Each week we analyse some of the hot headlines in health and nutrition news. This week cheese; obesity & diabetes/cancer risk; and sugar reduction in Kellogg’s cereals.
HEADLINE 1: A piece of cheese a day keeps the doctor away
Picked up in the news this week by the Daily Mail, The Express, The Sun, The Independent and The Guardian is the suggestion that eating cheese could reduce the risk of heart attacks and strokes.
This is based on a meta-analysis of studies which concluded that consuming 40g of cheese per day reduced the risk of heart attack by 14% and stroke by 10%.
Behind the headlines: the Nutrilicious dietetic view
While cheese lovers are likely to have rejoiced, there are limitations to the research on which the headlines were based. The lack of randomised controlled trials included within the meta-analysis means that no causal relationship can be assumed between eating cheese and risk of heart disease. There are far too many factors which could interfere with the results.
Interestingly, there are previous large studies that have found no association between heart disease and eating cheese. Again, it can be hard to prove that it is the cheese eating that is causing the effects.
The harm that eating too much cheese can cause to health is well documented. Although it is a good source of protein, calcium, phosphorous and vitamin B12, it can also be high in saturated fats. Having too much saturated fat in the diet can increase levels of LDL cholesterol in the blood, which is an established risk factor for heart disease. A 30g portion of cheddar cheese (a matchbox size) contains 6.5g saturated fat (over a quarter of the reference intake for saturated fat – 20g). It can also be quite easy to go above this recommended portion size.
Some cheeses can be high in salt and there is a lot of evidence to show that too much salt can increase the risk of high blood pressure, another risk factor for cardiovascular disease.
Cheese can be enjoyed as part of a healthy diet if eaten in moderation and can provide a valuable source of various nutrients. Sticking to the recommended 30g portion size and opting for lower fat varieties such as lighter/reduced fat cheddars, cottage cheese and ricotta, can help ensure we don’t exceed our recommended maximum amount of saturated fat.
Moreover, foods such as low-fat yogurts and lower fat milks can also provide us with calcium and protein (two of the key nutrients found in cheese) but provide less saturated fats (as well as fewer calories, which would be helpful for those trying to lose weight).
For more information, go to British Heart Foundation and the NHS
HEADLINE 2: Diabetes is a key factor in WORLDWIDE cancer surge
The Express, The Sun and The Daily Mail reported on a finding that diabetes and obesity have been linked to causing cancer.
Researchers found that people with a high BMI (defined as above 25kg/m) who also had diabetes were behind 5.6% of new cancer cases globally, affecting 792,600 people in 2012. The method used was through assessing the increase in new cases of 18 cancers based on the prevalence of diabetes and high BMI in 175 countries (using data about BMI and diabetes in 2002 and cancers recorded in 2012).
Behind the headlines: the Nutrilicious dietetic view
This is an interesting study as it is the first study to have looked at the combined effect of having diabetes and obesity on cancer risk. Whilst the headlines alert us to the finding that over 5% of cancers were attributable to diabetes and cancer, there were significant differences between various groups of people, regions and types of cancer which should be noted. These are discussed in the original study. For example, cancers attributable to diabetes and being overweight were nearly twice as common in women (496,700 cases) as they were in men (295,900 cases).
It should be noted that there were limitations of the study. It is questionable whether the 10-year gap used between recording diabetes and high BMI to cancer incidence is entirely appropriate to enable conclusions to be drawn, as recognised by the researchers.
What we understand already is that obesity is certainly a risk factor for cancer. Analysis conducted by the World Cancer Research Fund has found that being overweight (BMI 25kg- 29.9/m) or obese (BMI 30kg/m and above) increases the risk of 11 types of cancer.
The Diabetes UK website outlines the link between diabetes and cancer. Some of the complications associated with diabetes can increase the risk of cancer. However, well-managed diabetes can help reduce the risk of any complications. Diabetes UK have given their thoughts on this study and stated that, “Diabetes doesn’t directly cause cancer, but this study adds to the evidence that having diabetes can increase the risk of certain types of cancer.”
The main message to take home from these headlines is that the increasing prevalence of obesity and diabetes may lead to an increase in risk of certain cancers. Maintaining a healthy weight, eating well, keeping physically active, not smoking, and not exceeding the government guidelines for alcohol consumption can all help lower the risk of diabetes and cancer.
For more information, go to Diabetes UK and WCRF
HEADLINE 3: Kellogg’s to cut sugar in kids’ cereals by up to 40%
Also in the news this week is the announcement that Kellogg’s will cut the sugar levels in children’s cereals by up to 40%. This was reported by the BBC, the Daily Mail, the Evening Standard, The Times and The Sun.
Kellogg’s have said they will reduce sugar levels by 20-40% by the middle of 2018 for Coco Pops, Rice Krispies and Rice Krispies Multi-Grain Shapes. They are also going to stop making Ricicles from January 2018, due to the amount of sugar in the cereal, and are putting a stop to on-pack promotions aimed at children on Frosties.
Behind the headlines: the Nutrilicious dietetic view
This is a very positive and encouraging move from Kellogg’s as the battle to reduce sugar consumption in the UK continues.
In March this year, officials at Public Health England called on food firms to cut sugar by 5% by the end of this year and by 20% by 2020. The Scientific Advisory Committee on Nutrition currently advise that free sugar intake in the UK should account for no more than 5% of our daily energy intake. Advice for the different age groups is as follows:
- Children 4-6 years – no more than 19g free sugars per day (5 teaspoons)
- Children 7-10 years – no more than 24g free sugars per day (6 teaspoons)
- Children 11 years + and adults – no more than 30g free sugars per day (7 teaspoons)
Although not the highest source of sugar in our diets, cereals do contribute to daily intake, with the most recent National Diet and Nutrition Survey highlighting that cereals are responsible for 5% of the added sugar intakes of adults and 6-8% of that of 4-10-year olds and teens. In our blog post last year A Health Check on New Breakfast Opportunities we discussed the need for more breakfast options to offer lower sugar choices and so this certainly is a positive step forward. With gradually a lesser number of options available that are high in sugar, it may be less overwhelming for consumers to make healthier choices.
Here is how much sugar is currently in the Kellogg’s products and how much they are to be reduced by:
- Coco Pops – 9g sugar per 30g serving. To be reduced to 5.1g per 30g serving (40% reduction, changing from about 2 teaspoons of sugar to just over 1 teaspoon).
- Rice Krispies – 3g sugar per 30g serving. To be reduced to 2.4g per 30g serving (20% reduction, changing from ¾ teaspoon of sugar to a little under 2/3 teaspoon of sugar).
- Rice Krispies Multi-Grain Shapes – 6.3g sugar per 30g serving. To be reduced to 4.5g per 30g serving (30% reduction, changing from about 1.5 teaspoons of sugar to just over 1 teaspoon)
A step forward to reduce the sugar content of any foods available on the market can only surely be a positive one.
For more information, go to Kellogg’s – Sugar and Breakfast Cereal and SACN 2015 – Carbohydrates and Health Report
The growing trend for breakfasting on-the-go and at out of home establishments has been threatening breakfast cereal’s number one spot1. As well as a need for more convenience, breakfast cereals have been hit hard by the recent negative headlines with regard to their sugar content. But are the latest trends going to help improve or will they fuel the obesity epidemic?
What do the Brits fancy for breakfast?
Many surveys claim that up to 42% of us (and almost a quarter of school children) do not always have breakfast, stating time constraints are a major factor2,3. Kantar’s data however shows that only 7.7% of breakfast occasions were actually missed last year. This significant difference could be explained by the growing trend of eating ‘on-the-go’ or away from home which has grown by 10%4.
The UK seems to be slow to change its breakfast habits with the majority of breakfast occasions (84%) still taking place at home and breakfast cereals, toast and porridge remaining top favourites during the week whilst cooked breakfast continues to be popular at weekends2. The growing trend is for eating at catering establishments and portable on-the-go offerings with perceived health credentials such as breakfast biscuits, porridge pots and fruit and nut category, the latter seeing a 21.5% increase in 20152.
Breakfast cereals: UK’s no.1 choice with wholegrain cereals chosen by 37% of us during the week and still claiming over half the share of the market5,6. Many breakfast cereals have now significantly reduced their sugar levels, more ‘no-added-sugar’ variants are gaining shelf-space whilst a few indulgent variants still remain. According the to the latest National Diet and Nutrition Survey (NDNS), breakfast cereals account for just 5% of the added sugar intakes of adults and 6-8% of 4-10 year olds and teens.7 On the other hand, breakfast cereals (especially those that are fortified) do make a significant contribution to key vitamin and mineral intakes:
- B vitamins, in particular B1, B6 and folate.
6-9% of our vitamin D intake – vitamin D status is a growing concern in the UK6.
- Iron: 46% of teenage girls, and almost a quarter of women consume below the low reference nutrient intake (LRNI), which places them at high risk of deficiency. Cereals are a major source of iron contributing to 17% of teens, 23% of 4-10 year olds and 12% of adult intakes.
- Calcium: mainly due to the addition of milk but a handful are also fortified. Almost a fifth of teenage girls do not meet their LRNI placing them at higher osteoporosis risk in later life.
Looks like a hard act to follow, so how do other breakfast choices match up?
Porridge: Oats are making a come-back with 27% of us likely to make this choice in a week5. Porridge oats get a nutritional gold star from us, as they provide the gel-like fibre, beta-glucan, which has been proven to lower cholesterol levels – and boy almost 60% of us need to lower our cholesterol.8,9 However, how we serve them up is critical – piling on the sugar (even demerara sugar), drizzling with honey or syrup and making it with full cream milk converts this saint to a sinner. The porridge revival could be partly explained by the growing ‘on-the-go’ varieties which are now purchased by 9% of consumers4.
Toast continues to be popular for 32% of people during the week5. White toast provides calcium (accounting for 13% of teenagers’ intakes) whilst wholemeal and seeded breads provide fibre which, is highly relevant considering the 2015 new increased UK fibre recommendations6,10. Clearly, what we add to our toast is central to the nutritional quality, nut butters and unsaturated fat spreads providing healthy heart fats, whilst chocolate spreads (yes…that includes the favourite hazelnut and chocolate spread) and preserves are taking us on a sugar high.
Eggs: we can’t seem to get enough of them. Almost 3,000 million eggs are eaten at breakfast every year with one in five of us opting for an eggy breakfast at least once a week11. Eggs, originally classified as a complete nutrient food, provide protein, vitamin D, iron, phosphorus, iodine and selenium. In addition, it is reassuring to know that all the UK heart and health advisory bodies do not limit egg consumption (as the cholesterol found in food does not have a significant effect on blood cholesterol in most people)12. A gold star from us, if boiled or poached, however, the Brits favourite is a fried egg… oops, too much fat.
The growing convenience breakfast trends
Convenience, portability and time-saving options which also provide exceptional nutrition credentials are now in demand. A third of us are eating breakfast away of home at least once a week and 15% of us do so every day according to a Beacon 2015 survey13. In addition, gluten-free and high-protein health claims are also gaining traction4.
Out of home establishments:
- Greggs and MacDonald’s have a booming breakfast trade, however, the majority of options seem to include sausages and / or cheese which is a recipe for a heart attack with the hefty dose of saturated fat and salt levels. Some of the breakfast options providing up to 80% of daily saturated fat and over ¾ of daily salt recommendations. On the positive note, porridge oats are making an entry, however, for consumers to pick out the handful of healthier options amongst the sea of unhealthy options will be difficult. We feel a better balance and better promotion of healthier options are needed.
- Coffee shops: Coffees and other drinks on offer can be high in saturated fat and sugar laden, however, the options are there to opt for lower fat milks and sugar-free syrups. The mainstream coffee shops have improved their ‘healthier’ breakfast options with porridge, fruit salads, fruit and nuts and yogurt with granola on offer. However, the low fibre, higher fat and calorie croissants and muffins continue to be more popular.
- Cooked breakfasts: This is still a popular weekend choice, but with a whopping 800-1,000 calories for a classic fry-up, it has to have a thumbs down from us. Or does it? Making a few requests when ordering can bring this fat and calorie laden classic into healthy repute: poached eggs, beans, grilled lean bacon rasher, mushrooms, tomatoes, one sausage and toast instead of fried bread could almost half the calories whilst still providing fibre, protein as well as essential vitamins and minerals.
Breakfast drinks, breakfast biscuits and fruit and nut bars have become widely available, albeit at a higher unit cost. All are portion controlled, the breakfast drinks use skimmed milk as the main ingredient and most provide a range of vitamins and minerals – many matching the nutrition profile of breakfast cereals.
Breakfast biscuits: 19% of consumers are opting for breakfast biscuits over cereal bars4. Nutritionally, they mimic cereals from macro and most micronutrients. Calcium and protein levels from the milk added to cereal are clearly lacking in the biscuits, but the leading brand provides clear advice on paring up the biscuits with yogurt and / or fresh fruit / fruit juice. An excellent option in our point of view.
Breakfast drinks: Definitely a very small but growing market that has failed to take off in the past. The Australian number one brand is definitely leading on this category. Many utilise key health slogans such as protein, energy and fibre whilst omitting to highlight their less than impressively sugar content. Nutritionally, they seem to match up with for fat and protein, however, sugar content varies between 18g and 20g per serving compared to cereal at 0-11g per serving. Interestingly, protein content can be exceptionally high and calcium levels per serving are 2 – 3½ fold greater than for most cereals served with milk. This may be advantageous if it appeals to the 19% of teenage girls and 12% of young women who have calcium intakes below the low reference nutrient intakes. Nutrilicious opinion: get that sugar down.
Recent government advice has highlighted the need to cut sugar levels (free sugars to less than 5% total energy intake) and increase fibre intake (to 30g AOAC per day for teens and adults)10. Considering this advice it would seem beneficial for any new breakfast foods to be based on wholegrains and / or provide soluble fibres such as beta-glucans and inulin and to be limited in free sugars as much as possible. The vitamin and mineral fortification of breakfast cereals significantly contributes to the nation’s micronutrient status, thus any new options must ensure that these essential nutrients are not lacking<sup>6</sup>. With on-the-go eating and eating at out of home establishments becoming more popular, it is paramount that options lower in sugar dominate. Sugar is now the big enemy under scrutiny by government, health organisations and pressure groups such as Action on Sugar14. This also applies to porridge pots and cereal pots as not all are low sugar and/or high in fibre. To add to the challenges for innovation, the consumer continuous to demand a great taste as well as a healthy nutrition quality.
When comparing different options, it is clear that healthier options are available whether breakfasting at home, catering establishment, coffee shop or eating on the go. However, the new trends need to focus more on providing a better balance and promoting more of the healthier options. The porridge, fruit and nut, lower fat and sugar free options at catering establishments are a good start, but the likelihood of the consumer choosing these amongst the overwhelming selection of higher fat, salt and sugar options is questionable. Breakfast cereals do contribute significantly to vitamin and mineral intakes especially iron and calcium – and there is a risk for vulnerable groups to become deficient if they begin to move away from these.
With all the above in mind, there are many opportunities to develop new innovative ways to create tasty, convenient, nutritious breakfasts that allow for people on the go to eat a greater variety of foods to help meet their nutritional requirements. Whilst time may be limited for many in the morning, Variety is King in helping consumers achieve adequate nutrient intake.
- Financial Times Oct 3 (2014). Daneshkhu S: Cereal sales go soggy as breakfast shrinks. http://www.ft.com/cms/s/0/771a89b2-4af2-11e4-839a-00144feab7de.html#axzz3zVYhDqes
- Agriculture and Horticulture Development Board (AHDB) for Cereals & Oilseeds Market News: Cereals and bread still breakfast mainstays. 14 January 2016. http://cereals.ahdb.org.uk/markets/market-news/2016/january/14/prospects-cereals-and-bread-still-breakfast-mainstays.aspx
- British Nutrition Foundation. National Pupil and Teacher Survey 2015 UK Survey Results. https://www.nutrition.org.uk/attachments/article/846/UK%20Pupil%20and%20Teacher%20Survey%20Results%202015.pdf
- Grocer March Guide to Breakfast.
- Shake Up Your Wake Up, Fun Breakfast Facts (2015). http://www.shakeupyourwakeup.com/why-is-breakfast-important/our-breakfast-foods/fun-breakfast-facts
- Bates B et al (2014). National Diet and Nutrition Survey: results from Years 1 to 4 (combined) of the rolling programme for 2008 and 2009 to 2011 and 2012. Available at https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-results-from-years-1-to-4-combined-of-the-rolling-programme-for-2008-and-2009-to-2011-and-2012
- Scientific Advisory Committee on Nutrition 2015. Draft Vitamin D and Health report. Scientific consultation: 22 July to 23 September 2015. Available at https://www.gov.uk/government/consultations/consultation-on-draft-sacn-vitamin-d-and-health-report
- Heart UK (2016). The Power of Oat Beta Glucan. http://heartuk.org.uk/images/uploads/healthylivingpdfs/HUK_factsheet_F09_OatBetaGlucanF.pdf
- Townsend N, Bhatnagar P, Wilkins E, Wickramasinghe K, Rayner M (2015). Cardiovascular disease statistics, 2015. British Heart Foundation: London. Available at https://www.bhf.org.uk/publications/statistics/cvd-stats-2015
- Scientific Advisory Committee on Nutrition (2015). Carbohydrates and Health Report. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf
- Egg Info (2016). Industry Data. https://www.egginfo.co.uk/egg-facts-and-figures/industry-information/data
- Gray J and Griffin B (2009). Eggs and dietary cholesterol – dispelling the myth. Nutr Bull 36,199-211
- Beacon. Brits’ breakfast habits a big boost for the economy as people spend £76 million every day on eating out for breakfast. Survey 2015. Available at http://www.digitalnewsroom.co.uk/beacon/brits-breakfast-habits-a-big-boost-for-the-economy/
- Action on Sugar (2015). Breakfast Cereals Survey 2015. http://www.actiononsalt.org.uk/actiononsugar/Press%20Release%20/146900.pdf
The first-meal of the day is changing. Long ago, bacon-and-eggs were popular (and they still are for those anxious about carbohydrates, or for those staying in hotels where others will wash the greasy pans). Then there were periods of battle between toast-and-something or breakfast cereals and milk. Ready-to-eat (RTE) cereals are still the most popular start to the day, but sales are described as, ‘soggy’1 as items that are more portable gain ground: breakfast drinks and biscuits can be orally crammed while running late to the station or school. Or perhaps these on-the-run breakfast products are needed to balance the portable communication bars so constantly held in the other hand?
Other themes have put pressure on manufacturers of RTE cereals. Demands for salt and sugar reduction, demands for gluten-free variants, and shifts in consumer perceptions that carbohydrates are less healthy, and that more proteins is always a good thing.
But most-recent data report that RTE cereals contribute only 8% of free sugars intakes to the diets of children under 10 years of age, and less than 6% to the diets of teenagers2. And what appears extraordinary, is the view of some consumers that the three minutes it may take to eat cereal and milk in the morning, is two minutes too long.
But are these shifts in breakfast patterns a threat to the nutrient quality of diets, which may be a particular issue for the diets of children and teenagers? There is a near-constancy of data supporting the benefits of regularly including nutrient-enriched cereals into diets. Child and adolescent RTE cereal eaters appear be at lower risk of being overweight3,4. Also, breakfast cereal eating is associated with higher intakes of some micronutrients. In a study of more than 1200 European 12-17 year olds4, the RTE cereal-eating teens had higher intakes of various B vitamins, vitamin D, calcium and potassium. A review of various commonly-consumed breakfast cereals5 confirms their contributions to a wide variety of micronutrients, as well a typically contributing to intakes of fibre, whole grain and protein.
Not eating breakfast cereals does not mean not eating these nutrients: there are plenty of other food sources of course. But because they are such a rich and reliable source, it just means that regular intakes are a quick and easy short-cut to the assurance that children and teens have an early-morning head start to better diets. RTE cereal eating may be especially beneficial in the diets of those trying to limit energy6, and in those on low incomes, where there may be a lower variety of other nutrient-dense foods7.
It will be interesting to watch and monitor the national diet and nutrition surveys and see how changing breakfast choices may impact on the nutrient intakes of different groups within the population. In the meantime the slightly unexplained tight-squeeze of time in the morning certainly needs to be battled-against. Some planning of a calm breakfast, the night-before, is one way to encourage the interest of children and teens in sitting down to a few spoons of cereal. The technique of do-as-I-do must also be borne in mind by advocating parents. Lastly, some concessions to variety of products and comforting aura’s helps (suggestion: breakfast Swedish-style with candles and the strict rule of no-electronics at the table!).
- Financial Times Oct 3 2014. Daneshkhu S: Cereal sales go soggy as breakfast shrinks. www.FT.com (accessed 9.11.15)
- Bates B et al (2014) National Diet and Nutrition Survey (NDNS) Result for year 1 to year 4 (combined) of the rolling programme 2008-2012. PHE & FSA, London
- De la Hunty A, Gibson S, Ashwell M (2013) Does regular breakfast cereal consumption help children and adolescents stay slimmer? A systematic review and meta-analysis. Obesity Facts 6, 1, 70-85
- Michels N, De Henauw S, Breidenassel C et al (2015) European adolescent ready-to-eat cereal (RTEC) consumers have a healthier dietary intake and body composition compared to non-RTEC consumers
- Ruxton C (2014) The Role of Breakfast Cereals in Improving Public Health. Complete Nutrition, 14, 3, 69-71
- Reeves S (2015) The Role of Breakfast Cereal in Contributing to Nutrient Shortfalls Associated with Low Calorie Diets. Complete Nutrition, 15, 3, 59-61
- Holmer BA, Kaffa N, Campbell K & Sanders TAB (2012) The contribution of breakfast cereals to the nutritional intake of the materially deprived UK population. European Journal of Clinical Nutrition, 66, 10-17