childrens' cereals are getting nutritionally worse

 A recent assessment of ready-to-eat breakfast cereals marketed to kids found a substantial decrease in their nutritional value over time (see breakfast cereals getting worse JAMA2025 in dropbox, or doi:10.1001/jamanetworkopen.2025.11699)

 

Details:

-- this study evaluated the nutritional content, ingredients, packaging and target audiences of new childrens’ cereal products introduced into the US from 2010-2024

 

Results:

-- 1200 new ready-to-eat (RTE) cereal products were newly marketed:

-- new packaging was the most common change (which undoubtedly is associated with changes in their consumption), but in terms of nutrients:

    -- total fat per serving: increase from 1.13g (0.86-1.41g) to 1.51g (1.26-1.75g), a 33.6% increase

    -- sodium content per serving: increase from 156.0mg (142.1-169.8mg) to 206.1mg (193.9-218.3mg), a 32.1% increase

    -- total carbohydrates: increased a bit from 27.32g (26.40-28.23g) to 28.45g (27.64-29.26), a statistically significant trend from 2010 to 2019, p<0.001

    -- sugar content per serving: 10.28g (9.44 to 11.12g) to 11.40g (10.66-12.14g), a 10.9% increase

    -- protein content per serving: an average of 1.97g (1.78-2.16) down to 1.69g (1.47-1.92g), a 14% decrease

    -- dietary fiber per serving: an average of 3.82g (3.57-4.09) down to 2.94g (2.67-3.20g), a 23% decrease

   

 

Commentary:

-- ready-to-eat breakfast cereals are the predominant breakfast choice among children in the US, with data from National Health and Nutrition Survey of children and adolescents from 2016-18 (https://www.cdc.gov/nchs/data/databriefs/db386-H.pdf), finding that:

    -- percent of kids eating breakfast: for those aged 2-5, 96% ate breakfast; those aged 6-11, 86%; those aged 12-19, 73%

    -- percent eating read-to-eat cereal with high sugar content: those aged 2-5, 27%; those aged 6-11, 26%; those aged 12-19, 17%

    -- however, the consumption of milk was consistently higher: those aged 2-5, 60%; those aged 6-11, 47%; those aged 12-19, 32%

        -- it is important to emphasize with girls that there is maximum absorption of calcium during early puberty (https://pubmed.ncbi.nlm.nih.gov/10843156/ ), that the consumption of milk is in fact pretty low in that age group, and that we clinicians/nurses/dieticians/schools/public health advertising should really emphasize the importance of their having high calcium consumption (though the NHANES report did not comment on other sources of calcium, nor give the breakdown of milk consumed by girls vs boys).

       -- the issues is that high pubertal consumption of calcium leads to higher bone calcium stores and stronger bones at the age of 30 or so when women are at a time of progressive negative bone calcification, and this accelerates a lot at the time of menopause

-- this study was quite disturbing: pretty big increases in fat, sodium and sugar, along with pretty significant decreases in protein and fiber

    -- of course, the intent of the corporations is to "improve" the taste of the cereals (increasing fat, salt and sugar really alter the taste; fiber and protein less so....), not the rather important health associations

    -- the recommendations for sugar are < 25g/d, so the current amount in RTE's is 45.6% of the maximum total daily amount recommended (https://www.ahajournals.org/doi/10.1161/CIR.0000000000000439 )

-- my concern here is that breakfast typically has the worst foods to eat, a special concern for those of all ages who are overweight or have diabetes:

    -- the best foods are oatmeal (without sugar), eggs, and fruits

    -- the worst are these ready-to-eat cereals (even the ones that are promoted as "heart healthy"), bread (though sourdough, pumpernickel and dark rye are better than the others), sandwiches, etc (though bananas, watermelon, and some tropical fruits do have higher glycemic indices)

    -- the good news is that, in my experience, patients are able to change their breakfast foods with education and motivational interviewing

    -- and, for those who need to lose weight, it turns out that skipping breakfast completely does not lead to eating more at lunch: the total energy intake is actually lower by skipping breakfast (https://gmodestmedblogs.blogspot.com/2019/03/breakfast-not-lead-to-weight-loss.html )

 

Limitations:

-- this study only assessed new cereals introduced into the market (though certainly a large number of them....)

-- it would be useful to disaggregate the different changes in RTE cereals: was it changes in advertising or food composition that led to higher consumption?

-- it would also be useful to know the worst health offenders vs the ones that are less egregious. 

-- and, given the false moniker of "heart healthy", it would be helpful to be able to inform patients as to what the real situation about cereals is so that patients can make their own decisions for healthier foods

so, 

-- this problem with breakfast cereals is really a big issue for all of our patients, not just kids

-- and many people eat these cereals not just for breakfast.... 

-- it is so unfortunate that the approach to cereal manufacture is one revolved around taste, thereby promoting the 3 worst ingredients (fat, sugar, salt), at the expense of the most healthful (protein, fiber)

    -- as with all of these types of issues (eg cigarettes, vapes, alcohol,...), we really need a public health system that addresses these issues and has the power to implement healthful changes over company profits

geoff

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