Strategies to increase whole grain consumption among elementary school children

Whole grain intake is associated with numerous health benefits; however, children only consume about one-third of the recommended level. U.S. policy statements and regulatory guidelines all recommend higher intakes of whole grain foods to reduce risk for coronary heart disease (CHD), type 2 diabetes, and overweight/obesity. These recommendations are primarily based on epidemiological studies indicating that whole grains are associated with reduced risk for these leading U.S. chronic diseases.;Little research has been conducted to examine effective approaches to increase children's whole grain intake through school meals. With over 30 million school children participating in the National School Lunch Program (NSLP), school lunches and after-school snack programs in elementary schools provide an excellent venue for nutrition interventions.;This research was aimed at identifying diverse strategies to increase whole grain consumption among elementary school children participating in school lunches and/or after-school snack programs. This project consisted of three diverse and interrelated studies which included both qualitative and quantitative research tools: Study I consisted of the gradual incorporation of white whole wheat flour in bread products to be served on an elementary school lunch menu (Fall 2005-Spring 2006); Study II involved the introduction of whole grain snacks in an elementary after-school snack program (Spring 2007); and Study III compared intake for a Graham snack with varying whole grain levels in an elementary after-school snack program (Fall 2007).;Study I tested the feasibility of an innovative approach whereby the whole wheat content of bread products in school lunches was gradually increased over the course of a school year to increase whole grain intake by children. A convenience sample included children in K-6th grade from two elementary schools in a Midwestern city. Whole white wheat flour content of buns and rolls served twice weekly was increased from 0% to 91% in 7 incremental levels, over the school year. Plate waste methods were used on a whole school basis to estimate consumption. This study showed that mean consumption of whole grain (g/child) increased as the level of white whole wheat flour increased in modified bread products. Consumption of modified bread products did not differ statistically from baseline (0% whole grain flour) until the 67.5% level for white wheat was served. Consumption of buns and rolls varied with type of accompanying menu items regardless of wheat type or level. This approach involving a gradual increase in whole wheat content in menu items resulted in favorable whole grain consumption by children.;In study II, we compared the difference in consumption between snacks made with either a low level (5g/svg, 8g/svg) or high level (26g/svg) of whole grain flour among children participating in after-school snack programs. A total of 117 children (K-6th) from four elementary schools in a Midwestern city participated in this study, which included plate waste collection and group interviews. The mean consumption for Graham crackers 26g, (52.0+/-11.40), was significantly different from the mean consumption for Goldfish 0g, (78+/-4.3 1), Graham crackers 5g, (80.2+/-5.19), and Goldfish 8g, (75.4+/-5.24) (p< 0.05). Data from Study II suggested that children were more sensitive to the taste and texture of the 100% whole grain product as compared to snacks with less whole grain. Snack products with considerable whole grain content require additional research in order to increase their appeal to children.;Finally, in Study III, we examined graham snack consumption containing varying levels of whole wheat flour per serving by school-aged children. Subjects included 100 elementary school children (grades K-6) participating in after-school snack programs in four elementary schools. Over 8 weeks, children were offered graham snacks in a random order containing 5, 8, 12, and 16g of whole wheat flour per 30g serving. Plate waste was used to measure graham snack consumption, as children placed their unfinished snacks in a waste receptacle and subsequent waste was measured after each session. At week 9, a subgroup of children participated in taste tests and rated each snack for liking on a 9-point hedonic scale. Another subgroup of children was enrolled in group interviews to provide input about their perceptions of the products' quality and suggestions for improvement. Consumption for the 5, 8, 12, and 16g graham snacks was 80%, 76%, 79%, and 80%, respectively. The taste tests results showed no significant difference in rating of the four graham snacks. The group interviews indicated that overall, the products were well-liked, particularly for texture. Study III suggested that these snacks can contribute a significant dietary source of whole grain when offered through an after-school snack program. In addition, graham snacks containing a full serving (16 g) of whole grain appear to be a feasible approach to enhance children's consumption in this school environment.