Childhood obesity is on the rise in South Africa (SA), and child-directed marketing (CDM) is one of the contributing factors to children’s unhealthy food choices. This study assessed CDM on packaged breakfast cereals available in SA supermarkets and their nutritional quality.

Photographic images were examined in a descriptive quantitative study. A codebook of definitions of CDM was developed for this purpose. REDCap, an online research database, was used for data capturing, and SPSS was used for data analyses including cross-tabulations and one-way ANOVA.

The current study was set in the Western Cape province of SA.

Photographic images of all packaged breakfast cereals sold in major retailers in the Western Cape province of SA in 2019 were studied.

CDM strategies were classified as direct (to the child) or indirect (through the parent). A total of 222 breakfast cereals were studied, of which 96·9 % had a nutritional or health claim, 95·0 % had illustrations, 75·2 % had product and consumption appeals, 10·8 % had characters, 10·8 % consisted of different appeals, 8·6 % alluded to fantasy and 7·7 % had role models. In breakfast cereals with direct CDM, the protein and fibre content was significantly lower than in breakfast cereals without direct CDM. This study found a significantly higher total carbohydrate and total sugar content in breakfast cereals with direct CDM than those without direct CDM.

CDM was highly prevalent in breakfast cereals sold in SA. Regulations to curb the marketing of packaged foods high in nutrients of concern is recommended.

To compare the nutritional quality of New Zealand breakfast cereals in 2013 and 2017.

Nutrition Information Panel data were collected from all cereals available from two large supermarket chains in 2017 and compared with earlier published data collected in 2013.

Urban New Zealand supermarkets.

The nutritional content of breakfast cereals (‘biscuits and bites’, ‘brans’, ‘bubbles, flakes and puffs’, ‘children’s cereals’, ‘muesli’ and ‘oats’) was analysed for total energy, protein, fat (total and saturated), carbohydrate, sugar, fibre and Na. The Nutrient Profile Scoring Criterion (NPSC) for each cereal was calculated to determine the proportion of ‘less healthy’ cereals (NPSC≥4) in each product category.

The energy and fat content of bubbles, flakes and puffs, muesli and oats were significantly higher in 2017 compared with 2013 (all P≤0·01). However, there was a small reduction in Na overall in 2017 (P<0·05). There was no change between 2013 and 2017 in the proportion of ‘healthy’ or ‘less healthy’ breakfast cereals available.

The nutrient profile of breakfast cereals has not improved since 2013, suggesting that industry self-regulation of the nutritional composition of cereals in New Zealand is not working and needs urgent reconsideration.

To study the salt and sugars content of breakfast cereals sold in the UK between 1992 and 2015.

Cross-sectional surveys on salt and sugars content collected from the nutrition information panel of breakfast cereals in 1992, 2004, 2006, 2009, 2012 and 2015.

All major UK retailers operating at that moment in time (approximately ten).

The salt and sugars content was collected from product packaging and the nutrition information panels.

Cereals consistently surveyed across all five years (n22) showed a significant reduction in salt content of 47 % (P<0·001). Sugars content of breakfast cereals (n 15), however, did not show a significant change; 25·65 g/100 g in 1992 and 22·45 g/100 g in 2015 (P=0·170). There was a large variation in salt and sugars content between different categories and within the same type of category.

The study shows the progressive reduction in salt content of breakfast cereals in the UK since 2004 as a result of the successful salt reduction programme, particularly the setting of incremental salt targets. Further reductions in salt content need to be made as cereals remain a major contributor to salt intake. Sugars content, however, has been consistently high due to the lack of a sugar reduction strategy. The research demonstrates that the sugars content of breakfast cereals in the UK is of concern, particularly in children’s breakfast cereals, with a typical serving (30 g) containing a third of a 4–6-year-old’s maximum daily recommendation (19 g/d) for free sugars intake in the UK. More can and should be done to reformulate, with an urgent need to set incremental sugar reduction targets.

To evaluate whether consumption of breakfast cereals is associated with BMI in a sample of Greek adolescents.

A cross-sectional health and nutrition survey.

During 2004–5, 2008 schoolchildren aged 12–17 years were selected from twelve schools located in Vyronas region (Athens metropolitan area). Height and weight were measured and BMI was calculated. A semi-quantitative FFQ was applied and multiple logistic regression analysis was used.

Overall, 4·7 % of boys and 1·7 % of girls were obese, whereas 19·4 % of boys and 13·2 % of girls were overweight. Only 20·7 % of boys and 15·5 % of girls reported that they consume cereals as a first choice for breakfast. Consumption of breakfast cereals was associated with lower BMI in boys (P = 0·08) and girls (P = 0·019), irrespective of age and physical activity status. More prominent results were observed for daily cereal consumption or for more than two daily servings of cereals consumed for breakfast. Consumption of pre-sweetened breakfast cereals was associated with lower BMI compared with non-pre-sweetened or no intake of cereals, in both genders (P < 0·001). Consumption of breakfast cereals was associated with 33 % (95 % CI 14 %, 48 %) lower likelihood of overweight/obesity, irrespective of age, sex and physical activity status.

Consumption of breakfast cereals was associated with lower BMI levels and a lower likelihood of overweight/obesity in both genders; thus a solid basis for public health professionals could be built when issuing advice on weight management.

To examine associations between breakfast cereal consumption and iron status and identify dietary patterns that might improve iron status in this vulnerable group.

Analysis of data from the UK National Diet and Nutrition Survey (NDNS) of children aged 1.5–4.5 years, including dietary intakes calculated from 4-day weighed records.

Data were used from 904 children with haematological measurements, excluding those taking iron supplements; 20% had low iron stores (ferritin < 10 μg l−1) while 8% were anaemic (Hb < 11 g dl−1).

High cereal consumers had significantly higher iron intakes than low cereal consumers (classified by tertiles) but the 10% difference in mean ferritin levels was not significant (P = 0.067). Lower intakes of vitamin C and meat among high consumers of cereal may have diluted the impact of cereal iron on iron status. When children were reclassified according to their intakes of vitamin C and iron from meat and breakfast cereals, the group with high (above median) intakes of two or more factors had a higher mean haemoglobin (Hb) level and a lower prevalence of anaemia compared with the group with low (below median) intakes of all three dietary constituents.

Nutritional advice that aims to improve iron status should emphasize not only rich sources of iron but also factors that may enhance or inhibit absorption. Strategies to optimize iron status in this vulnerable age group include consuming an iron-fortified breakfast cereal, vitamin C-rich fruit or drink at breakfast, and avoiding tea with (or after) meals.

This study examined the relationship between breakfast cereal consumption and non-milk extrinsic sugars (NMES) intake and the possible implications of this for caries in preschool children.

Data from the 1995 UK National Diet and Nutrition Survey (NDNS) of children aged 1.5–4.5 years were reanalysed. Four-day weighed food records and dental examinations were available on 1450 children living in private households in Britain. Children were classified by tertiles (age-adjusted) according to the proportion of energy derived from breakfast cereals, and the amount of NME sugar from cereals. There were no significant differences in social class background between any of the groups.

Children with diets high in breakfast cereals as a proportion of total energy (top third) had lower proportional intakes of NMES, compared with low consumers of cereals (lowest third). Consumption of sweetened cereals was positively associated with NMES intake. However, caries experience was unrelated to breakfast cereal consumption, whether presweetened or not.

Although presweetened cereals are relatively high in NMES, their cariogenic potential is probably minimal in the circumstances in which they are normally consumed.

To examine associations between breakfast cereal consumption and the dietary habits, nutrient intakes and nutritional status of young people, considering both nutrient adequacy and safety issues (fortification).

Using archived data from 1688 children in the (British) National Diet and Nutrition Survey of Young People aged 4 to 18 years, nutrient intakes and status were compared across thirds of breakfast cereal consumption (T1 to T3), adjusted for age and energy intake. Cereals provided on average 2%, 6% and 12% of energy in T1, T2 and T3, respectively, for boys; 1%, 4% and 10%, respectively, for girls.

Intakes of iron, B vitamins and vitamin D were around 20–60% higher in T3 compared with T1, with significant linear relationships observed for iron, thiamin, riboflavin and folate (T1 < T2 < T3). After excluding low energy reporters and the unwell, 14% of girls had iron intakes below the Lower Reference Nutrient Intake and this varied fivefold between T1 and T3 (27%, 12% and 5%; P = 0.0001). High consumers of breakfast cereals (T3) had better folate, vitamin B12 and riboflavin status and lower total and low-density lipoprotein cholesterol. There was also an association with thiamin and vitamin B6 status in girls. However, iron status (haemoglobin, ferritin and transferrin saturation) was not significantly different between groups, possibly due to lower meat intakes in T3. Total iron intakes were within tolerable levels (maximum of 32 mg day−1 in one girl taking supplements).

The nutritional benefits of breakfast cereals are demonstrated in status measurements as well as in nutrient intakes in this study. Concerns about excessive iron intakes from fortification appear unjustified.