Evaluating an intervention to increase cereal fiber intake in children: a randomized controlled feasibility trial

Research output: Contribution to journalArticlepeer-review

Authors

  • Angela S Donin
  • Claire Nightingale
  • Michael R Perkin
  • Michael Ussher
  • Susan A Jebb
  • Rikard Landberg
  • Paul Welsh
  • Naveed Sattar
  • Chris G Owen
  • Alicja R Rudnicka
  • Derek G Cook
  • Peter H. Whincup

Colleges, School and Institutes

Abstract

Background
Observational studies have shown that higher cereal fiber intake is associated with reduced type 2 diabetes risk. However, it remains uncertain whether this association is causal.

Objective
This study evaluated the feasibility of an intervention to increase cereal fiber intake in children using breakfast cereals.

Methods
The study was a 2-arm parallel group randomized controlled trial in 9–10-y-old children, who received free supplies of high-fiber breakfast cereals (>3.5 g/portion) or low-fiber breakfast cereals (<1.0 g/portion) to eat daily for 1 mo with behavioral support to promote adherence. Children provided baseline and 1-mo fasting blood samples, physical measurements, and 24-h dietary recalls. The primary outcome was the group difference in change in plasma total alkylresorcinol (AR) concentration; secondary outcomes were group differences in nutrient intakes and adiposity indices. Analyses (complete case and multiple imputation) were conducted by regressing the final AR concentration on baseline AR in models adjusted for sex, ethnicity, age, and school (random effect).

Results
Two-hundred seventy-two children were randomly assigned (137 receiving a low-fiber and 135 a high-fiber diet) and 193 (71%) provided fasting blood samples at baseline and follow-up. Among randomized participants, median (IQR) of baseline AR was 43.1 (24.6–85.5) nmol/L and of cereal fiber intake was 4.5 (2.7–6.4) g; 87% of participants reported consuming the cereal on most or all days. Compared with changes in the low-fiber group, the high-fiber group had greater increases in AR (40.7 nmol/L; 95% CI: 21.7, 59.8 nmol/L, P < 0.0001) and in reported cereal fiber intake (2.9g/d; 95% CI: 2.0, 3.7 g; P < 0.0001). There were no appreciable differences in other secondary outcomes.

Conclusions
We have developed a simple and acceptable nutritional intervention that increases markers of daily cereal fiber intake in children. This intervention could be used to test whether increases in cereal fiber intake in children might reduce insulin resistance. This trial was registered at www.isrctn.com as ISRCTN33260236.

Details

Original languageEnglish
Pages (from-to)379–386
JournalThe Journal of Nutrition
Volume151
Issue number2
Early online date9 Dec 2020
Publication statusPublished - Feb 2021

Keywords

  • Cereal fiber, children, type 2 diabetes risk, feasibility trial, dietary intervention

Sustainable Development Goals