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

Research output: Contribution to journalArticlepeer-review


  • 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

External organisations

  • University of Glasgow
  • Population Health Research Institute, St George's University of London


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 two-arm parallel group randomized controlled trial in 9-10-year-old children, who received free supplies of high fiber breakfast cereals (>3.5 gram/portion) or low fiber breakfast cereals (<1.0 gram/portion) to eat daily for one month with behavioral support to promote adherence. Children provided baseline and one-month fasting blood samples, physical measurements and 24-hour 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 final AR on baseline AR in models adjusted for sex, ethnicity, age and school (random effect). Results: 272 children were randomized (137 low fiber, 135 high fiber) and 193 (71%) provided fasting blood samples at baseline and follow-up. Among randomized participants, median (IQR) baseline AR was 43.1 nmol/L (24.6, 85.5 nmol/L) and median (IQR) cereal fiber intake was 4.5g (2.7, 6.4g), 87% reported consuming the cereal on most or all days. Compared to 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, 3.7g, p<0.0001). There were no appreciable differences in other secondary outcomes. Conclusions: We have developed a simple and acceptable nutritional intervention which 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. Key words: Cereal fiber, children, type 2 diabetes risk, feasibility trial, dietary intervention.


Original languageEnglish
JournalThe Journal of Nutrition
Publication statusAccepted/In press - 9 Oct 2020


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