The Role of Ready-to-Eat Cereal Fortification in Nutrient Intakes among Children and Teens: a Modeling Study Using NHANES 2011-2012

Fortified RTE cereals have historically played an important role in providing nutrients of public health concern for both children and adults; however, there have been some questions about the role of fortification of RTE cereal. Therefore, our objective was to quantify fortified RTE cereal's contribution to nutrient intakes in the total population (RTE cereal eaters and non‐eaters) of children (4–12 years, n=1,646) and teens (13–18 years, n = 862) from a representative sample of the U.S. population. Using data from the National Health and Examination Survey (NHANES) 2011–2012, we evaluated the % below the Estimated Average Requirement (EAR) and above the Upper Level (UL), calculated using the NCI Usual Dietary Intake method, of nutrients typically fortified in RTE cereal under three scenarios: 1) current levels of fortification; 2) removal of RTE fortification; and 3) if RTE cereal fortification was modified to optimize nutrient intakes. Under the third model, we changed the nutrient content of all RTE cereal reported consumed in NHANES 2011–2012 to contain 10%–20% of the daily value (DV) for most nutrients versus the current fortification level of 10%–25% DV. Because DVs are set based on a 2,000 kcal diet, these fortification levels were selected based on the impact to the nutrient intake of the total population (children, teens and adults); however, here we focus on the impact to children and teens. At baseline there was a small percentage (<3.5%) of children and teens below the EAR for thiamin, riboflavin, niacin, vitamin B6, vitamin B12, and iron. Nutritional inadequacy (% below EAR) was higher among children and teens for folate (0.4% and 9%), zinc (3% and 14%), vitamin A (9% and 53%), vitamin C (6% and 44%) and, particularly, vitamin D (93% and 90%). 78%, 58%, and 8% of children were above the UL for niacin, folic acid and zinc intake while these percentages were lower for teens (27%, 10% and 0%, respectively). Under a zero fortification modeling scenario we found that the % of children and teens below the EAR increased modestly for folate (0.4% and 9% below EAR), zinc (3% and 14% below EAR), and iron (0.04% and 3% below EAR) while the % above the UL decreased for children and teens for folic acid (58% and 10% above UL) and zinc (8% and 0% above UL). Using the optimized fortification levels, the percentage of children and teens below the EAR was ≤4% for B‐vitamins and iron; 4% and 18% for children and teens, respectively, for zinc; and 79% and 80% for children and teens for vitamin D. The percent above the UL for the modeled optimized fortification levels was 0% for children and teens for iron, vitamin B6, zinc (teens only) and vitamin D, 55% and 16% for children and teens for niacin and 4% for children for zinc. Overall, our fortification modeling demonstrates that RTE cereal provides an important source of nutrients in the diet and that fortification levels of RTE cereal can be optimized to minimize the percent of the population with inadequacy and intakes above the upper level. Support or Funding Information Funded by the Bell Institute of Health and Nutrition, General Mills, Inc.