Koo Hui Chin1, Satvinder Kaur2, Chan Kai Quin1, Lim Geok Pei1 1Tunku Abdul Rahman University College
2UCSI University
Nutrition Society of Malaysia - 36th Scientific Conference
Studies of whole grain consumption
among children and adolescents
Major source of dietary fiber, vitamins, minerals and
phytochemicals (Slavin et al., 2016)
Whole Grain
Agency or organization Whole grain definition
American Association of Cereal Chemists International (AACCI)
Whole grain shall consist of the intact, ground, cracked, or flaked caryopsis
whose principal components, the starchy endosperm, germ, and bran, are present
in the same relative proportions as they exist in the intact grain.
Whole grains council Whole grain or foods made from them contain all the essential parts and naturally
occurring nutrients of the entire grain seed in their original proportions. If the
grain has been processed, the food product should deliver the same rich balance
of nutrients that are found in the original grain seed.
HEALTHGRAIN Whole grain shall consist of the intact, ground, cracked, or flaked kernel after the
removal of inedible parts, such as the hull and husk. The principal anatomical
components, the starchy endosperm, germ, and bran, are present in the same
relative proportions as they exist in the intact kernel. Small losses of
components, i.e., <2% of the grain and <10% of the bran, that occur through
processing methods consistent with safety and quality are allowed.
Korczak et al. 2016
Whole grain definition
Korczak et al. 2016
Whole grain food definition
Agency or organization Whole grain food definition
American Association of Cereal
Chemists International (AACCI)
A whole grain food product must contain ≥8 g WGs/30 g
product.
USDA ≥8 g dry whole grain ingredient per labeled serving and
per reference amount customarily consumed (RACC)
and ≥51% of the grain components are whole grain.
Industry roundtable Whole grain food provides ≥8 g whole grain /30 g
(27/100 g) but does not contain excessive amounts of
fat, sugar, sodium, or calories.
Food and Drug Administration (FDA) Foods must be ≥51% whole grain by weight per
rreference amount customarily consumed (RACC).
Dietary fiber is used as a marker for compliance but may
be waived on single-ingredient whole grain foods (e.g.,
brown rice).
Korczak et al. 2016
Whole grain stamps
100% Stamp: All grain is whole grain; at least
16g whole grain per serving.
50%+ Stamp: 50% or more of grain is whole
grain; at least 8g per serving.
Basic Stamp: At least 8g of whole grain per
serving.
At least half of the total grains should
be whole grain
Children: 32g/day
Adult: 48/g day
Whole grain recommendations
Countries Year Quantitative Qualitative
UK 2018 None Choose whole grains
Canada 2019 None Whole grain should be consumed regularly. Eat
plenty of whole grain food. Choose WG foods.
Singapore 2015 None Inclusion of more whole-grain foods
Denmark 2013 ≥75 g/d Choose whole grain first—it’s easy if you look
for the WG logo when you shop.
Norway 2014 70–90 g/d Eat whole grain cereal products every day.
Sweden 2015 70 g/d in females—90 g/d in
males
Choose whole grain varieties when you eat
pasta, bread, grain and rice.
France 2019 At least one WG starch per day
(no information vs.
corresponding quantity of WG
ingredients)
Starches can be consumed every day. It is
recommended to consume the whole grain
version when they are grain-based: whole grain
bread, whole grain rice, whole grain pastas,
etc.
Whole grain recommendations
↓ adiposity level
(Koo et al. 2018)
↓ fasting insulin level
(Cecilie et al. 2018)
↑ folate (Hur et al. 2012)
Cardiometabolic profile
(Damsgaard et al. 2017)
Health benefits of whole grain in children and adolescents
Healthy bone (van den Hooven et al. 2015)
Whole grain daily intakes in children
and adolescents in several countries
Meynier et al. 2020
National campaign named Fuldkorn: ↑ in whole grain content of several commercial food products, use of whole grain logo on foods with high content in whole grain, communication to improve consumer knowledge vs. whole grain, information materials to assist bakers and retailers => broad partnership with involvement of multiple stakeholders
Programs to promote whole grain in children and adolescent
National Health and Nutrition Examination Survey shows significant trend toward increased intake of whole grains in US, including adolescent population (Tester et al. 2017)
Countries Name Setting Components used to promote whole grain
USA Power of 3: Get
healthy with whole
grain food
School Classroom education lessons; school cafeteria
menu changes to ↑ availability of WG (for a
variety of foods); family-oriented activities
Netherland Van Kleef 2014 School Nudging (use of fun shape for WG breads)
USA
Radford 2014
School & home Provision for FREE of a large variety of
commercially available WG-containing foods at
home and WG-containing snacks at school
USA Keast 2011 Food industries Modest change in food formulation to ↑ WG
content in foods that are commonly consumed
Malaysia GReat-Child Trial School Classroom education lessons; whole grain food
substitution; diet counseling for parents
Barriers to whole grain consumption in children and adolescents
Meynier et al. 2020
Children Adolescents
Dislike taste/ texture Poor availability
Lack of appeal (appearance /
pack/ marketing)
Time-consuming to prepare/
eat
Difficult to identify Lack of appeal (appearance /
pack/ marketing)
Lack of knowledge on nutrition
& health benefits
Cost
How about barriers to whole grain consumption specifically for Malaysian population? Due to the fact that food accessibility, cultural, socioeconomic background and food preference may show a discrepancy between settings (Moghames et al. 2016), we are conducting a theory-based qualitative study to investigate barriers to whole grain consumption in Malaysian population
Italian population (Sette et al. 2017)
Sources of whole grain intake in children and adolescents
Malaysian population (Norimah et al. 2015)
RTEC
bread
Sweet cracker
& biscuit
pasta & rice
others
French population (Bellisle et al. 2014)
Mann et al. 2015
↑ Energy, carbohydrate, protein*
↑ Sugar*
↑ Fiber, micronutrients*
↑ Saturated fatty acid
↑ Natrium in T3 compared to T2*
Whole
grain and
other fatty
acids
intake in
Kuala
Lumpur
children
A total of 412 children aged 9-11 years
(Krejcie & Morgan 1970) recruited using
cluster random sampling method in
Kuala Lumpur, Malaysia
Participants Recruitment
1. Healthy
Malaysian
children aged 9-
11 years
2. Able to read,
write and
understand Malay
3. Written parental
consent obtained
Inclusion
criteria
1. Children with
serious
comorbidity
requiring
therapeutic diet
Exclusion
criteria
Linear regression for variables predicted by whole grain intake
Majority
Minority
It is known that food processing might have
great impact on the biological activities of
whole grain as it is, and could attenuate any
subsequent health benefits (Kostecka 2015)
Inconsistencies in labelling and wide variations in the amounts of whole grain found in foods labelled as whole-grain food have lead to the public becoming confused, and have created an uncertainty in product development for the food industry, complicating the work of scientists who are researching the link between whole grain and health (Ross et al. 2017)
Future intervention and industry collaboration may be
needed to promote wholegrain products, which are
low in sugar, salt and saturated fatty acids, but high in
essential fatty acids
Whole grain food frequency questionnaire for Malaysian children population
Flow chart to depict the development and validation phase of the FFQ
Food groups contribution to whole grain FFQ
Food groups Percentage of
contribution (%)
Examples
Ready-to-eat cereal,
muesli and snack bar
55.8 Yogood Crunchy muesli, Weetabix Oatibix flakes,
Kellogg’s Mueslix
Biscuit, cookie and
chip
21.1 Jacob’s Weetameal, McVitie’s digestive biscuit, Tesco
Oaties
Hot cereal drink 12.2 Ecobrown’s whole grain rice drink, Nestle Nestum with
brown rice, Quaker oat cereal drink
Bread, cake and
muffin
4.5 Whole grain bread, whole meal paratha, whole wheat
cake
Rice, noodle and pasta 3.2 Brown rice, brown rice noodle, brown rice porridge
Other whole grain
products
3.2 Barley, corn, quinoa
Facilitators of whole grain consumption in children and adolescents
Meynier et al. 2020
Children Adolescents
↑ sensory appeal ↑ Availability of whole grain
food
Incorporate whole grain in usual
and well-liked products
↑ sensory appeal
Familiarization to whole grain
food
Incorporate whole grain in
usual and well-liked products
↑ Availability of whole grain food ↑ variety of whole grain food
Perhaps, whole grain cookbook may help in improving whole grain consumption? We are developing a whole grain cookbook specifically for multiethnic Malaysian population.
Efforts
Global definition of whole grains
Whole grain application food
policy
Sustainability of whole grains
Food manufacturing making whole grain food
more accessible, convenient and palatable
Practices of Public-private partnerships and communication
Brownlee et al. 2018; Foster et al. 2020
References
Alexandra M, Aurelie CR, Elisabeth R (2020), Main factors influencing whole grain consumption in children and
adults-A narrative review, Nutrients,
Norimah AK, Koo HC, JM HJ, MT MN, Tan SY, et al. (2015) Correction: Whole Grain Intakes in the Diets Of
Malaysian Children and Adolescents – Findings from the MyBreakfast Study. PLOS ONE 10(11): e0142763.
Olukotun O, Seal N. A systematic review of dietary assessment tools for children age 11 years and younger. Infant
Child Adolesc Nutr. 2015;7:139–47.
Fatihah F, Ng BK, Hazwanie H, Norimah AK, Shanita SN, Ruzita AT, et al. Development and validation of a food
frequency questionnaire for dietary intake assessment among multi-ethnic primary school-aged children. Singap
Med J. 2015;56(12):687–894.
Noor Hafizah Y, Ang LC, Yap F, Nurul Najwa W, Cheah WL, Ruzita AT, et al. Validity and reliability of a food
frequency questionnaire (FFQ) to assess dietary intake of preschool children. Int J Environ Res Public Health.
2019;16(23):4722.
