New RCT: Daily consumption of fortified breakfast cereal by adolescent girls improves their nutrient status

By Rob Winwood

A new randomised, double blind placebo controlled trial carried out with a cohort of 71 adolescent girls in Sheffield, UK, has clearly shown that fortification of breakfast cereals is a means to drastically improve the micronutrient status of this at-risk group. The girls, aged 16 to 19 years and previously identified as having low riboflavin and haemoglobin status, received 50g of fortified or unfortified cereal and 150 ml of semi-skimmed milk (2% fat) each day for 12 weeks. They also kept a food diary during this time so total micronutrient intake could be assessed. Their micronutrient status was determined at baseline and at the completion of the 12-week intervention. The 50g portion of fortified cereal, a wheat, rice and barley based flake, contained the following interventions in addition to those found in the unfortified version:- 3.95 µg Vitamin D, 50 mg Vitamin C, 0.85 mg Vitamin B₁, 1.1 mg Vitamin B₂, 16.4 mg Niacin, 1.08 mg  Vitamin B₆, 148 µg folic acid and 5.75 mg Iron. After 12 weeks, there was a dramatic increase in the mean micronutrient status of the intervention arm as follows: +205% Vitamin D,  +83.3% Vitamin B₁, +125% Vitamin B₂, +51.9% Niacin, +131% Vitamin B₆, +83.6% folic acid and +47.2% Iron.

At the end of 12 weeks, the girls in the intervention arm all met the Reference Nutrient Intake (RNI) for all of the micronutrients with the exception of iron and calcium, but were still lower than the DRI (Dietary Reference Intakes in the USA) for folate and Vitamin D.

The UK National Diet and Nutrition Survey has indicated that adolescent girls have a poor nutritional status, and are deficient in the micronutrients Vitamin B2, Vitamin D, calcium and iron (2). In the USA, the Health and Nutrition Examination Surveys (NHANES) have shown that adolescents are more at risk of nutritional deficiencies than any other group (3). Also in the USA, it has been shown the consumption of breakfast and milk by adolescents has reduced over recent decades (4), with girls more likely to skip breakfast than boys.

Various cross-sectional studies have shown that consumption of breakfast is important in improving nutritional status and adoption of a healthy lifestyle (5).

In summary, the new study (1) has clearly demonstrated that a simple, daily portion of fortified cereal can remedy many micronutrient deficiencies exhibited by adolescent females.

1. Powers HJ, Stephens M, Russell J & Hill, MH; “Fortified breakfast cereal consumed daily for 12 wk leads to a significant improvement in micronutrient intake and micronutrient status in adolescent girls: a randomised controlled trial”; Nutrition Journal 2016, 15(1), 69. http://doi.org/10.1186/s12937-016-0185-6
2. Public Health England and Food Standards Agency; “National Diet and Nutriton Survey: Results form years 1 to 4 (Combined) of the Rolling programme for 2008/2009 to 2011/2012”; May 2014; PHE publications gateway number: 2014051.
3. Second National Report on Biochemical Indicators of Diet and Nutrition in the US PopulationCDC2012 (www.cdc.gov/nutritionreport/pdf/ExecSummary_Web_032612.pdf); 24th October 2015
4. Siega-Riz AM, Popkin BM & Carson T; “Trends in breakfast consumption in the United States from 1965-1991”; Am J Clin Nutr 1998; 67: S748-56.
5. Sandercock GR, Voss C and Dye L; “Associations between habitual school-day breakfast consumption, body mass index, physical activity and cardiorespiratory fitness in English schoolchildren”; Eur J Clin Nutr 2010; 64(10); 1086-92.