SYMPOSIUM

3rd December, 2015Hotel Istana, Kuala Lumpur

Presentation 6: Wholegrain consumptionNorimah A Karim, PhDProfessorUniversiti Kebangsaan Malaysia

Introduction• A growing body of epidemiological evidence indicates thatconsumption of whole grain may be protective against several chronicdiseases in adults including diabetes (De Munter & Hu, 2007; Ye etal., 2012) and obesity (Harland & Garton, 2008; Mozaffatian et al.,2011).

• In children and adolescents, the association between consumption ofwhole grain and health benefits has been less explored but severalstudies have reported improved nutrient intakes and diet qualityamong whole grain consumers compared to non-consumers (Mann etal., 2015; Bellisle et al., 2014; Devlin et al., 2013; O’Neil et al., 2010).

• Little is known however, about whole grain consumption patterns inMalaysia.

• 24-hour dietary recall/food record à Whole grain consumers were defined as children who consumed a wholegrain food on at least one of the recall/record days

• A database was created using excel spreadsheet where the details of all wholegrain foods consumed were recorded

• The amount of whole grain per 100g in each wholegrain food was estimated by one of three methods:1) using quantitative ingredient declarations on food package labels2) directly contacting the manufacturers to obtain the information 3) taking an average of the whole grain content of similar products

• The amount of whole grain consumed was calculated using the formula:(Whole grain per 100g) x weight of the wholegrain foods consumed (g)

Eg:

Whole grain calculation

Time Item Brand Quantity Weight (g) Total whole grain/100g Whole grain intakes (g)

6.30am Cookie Crisp Breakfast Cereal

Nestle ½ Bowl 30 27.1 (27.1/100) x 30 = 8.13

From 24-HDR/food record Whole grain database: method 1-food label (WG/100) x g consumed

25.0%

24.8%

24.9%

17.3%

20.3%

18.8%

75.0%

75.2%

75.1%

82.7%

79.7%

81.2%

Boys

Girls

Primary school (total)

Boys.

Girls.

Secondary school (total)

Whole grain consumer Non whole grain consumer

Findings #1Low prevalence of whole grain consumption among primary (24.9%)

and secondary (18.8%) school children

Consumption of whole grains by sex (n= 8631)

Higher proportion of primary school children consumed

whole grain when compared with secondary school children

2.3g/d

9.2g/d

1.7g/d

9.1g/d

Total sample Whole grain consumer

Primary school childrenSecondary school children

Mean daily intakes of whole grain

Findings #2• Intake of wholegrain among all children was very low (≈2g)• Even among consumers, the amount consumed (about 9g/d) was

far below the recommended intake for both primary and secondary school children

Wheat, 77.7%

Oats, 13.7%

Maize/Corn, 7.4%

Rice, 1.2%

Findings #3

The main source of whole grain was wheat

RTEC , 56.9%Hot

cereal, 24.6%

Biscuits, 10.9%

Bread , 4.9%

Others, 2.0% Rice

1% 0.2%

Primary School(n=5556)

Secondary School(n=3075)

Findings #4The main source of wholegrain foods was ready-to-eat cereals

(RTEC), contributing 60-70% of whole grain intakes

RTEC , 68.6%

Hot cereal, 18.6%

Biscuits, 8.7%

Bread , 1.8% Others,

1.6%Rice, 0.6%

Pasta/ noodle,

0.1%

24.0%

17.0%21.3%

19.2%

34.9%

20.9%

27.2%24.7%

Primary school children Secondary school children

Malay Chinese Indian Bumiputera Sabah/Sarawak

Findings #5The prevalence of whole grain consumers was highest among Indians in primary schools and Bumiputera Sabah/Sarawak in secondary schools

(p=0.001)(n=5556) (n=3075)

(p=0.012)

38.0%

21.2%

20.5%

13.5

Primary school (n=5556)

Secondary school (n=3075)

Rural Urban

Findings #4Consumption of whole grain was higher in the urban than rural area for both primary and secondary school children

(p=0.001)

(p=0.001)

21.224.2

26.2 27.231.9

14.5 16.3

22.3

28.924.6

<1500 1501-3500 3501-5500 5501-7500 >7500Monthly household income (RM)

(n=8112)

Primary school Secondary school

Findings #4More primary and secondary school children in the higher

income groups consumed whole grains

At almost every income group, more primary school children consumed whole grains

(p=0.001)

16.5% 18.0%

22.9%

16.0%

29.3%

24.2%

Primary school (n=5556) Secondary school (n=3075)

Father’s education level

Primary education Secondary education Tertiary education

Findings #4Consumption of whole grain was higher among primary and

secondary school children whose fathers had tertiary education

(p=0.001) (p=0.001)

1.3% 2.2% 2.3%

97.6% 97.9% 97.7%

Primary school Secondary school Total

AdequateInadequate

*Half of the cereal intake should come from wholegrain foods/product, equivalent to 2 – 4 servings (≈43g)

Findings #7Almost all of the children (97.7%) did not meet the Malaysian

Dietary Guidelines* wholegrain recommendation

(n=5556) (n=3075) (n=8631)

50%

37 %

11%

1.8% 0.5%*1/2 serve (< 8g/d )

≥1/2 to <1 serve (≥8 to <16g/d)

≥1 to <2 serves (≥16 to <32g/d)

≥2 to <3 serves (≥32 to <48g/d)

≥3 serves (≥48g/d)

Findings #7Proportion of school children who consumed whole grains achieving

different levels of the US whole grain intake recommendation of48g/d or 3 x 16g serves/d

*Less than 1% of the children who consumed whole grain achieved the US quantitative whole grain recommendation of 48g/d

0.6% 0.2% 0.5%

99.4% 99.8% 99.5%

Primary school Secondary school Total

AdequateInadequate

Findings #7Less than 1% of primary and secondary school children met the

US quantitative whole grain recommendation of 48g/d

(n=5556) (n=3075) (n=8631)

Global overview of Whole Grain Intakes (g/d) in Children

% consumers

0

10

20

30

40

50

60

70

Denmark Germany Ireland UK US France Italy Malaysia

54

21.518.5

14.99.1

3.7 2 2.2

20.516.8

8 10.1 9

Mea

nW

hole

grai

n in

take

(g/d

) Total Population Consumers only

91% 89% 61% 48% 24% 25%≈80% ≈80%

Findings #7Compared to other countries, whole grain intakes among primary

school children in Malaysia are amongst the lowest reported in the world

Global overview of Whole Grain Intakes (g/d) in Teenagers

% consumers

87% 76% 61% 41% 24% 19%≈80%

0

10

20

30

40

50

60

Denmark Germany Ireland UK US France Italy Malaysia

54

24.1 23.2

10.29.1

5.32.2 1.7

26.9

14.812.9

11.19

Me

an

Wh

ole

gra

in i

nta

ke

(g/d

)

Total Population Consumers only

≈80%

Findings #7Compared to other countries, whole grain intakes among secondary

school children in Malaysia are amongst the lowest reported in the

world

• Efforts are needed to understand the barriers to whole grain consumption among Malaysian children

• Increase nutrition education in schools on the health benefits of whole grain and how to identify whole grain foods is also warranted

• Encourage children to consume a greater variety of wholegrain foods, for example, wholemeal cereal, wholemeal bread, brown rice, wholemeal noodle and pasta

• Increase availability and affordability of whole grain foods• Steps should be taken by the regulatory authority in Malaysia to

encourage manufacturers to add or increase whole grain in products such as:§ Approval of a definition for whole grain and a wholegrain food§ Development of a distinctive food label logo which signifies that a

food is a good source of whole grain

Recommendations

References• Hill GM (1995). The impact of breakfast especially ready-to-eat cereals on nutrient intakeand health of children. Nutrition Research, 15(4), 595-613.

• Grosvenor MB, Smolin LA (2002). Nutrition from Science to Life. United States of America:Harcourt College Publishers, Inc.

• Utter J, Scragg R, Mhurchu CN, Schaaf D (2007). At-home breakfast consumption amongNew Zealand children: Associations with body mass index and related nutrition behaviors.Journal of the American Dietetic Association, 107, 570-576.

• Crepinsek MK, Singh A, Bernstein LS, McLaughlin JE (2006). Dietary effects of universal-free school breakfast: Findings from the evaluation of the school breakfast program pilotproject. Journal of the American Dietetic Association, 106, 1796-1803.

• Rampersaud GC, Pereira MA, Girard BL, Adams J (2005). Breakfast habits, nutritionalstatus, body weight, and academic performance in children and adolescents. Journal of theAmerican Dietetic Association, 105, 743-760.

• Alexy U, Zorn C, Kersting M (2010). Whole grain in children's diet: intake, food sources andtrends. Eur J Clin Nutr 64:745-751.

• Bellisle, F, Hebel P, Colin J, Reye B, Hopkins S (2014). Consumption of whole grains inFrench children, adolescents, and adults. Br J Nutr

References• DTU Food - The National Food Institute (Denmark) (2008) Fuldkorn - Definition ogvidensgrundlag for anbefaling af fuldkornsindtag i Danmark [Wholegrain - Definition andscientific background for recommendations of wholegrain intake in Denmark]. DTU Food,Søborg

• Reicks M, Jonnalagadda S, Albertson AM, Joshi N (2014) Total dietary fiber intakes in theUS population are related to whole grain consumption: results from the National Health andNutrition Examination Survey 2009 to 2010. Nutr Res 34:226-234

• Norimah AK, Koo HC, JM HJ, MT MN, Tan SY,Appukutty M, et al. (2015) Whole GrainIntakes in the Diets Of Malaysian Children and Adolescents – Findings from the MyBreakfastStudy. PLoS one 10 (10): e0138247. doi:10.1371/journal.pone.0138247

• Mann KD, Pearce MS, McKevith B, Thielecke F and Seal CJ (2015) Low whole grain intakein the UK: results from the National Diet and Nutrition Survey rolling programme 2008-2011.British Journal of Nutrition DOI: 10.1017/S0007114515000422

• Sette S, D’Addezio L, Piccinelli R, Hopkins S, Le Donne C, Ferrari, Lorenza M, MisturaL,Turrini A (2015) Intakes of whole grain in an Italian sample of children, adolescents andadults. European Journal of Nutrition (DOI) 10.1007/s00394-015-1097-5

Thank You