Relationship between Whole Grain and Fiber Consumption and BodyWeight Measures among 6- to 18-Year-Olds

Michael Zanovec, MS, Carol E. O’Neil, PhD, RD, Susan S. Cho, PhD, Ronald E. Kleinman, MD, and Theresa A. Nicklas, DrPH

Objectives To examine the relationship between whole grain and fiber consumption and body weight measures inchildren 6 to 12 (n = 3868) and adolescents 13 to 18 (n = 4931) years old.Study design Combined 1999 to 2004 National Health and Nutrition Examination Survey data were analyzed.Mean body mass index (BMI), BMI percentile, BMI z-score, waist circumference, and prevalence of overweight/obesity were compared across categories of whole grain consumption (0 to <0.6, $0.6 to <1.5, $1.5 to <3, and$3 servings) with (1) a sex, ethnicity, and total energy intake–adjusted model and (2) a cereal fiber plus model 1covariates profile.Results Mean whole grain intake was 0.59 and 0.63 servings/d among children 6 to 12 years and adolescents 13to 18 years, respectively. In children, consumption of $3 servings of whole grain was not associated with bodyweight measures; however, consumption of 1.5 to <3 servings was positively associated with all weight measures.In adolescents, BMI z-score was significantly lower in the highest whole grain consumption group compared withthe lowest 2 groups; BMI percentile and waist circumference (model 1 only) were also significantly lower in the high-est whole grain consumption group.Conclusions Overall consumption of whole grain was below current recommendations of at least 3 servings perday. Only in adolescents was this level of whole grain intake associated with lower BMI z-scores. (J Pediatr2010;157:578-83).

Two of the key messages from the 2005 Dietary Guidelines for Americans is the recommendation that at least half of allgrains consumed be whole grains and fiber intake be 14 g/1000 kcal.1 Children 4 to 8 years are advised to consume at least2 servings (ounce equivalents) of whole grains each day, whereas children 9 years and older should consume 3 servings

per day.1,2 Despite the health benefits of consuming whole grains, the average intake is less than 1 serving per day, and less than10% of Americans 2 years of age and older consume 3 servings per day.3 The average daily intake of fiber is 12 g for children4 and15 g for adolescents,5 which is low enough to be of concern.1

By definition, whole grains include cereal grains that consist of the intact, ground, cracked or flaked fruit of the grains whoseprincipal components (bran, germ, endosperm) are present in the same relative proportions as they exist in the intact grain.6

Bran is the fiber-rich component7; germ (and bran) is a rich source of protein, lipids, B vitamins, and minerals (Ca, Mg, K, P,Na, Fe); endosperm is composed mostly of starch and small amounts of protein and lipids. During processing, most of thenutritive value of whole grain is preserved.8

Determining whole grain intake has been a challenge because studies quantifying intake or assessing health impacts have useddifferent definitions.3,6,9 According to a recent review of 33 studies that evaluated whole grain consumption and cardiovasculardisease risk, only 4 used the current definition used by the Food and Drug Administration (FDA).9 Most studies have definedwhole grains with a method proposed by Jacobs et al.10 They defined whole grains as those containing at least 25% whole grain

From the Louisiana State University Agricultural Center,Baton Rouge, LA (M.Z., C.O’N.), NutraSource, Inc.,Clarksville, MD (S.C.), Harvard Medical School, Boston,MA (R.K.), and the Children’s Nutrition Research Center,Department of Pediatrics, Baylor College of Medicine,Houston, TX (T.N.)

Supported by funds from Kellogg’s Corporate Citizen-ship Fund. Partial support was received from the USDAHatch Projects 940-36-3104 Project #93673 and LAB93676 #0199070. This work is a publication of the UnitedStates Department of Agriculture (USDA/ARS). Funded in

or bran by weight. The FDA definition of whole grain for food labeling specifiesthat whole grain foods contain at least 51% whole grain ingredient(s) by weightper reference amount customarily consumed.11 Additionally, bran is not consid-ered a whole grain. Because the previous studies cited above used the older def-inition including added bran, whole grain consumption may have beenoverestimated compared with estimates without added bran.

Epidemiologic and prospective, cohort studies of adult populations have re-ported an inverse relationship between whole grain intake and changes inbody mass index (BMI) and waist circumference (WC) in men and women.12-14

part with federal funds from the USDA/Agricultural Re-search Service under Cooperative Agreement No. 58-6250-6-003. We have participated in the concept anddesign, analysis, and interpretation of data, drafting orrevising of the manuscript, and have approved themanuscript as submitted. The authors declare no con-flicts of interest.

The abstract was presented at the 2009 ExperimentalBiology meeting in New Orleans, LA.

0022-3476/$ - see front matter. Copyright � 2010 Mosby Inc.

All rights reserved. 10.1016/j.jpeds.2010.04.041

BMI Body mass index

FDA Food and Drug Administration

MPED MyPyramid Equivalents Database

NHANES National Health and Nutrition Examination Survey

USDA United States Department of Agriculture

WC Waist circumference

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Vol. 157, No. 4 � October 2010

In children, however, the effects of whole grains on health anddisease endpoints are unclear. One study of children in the5th to 8th grade (n = 357) found that increased consump-tion of whole grains was related to lower BMI.15 The mech-anisms of these beneficial effects are also not clear; becausewhole grain foods are rich sources of dietary fiber in mostcountries, it is difficult to separate out the protection of fiberfrom whole grains. The purpose of this study was to exam-ine the relationship of whole grain consumption, with andwithout adjustment for total cereal fiber intake, with bodyweight measures in a recent, nationally representative sam-ple of children and adolescents.

Methods

The National Health and Nutrition Examination Survey(NHANES) is a continuous program that includes a seriesof cross-sectional surveys designed to collect nationally rep-resentative information on the nutrition and health statusof the civilian, noninstitutionalized U.S. population. Con-ducted by the National Center for Health Statistics, NHANESdata are collected by use of a complex, stratified, multistageprobability cluster sampling design. NHANES survey dataare collected via an in-home interview for demographicand basic health information, and a comprehensive healthexamination conducted in a mobile examination center. De-tailed descriptions of the sample design, interview proceduresand physical examinations conducted are available at http://www.cdc.gov/nchs/nhanes.htm. As recommended byNHANES, the data sets from 1999–2000, 2001–2002, and2003–2004 were concatenated16 to increase sample size.

The NHANES data collected from 1999-2004 were used tocompare whole grain consumption and weight in children 6to 12 years of age (n = 3868) and adolescents 13 to 18 years ofage (n = 4931). Pregnant and lactating females were excluded(n = 995). In addition, there were 6 foods introduced in 2003that could contain whole grain; however, there was no infor-mation available to calculate the whole grain content of thesefoods. The foods included Milk n’ Cereal bar (General Mills,Inc., Minneapolis, Minnesota), several character cereals,Berry Burst Cheerios (General Mills, Inc.), Fruit Harvest ce-real (Kellogg’s, Battle Creek, Michigan), and Optimum Na-ture’s Path (Nature’s Path Organic, Richmond, BritishColumbia). The 31 individuals who consumed at least oneof these products were excluded from the analyses.

Only individuals with complete demographic data, bodymeasurements, and whose dietary interview data weredeemed reliable by the National Health Statistics Center staffwere included. Because of the nature of the analysis (second-ary data analysis), and the lack of personal identifiers, thisstudy was exempted by the Institutional Review Board ofthe LSU AgCenter.

To obtain dietary data, trained interviewers conducted in-person 24-hour dietary recalls with automated datacollection systems that included multiple passes.17 For datacollection years, 1999–2002, only 1 interview administered24-hour dietary recall was conducted. In 2003–2004, 2 days

of intake were collected; however, for this study, only day 1interview administered recalls were included in the analysisto ensure consistency with the 1999–2002 dietary data. Chil-dren 6 to 11 years were assisted by an adult; adolescents 12 to18 years provided their own recall. Detailed descriptions ofthese methods are provided in the NHANES Dietary Inter-viewer’s Training Manual.17

The MyPyramid Equivalents Database (MPED) for UnitedStates Department of Agriculture (USDA) Survey Food Co-des, versions 118 and 219 were used in NHANES 1999–2002and 2003–2004, respectively, to calculate whole grain intake.The MPED is currently the only database available that pro-vides quantified measures of whole grain foods with separatetables based on the old and new (without added bran andpearled barley) definition for whole grain. The MPED fooddata files contain the number of servings (or ounce-equivalents) per 100 grams of food by 32 MyPyramid foodgroups.18,19

Participants were categorized into 1 of 4 whole grain con-sumption categories: > 0 to < 0.6 servings, >0.6 to <1.5 serv-ings, >1.5 to <3.0 servings, and $3.0 servings. Thiscategorization was chosen because the recommendation formost children is 3 servings per day; 1.5 servings representshalf of the recommendation; and the average number of serv-ings was approximately 0.6 servings. Whole grain intake wascalculated using the new definition for whole grain (exclud-ing bran) as outlined by the USDA Pyramid serving’s data-base.19

The Anthropometry Procedures Manual20 used in the1999-2004 NHANES provides information about equip-ment, calibration, methods, and quality control. Body massindex values were calculated as weight in kilograms dividedby height in meters squared (kg/m2). The percentile ofBMI-for-age was calculated with the Statistical Analysis Soft-ware program for Centers for Disease Control Growth Chartsavailable from the Centers for Disease Control and Preven-tion.21 Overweight was defined as a sex- and age-specificBMI between the 85th and 95th percentile, and obese was de-fined as a BMI $95th percentile.22

Statistical AnalysisData were analyzed with SAS (Release 9.1.3; SAS Institute,Cary, North Carolina) and SUDAAN (Release 9.0.1; RTI, Re-search Triangle Park, North Carolina) software programs. Allanalyses included sample weights that account for the un-equal probabilities of selection caused by oversampling andnonresponse. Sample-weighted data were used in all analysesto adjust the variance for the complex sample design. For the6 years 1999–2004, a 6-year sample weight variable was cre-ated by assigning 2/3 of the 4-year sample weight for 1999–2002 if the person was sampled in 1999–2002 or assigning1/3 of the 2-year sample weight for 2003–2004 if the personwas sampled in 2003–2004.16 The 6-year sample weight wasused in all analyses.

Unadjusted means and standard errors were calculated forbody weight measures. To control for covariates in an analy-sis of variance, least-square mean body weight measures,

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standard errors of the least-square means, and t test statisticsfor differences between least-square means were calculated.Analyses were conducted separately for children 6 to 12 yearsand adolescents 13 to 18 years. In the first set of linear regres-sion analyses (Model 1), least-square means were calculatedto adjust the between-group differences for sex, ethnicity,and total energy intake. A second model (model 2) was ex-tended to include all fiber consumed from cereal. A P valueof < .05 was considered significant.

Results

The sample consisted of 44% children 6 to 12 years and 56%adolescents 13 to 18 years; 50% were males. Sixteen percentwere overweight, and 17% were obese. Mean whole grainconsumption was 0.61 servings per day; 45% consumed nowhole grain; 69% consumed below the mean, and only4.2% consumed at least 3 servings of whole grain per day(data not shown).

The sample-weighted, unadjusted mean BMI, WC, andpercent overweight and obese are shown in Table I.Among children 6 to 12 years old, the mean BMI and WCwas 18.9 kg/m2 and 66.3 cm, respectively. The mean BMIand WC of adolescents 13 to 18 years was 23.4 kg/m2 and81.0 cm, respectively. The proportion of children andadolescents classified as overweight or obese in each agegroup was 33.6% and 32.3%, respectively.

Covariate-adjusted mean BMI z-scores, BMI-for-age per-centiles, WC, and percent overweight and obese by wholegrain consumption groups before and after adjustment forcereal fiber is shown by age group in Tables II and III forchildren and adolescents, respectively. Among children 6 to12 years, consumption of at least 3 servings of whole grainwas not associated with any of the body weight measures;however, all variables were lower in the highest whole grainconsumption group (Table II). Furthermore, consumptionof at least 1.5 servings of whole grain was associated withsignificantly higher BMI z-score, BMI percentile, WC, andpercent overweight and obese in both models, as comparedwith the 2 lowest whole grain consumption groups. Inadolescents 13 to 18 years, BMI z-score, BMI percentile,and WC were all significantly lower in the highest whole

Table I. Unadjusted body weight measures in children 6to 12 and adolescents 13 to 18 years of age, NHANES1999–2004

Variable6-12 Years(n = 3868)

13-18 Years(n = 4931)

BMI (kg/m2) 18.87 � 0.09 23.39 � 0.11Waist circumference (cm) 66.30 � 0.27 81.03 � 0.27% Overweight* 16.41 � 0.85 15.64 � 0.73% Obese† 17.18 � 0.82 16.65 � 0.72% Overweight and Obese 33.59 � 1.06 32.29 � 0.93

SE, Standard error.*Overweight = Sex-specific BMI-for-age $ 85th to < 95th percentile.†Obese = Sex-specific BMI-for-age $ 95th percentile.

580

grain consumption group compared with the lowestconsumption group before controlling for cereal fiber(Model 1); however, only BMI z-score remained significantafterward (Table III).

Discussion

Only 4% of children and 4.3% of adolescents in this studyconsumed at least 3 servings of whole grain. These amountswere lower than previously reported,3,23 but this is likely theresult of the definition of whole grain used. Previous estimatesof whole grain consumption were based on the method of Ja-cobs et al,10 which defined whole grains as foods containing atleast 25% whole grain or bran by weight. When bran is in-cluded, whole grain consumption may be overestimated com-pared with the new definition without bran. In this study,bran was excluded as a whole grain to reflect the most recentdefinition proposed by the FDA and used by the USDA.

Children’s food preferences24,25 are key determinants oftheir consumption. A wide variety of reasons for consumersnot choosing whole grain have been put forward and includea lack of understanding of the health benefits, an inability toidentify or purchase whole grains, or to incorporate wholegrains into the family lifestyle, a lack of familiarity with prep-aration methods, the higher price of some whole grain prod-ucts, and decreased preference for whole grain foods becauseof the reported poor taste or texture.3,26-29 Evidence suggeststhat whole grains are less available in food service operationthan in the home.30 One 4-month pilot intervention-controltrial found that a multicomponent intervention successfullyincreased students consumption of whole grains served atlunch by 1.0 serving per day and reduced refined grain con-sumption.31 More school-based interventions are needed tohelp increase the number of whole grain servings that chil-dren and adolescents consume each day.

The associations observed among adolescents, notably be-tween consumption of 3 or more servings of whole grains andBMI-for-age percentile and WC, appeared to be moderatedby the addition of cereal fiber as a covariate. The previousdefinition of whole grains did not separate out the fiber-rich bran content added during processing. This is importantto note because whether fiber or whole grain is associatedwith body weight is understudied and warrants further inves-tigation. One study13 in adults found that the associations be-tween whole grain foods and body weight were partiallydriven by bran, and that the current definition of whole grainfoods may not adequately capture all the benefits of reducedbody weight associated with whole grains because added branis excluded from the definition. Others contend that compo-nents within whole grains act synergistically,32 althoughmore research is needed in this area.

This study examined the effect of whole grains on weight,with and without adjustment for cereal fiber. Some studieshave observed an inverse association between fiber intakeand BMI z-score33 and adiposity.34 A 3-year study33 of Dan-ish children 8 to 10 years of age (n = 398) found that fiber in-take was inversely associated with change in BMI z-score in

Zanovec et al

Table II. Covariate-adjusted mean body weight measures by whole grain consumption groups in children 6 to 12 years ofage: NHANES 1999–2004

Whole grain servings groups

Total(n = 3868)

Group A ‡ 0 to < 0.6(n = 2675 [69.1%])

Group B ‡ 0.6 to < 1.5(n = 712 [18.4%])

Group C ‡ 1.5 to < 3(n = 328 [8.5%])

Group D ‡ 3(n = 153 [4.0%])

Dependent variable LSM SE LSM SE LSM SE LSM SE LSM SE

Whole grain intake (servings)Model 1 0.65 0.00 0.12 0.01 0.99 0.01 2.02 0.03 4.30 0.12Model 2 0.65 0.00 0.12 0.01 0.99 0.01 2.00 0.03 4.27 0.12

Total dietary fiber (g)Model 1 12.60 0.11 11.78 0.14B C D 13.03 0.25A C D 15.18 0.47A B D 17.98 0.63A B C

Model 2 12.60 0.11 12.05 0.14B C D 12.90 0.24A C D 14.29 0.39A B D 16.22 0.59A B C

BMI Z-ScoreModel 1 0.86 0.03 0.91 0.04C 0.80 0.07C 0.85 0.11A B 0.47 0.13Model 2 0.86 0.03 0.90 0.04C 0.80 0.07C 0.86 0.11A B 0.48 0.14

BMI-for-age percentileModel 1 65.62 0.67 66.21 0.83C 65.35 1.50C 65.70 2.32A B 57.99 3.07Model 2 65.62 0.67 66.10 0.84C 65.40 1.51C 66.04 2.36A B 58.68 3.17

WC (cm)Model 1 66.30 0.23 66.66 0.29C 65.77 0.48C 65.83 0.76A B 64.06 1.01Model 2 66.30 0.23 66.64 0.30C 65.78 0.48C 65.88 0.76A B 64.17 1.07

% OverweightModel 1 16.42 0.85 16.26 1.07C 16.13 1.81C 18.23 3.09A B 16.44 4.01Model 2 16.42 0.85 16.41 1.08C 16.07 1.81C 17.75 3.15A B 15.45 4.06

% ObeseModel 1 17.19 0.81 18.39 1.07C 14.61 1.65C 17.70 2.82A B 8.72 3.02Model 2 17.19 0.81 18.30 1.07C 14.65 1.65C 17.99 2.81A B 9.31 3.21

% Overweight or ObeseModel 1 33.61 1.05 34.64 1.33C 30.74 2.26C 35.94 3.71A B 25.16 4.60Model 2 33.61 1.05 34.70 1.34C 30.72 2.26C 35.74 3.75A B 24.76 4.75

Mean whole grain intake = 0.59 servings/day.Sample-weighted least-square mean and standard error are estimated with PROC REGRESS of SUDAAN.Model 1 covariates include sex, ethnicity, total energy intake.Model 2 covariates include sex, ethnicity, total energy intake, cereal fiber (all dietary fiber eaten from cereal).The letters A, B, C, or D attached to a group specify the other groups that are significantly different from the current group (P < .05).Overweight = BMI $ 85th percentile to < 95th percentile of BMI-for-age.Obese = BMI $ 95th percentile of BMI-for-age.

October 2010 ORIGINAL ARTICLES

normal weight boys only, whereas a direct association wasobserved in overweight boys, and no association was ob-served in girls. In another 2-year longitudinal study con-ducted with children aged 5 and 7 years (n = 521) and 7and 9 years (n = 682), Johnson et al34 found that anenergy-dense, low-fiber, high-fat diet was associated withhigher fat mass and greater odds of excess adiposity.

Most children do not meet the fiber requirement, withmean intakes approximately half of the recommendation35

for Adequate Intake.36 This study showed that higher wholegrain consumption was associated with increased fiber intake;however, mean intakes still fell well below recommendationsfor both age groups even among subjects in the highest wholegrain consumption group. Children and adolescents in thisstudy who consumed at least 3 servings of whole grains hadmean fiber intakes of 18 g/d and 22 g/d, respectively. Recom-mended fiber intakes range from 25 g/d in children 4 to 8years, to 26 g/d for females 9 to 18 years and 31 g/d for males9 to 13 years and 38 g/d for males 14 to 18 years.36 Fruit, veg-etable, and whole grain intake should be encouraged in chil-dren and adolescents to help them meet the fiber requirement.

One unexpected finding of this study was that in children 6to 12 years, consumption of 1.5 to <3 servings of whole grainswas associated with higher BMI z-score, BMI percentile, WC,and percent overweight/obese. Several explanations could be

Relationship between Whole Grain and Fiber Consumption and B

postulated for this finding. For instance, in adults, consump-tion of whole grains has been associated with an overallhealthier lifestyle, including regular physical activity. Physicalactivity increases appetite, which may result in higher weightmeasures; this may be reflective of better growth, particularlyin adolescents.

Several limitations of this study should be noted. First, be-cause of the cross-sectional design of NHANES data, causalinferences cannot be drawn. Further, information obtainedfrom a single 24-hour dietary recall may not necessarily re-flect typical consumption patterns; however, 24-hour recallsused in epidemiologic studies have been shown to producereasonably accurate group estimates of nutrient intake be-cause of such a large sample size.37 Because parents of chil-dren 6 to 11 years reported or assisted with the dietaryrecall, reporting errors may have occurred. Approximatelyhalf of children’s total energy intake is consumed at schoolor away from home; therefore parents may not be able to ac-curately report what children eat throughout the day. Thisstudy did not include physical activity data, which may affectweight, because of the problems assessing physical activity inNHANES samples. It is possible that there could be an inverseassociation between consumption of whole grains and weightif whole grain consumers exercise more than non-wholegrain consumers because exercise promotes weight loss.

ody Weight Measures among 6- to 18-Year-Olds 581

Table III. Covariate-adjusted mean body weight measures by whole grain consumption groups in adolescents 13 to 18years of age: NHANES 1999–2004

Whole grain servings groups

Total(n = 4931)

Group A ‡ 0 to < 0.6(n = 3426 [69.5%])

Group B ‡ 0.6 to < 1.5(n = 814 [16.5%])

Group C ‡ 1.5 to < 3(n = 477 [9.7%])

Group D ‡ 3(n = 214 [4.3%])

Dependent variable LSM SE LSM SE LSM SE LSM SE LSM SE

Whole grain intake (servings)Model 1 0.68 0.01 0.10 0.01B C D 1.01 0.01 2.04 0.03A B D 4.73 0.17Model 2 0.68 0.01 0.12 0.01B C D 1.01 0.01 1.98 0.04A B D 4.59 0.18

Total dietary fiber (g)Model 1 13.61 0.12 12.41 0.14B C D 14.07 0.27A C D 16.86 0.46A B D 21.80 0.76A B C

Model 2 13.61 0.11 12.70 0.14B C D 14.01 0.26A C D 15.96 0.42A B D 19.89 0.78A B C

BMI Z-scoreModel 1 0.81 0.03 0.88 0.04C D 0.74 0.07C 0.64 0.08A B 0.46 0.13A

Model 2 0.81 0.03 0.86 0.04C D 0.74 0.07C 0.68 0.08A B 0.55 0.13A

BMI-for-age percentileModel 1 65.26 0.61 66.67 0.73B C D 63.28 1.56A C 62.71 1.83A B 57.90 3.17A

Model 2 65.26 0.61 66.51 0.75C 63.31 1.56C 63.21 1.89A B 58.95 3.19WC (cm)

Model 1 81.03 0.26 81.45 0.33C D 80.97 0.66C 79.72 0.77A B 78.20 1.10A

Model 2 81.03 0.26 81.32 0.33C 81.00 0.66C 80.13 0.80A B 79.05 1.10% Overweight

Model 1 15.64 0.72 16.76 0.93B C 12.21 1.51A C 15.61 2.14A B 12.00 2.85Model 2 15.64 0.72 16.78 0.94B C 12.21 1.51A C 15.55 2.22A B 11.88 2.84

% ObeseModel 1 16.65 0.72 17.48 0.90C 16.72 1.75C 13.23 1.98A B 12.14 2.61Model 2 16.65 0.71 16.99 0.89C 16.81 1.75C 14.76 2.06A B 15.33 2.93

% Overweight or ObeseModel 1 32.29 0.92 34.23 1.15B C 28.94 2.14A C 28.84 2.75A B 24.14 3.67Model 2 32.29 0.92 33.77 1.17C 29.02 2.14C 30.31 2.85A B 27.21 3.87

Mean whole grain intake = 0.63 servings/d.Sample-weighted least-square mean and standard error are estimated with PROC REGRESS of SUDAAN.Model 1 covariates include sex, ethnicity, total energy intake.Model 2 covariates include sex, ethnicity, total energy intake, cereal fiber (all dietary fiber eaten from cereal).The letters A, B, C, or D attached to a group specify the other groups which are significantly different from the current group (P < .05).Overweight = BMI $ 85th percentile to < 95th percentile of BMI-for-age.Obese = BMI $ 95th percentile of BMI-for-age.

THE JOURNAL OF PEDIATRICS � www.jpeds.com Vol. 157, No. 4

In this study, several body weight variables were associatedwith whole grain intakes in adolescents, but not children;however, after adjustment for cereal fiber, only BMI z-scorewas associated with whole grain intake. More studies areneeded to separate the independent effects of whole grainsand fiber on health. Data from this study suggests that cerealfiber is an important component of whole grains and may bemore important for weight and adiposity measures thanwhole grains alone. Further research is needed, includingrandomized controlled intervention trials and school-basedinterventions looking at whole grains, fiber, and weight inchildren and adolescents. The major strengths of this studyare the use of the most recent national dataset which is rep-resentative of the U.S. population and the new recently re-leased definition of whole grains. n

Submitted for publication Dec 2, 2009; last revision received Apr 1, 2010;

accepted Apr 23, 2010.

Reprint requests: Carol E. O’Neil, PhD, MPH, RD, LSU AgCenter, School of

Human Ecology, 261 Knapp Hall, Baton Rouge, LA 70803. E-mail: coneil1@

lsu.edu.

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