Renee A. Rosen

Healthy whole-grain choices for children and parents: a multi-component school-based pilot intervention

OBJECTIVE The aim of the present study was to pilot-test a school-based intervention designed to increase consumption of whole grains by 4th and 5th grade children. DESIGN This multi-component school-based pilot intervention utilised a quasi-experimental study design (intervention and comparison schools) that consisted of a five-lesson classroom curriculum based on Social Cognitive Theory, school cafeteria menu modifications to increase the availability of whole-grain foods and family-oriented activities. Meal observations of children estimated intake of whole grains at lunch. Children and parents completed questionnaires to assess changes in knowledge, availability, self-efficacy, usual food choice and role modelling. SETTING/SAMPLE Parent/child pairs from two schools in the Minneapolis metropolitan area; 67 in the intervention and 83 in the comparison school. RESULTS Whole-grain consumption at the lunch meal increased by 1 serving (P < 0.0001) and refined-grain consumption decreased by 1 serving for children in the intervention school compared with the comparison school post-intervention (P < 0.001). Whole-grain foods were more available in the lunches served to children in the intervention school compared with the comparison school post-intervention (P < 0.0001). The ability to identify whole-grain foods by children in both schools increased, with a trend towards a greater increase in the intervention school (P = 0.06). Parenting scores for scales for role modelling (P < 0.001) and enabling behaviours (P < 0.05) were significantly greater for parents in the intervention school compared with the comparison school post-intervention. CONCLUSIONS The multi-component school-based programme implemented in the current study successfully increased the intake of whole-grain foods by children.

Dietary Modeling Shows that Substitution of Whole-Grain for Refined-Grain Ingredients of Foods Commonly Consumed by US Children and Teens Can Increase Intake of Whole Grains

BACKGROUND Currently available whole-grain foods are not frequently consumed, and few children achieve the whole-grain intake recommendation. OBJECTIVE To investigate the influence on whole-grain consumption of substituting whole-grain for refined-grain ingredients of foods commonly consumed by children. DESIGN Secondary cross-sectional analysis of publicly available food consumption data collected by the US Department of Agriculture. PARTICIPANTS/SETTING A nationally representative sample of US children aged 9 to 18 years (n=2,349) providing 24-hour dietary recall data in the 2003-2004 National Health and Nutrition Examination Survey. MAIN OUTCOME MEASURES Whole-grain intake was modeled by replacing varying proportions of refined flour contained in foods such as pizza crust, pasta, breads, and other baked goods with whole-wheat flour, and by replacing a proportion of white rice with brown rice. Replacement levels were based on the acceptability of whole-grain foods tested among children in elementary schools, and ranged from 15% to 50%; the majority were ≤25%. STATISTICAL ANALYSES PERFORMED Sample-weighted mean premodeled and postmodeled whole-grain intake, standard errors, and statistical significance of differences between demographic subgroups were determined using SUDAAN (version 9.0.3, 2007, Research Triangle Institute, Research Triangle Park, NC). RESULT Whole-grain intake increased 1.7 oz eq per day (from 0.5 to 2.2 oz eq/day). Premodeled and postmodeled whole-grain intakes were 6% and 28%, respectively, of total grain intake (7.7 oz eq/day). Major sources of postmodeled whole-grain intakes were breads/rolls (28.0%); pizza (14.2%); breakfast cereals (11.0%); rice/pasta (10.6%); quick breads such as tortillas, muffins, and waffles (10.8%); other baked goods (9.9%); and grain-based savory snacks other than popcorn (7.3%). Premodeled whole-grain intake differed by poverty level, but postmodeled whole-grain intake did not. CONCLUSIONS The substitution of whole grain for a specific proportion of refined grain ingredients of commonly consumed foods increased whole-grain intake and reduced disparities between demographic subgroups of children and teens.

The Development of Psychosocial Measures for Whole-Grain Intake among Children and Their Parents

The effectiveness of behavioral intervention programs can be assessed by measuring changes in behavior using reliable and valid instruments. To our knowledge, a reliable instrument designed to measure changes in psychosocial determinants of whole-grain intake by children due to an intervention does not exist in the literature. This article describes the development and testing of two questionnaires designed to measure psychosocial determinants of whole-grain intake among children and their parents. The questionnaires were pilot-tested with 39 parent/child pairs from one school and subsequently used in an intervention program with 150 parent/child pairs from two schools. Internal consistencies for the child and parent scales were modest (alpha=.41 to .63), with the exception of intention to choose whole-grain foods for children, which was low (alpha=.19). Test-retest reliability of the child and parent scales was acceptable (r=0.58 to 0.90). Principal components analysis confirmed three parenting subscales: enabling behaviors, whole grain health benefits, and role modeling. Identification of whole-grain foods remains a substantial barrier to the development of a questionnaire that accurately measures psychosocial determinants related to whole-grain intake. Future work should focus on instrument development and testing on a broader scale.

Associations between Whole-Grain Intake, Psychosocial Variables, and Home Availability among Elementary School Children

OBJECTIVE Develop, refine, and test psychosocial scales for associations with whole-grain intake. METHODS A cross-sectional survey was conducted in a Minneapolis/St. Paul suburban elementary school with children in fourth through sixth grades (n = 98) and their parents (n = 76). Variables of interest were child whole-grain intake, self-efficacy, outcome expectations, preferences, knowledge regarding whole-grain food, and whole-grain availability at home. Correlation analysis and one-way analysis of variance were used to analyze data. RESULTS Internal consistency and test-retest correlation coefficients for child psychosocial scales were modest or acceptable (α = .55-.70). Parents reported a mean of 15 ± 7 whole-grain products available at home. Child mean daily intake of total grain was about 8 servings, and intake of products containing whole grain was slightly over 2 servings. Reported home availability and refined-grain intake were significantly related to whole-grain intake, whereas psychosocial variables were not. CONCLUSIONS AND IMPLICATIONS Home availability may be a more important variable associated with whole-grain intake than psychosocial variables.

A gradual approach to increasing whole grain consumption in children

Not Enough Whole Grains Recommendations by numerous organizations and authorities suggest we consume at least three servings of whole grain (3 ounces) per day in order to receive the healthful benefits whole grains provide (23,24). Yet, despite these recommendations, dietary studies indicate that whole grain consumption by children is far less than the recommended intake—averaging less than one serving of whole grain daily for children 6–11 years old (10). These findings raise questions about what can be done to improve children’s diets to ensure they get enough whole grains. A Gradual Approach to Increasing Whole Grain Consumption in Children ➤ FEATURE

Developing and delivering healthier grain-based foods

Government agencies, scientific and trade organizations, and numerous health-interested groups in the United States and in nations around the globe are asking for changes in the food supply to promote improvements in human health. With disease rates escalating and greater dollars being spent on health care costs, improving the health of the population is becoming critical. Recommendations by organizations and authorities, such as Dietary Guidelines and MyPyramid, suggest Americans consume a healthier diet with greater emphasis on fiber-rich plant foods-fruits, vegetables, and whole grains; less total fat and saturated fat; and fewer calories overall to work toward reducing the incidence of obesity and achieving better health for the population. To attain better health, all disciplines (scientists, food companies, government agencies, and trade organizations) must come together and collaborate to create a vision and strategic plan for human health promotion. Making gradual changes to shift the food supply and proactively engaging all grain-based disciplines can help facilitate success. Allowing time for consumers to adapt to changes to food products is a positive way to foster the success of healthier foods in the marketplace. Shifting research dollars and focus to include different perspectives within the supply chain can help in the development and delivery of healthier grain-based foods. The Grains for Health Foundation, a new model for shifting the food supply, seeks to facilitate collaboration across the supply chain, to create tasty healthier grain-based foods that will help consumers meet public health objectives such as the Dietary Guidelines

Consumption and consumer challenges of wholegrain foods

Whole grain intake is associated with health benefits such as reduced risk of cardiovascular disease. However, lack of a global definition of what constitutes a wholegrain food complicates interpretation and communication of research findings. Many populations underconsume wholegrain foods due to both internal factors (difficulty in identifying wholegrain foods and their unique sensory characteristics) and external factors (availability, cost, and the convenience of refined grains). Approaches to introducing wholegrain foods include promoting them early in life, employing the repeated exposures technique, and minimizing sensory differences. Emerging trends include improving the nutritional quality of the final product. Future research may focus on outcomes that improve the healthfulness and availability of grain-based foods, while collaboration will be necessary to ensure that pivotal findings reach industry in a timely manner. Whole grains offer a unique opportunity to enhance diets globally.

Fibre-Rich and Wholegrain Foods: Improving Quality

Whole grain intake is associated with health benefits such as reduced risk of cardiovascular disease. However, lack of a global definition of what constitutes a wholegrain food complicates interpretation and communication of research findings. Many populations underconsume wholegrain foods due to both internal factors (difficulty in identifying wholegrain foods and their unique sensory characteristics) and external factors (availability, cost, and the convenience of refined grains). Approaches to introducing wholegrain foods include promoting them early in life, employing the repeated exposures technique, and minimizing sensory differences. Emerging trends include improving the nutritional quality of the final product. Future research may focus on outcomes that improve the healthfulness and availability of grain-based foods, while collaboration will be necessary to ensure that pivotal findings reach industry in a timely manner. Whole grains offer a unique opportunity to enhance diets globally.