Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality among Infants, Toddlers, and Children in the National Health and Nutrition Examination Survey 2015–2016
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source and Population
2.2. RTE Cereal Consumption
2.3. Outcome Variables
2.3.1. Macro- and Micro-nutrients
2.3.2. Percent Contribution of RTE Cereal to Daily Nutrient Intake
2.3.3. Food Group Intake
2.3.4. Healthy Eating Index 2015 Scores
2.4. Covariates
2.5. Statistical Analysis
3. Results
3.1. Prevalence of RTE Cereal Consumption and Demographic Characteristics of RTE Cereal Eaters
3.2. Trends in RTE Cereal Consumption
3.3. Differences in Nutrient Intakes for the Total Day between RTE Cereal Eaters and RTE Cereal Non-Eaters
3.4. Contribution of RTE Cereal to Daily Nutrient Intakes
3.5. Food Group Intake for RTE Cereal Eaters and RTE Cereal Non-Eaters
3.6. Healthy Eating Index for RTE Cereal Eaters and RTE Cereal Non-Eaters
4. Discussion
4.1. Cereal Consumption over Time
4.2. Nutrient and Food Group Intakes in Infants and Toddlers
4.3. Nutrient and Food Group Intakes in Children and Adolescents
4.4. Nutrient Intakes across All Age Groups
4.5. Public Health Implication
4.6. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Infants and Toddlers (0.5 to 2 Years) | Children (>2 to 12 Years) | Adolescents (13 to 17 Years) | All Children (0.5 to 17 Years) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
RTE Cereal Eaters | RTE Cereal Non-Eaters | p2 | RTE Cereal Eaters | RTE Cereal Non-Eaters | p2 | RTE Cereal Eaters | RTE Cereal Non-Eaters | p2 | RTE Cereal Eaters | RTE Cereal Non-Eaters | p2 | ||
n | 88 | 236 | 688 | 1169 | 242 | 546 | 1018 | 1951 | |||||
Mean Age years ± SE | 1.4 ± 0.07 | 1.2 ± 0.03 | 0.007 | 6.7 ± 0.2 | 7.3 ± 0.1 | 0.007 | 14.7 ± 0.1 | 15.2 ± 0.1 | 0.002 | 8.7 ± 0.2 | 9.4 ± 0.2 | 0.06 | |
Female, n (weighted %) | 39 (41%) | 113 (42%) | 0.89 | 341 (50%) | 593 (49%) | 0.65 | 103 (49%) | 279 (51%) | 0.71 | 483 (49%) | 985 (49%) | 0.81 | |
Race/Ethnicity, n (weighted %) | Mexican American | 15 (15%) | 45 (15%) | 0.007 | 161 (18%) | 232 (14%) | 0.36 | 51 (17%) | 121 (16%) | 0.85 | 227 (17%) | 398 (15%) | 0.56 |
Other Hispanic | 12 (8%) | 30 (9%) | 89 (9%) | 153 (9%) | 33 (10%) | 59 (7%) | 134 (9%) | 242 (8%) | |||||
Non-Hispanic White | 43 (65%) | 69 (45%) | 192 (48%) | 356 (52%) | 77 (53%) | 157 (54%) | 312 (50%) | 582 (52%) | |||||
Non-Hispanic Black | 14 (8%) | 55 (16%) | 148 (14%) | 266 (15%) | 50 (13%) | 123 (14%) | 212 (13%) | 444 (14%) | |||||
Other | 4 (4%) | 37 (15%) | 98 (11%) | 162 (10%) | 31 (8%) | 86 (9%) | 133 (9%) | 285 (10%) | |||||
PIR ≤1.85, n (weighted %) | 56 (60%) | 152 (61%) | 0.76 | 419 (53%) | 662 (44%) | 0.10 | 138 (46%) | 332 (47%) | 0.99 | 613 (51%) | 1146 (46%) | 0.25 | |
PIR >1.85 and ≤3.5, n (weighted %) | 14 (18%) | 43 (20%) | 164 (27%) | 268 (27%) | 55 (25%) | 113 (25%) | 233 (26%) | 424 (26%) | |||||
PIR >3.5, n (weighted %) | 18 (22%) | 41 (19%) | 105 (21%) | 239 (29%) | 49 (29%) | 101 (28%) | 172 (23%) | 381 (28%) | |||||
Breakfast skipping 3, n (weighted %) | 19 (25%) | 85 (30%) | 0.55 | 17 (3%) | 206 (17%) | <0.0001 | 20 (8%) | 210 (36%) | <0.0001 | 56 (6%) | 501 24% | <0.0001 |
Infants and Toddlers (0.5 to 2 Years) | Children (>2 to 12 Years) | Adolescents (13 to 17 Years) | All Children (0.5 to 17 Years) | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Model 1 2 | Model 2 3 | Model 1 2 | Model 2 3 | Model 1 2 | Model 2 3 | Model 1 2 | Model 2 3 | |||||||||
% diff | p4 | % diff | p4 | % diff | p4 | % diff | p4 | % diff | p4 | % diff | p4 | % diff | p4 | % diff | p4 | |
Energy | −1.8 | 0.79 | NA | NA | –0.2 | 0.93 | NA | NA | −0.1 | 0.99 | NA | NA | 0.8 | 0.74 | NA | NA |
Total Carbohydrate | 0.3 | 0.97 | 2.0 | 0.51 | 7.9 | 0.01 | 8.2 | <0.0001 | 10.0 | 0.04 | 10.1 | <0.0001 | 9.7 | 0.0008 | 9.0 | <0.0001 |
Total Sugar | −0.1 | 0.99 | 1.2 | 0.78 | 13.0 | 0.006 | 13.3 | 0.0004 | 12.9 | 0.06 | 13.0 | 0.001 | 13.1 | 0.002 | 12.4 | 0.0001 |
Added sugar | −3.4 | 0.79 | −0.8 | 0.94 | 11.2 | 0.08 | 11.6 | 0.04 | 3.9 | 0.59 | 4.1 | 0.39 | 10.7 | 0.04 | 9.9 | 0.02 |
Fiber | −4.6 | 0.52 | −2.8 | 0.59 | 6.9 | 0.04 | 7.1 | 0.005 | 14.6 | 0.002 | 14.7 | 0.0008 | 10.4 | 0.0004 | 9.9 | <0.0001 |
Total Fat | −4.7 | 0.51 | −2.7 | 0.35 | −10.1 | 0.003 | −9.9 | <0.0001 | −9.2 | 0.11 | −9.2 | 0.0004 | −9.0 | 0.006 | −10.0 | <0.0001 |
Saturated Fat | −2.8 | 0.70 | −0.9 | 0.86 | −9.8 | 0.02 | −9.6 | <0.0001 | −3.8 | 0.54 | −3.7 | 0.31 | −7.0 | 0.05 | −8.0 | 0.0001 |
Protein | -0.3 | 0.98 | 1.5 | 0.82 | −0.9 | 0.76 | −0.6 | 0.69 | −8.0 | 0.16 | −8.0 | 0.02 | −1.9 | 0.54 | −2.7 | 0.15 |
Calcium | 3.9 | 0.65 | 5.2 | 0.50 | 14.7 | 0.002 | 15.0 | <0.0001 | 26.3 | 0.0002 | 26.5 | <0.0001 | 18.3 | <0.0001 | 17.7 | <0.0001 |
Iron | 15.9 | 0.20 | 16.7 | 0.14 | 70.3 | <0.0001 | 70.8 | <0.0001 | 77.2 | <0.0001 | 77.6 | <0.0001 | 70.1 | <0.0001 | 69.6 | <0.0001 |
Magnesium | 2.6 | 0.76 | 4.3 | 0.41 | 6.4 | 0.08 | 6.6 | 0.003 | 11.0 | 0.10 | 11.1 | 0.02 | 9.2 | 0.01 | 8.5 | 0.0003 |
Potassium | −0.7 | 0.93 | 0.8 | 0.84 | 7.6 | 0.03 | 7.8 | 0.0002 | 7.3 | 0.20 | 7.4 | 0.02 | 8.0 | 0.02 | 7.4 | 0.0002 |
Sodium | −6.1 | 0.54 | −3.6 | 0.61 | −6.4 | 0.005 | −6.2 | 0.003 | −6.9 | 0.19 | −6.9 | 0.06 | −5.4 | 0.05 | −6.2 | 0.02 |
Zinc | 26.6 | 0.03 | 27.6 | 0.008 | 42.9 | <0.0001 | 43.4 | <0.0001 | 38.2 | 0.002 | 38.3 | 0.0001 | 42.4 | <0.0001 | 42.1 | <0.0001 |
Vitamin A | 14.3 | 0.08 | 15.0 | 0.05 | 51.8 | <0.0001 | 52.2 | <0.0001 | 68.9 | <0.0001 | 69.3 | <0.0001 | 53.0 | <0.0001 | 52.7 | <0.0001 |
Thiamin | 20.0 | 0.03 | 22.1 | 0.0007 | 37.9 | <0.0001 | 37.1 | <0.0001 | 45.6 | <0.0001 | 46.6 | <0.0001 | 42.1 | <0.0001 | 41.6 | <0.0001 |
Riboflavin | 19.0 | 0.02 | 20.1 | 0.001 | 36.6 | <0.0001 | 37.5 | <0.0001 | 49.7 | <0.0001 | 49.1 | <0.0001 | 40.4 | <0.0001 | 40.3 | <0.0001 |
Niacin | 18.7 | 0.11 | 19.9 | 0.02 | 34.2 | <0.0001 | 34.5 | <0.0001 | 28.2 | 0.0005 | 28.4 | <0.0001 | 33.2 | <0.0001 | 32.7 | <0.0001 |
Vitamin B6 | 35.6 | 0.008 | 35.9 | 0.0002 | 62.7 | <0.0001 | 62.7 | <0.0001 | 56.6 | <0.0001 | 57.6 | <0.0001 | 61.1 | <0.0001 | 60.8 | <0.0001 |
Folate | 70.7 | 0.0005 | 71.2 | <0.0001 | 89.1 | <0.0001 | 89.8 | <0.0001 | 92.1 | <0.0001 | 92.6 | <0.0001 | 92.5 | <0.0001 | 92.5 | <0.0001 |
Vitamin B12 | 39.2 | 0.004 | 39.7 | 0.003 | 79.6 | <0.0001 | 79.9 | <0.0001 | 83.2 | <0.0001 | 83.5 | <0.0001 | 81.2 | <0.0001 | 80.8 | <0.0001 |
Vitamin C | −2.4 | 0.86 | −1.2 | 0.91 | 17.4 | 0.002 | 17.6 | 0.002 | 16.3 | 0.16 | 16.4 | 0.10 | 15.5 | 0.01 | 15.1 | 0.005 |
Vitamin D | 14.9 | 0.13 | 15.7 | 0.09 | 59.3 | <0.0001 | 59.7 | <0.0001 | 113.3 | <0.0001 | 113.3 | <0.0001 | 63.8 | <0.0001 | 63.6 | <0.0001 |
Vitamin E | −20.4 | 0.09 | −18.8 | 0.04 | 0.6 | 0.90 | 0.9 | 0.80 | 1.4 | 0.89 | 1.6 | 0.84 | −0.6 | 0.92 | −1.4 | 0.71 |
Infants and Toddlers (0.5 to 2 Years) | Children (>2 to 12 Years) | Adolescents (13 to 17 Years) | All Children (0.5 to 17 Years) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
RTEC Eaters 2 | RTEC Non-Eaters | p-Value 3 | RTEC Eaters 2 | RTEC Non-Eaters | p-Value 3 | RTEC Eaters 2 | RTEC Non-Eaters | p-Value 3 | RTEC Eaters 2 | RTEC Non-Eaters | p-Value 3 | |
Total dairy (cup eq.) | 2.1 ± 0.18 | 1.7 ± 0.13 | 0.15 | 2.2 ± 0.18 | 1.8 ± 0.14 | <0.0001 | 2.3 ± 0.09 | 1.6 ± 0.08 | <0.0001 | 2.2 ± 0.17 | 1.7 ± 0.15 | <0.0001 |
Fluid milk (cup eq.) | 1.8 ± 0.10 | 1.3 ± 0.21 | 0.05 | 1.5 ± 0.13 | 1.0 ± 0.09 | <0.0001 | 1.4 ± 0.15 | 0.7 ± 0.12 | <0.0001 | 1.5 ± 0.09 | 1.0 ± 0.08 | <0.0001 |
Total fruit (cup eq.) | 1.0 ± 0.10 | 0.9 ± 0.08 | 0.76 | 1.1 ± 0.14 | 1.0 ± 0.12 | 0.33 | 1.1 ± 0.15 | 0.9 ± 0.12 | 0.03 | 1.1 ± 0.07 | 1.0 ± 0.06 | 0.01 |
Whole fruit (cup eq.) | 0.6 ± 0.06 | 0.6 ± 0.06 | 0.32 | 0.7 ± 0.13 | 0.7 ± 0.12 | 0.36 | 0.8 ± 0.15 | 0.5 ± 0.12 | 0.03 | 0.7 ± 0.06 | 0.6 ± 0.06 | 0.04 |
Fruit juice (cup eq.) | 0.3 ± 0.08 | 0.3 ± 0.05 | 0.86 | 0.4 ± 0.03 | 0.4 ± 0.03 | 0.98 | 0.3 ± 0.07 | 0.3 ± 0.07 | 0.83 | 0.4 ± 0.03 | 0.3 ± 0.03 | 0.65 |
Vegetables (cup eq.) | 0.5 ± 0.09 | 0.6 ± 0.10 | 0.06 | 0.9 ± 0.07 | 0.9 ± 0.07 | 0.50 | 0.9 ± 0.13 | 1.0 ± 0.11 | 0.03 | 0.8 ± 0.06 | 0.9 ± 0.07 | 0.27 |
Total protein foods including legumes (oz eq.) | 1.3 ± 0.14 | 1.8 ± 0.10 | 0.02 | 3.7 ± 0.15 | 4.3 ± 0.12 | 0.009 | 4.1 ± 0.24 | 5.7 ± 0.25 | <0.0001 | 3.6 ± 0.11 | 4.4 ± 0.10 | 0.0001 |
Total Grains (oz eq.) | 2.7 ± 0.17 | 2.6 ± 0.14 | 0.7 | 6.2 ± 0.15 | 6.5 ± 0.12 | 0.15 | 7.9 ± 0.23 | 7.7 ± 0.20 | 0.50 | 6.3 ± 0.13 | 6.4 ± 0.11 | 0.55 |
Whole grains (oz eq.) | 0.7 ± 0.07 | 0.4 ± 0.05 | 0.006 | 1.1 ± 0.10 | 0.8 ± 0.09 | <0.0001 | 1.4 ± 0.20 | 0.7 ± 0.13 | 0.002 | 1.2 ± 0.10 | 0.7 ± 0.07 | <0.0001 |
Refined Grains (oz eq.) | 2.0 ± 0.16 | 2.2 ± 0.12 | 0.33 | 5.1 ± 0.16 | 5.7 ± 0.11 | 0.002 | 6.5 ± 0.22 | 7.0 ± 0.17 | 0.05 | 5.2 ± 0.12 | 5.7 ± 0.08 | 0.002 |
Maximum Score | Infants and Toddlers (0.5 to 2 Years) | Children (>2 to 12 Years) | Adolescents (13 to 17 Years) | All Children (0.5 to 17 Years) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
RTEC Eaters 2 | RTEC Non-Eaters | p-Value 3 | RTEC Eaters 2 | RTEC Non-Eaters | p-Value 3 | RTEC Eaters 2 | RTEC Non-Eaters | p-Value 3 | RTEC Eaters 2 | RTEC Non-Eaters | p-Value 3 | |||
Total vegetables | 5 | 1.9 ± 0.22 | 2.4 ± 0.16 | 0.03 | 2.3 ± 0.10 | 2.2 ± 0.07 | 0.62 | 2.2 ± 0.11 | 2.4 ± 0.10 | 0.15 | 2.2 ± 0.07 | 2.3 ± 0.05 | 0.42 | |
Greens and beans | 5 | 0.6 ± 0.36 | 1.0 ± 0.10 | 0.32 | 1.0 ± 0.11 | 1.1 ± 0.10 | 0.66 | 0.9 ± 0.15 | 1.0 ± 0.11 | 0.59 | 1.0 ± 0.09 | 1.0 ± 0.06 | 0.39 | |
Total fruit | 5 | 3.7 ± 0.21 | 3.4 ± 0.17 | 0.39 | 2.8 ± 0.14 | 2.7 ± 0.09 | 0.77 | 2.6 ± 0.15 | 2.1 ± 0.10 | 0.02 | 2.8 ± 0.10 | 2.6 ± 0.07 | 0.08 | |
Whole fruit | 5 | 3.7 ± 0.25 | 3.3 ± 0.20 | 0.32 | 2.7 ± 0.18 | 2.7 ± 0.12 | 0.87 | 2.5 ± 0.20 | 1.9 ± 0.11 | 0.01 | 2.7 ± 0.11 | 2.5 ± 0.10 | 0.09 | |
Whole grains | 10 | 3.9 ± 0.31 | 2.3 ± 0.25 | 0.003 | 4.0 ± 0.16 | 2.6 ± 0.15 | <0.0001 | 4.2 ± 0.36 | 2.1 ± 0.26 | 0.002 | 4.0 ± 0.16 | 2.5 ± 0.14 | <0.0001 | |
Dairy | 10 | 7.7 ± 0.30 | 6.4 ± 0.26 | 0.002 | 7.8 ± 0.22 | 6.3 ± 0.14 | <0.0001 | 7.3 ± 0.17 | 5.4 ± 0.14 | <0.0001 | 7.8 ± 0.16 | 6.1 ± 0.11 | <0.0001 | |
Total protein foods | 5 | 2.1 ± 0.18 | 2.4 ± 0.15 | 0.11 | 3.4 ± 0.09 | 3.8 ± 0.08 | 0.01 | 3.4 ± 0.08 | 3.8 ± 0.09 | 0.007 | 3.4 ± 0.06 | 3.7 ± 0.07 | 0.008 | |
Seafood and plant proteins | 5 | 0.6 ± 0.18 | 0.9 ± 0.12 | 0.25 | 1.7 ± 0.09 | 1.7 ± 0.12 | 0.80 | 1.8 ± 0.15 | 1.7 ± 0.14 | 0.69 | 1.7 ± 0.09 | 1.6 ± 0.10 | 0.66 | |
Fatty acids | 10 | 1.2 ± 0.37 | 1.4 ± 0.18 | 0.66 | 3.8 ± 0.20 | 4.0 ± 0.12 | 0.33 | 3.6 ± 0.22 | 4.7 ± 0.19 | 0.002 | 3.5 ± 0.14 | 4.0 ± 0.07 | 0.02 | |
Sodium | 10 | 8.4 ± 0.52 | 7.8 ± 0.27 | 0.35 | 5.4 ± 0.18 | 4.7 ± 0.14 | 0.001 | 4.8 ± 0.34 | 4.0 ± 0.18 | 0.04 | 5.5 ± 0.16 | 4.8 ± 0.14 | 0.005 | |
Refined grains | 10 | 8.5 ± 0.35 | 7.8 ± 0.25 | 0.12 | 5.7 ± 0.20 | 4.7 ± 0.15 | 0.0005 | 5.2 ± 0.36 | 4.5 ± 0.23 | 0.09 | 5.7 ± 0.15 | 4.9 ± 0.11 | 0.0002 | |
Saturated fat | 10 | 2.6 ± 0.53 | 2.6 ± 0.36 | 0.96 | 5.8 ± 0.17 | 4.7 ± 0.19 | 0.001 | 5.9 ± 0.34 | 5.4 ± 0.20 | 0.22 | 5.6 ± 0.15 | 4.7 ± 0.10 | 0.0004 | |
Added sugar | 10 | 9.4 ± 0.14 | 9.2 ± 0.15 | 0.24 | 6.5 ± 0.18 | 7.1 ± 0.13 | 0.02 | 6.1 ± 0.34 | 6.3 ± 0.22 | 0.60 | 6.6 ± 0.15 | 7.1 ± 0.11 | 0.009 | |
Total HEI 2015 Score | 100 | 54.2 ± 1.25 | 50.9 ± 0.94 | 0.06 | 52.9 ± 0.50 | 48.3 ± 0.73 | <0.0001 | 50.5 ± 0.79 | 45.3 ± 0.70 | <0.0001 | 52.6 ± 0.29 | 47.7 ± 0.57 | <0.0001 |
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Smith, J.D.; Zhu, Y.; Vanage, V.; Jain, N.; Holschuh, N.; Hermetet Agler, A. Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality among Infants, Toddlers, and Children in the National Health and Nutrition Examination Survey 2015–2016. Nutrients 2019, 11, 1989. https://doi.org/10.3390/nu11091989
Smith JD, Zhu Y, Vanage V, Jain N, Holschuh N, Hermetet Agler A. Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality among Infants, Toddlers, and Children in the National Health and Nutrition Examination Survey 2015–2016. Nutrients. 2019; 11(9):1989. https://doi.org/10.3390/nu11091989
Chicago/Turabian StyleSmith, Jessica D., Yong Zhu, Vipra Vanage, Neha Jain, Norton Holschuh, and Anne Hermetet Agler. 2019. "Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality among Infants, Toddlers, and Children in the National Health and Nutrition Examination Survey 2015–2016" Nutrients 11, no. 9: 1989. https://doi.org/10.3390/nu11091989