Background: Inadequate intake of calcium-rich foods among US adults and children is a public health concern. Fluid milk is one of the best calcium sources because of its bioavailability and its versatility as both a beverage and a complement to various solid foods. One of the foods commonly consumed with milk is ready-to-eat breakfast cereal (RTEC).
Objective: We aimed to establish the association between the intake of RTEC, milk, and calcium within the context of the most current population dietary practices. We hypothesized that RTEC consumption facilitates milk consumption and is associated with adequacy of calcium intake in the US population.
Design: The most recent National Health and Nutrition Examination Survey, 1999-2000, data set was used as the source of data for this research.
Subjects/setting: US subjects aged 4 years and older (n=7,403), excluding pregnant and/or lactating women. Data were stratified according to sex and age (4 to 8 years, 9 to 13 years, 14 to 18 years, 19 to 30 years, 31 to 50 years, 51 to 70 years, and 71+ years), and then by consumption of breakfast, RTEC, and milk.
Statistical analyses performed: SAS (release 8.1, 2000, SAS Institute Inc, Cary, NC) and SUDAAN (release 8.0.2, 2003, Research Triangle Institute, Research Triangle Park, NC) were used to calculate sample weighted means, standard errors, and population percentages. Multiple regression and multiple logistic regression models, with controls for covariates, were used to determine the predictability of total calcium intake from breakfast consumption compared to breakfast nonconsumption, and from inclusion of RTEC and milk in the breakfast meal compared with breakfast meal content without RTEC and milk.
Results: RTEC was predominantly consumed at breakfast. Average calcium intake at breakfast was seven times greater when RTEC was consumed with milk than when RTEC was consumed without milk. In multiple regression analyses, breakfast consumption, and milk consumption with or without RTEC all strongly predicted total daily calcium intake (P<0.05) while controlling for covariates. The percentage of respondents below the Adequate Intake level for calcium was higher for non-RTEC breakfast consumers than for RTEC breakfast consumers in all age-sex categories except those older than age 70 years, and girls aged 9 to 13 years.
Conclusions: Consumption of RTEC at breakfast was associated with greater daily intake of both milk and calcium in all age and sex groups in the US population.