Dietary Modeling Shows that Substitution of Whole-Grain for Refined-Grain Ingredients of Foods Commonly Consumed by US Children and Teens Can Increase Intake of Whole Grains

BACKGROUND: Currently available whole-grain foods are not frequently consumed, and few children achieve the whole-grain intake recommendation. OBJECTIVE: To investigate the influence on whole-grain consumption of substituting whole-grain for refined-grain ingredients of foods commonly consumed by children. DESIGN: Secondary cross-sectional analysis of publicly available food consumption data collected by the US Department of Agriculture. PARTICIPANTS/SETTING: A nationally representative sample of US children aged 9 to 18 years (n=2,349) providing 24-hour dietary recall data in the 2003-2004 National Health and Nutrition Examination Survey. MAIN OUTCOME MEASURES: Whole-grain intake was modeled by replacing varying proportions of refined flour contained in foods such as pizza crust, pasta, breads, and other baked goods with whole-wheat flour, and by replacing a proportion of white rice with brown rice. Replacement levels were based on the acceptability of whole-grain foods tested among children in elementary schools, and ranged from 15% to 50%; the majority were ≤25%. STATISTICAL ANALYSES PERFORMED: Sample-weighted mean premodeled and postmodeled whole-grain intake, standard errors, and statistical significance of differences between demographic subgroups were determined using SUDAAN (version 9.0.3, 2007, Research Triangle Institute, Research Triangle Park, NC). RESULT: Whole-grain intake increased 1.7 oz eq per day (from 0.5 to 2.2 oz eq/day). Premodeled and postmodeled whole-grain intakes were 6% and 28%, respectively, of total grain intake (7.7 oz eq/day). Major sources of postmodeled whole-grain intakes were breads/rolls (28.0%); pizza (14.2%); breakfast cereals (11.0%); rice/pasta (10.6%); quick breads such as tortillas, muffins, and waffles (10.8%); other baked goods (9.9%); and grain-based savory snacks other than popcorn (7.3%). Premodeled whole-grain intake differed by poverty level, but postmodeled whole-grain intake did not. CONCLUSIONS: The substitution of whole grain for a specific proportion of refined grain ingredients of commonly consumed foods increased whole-grain intake and reduced disparities between demographic subgroups of children and teens.