An increase of cereal intake as an approach to weight reduction in children is effective only when accompanied by nutrition education: a randomized controlled trial.
BACKGROUND
The main emphasis of dietary advice for control of obesity has been on reducing dietary fat. Increasing ready to eat cereal (RTEC) consumption could be a strategy to reduce fat intake and increase carbohydrate intake resulting in a diet with lower energy density.


OBJECTIVE
1. To determine if an increase in RTEC intake is an effective strategy to reduce excess body weight and blood lipids in overweight or at risk of overweight children. 2. To determine if a nutrition education program would make a difference on the response to an increase in cereal intake. 3) To determine if increase in RTEC intake alone or with a nutrition education program has an effect on plasma lipid profile.


METHODS
One hundred and forty seven overweight or at risk of overweight children (6-12 y of age) were assigned to one of four different treatments: a. One serving of 33 +/- 7 g of RTEC for breakfast; b. one serving of 33 +/- 7 g of RTEC for breakfast and another one for dinner; c. one serving of 33 +/- 7 g of RTEC for breakfast and a nutrition education program. d. Non intervention, control group. Anthropometry, body composition, physical activity and blood lipids were measured at baseline, before treatments, and 12 weeks after treatments.


RESULTS
After 12 weeks of intervention only the children that received 33 +/- 7 g of RTEC and nutrition education had significantly lower body weight [-1.01 (-1.69, -0.34) ], p < 0.01], lower BMI [-0.95 (-1.71, -0.20), p < 0.01] and lower total body fat [-0.71 (-1.71, 0.28), p < 0.05] compared with the control group [1.19 (0.39, 1.98), 0.01 (-0.38, 0.41), 0.44 (-0.46, 1.35) respectively]. Plasma triglycerides and VLDL were significantly reduced [-20.74 (-36.44, -5.05), -3.78 (-6.91, -0.64) respectively, p < 0.05] and HDL increased significantly [6.61 (2.15, 11.08), p < 0.01] only in this treatment group. The groups that received 1 or 2 doses of RTEC alone were not significantly different to the control group.


CONCLUSIONS
A strategy to increase RTEC consumption, as a source of carbohydrate, to reduce obesity is effective only when accompanied by nutrition education. The need for education could be extrapolated to other strategies intended for treatment of obesity.


BACKGROUND
Australian New Zealand Clincial Trial Registry. Request no: ACTRN12608000025336.
Rosado
Jorge L
JL
Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro, México. jlrosado@avantel.net
del R Arellano
María
M
Montemayor
Karina
K
García
Olga P
OP
Caamaño
María del C
Mdel C
D015992:Body Mass Index; D002648:Child; D053198:Child Nutrition Sciences / Q000193:education*; D002664:Child Nutritional Physiological Phenomena / Q000502:physiology*; D004038:Diet, Reducing; D004041:Dietary Fats / Q000008:administration & dosage / Q000009:adverse effects; D002523:Edible Grain; D002149:Energy Intake / Q000502:physiology; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D050177:Overweight / Q000097:blood / Q000178:diet therapy*; D015431:Weight Loss / Q000187:drug effects* / Q000502:physiology
D004041:Dietary Fats; D008055:Lipids
J Nutr. 2000 Feb;130(2S Suppl):459S-461S
10721928
Arch Cardiol Mex. 2003 Jan-Mar;73(1):62-77
12820496
J Nutr. 2000 May;130(5):1204-11
10801920
Int J Obes Relat Metab Disord. 1995 Feb;19(2):132-7
7735340
Annu Rev Public Health. 2001;22:337-53
11274525
Int J Obes (Lond). 2005 Apr;29(4):362-8
15768041
Ethn Dis. 2002 Winter;12(1):S1-41-5
11913619
Am J Clin Nutr. 1996 Sep;64(3 Suppl):489S-497S
8780369
Int J Obes Relat Metab Disord. 2004 Apr;28(4):483-93
14993915
J Nutr. 2002 Dec;132(12):3830S-3834S
12468634
Curr Cardiol Rep. 2005 Nov;7(6):445-56
16256015
Salud Publica Mex. 2000 Jul-Aug;42(4):315-23
11026073
Obes Res. 2001 Nov;9 Suppl 4:239S-243S
11707548
Am J Clin Nutr. 2000 Oct;72(4):1032-9
11010948
Obesity (Silver Spring). 2006 Aug;14(8):1392-401
16988082
J Nutr. 2004 Sep;134(9):2342-8
15333726
J Nutr. 2006 Apr;136(4):1103-6
16549488
Pediatr Clin North Am. 2001 Aug;48(4):981-93
11494647
Am J Clin Nutr. 1976 Jun;29(6):675-84
1274890
J Nutr. 2000 Feb;130(2S Suppl):284S-288S
10721889
Int J Obes Relat Metab Disord. 1995 Apr;19(4):260-9
7627250
Br J Nutr. 2000 Mar;83 Suppl 1:S25-32
10889789
J Nutr. 2000 Feb;130(2S Suppl):268S-271S
10721885
Pediatr Clin North Am. 2001 Aug;48(4):893-907
11494642
J Am Diet Assoc. 2004 Mar;104(3):387-94
14993861
Pediatrics. 2002 Jul;110(1 Pt 2):236-8
12094001
Eur J Clin Nutr. 1997 Jul;51(7):455-61
9234028