the consumption of
wholegrain and high-fibre (WGHF) breakfast cereals was
lower for deprived individuals compared with the UK general
population (National Diet and Nutrition Surveys (NDNS)) for
the majority of age and sex groups (boys 46% vs 52%, girls
42% vs 45%, 19–64 years: men 24–31% vs 46%, women
27–37% vs 50%, 65 years and over: men 48% vs 51%, women
52% vs 50%) (Finch et al., 1998; Henderson et al., 2002;
Nelson et al., 2007; Bates et al., 2009). Breakfast cereals
contributed less to non-starch polysaccharide (NSP) intakes
in adults in LIDNS compared with NDNS (19–64 years: men
4% vs 11%, women 5% vs 12%, 65 years and over: men 9% vs
12%, women 9% vs 13%) (Henderson et al., 2003a; Nelson
et al., 2007). The contribution of WGHF breakfast cereals to
NSP intakes in children aged 4–18 years in LIDNS was also
lower than in NDNS (boys 7% vs 10%, girls 5% vs 8%)
(Gregory et al., 2000; Nelson et al., 2007). In LIDNS, breakfast
cereals contributed significantly to intakes of iron in the lowincome population—12% in men, 15% in women, 26% in
boys and 23% in girls (of which 6, 8, 12 and 9%, respectively,
came from WGHF breakfast cereals). In men and women in
NDNS, 3–20% of micronutrient intakes came from breakfast
cereals, with significant contributions to intakes of B
vitamins (8–16%) and vitamin D (12–14%) (Henderson
et al., 2003b). Differences between the surveys in age groups
for children (LIDNS 2–18 years, NDNS 4–18 years) as well as
methodological differences described elsewhere (Nelson et al.,
2007) should be noted. Although breakfast cereals generally
contributed less to the diets of the low-income population
compared with the general population, the contribution made
to intakes is likely to be important, particularly for some
subgroups, and warranted further investigation.
The aim of the present analysis was to investigate further
the contribution that breakfast cereals make to the nutrient
intakes of the low-income UK population by comparing
breakfast cereal consumers with non-consumers, and by
comparing the nutrient intakes of breakfast cereal consumers
according to the type of cereal consumed.
Materials and methods
The present study is based on secondary analysis of data
collected in LIDNS. LIDNS was commissioned by the UK
Food Standards Agency to provide a comprehensive picture
of the food consumption and nutritional status of a
nationally representative sample of respondents living in
low-income households in the UK. Details of the full LIDNS
methodology (including weighting and survey design) and
results are provided in the main survey report (Nelson et al.,
2007). Briefly, a nationally representative sample of lowincome households was identified using an index of material
deprivation assessed using a doorstep screening questionnaire. This questionnaire was based on markers of material
deprivation including receipt of benefits, household composition, car ownership and employment status. In eligible
households, up to two respondents per household were
randomly selected to take part in the survey.
The survey sample used a multistage clustered design,
selected in stages, with the cluster hierarchy being: wards,
addresses, households and individual respondents. The
target population to ‘screen-in’ was the 15% most deprived
households in the UK. In order to account for over-sampling
in certain areas and to ensure that the correct population
proportions were used in the analysis, the final dataset
was weighted so that the reported findings reflect
the demographic characteristics of the UK low-income
population as a whole.
The key stages of the survey, administered by trained
interviewers and nurses, involved a face-to-face interview
and self-completion questionnaire, dietary data collection,
anthropometric measurements (which varied by age) and
the collection of blood samples (in those 8 years and over) to
measure indices of nutritional status. Fieldwork was carried
out in five fieldwork waves from November 2003 to January
2005. Results are based on a sample of 3728 respondents
(unless specified otherwise), 37% males and 63% females,
aged 2 and over.
Dietary data collection used a 24-h recall ‘multiple pass’
method repeated on four non-consecutive days within a
10-day period, including 1 weekend day where possible. The
method was based on the principle used in the United States
(Moshfegh et al., 1999) but modified for use in the Low
Income Diet Methods Study (Nelson et al., 2003) and again
for LIDNS. Information was collected in multiple phases
within a single interview, allowing the respondent several
opportunities to recall what they ate and drank over the
previous 24-h period. Portion size was estimated using
packet weights, number of items, a photographic food atlas
(Nelson et al., 1997) or household measures. Where possible,
one of the four 24-h recalls was conducted over the
telephone. Respondents providing three or four 24-h
recalls were considered to be fully productive and were
included in the analysis. Productive interviews were held
with 55% of eligible individuals. Of the fully productive
individuals, 3656 completed all 4 recall days and 72
completed 3 days. For each respondent, the mean food and
nutrient intakes were computed over the 3 or 4 days of data
(as appropriate). The mean and median estimates of intake
for the whole sample and sample subgroups were then
European Journal of Clinical Nutrition
Contribution of breakfast cereals to low-income diets
BA Holmes et al
12
computed using these mean values for each respondent
(Nelson et al., 2007).
Intakes of nutrients were calculated from the records of
food consumption using a specially adapted nutrient
databank developed for the UK NDNS (Gregory et al., 1990;
Gregory et al., 1995, 1998, 2000; NDNS, 2003) and modified
for LIDNS with many nutrient values updated (including
new analytical values for breakfast cereals), and new codes
added to accommodate new products that had become
available and additional homemade recipes.
The following groups were created for the analysis after a
review of the LIDNS data according to breakfast cereal
consumption, and after discussions between the authors
considering the aims of the analysis: Consumers and nonconsumers of breakfast cereals (consumers were defined as
respondents who consumed breakfast cereal, regardless of
quantity, frequency or type, at some point over the 4-day
recording period), WGHF breakfast cereal consumers, and
other breakfast cereal consumers. WGHF breakfast cereals
included cereals with an NSP (Englyst fibre) content of X4 g/
100 g, for example, All Bran, muesli, Shredded Wheat and
including porridge and Ready Brek. Other breakfast cereals,
not wholegrain or high-fibre included cereals with an NSP
(Englyst fibre) content of o4 g/100 g, for example,
cornflakes, rice crispies, Coco Pops, Sugar Puffs.
Consumers according to cereal type were identified as a
result of food groupings used in LIDNS (Nelson et al., 2007),
based on those used in NDNS (Henderson et al., 2002).
Respondents consuming both types of cereal (WGHF and
other breakfast cereals) were excluded from the analysis
comparing the two types of cereal consumers. Overall, 485
subjects (unweighted) consumed both types of cereal and
were excluded from these analyses (representing 13% of the
full sample, 6% of children and 7% of adults).
Data analysis was carried out using SPSS Version 17.0 (SPSS
Inc, 2010). Multivariate analysis of variance was used to test
for differences between consumers and non-consumers by
age group, and comparisons between subgroups use a
Bonferroni post-hoc test that was only conducted where
there was a statistically significant interaction between the
age and gender group, and cereal intake category. In order to
minimize spurious statistical significance from multiple tests,
Po0.01 was set to signify statistical significance. Comparisons
between the proportions of participants meeting the reference
nutrient intakes for micronutrients were done with Pearson’s
w2-test. All values are weighted unless specified otherwise.
Nutrient intake data excludes dietary supplements. No adjustments were made in the analysis for mis-reporting of data. Boys
and girls refer to those aged 2–18 years, and men and women
refer to those aged 19 years and over.
Results
Table 1 shows the mean age and body mass index of the
study population according to reported breakfast cereal
consumption. Fewer men consumed breakfast cereal than
women (49% vs 58%) (Table 2). Men aged 35–49 years were
the least likely to be consumers of breakfast cereals (35%),
and women aged 65 years and over were most likely to be
consumers (72%). On an average 24% of men and 27% of
women reporting being consumers of only WGHF breakfast
cereals accounting for 44 and 41% of breakfast cereal
consumers, respectively. Boys and girls aged 2–18 years were
more likely to consume breakfast cereals (both 80%). The
proportion of consumers was greater among younger
children aged 2–10 years (89% of boys and 88% of girls)
compared with 67 and 70% in boys and girls aged 11–18
years. WGHF breakfast cereals were consumed by 20% of
boys and 19% of girls accounting for 36 and 29% of breakfast
cereal consumers, respectively, a lower proportion than
observed in adults. The median intake among consumers
of breakfast cereals was 10 g greater in men than women and
4 g and 7 g greater in boys than women and girls respectively.
The median intake among consumers of WGHF breakfast
cereals was 10 g higher in men than women and 10 g higher
in boys than girls.
Breakfast cereal consumers vs non-breakfast cereal consumers
Energy intakes did not differ between consumers and nonconsumers of breakfast cereals (Table 3). The proportion of
Table 1 Age and BMI of adults (19 years and over) and children (2–18 years) in the LIDNS survey, by cereal consumers and non-consumers
Cereal consumer
Men
Women
Boys
Yes
Girls
Yes
No
Yes
No
No
Yes
Age (years)
n (unweighted)
Mean (s.d.)
481
54.7 (19.8)
465
48.1 (18.4)
1057
54.6 (21.2)
793
46.0 (18.7)
340
8.9 (4.3)
99
11.8 (4.8)
394
8.6 (4.5)
99
12.1 (4.2)
BMI (kg/m2 )
n (unweighted)
Mean (s.d.)
452
27.0 (5.1)
427
27.3 (5.3)
983
28.1 (6.1)
752
28.0 (7.1)
323
18.7 (4.2)
92
20.5 (4.7)
376
19.2 (4.2)
94
20.9 (4.0)
Abbreviations: BMI, body mass index; LIDNS, Low Income Diet and Nutrition Survey.
No statistical difference in BMI according to breakfast cereal consumption: univariate analysis of variance adjusted for age and gender.
European Journal of Clinical Nutrition
No
Contribution of breakfast cereals to low-income diets
BA Holmes et al
13
Table 2 Mean daily intake of breakfast cereals (grams/day) by adults (19 years and over) and children (2–18 years) in the LIDNS survey in all participants
and in consumers only
All breakfast cereals
WGHF breakfast cereals only
Men
Women
Boys
Girls
Men
Women
Boys
Girls
All participants
n (unweighted)
Mean (s.d.)
Median
946
28.3 (59.1)
0.0
1850
22.5 (40.0)
9.5
439
29.8 (33.7)
21.1
493
22.8 (30.7)
17.5
946
22.4 (58.3)
0.0
1850
17.0 (39.4)
0.0
439
15.8 (31.2)
0.0
493
12.4 (29.6)
0.0
Consumers only
n (unweighted)
% consumers
Mean (s.d.)
Median
481
49
58.0 (73.8)
35.0
1057
58
39.1 (46.2)
25.0
340
80
37.4 (33.8)
28.8
394
80
28.5 (31.9)
21.3
212
24
72.7 (89.7)
40.0
434
27
48.6 (54.4)
30.0
121
20
43.1 (46.8)
30.8
113
19
34.1 (48.4)
20.0
Abbreviations: LIDNS, Low Income Diet and Nutrition Survey; WGHF, wholegrain and high fibre.
Table 3 Mean daily intake of selected nutrients by adults (19 years and over) and children (2–18 years) in the LIDNS survey according to reported
consumption of breakfast cereals
Cereal consumer
n (unweighted)
Energy (MJ/day)
Protein (% en)
Total fat (% en)
Saturated fat (% en)
Carbohydrate (% en)
NMES (% en)
NSP (g)
Thiamin (mg)
Riboflavin (mg)
Niacin (mg)
Folate (mg)
Biotin (mg)
Vitamin B6 (mg)
Vitamin B12 (mg)
Vitamin D (mg)
Calcium (mg)
Iron (mg)
Zinc (mg)
Men
Women
Boys
P-valuea
Girls
Yes
No
Yes
No
Yes
No
Yes
No
481
8.95±2.52
16.2±3.4
35.4±6.2
13.7±3.4
48.3±6.3
13.4±7.0*
13.9±5.3**
1.84±0.63
2.11±0.87
11.6±6.1
306±120
34.9±15.1
2.5±0.8
6.6±4.4
3.7±2.5**
1000±418
12.4±4.0
9.5±3.2
465
8.17±2.61
16.3±3.8
36.4±7.8
13.7±4.2
47.3±8.5
15.6±10.1
11.5±5.4
1.34±0.59
1.46±0.70
7.2±5.9
245±126
30.7±16.6
2.1±1.1
5.8±7.0
2.9±2.0
780±364
9.7±4.3
8.7±3.9
1057
6.92±2.11
16.4±3.6
34.1±6.6**
13.7±3.8
49.5±6.4
12.8±6.9
11.6±4.6**
1.48±0.54
1.67±0.68
8.3±4.4
240±94
25.0±10.1**
1.9±0.7
4.9±3.4
2.5±1.7
772±306
9.9±3.5
7.1±2.6**
793
6.67±2.15
16.0±3.8
36.6±7.1
13.8±4.0
47.4±7.6
13.4±8.7
9.6±3.8
1.07±0.36
1.14±0.55
4.5±3.5
178±79
22.0±11.9
1.6±0.8
4.4±4.7
2.5±2.9
635±268
7.2±2.9
6.5±2.3
340
8.47±2.33
13.1±2.5
35.5±4.8**
14.2±2.8
51.4±5.6
17.7±6.6*
11.2±4.2
1.71±0.73
1.80±0.85
10.6±5.9
222±89
24.4±10.7
2.2±1.0
4.7±2.6
2.2±1.4
887±374
10.7±4.6
7.2±2.9
99
8.26±2.83
13.3±2.5
38.3±4.8
14.2±2.7
48.3±5.4
14.9±6.8
10.8±4.4
1.24±0.66
1.11±0.69
4.5±3.4
162±69
22.0±11.8
1.6±0.8
3.5±2.3
2.1±1.3
747±381
7.4±3.1
6.9±2.8
394
7.54±2.17
13.2±2.6
35.4±4.9
14.2±2.9
51.3±5.3
16.2±5.9
10.3±3.9
1.43±0.52
1.46±0.58
7.8±3.6
197±69
21.8±12.0
1.9±0.7
3.9±2.1
1.9±1.2
750±310
8.9±3.0
6.2±2.4
99
7.56±2.15
13.4±3.3
36.8±5.2
13.3±2.8
49.8±5.8
17.9±8.4
9.7±3.5
1.14±0.48
0.90±0.38
3.9±2.2
146±55
18.4±7.8
1.6±0.6
3.0±1.7
1.9±1.0
576±233
6.8±2.1
6.0±2.1
0.028b
0.128
0.006b
0.097
o0.0001
o0.0001b
o0.0001b
o0.0001
o0.0001
o0.0001
o0.0001
o0.0001
o0.0001
o0.0001
0.0001b
o0.0001
0.0005
o0.0001
Abbreviations: LIDNS, Low Income Diet and Nutrition Survey; NMES, non-milk extrinsic sugars; NSP, non-starch polysaccharide; % en, percentage of energy.
Mean values±s.d.; *Po0.01 and **Po0.001 compared consumers with non-consumers using a Bonferroni multiple comparison test only if the consumer/nonconsumer group interaction was Po0.01.
a
Probability is from multivariate analysis of variance with consumer/non-consumer and age group as factors.
b
A significant age group consumer/non-consumer interaction.
energy derived from fat was 1–2% lower and that derived
from carbohydrates correspondingly higher. There were no
consistent differences between consumers in the intake of
non-milk extrinsic sugars (NMES) with intakes lower in men
but greater in boys who were consumers. Mean intakes of
NSP were significantly higher in consumers of breakfast
cereals for men and women, but no significant differences
were noted among children. Mean intakes of thiamin,
riboflavin, niacin, biotin, vitamin B6, vitamin B12, folate,
calcium, iron and zinc were consistently higher in the
consumers of breakfast cereals for all groups. The high
calcium intake is unlikely to be attributable to cereal intake
as cereals are a poor source of calcium. Milk intake was
significantly greater (Po0.00001) among consumers of
breakfast cereals compared with non-consumers. The mean
daily intake of milk in ml with 99% confidence interval for
consumers vs non-consumers were: men 290 (268, 312) vs
160 (139, 181); women 234 (220, 250) vs 153 (136, 171); boys
267 (247, 288) vs 155 (114, 196); girls 202 (181, 223) vs 101
(58, 144).
European Journal of Clinical Nutrition
Contribution of breakfast cereals to low-income diets
BA Holmes et al
14
In both consumers and non-consumers of breakfast
cereals, average micronutrient intakes generally exceeded
the UK reference nutrient intake with some exceptions
including iron, folate, zinc in some groups. A significantly
higher proportion of respondents who consumed breakfast
cereals met the reference nutrient intake for micronutrients
Table 4 Proportions (%) of adults (19 years and over) and children
(2–18 years) in the LIDNS survey meeting the UK RNI for selected
micronutrients according to reported consumption of breakfast cereals
Cereal consumer
n (unweighted)
Thiamin
Riboflavin
Niacin equivalents
Folate
Vitamin B6
Vitamin B12
Calcium
Iron
Zinc
Men
Women
Boys
Girls
Yes
No
Yes
No
Yes
No
Yes
No
481
97**
86**
98**
85**
94**
99**
80**
83**
48**
465
72
55
93
58
73
95
55
54
33
1057
92**
83**
99**
62**
88**
97**
54**
38**
47
793
78
46
96
29
70
89
33
10
38
340
98**
85**
100**
84**
97**
100**
69**
61**
44
99
84
37
95
43
67
91
38
15
30
394
98**
82**
98
76**
98**
99**
67**
38**
29
99
81
31
96
25
79
93
39
13
24
with the greatest differences observed for riboflavin, folate
and iron (Table 4).
WGHF breakfast cereal consumers vs other breakfast cereal
consumers
Table 5 shows the comparison between consumers of WGHF
breakfast cereals and consumers of other cereals. In contrast
to the results of the consumers vs non-consumers of
breakfast cereals, there were few statistically significant
differences. Overall the intakes of NSP, niacin, biotin,
calcium and zinc, and the proportion of energy derived
from protein were higher in those consuming WGHF cereals.
Intakes of vitamin B6 on the other hand tended to be lower
in the male participants consuming WGHF cereals. There
were no significant differences in NMES between groups.
Discussion
Abbreviations: LIDNS, Low Income Diet and Nutrition Survey; RNI, reference
nutrient intake.
**Po0.001 compared with non-consumers using a w2-test.
The analyses allowed comparisons to be made between
nutrient intakes of the low-income UK population according
to breakfast cereal consumption. The results highlight the
important contribution that breakfast cereals appear to make
to the daily nutrient intakes of consumers in the low-income
population. The results showed that the proportion of
energy derived from fat was 1–2% lower and that of
Table 5 Mean daily intake of selected nutrients by adults (19 years and over) and children (2–18 years) in the LIDNS survey according to whether they
reported consuming WGHF or other breakfast cereal
Cereal type
n (unweighted)
Energy (MJ/day)
Protein (% en)
Total fat (% en)
Saturated fat (% en)
Carbohydrate (% en)
NMES (% en)
NSP (g)
Thiamin (mg)
Riboflavin (mg)
Niacin (mg)
Folate (mg)
Biotin (mg)
Vitamin B6 (mg)
Vitamin B12 (mg)
Vitamin D (mg)
Calcium (mg)
Iron (mg)
Zinc (mg)
Men
Women
Boys
P-valuea
Girls
WGHF
Other
WGHF
Other
WGHF
Other
WGHF
Other
234
8.89±2.53
16.6±3.4
35.5±6.5
13.6±3.5
47.9±6.2
12.9±6.7
15.6±5.4
1.8±0.6
2.0±0.9
10.6±6.0
301±112
36.6±15.3
2.4±0.9*
6.7±4.9
3.7±2.3
1009±417
12.1±4.0
9.9±3.2
160
8.69±2.28
15.8±3.4
35.4±6.0
13.8±3.3
48.9±6.4
14.2±7.9
11.2±4.1
1.7±0.5
2.0±0.7
11.3±5.1
294±114
31.2±14.6
2.6±0.8
6.1±3.8
3.7±2.2
908±332
12.1±4.0
8.7±3.1
481
6.82±2.01
16.7±3.6
34.1±6.6
13.7±3.8
49.1±6.3
12.1±6.6
12.6±4.8
1.5±0.5
1.6±0.6
8.0±4.5
238±88
25.4±9.3
1.8±0.6
4.7±2.5
2.5±1.7
788±287
9.5±3.2
7.3±2.6
398
6.84±2.22
15.9±3.7
34.5±6.2
13.9±3.7
49.6±6.2
13.8±7.6
9.5±4.0
1.4±0.5
1.6±0.7
7.9±4.2
223±93
22.9±9.9
2.0±0.7
5.0±4.0
2.4±1.6
714±322
9.5±3.6
6.7±2.7
94
7.88±2.35
13.2±2.6
35.1±5.5
14.2±2.8
51.7±6.1
17.6±8.1
12.3±4.7
1.7±0.9
1.7±1.0
11.8±6.9*
224±93
23.1±9.6
2.0±1.0*
4.1±2.2
1.8±1.3
846±434
10.5±5.7
6.8±2.8
140
8.31±2.24
12.8±2.3
35.6±4.7
13.9±2.7
51.6±5.4
18.4±6.7
10.0±3.7
1.6±0.6
1.5±0.7
8.4±4.5
200±73
22.4±10.8
2.2±1.0
4.3±2.2
2.1±1.2
801±323
9.7±3.7
6.6±2.7
101
7.42±1.90
13.4±2.6
35.6±4.5
14.4±2.9
50.9±4.8
16.4±4.9
10.9±4.0
1.4±0.5
1.4±0.6
7.2±3.9
187±65
21.0±8.5
1.8±0.8
3.9±1.9
2.0±1.5
753±319
8.4±3.0
6.2±2.1
179
7.48±2.34
13.0±2.8
35.0±5.2
13.9±2.7
52.0±5.6
16.1±6.4
10.1±4.0
1.4±0.5
1.4±0.6
7.2±3.2
200±73
21.6±13.9
1.9±0.6
3.8±2.2
1.8±1.1
719±304
8.8±3.1
6.1±2.7
0.47
0.001
0.61
0.38
0.02
0.13
o0.0001
0.051
0.10
0.006b
0.009b
o0.0001
o0.009b
0.65
0.76
0.0003
0.87
0.0003
Abbreviations: LIDNS, Low Income Diet and Nutrition Survey; NMES, non-milk extrinsic sugars; NSP, non-starch polysaccharide; RNI, reference nutrient intake;
WGHF, wholegrain and high fibre; % en, percentage of energy.
Mean values±s.d.; *Po0.01 and **Po0.001 compared test with other breakfast cereals using a Bonferroni multiple comparison test only if the cereal type x group
interaction was Po0.01.
a
Probability is from multivariate analysis of variance with cereal type and age group as factors.
b
Denotes a significant age group cereal type interaction.
European Journal of Clinical Nutrition
Contribution of breakfast cereals to low-income diets
BA Holmes et al
15
carbohydrate was 1–2% higher in consumers compared
with non-consumers with no difference in saturated
fatty acid intake between groups. This finding is in
agreement with other reports (McNulty et al., 1996;
Barton et al., 2005; Song et al., 2006; Deshmukh-Taskar
et al., 2010). Skipping breakfast has also been associated with
increased snacking, especially of high fat snacks (Kirk et al.,
1997; Sjoberg et al., 2003). However, the present study found
no evidence to suggest that reported energy intakes or body
mass index were higher in non-consumers of breakfast
cereals.
It is widely believed that breakfast cereals are an important
source of NMES and the UK government have imposed
restrictions on advertising breakfast cereals on television to
children that are high in NMES (Ofcom, 2006). The present
study found no consistent association between breakfast
cereal intake and intake of NMES. With regard to sugar
intakes and breakfast cereal consumption, the evidence in
the literature is also conflicting. Sugar intakes were higher in
breakfast consumers in some studies (Nicklas et al., 2000;
Galvin et al., 2002; Sjoberg et al., 2003) but lower in others
(Nicklas et al., 1993) although these studies were not
restricted to breakfast cereal. Secondary analysis of NDNS
data for children 1.5–4.5years indicated that children with
diets high in breakfast cereals as a percentage of their total
energy had a lower proportional intake of NMES, compared
with low consumers of breakfast cereals. Consumption of
sweetened cereals was, however, positively associated with
NMES intake (Gibson, 1999). It has also been suggested that
even though some types of breakfast cereals contain added
sugar they remain good sources of micronutrients and have a
positive impact on diet quality (Gibson, 2003; Gibson and
Boyd, 2009). This conclusion is supported by the findings of
the present study.
Most of the previous studies agree that breakfast consumers are more likely to have a better overall diet quality
and nutrient intakes that more often align with current
dietary recommendations (Rampersaud et al., 2005). Breakfast consumers have previously been reported to make better
choices throughout the day, for example, consuming more
vegetables and milk, and less soft drinks (Lattimore and
Halford, 2003). Along with the evidence that breakfast
consumers make better dietary choices overall, it seems that
breakfast and cereal consumption may be one component of
an overall healthy lifestyle that helps to maintain adequate
nutrient intake, healthy body weight (Barton et al., 2005)
and promote positive health outcomes (Albertson et al.,
2008). Pilot studies in adults and children suggest that both
breakfast frequency and composition may have important
effects on a variety of factors, supporting the evidence that a
nutritious breakfast is a key factor in promoting healthy
body weight, chronic disease risk reduction and positive
mental health (Pereira et al., 2011).
The separation of the types of breakfast cereals based on
NSP content highlighted that consumers of WGHF breakfast
cereals had, not surprisingly, a higher intake of NSP.
However, there were few significant differences in micronutrient intake. In part this is likely to be a consequence of
the widespread voluntary fortification of breakfast cereals
with vitamins and minerals in the UK. The addition of
vitamins and minerals to breakfast cereals is not permitted in
several European countries, notably France and Denmark.
Higher intakes of NSP from breakfast cereals have also been
linked to high intakes of NSP from other sources (Emmett
et al., 1993), indicating that the rest of the diet reflects the
choice of cereal.
Overall, the analyses demonstrate the benefits of consuming breakfast cereals seen through higher micronutrient
intakes in all groups. With the exception of NSP intake, the
benefits observed appeared to be apparent regardless of the
type of cereal consumed. The findings have implications for
dieticians and those who might promote the importance of
eating breakfast or run breakfast programs, such as those
based in schools. The challenge of promoting the potential
benefits of breakfast, particularly with reference to lowincome groups, is to ensure that a distinction is made
between promoting a nutrient-rich breakfast cereal, as
opposed to simply promoting breakfast per se.
The present analysis has some limitations that
are acknowledged by the authors. The definition of breakfast
cereal consumers means that subjects were identified as
consumers if they consumed breakfast cereal at some
point over the 4 days for which dietary data were collected.
Some subjects will have consumed breakfast cereal only
once during the 4 days, while others will have consumed it
more regularly, for example, on a daily basis, and possibly
even more than once a day. The analysis does not, therefore,
take into account any link between frequency of consumption of breakfast cereal, or low and high consumption
of breakfast cereal and nutrient intake. Additionally, breakfast cereals may have been consumed at any occasion during
the day, that is, not only at breakfast time. Analysis to
further investigate nutrient intakes according to frequency
of breakfast cereal consumption, low, medium and high
levels of intake, and breakfast cereal consumption according
to a meal name or predefined time would be an interesting
next step. Finally, due to the cross-sectional design of this
survey, it is difficult to examine links between breakfast
cereal consumption, nutrient intake and BMI, and thus
further research in this population conducted over time is
needed.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
LIDNS was funded by the Food Standards Agency and carried
out by the National Centre for Social Research, King’s
European Journal of Clinical Nutrition
Contribution of breakfast cereals to low-income diets
BA Holmes et al
16
College London, and the Royal Free and University College
London Medical School. The literature review and secondary
analysis was carried out for Kings College London through
additional monies obtained from the Association of Cereal
Food Manufacturers (ACFM). The authors gratefully
acknowledge the FSA, ACFM and Caroline Lynch from
Nexus Communications Group.
References
Albertson AM, Thompson D, Franko DL, Kleinman RE, Barton BA,
Crockett SJ (2008). Consumption of breakfast cereal is associated
with positive health outcomes: evidence from the National Heart,
Lung, and Blood Institute Growth and Health Study. Nutr Res 28,
744–752.
Barton BA, Eldridge AL, Thompson D, Affenito SG, Striegel-Moore
RH, Franko DL et al. (2005). 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 105, 1383–1389.
Bates B, Lennox A, Swan G (2009). National Diet and Nutrition Survey.
Headline Results from Year One of the Rolling Programme (2008/2009).
London.
Crawley HF (1993). The role of breakfast cereals in the diets of 16–17year-old teenagers in Britain. J Hum Nutr Diet 6, 205–216.
Deshmukh-Taskar PR, Nicklas TA, O’Neil CE, Keast DR, Radcliffe JD,
Cho S (2010). 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. J Am Diet Assoc 110, 869–878.
Emmett PM, Symes CL, Heaton KW (1993). The contribution of
breakfast cereals to non-starch polysaccharide intakes in English
men and women. J Hum Nutr Diet 6, 217–222.
Finch S, Doyle W, Lowe C, Bates CJ, Prentice A, Smithers G et al.
(1998). National Diet and Nutrition Survey: People Aged 65 Years and
Over. Volume 1: Report of the Diet and Nutrition Survey. TSO: London.
Galvin M, Kiely M, Flynn A (2002). Impact of ready-to-eat breakfast
cereal (RTEBC) consumption on adequacy of micronutrient
intakes and compliance with dietary recommendations in Irish
adults. Public Health Nutr 6, 351–363.
Gibson S (1999). Breakfast cereal consumption in young children:
associations with non-milk extrinsic sugars and caries experience:
further analysis of data from the UK National Diet and Nutrition
Survey of children aged 1.5–4.5 years. Public Health Nutr 3,
227–232.
Gibson S (2003). Micronutrient intakes, micronutrient status and
lipid profiles among young people consuming different amounts
of breakfast cereals: further analysis of data from the National Diet
and Nutrition Survey of Young People aged 4 to 18 years. Public
Health Nutr 6, 815–820.
Gibson SA, Boyd A (2009). Associations between added sugars and
micronutrient intakes and status: further analysis of data from the
National Diet and Nutrition Survey of Young People aged 4 to 18
years. Br J Nutr 101, 100–107.
Gibson SA, O’Sullivan KR (1995). Breakfast cereal consumption
patterns and nutrient intakes of British schoolchildren. J R Soc
Promot Health 115, 366–370.
Gregory J, Foster K, Tyler H, Wiseman H. (1990). The Dietary and
Nutritional Survey of British Adults. HMSO: London.
Gregory JR, Collins DL, Davies PSW, Hughes JM, Clarke PC (1995).
National Diet and Nutrition Survey: Children Aged 1.5 to 4.5 Years.
Volume 1: Report of the Diet and Nutrition Survey. HMSO: London.
Gregory JR, Lowe S, Bates CJ, Prentice A, Jackson LV, Smithers G et al.
(2000). National Diet and Nutrition Survey: Young People Aged 4 to 18
Years. Volume1: Report of the Diet and Nutrition Survey. TSO: London.
European Journal of Clinical Nutrition
Henderson L, Gregory J, Swan G (2002). National Diet and Nutrition
Survey: Adults Aged 19 to 64 years. Volume 1: Types and Quantities
of Food Consumed. TSO: London.
Henderson L, Gregory J, Irving K, Swan G (2003a). National Diet and
Nutrition Survey: Adults Aged 19 to 64 Years. Volume 2: Energy,
Protein, Carbohydrate, Fat and Alcohol Intake. TSO: London.
Henderson L, Irving K, Gregory J, Bates CJ, Prentice A, Perks J et al.
(2003b). National Diet and Nutrition Survey: Adults Aged 19 to 64
years. Volume 3: Vitamin and Mineral Intake and Urinary Analytes.
TSO: London.
Keski-Rahkonen A, Kaprio J, Rissanen A, Virkkunen M, Rose RJ
(2003). Breakfast skipping and health-compromising behaviors in
adolescents and adults. Eur J Clin Nutr 57, 842–853.
Kirk TR, Burkill S, Cursiter M (1997). Dietary fat reduction achieved
by increasing consumption of a starchy food-an intervention
study. Eur J Clin Nutr 51, 455–461.
Lattimore PJ, Halford JCG (2003). Adolescence and the diet-dieting
disparity: healthy food choice or risky health behaviour? Br J
Health Psychol 8, 451–463.
McNulty H, Eaton-Evans J, Cran G, Woulahan G, Boreham C,
Savage J et al. (1996). Nutrient intakes and impact of fortified
breakfast cereals in schoolchildren. Arch Dis Child 75, 474–481.
McNulty H, Eaton-Evans J, Woulahan G, Strain JJ (1994). The
contribution of breakfast to daily micronutrient intakes of adults
in Great Britain (abtract). Proc Nutr Soc 53, 251.
Merten MJ, Williams AL, Shriver LH (2009). Breakfast consumption
in adolescence and young adulthood: parental presence, community context, and obesity. J Am Diet Assoc 109, 1384–1391.
Moore GF, Tapper K, Murphy S, Lynch R, Raisanen L, Pimm C,
Moore L (2007). Associations between deprivation, attitudes
towards eating breakfast and breakfast eating behaviours in
9–11-year-olds. Public Health Nutr 10, 582–589.
Moshfegh AJ, Borrud LG, Perloff B, LaComb RP (1999). Improved
method for the 24-h dietary recall for use in national surveys
[abstract]. FASEB J 13, A603.
National Diet and Nutrition Survey (NDNS) (2003). Adults Aged 19 to
64 Years. Technical Report c)Appendices. TSO: London.
Nelson M, Atkinson M, Meyer J (1997). Food Portion Sizes:
a Photographic Atlas of Food Portion Sizes. Food Standards Agency:
London.
Nelson M, Dick K, Holmes B, Dowler E, Thomas R (2003) Low Income
Diet Methods Study. Food Standards Agency: London.
Nelson M, Erens B, Bates B, Church S, Boshier T (2007). Low Income
Diet and Nutrition Survey. TSO: London. Available at http://
www.food.gov.uk.
Nicklas T, O’Neil C, Berenson G (1998). 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 67,
757S–763S.
Nicklas TA, Bao W, Webber LS, Berenson GS (1993). Breakfast
consumption affects adequacy of total daily intake in children.
J Am Diet Ass 93, 886–891.
Nicklas TA, Myers L, Berenson GS (1995). Total nutrient intake and
ready-to-eat cereal consumption of children and young adults in
the Bogalusa Heart Study. Nutr Rev 53, S39–S45.
Nicklas TA, O’Neil C, Myers L (2004). The importance of breakfast
consumption to nutrition of children, adolescents and young
adults. Nutr Today 39, 30–39.
Nicklas TA, Reger CMS, Myers L, O’Neil CE (2000). Breakfast
consumption with and without vitamin-mineral supplement use
favorably impacts daily nutrient intake of ninth-grade students.
J Adolesc Health 27, 314–321.
O’Dea JA, Caputi P (2001). Association between socioeconomic
status, weight, age and gender, and the body image and weight
control practices of 6- to 19-year-old children and adolescents.
Health Educ Res 16, 521–532.
Ofcom (2006). Television Advertising of Food and Drink Products to
Children. Ofcom: London http://stakeholders.ofcom.org.uk/
consultations/foodads_new/summary. Accessed 23 March 2011.
Contribution of breakfast cereals to low-income diets
BA Holmes et al
17
Pereira MA, Erickson E, McKee P, Schrankler K, Raatz S, Lytle L,
Pellegrini A (2011). Breakfast frequency and quality may affect
glycemia and appetite in adults and children. J Nutr 141, 163–168.
Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD (2005).
Breakfast habits, nutritional status, body weight, and academic
performance in children and adolescents. J Am Diet Ass 105, 743–760.
Ruxton CHS, Kirk TR (1997). Breakfast: a review of associations with
measures of dietary intake, physiology and biochemistry. Br J Nutr
78, 199–213.
Ruxton CHS, O’Sullivan KR, Kirk TR, Beltons NR (1996). The
contribution of breakfast to the diets of a sample of 136
primary-schoolchildren in Edinburgh. Br J Nutr 75, 419–431.
Sjoberg A, Hallberg L, Hoglund D, Hulthen L (2003). Meal pattern,
food choice, nutrient intake and lifestyle factors in The Goteborg
Adolescence Study. Eur J Clin Nutr 57, 1569–1578.
Song WO, Chun OK, Kerver J, Cho S, Chung CE, Chung SJ (2006).
Ready-to-eat breakfast cereal consumption enhances milk and
calcium intake in the US population. J Am Diet Ass 106, 1783–1789.
SPSS Inc (2010). SPSS for Windows Release 17.0, SPSS Inc.:
Chicago, IL.
Timlin MT, Pereira MA, Story M, Neumark- Sztainer D (2008).
Breakfast eating and weight change in a 5-year prospective
analysis of adolescents: project EAT (Eating Among Teens).
Pediatrics 121, e638–e645.
Van den Boom A, Serra-Majem L, Ribas L, Ngo J, Perez-Rodrigo C,
Aranceta J, Fletcher R (2006). The contribution of ready-to-eat
cereals to daily nutrient intake and breakfast quality in a
Mediterranean setting. J Am Coll Nutr 25, 135–143.
Williams P (2007). Breakfast and the diets of Australian children and
adolescents: an analysis of data from the 1995 National Nutrition
Survey. Int J Food Sci Nutr 58, 201–216.
Williamson CS (2010). Breakfast cereals- why all the bad press? Nutr
Bull 35, 30–33.
Wilson NC, Parnell WR, Wohlers M, Shirley PM (2006).
Eating breakfast and its impact on children’s daily diet. Nutr Diet
63, 15–20.
European Journal of Clinical Nutrition