February 2008

Healthy Refinements: Kids’ Diets Get a Whole Grain Boost
By Sharon Palmer, RD
Today’s Dietitian
Vol. 10 No. 2 P. 46

The whole grain message is getting through, and schools and even restaurants are doing their part to help ingrain it into parents’ and children’s minds.

White bread and refined breakfast cereal have been staple grain foods for kids for decades, but there’s new hope for whole grains. That’s because some parents are starting to realize that whole grains are healthier for their children. According to the Report on Healthy and Organic Foods 2006, only a label indicating no added sugar is a more attractive attribute than one touting whole grains when consumers select foods for children. When asked about the specific benefits of the top functional foods, 72% of consumers associated whole grains with benefits related to cardiovascular disease, and 86% associated fiber and whole grains with intestinal health, according to the 2007 International Food Information Council’s Consumer Attitudes Toward Functional Foods/Foods for Health survey.

Consumers now have a positive attitude about getting their families to feast on whole grains and are actively seeking them. This may explain why food manufacturers have jumped at the chance to plaster the whole grain message all over children's favorite foods—from Trix breakfast cereal to Kraft Macaroni & Cheese. More products are bragging about their whole grain content, further propping up the health halo that whole grains now proudly wear.

New product launches of foods making a whole grain claim have grown sharply since 2000. According to the Mintel Global New Products Database, in 2006 nearly 10 times as many new whole grain products were introduced as in 2000. Government and leading health organizations can take credit for getting the whole grains party started. After the release of the 2005 Dietary Guidelines for Americans, the average shopper purchased approximately 15% more whole grain products. Restaurants have further helped promote whole grains that kids can sink their teeth into—from whole grain burritos to whole grain pizza. While taste—the king in consumer decision making—was once a barrier to increasing whole grain consumption, it may no longer be.

A Healthy Habit for Children
A body of scientific evidence about the health benefits of whole grains has been mounting. Though there is a dearth of data correlating whole grain consumption in children with chronic disease prevention later in life, experts believe that introducing whole grains early can build healthy eating behaviors that can have positive effects for a lifetime.

“Whole grains are more nutrient dense; they have a variety of phytochemicals and antioxidants. Three servings of whole grains per day can significantly reduce the risk for heart disease, certain types of cancer, and diabetes,” says Leonard F. Marquart, PhD, RD, assistant professor at the University of Minnesota’s department of food science and nutrition, who believes that whole grains can be a piece of the puzzle in addressing concerns of pediatric obesity and related diseases. “Whole grains have a filling effect. Those that consume more whole grains have a lower BMI [body mass index] and gain less weight over time. When you make changes, a lot of impact comes through kids vs. waiting later on,” adds Marquart.

The pediatric obesity epidemic may be fueled by an increase in refined carbohydrates, according to Alan Greene, MD, FAAP, pediatrician and assistant clinical professor at Stanford University School of Medicine in California, who presented at the Getting Whole Grains to 3 International Conference in January 2006. “Heart disease risk factors include elevated blood pressure, elevated blood glucose, elevated triglycerides, decreased HDL [high-density lipoprotein] cholesterol, and increased waist size. Two thirds of Americans had one or more of these risk factors by the age of 18. One eighth of them have full-blown metabolic syndrome,” says Greene.

According to autopsy results, atherosclerosis may begin developing as early as the first decade of life. In a University of California, Los Angeles study, boys and girls at varying levels of fitness and adiposity without documented atherosclerosis were placed on a high-fiber, low-fat, low-cholesterol diet (which included lots of fruits, vegetables, and whole grains) at the Pritikin two-week residential program, where food was provided ad lib and exercise was performed daily for up to 2.5 hours per day. After the two-week period, significant reductions in BMI, total cholesterol, and triglycerides were observed. In addition, reduction in insulin levels in conjunction with decrements in leptin, a hormone thought to be connected to appetite, were discovered.1

Recent research is also exploring whole grain’s potential benefits for healthier carotid arteries and blood pressure levels and reducing the risk of asthma, inflammatory disease, colorectal cancer, gum disease, and tooth loss. In a study published in the December 2006 issue of Thorax, researchers from the Dutch National Institute of Public Health and the Environment found that children who ate whole grains were 54% less likely to develop asthma and 45% less likely to develop wheezing than children who did not eat whole grains.2

According to the 2005 Dietary Guidelines for Americans, all age groups should consume at least one half of their grains as whole grains. MyPyramid recommends 1.5 whole grain servings for females and males aged 2 to 3; two for females and 2.5 for males aged 4 to 8; and three for females and males aged 9 to 13. The American Heart Association recommends eating foods with whole grain listed as the first ingredient on the label and to make at least one half of daily grain servings whole grain. Across the globe, similar recommendations are made for consumers. One serving of whole grain is one slice of 100% whole grain bread, 1 cup of 100% whole grain cereal, or 1/2 cup of 100% whole grain hot cereal, cooked pasta, rice, or other grain. For food products containing whole grains, 16 grams or more of whole grain ingredients counts as a full serving.

Tempting Children to Dig Whole Grains
While plenty of food manufacturers offer tasty solutions for whole grain needs, children still have a long way to go to meet current recommendations. Recent surveys suggest that children eat roughly one to less than one serving of whole grains per day. Adults are warming up to chefs whipping up whole grain creations such as faro risotto, barley-stuffed zucchini, and squid with quinoa, but different tactics are needed to tempt kids.

Jesse Cool, food author and chef/owner of the California restaurants Flea St. Café, JZ Cool Eatery, and Cool Café, believes that it all starts with parents teaching their children to eat whole grains. At the whole grains conference, Cool emphasized that “we need to change the way that parents and adults feed kids. My job is to get them to eat whole grains by imitating junk foods, such as whole wheat burritos, whole grain pasta with meat sauce, sandwiches with whole grains, whole grain crust on pizza, and brown rice pancakes.”

“For some kids, the appearance of whole grains, since they are brown, don’t look so good. If you use white whole wheat or barley flour, it appears more refined. It looks more like what they are used to. The acceptance with this is greater than bread products made with red whole wheat flour that looks darker,” says Terri Burgess-Champoux, PhD, RD, LD, a postdoctoral fellow in the Adolescent Health Training Program at the University of Minnesota. Burgess-Champoux studied the acceptance of whole grains in a school-based project for her dissertation.

Many whole grain products can capture a child’s attention and taste buds. Whole grain ingredients can make an appearance in favorites foods such as breakfast cereals, pretzels, pitas, pastas, pizzas, tacos, wraps, cookies, sandwiches, bagels, burgers, granola bars, waffles, pancakes, graham crackers, soups, corn bread, chips, and popcorn.

The ABCs of Whole Grains
Schools may be the perfect setting to encourage children to eat more whole grains. “There are 30 million kids getting school lunches every day. You have a captive audience whereby to introduce whole grains in a context unlike other situations,” says Marquart, who led a research project on whole grain consumption in schools.

Marquart reports that the key issues in getting children to become whole grain fans include making them familiar with whole grains, increasing availability, and creating a natural transition. Marquart’s research team found success using white whole wheat flour in foods because it is lighter in color, easier to mix in foods, and tolerated better by children and it allows for a transition to whole grains. The study project was performed in first through sixth grades at Hopkins School District in Minnesota, which served approximately 550 lunches per day. Using pizza with a 50/50 blend of white whole wheat flour and refined red wheat flour providing 16 grams of whole grains per serving, the researchers studied plate waste. They found, on average, that the children ate 75% of the pizza. In addition, dinner rolls and breadsticks made with white whole wheat flour were found to be as acceptable to the children as those made with refined flour.

In a second project led by Marquart in the same district, children were fed whole grain products as part of the classroom curriculum that also included family involvement. Whole grain foods were substituted on the menu, and meal intake was observed. It was found that whole grain consumption increased by one serving when it was served for lunch in items such as pizza, pasta, tortillas, buns, and rolls. Burgess-Champoux, who also worked on the research project, reports, “We wanted to make connections between the school and home. Parents are very important; you have to really work on engaging them.” Some innovative methods used to involve parents included weekly newsletters, parent-child activities such as word searches, bakery and grocery tours, and a Whole Grain Day that included cooking and food samples, T-shirt giveaways, and a whole grain quiz bowl.

Currently, schools are not required to serve whole grains, as regulations indicate grains may be enriched or whole. In a 2004 communication to child nutrition programs in all states, the USDA encouraged school food authorities to investigate the availability of whole grain products when developing product specifications and making their procurement plans. Schools participating in the school meals program are encouraged to consider purchasing and offering whole grains and improving nutritional well-being. Although all government nutrition programs are required to be consistent with the Dietary Guidelines, the National School Lunch Program regulations trail behind the release of the most recent guidelines. Regulations are anticipated to be updated to conform with the Dietary Guidelines.

Some schools are stepping up to the plate to offer whole grains. The School Nutrition Association 2007 Trends Report found that increasing availability of whole grain products is the most commonly reported effort in place in school districts across the nation. Approximately 85% of districts implementing specific food and nutrition policies report an increase in availability of whole grain products. The HealthierUS Schools Challenge is a voluntary USDA program offering recognition to schools that improve overall nutrition. They grant Silver Award status to schools that serve whole grains three times per week and Gold Award status to schools that serve whole grain all five days. Foods qualifying as whole grain must be formulated with at least 51% of their grain as whole grain.

Many schools are promoting whole grains in the cafeteria, as well as through newsletters, buttons, posters, games, magnets, stickers, and decorations. Alaska Gateway School District in Tok, Alaska, uses whole grain buns. Operators at Clymer Central School Cafeteria in New York are finding success using white whole wheat bread for their peanut butter and jelly sandwiches and whole grain buns for their sub sandwiches. When the Chappaqua Central School district in Westchester County, N.Y., mandated that their schools offer whole wheat alternatives, the foodservice director tempted kids with products such as white rice mixed with brown rice, whole wheat spaghetti intertwined with the standard kind, and sandwiches made from one slice of white bread and one slice of wheat.

Restaurants Dishing Up Whole Grains
Restaurants are also helping expose kids to whole grains—an important step since American families are eating away from home more often. The Whole Grains Council’s program, Just Ask for Whole Grains, encourages consumers to ask for whole grain options at their favorite eating establishments with the goal that every restaurant provide at least one whole grain option on the menu. Many restaurants are ponying up to the challenge and offering kid-friendly whole grain fare. Atlanta Bread Company uses whole grain bread for sandwiches, McDonald’s features a Premium Chicken Sandwich with a whole grain bun, TGI Friday’s serves turkey burgers on whole wheat buns, Denny’s offers whole grain bagels, Taco Time utilizes a whole wheat tortilla, and Olive Garden serves whole grain pasta—just to name a few. P.F. Chang’s won the Whole Grains Council’s 2007 Challenge for serving 10 million pounds of brown rice over the year, reporting that 45% of their diners choose it over white rice.

And the whole grains message doesn’t stop there; it is woven into health promotion campaigns for many cities and states. Head Start; Women, Infants, and Children; and after-school programs are teaching kids about whole grains. Even day care providers are encouraging kids to eat whole grains. Dietitians are relying on whole grains in working with kids with special nutritional needs. At Camp Sweet Freedom, a day camp for children who use insulin, and Camp Strongheart, a camp for overweight children, in Kannapolis, N.C., instructors include whole grain cooking lessons and taste challenges to incorporate this key message. National Nutrition Month has also become a time for whole grain education to shine.

“If we can get kids to accept whole grains at a young age, this behavior can reach into adulthood,” says Burgess-Champoux. “We have to offer these foods multiple times at frequent exposures. It’s not only at school; these changes need to also occur [in] the home environment.”

— Sharon Palmer, RD, is a contributing editor at Today’s Dietitian and a freelance food and nutrition writer in southern California.

1. Roberts C, Chen A, Barnard R. Effect of a short-term diet and exercise intervention in youth on atherosclerotic risk factors. Atherosclerosis. 2007;191(1):98-106.

2. Tabak C, Wijga AH, de Meer G, et al. Diet and asthma in Dutch school children (ISAAC-2). Thorax. 2006;61(12):1048-1053.

Whole Grain Recipes
Whole Wheat Veggie Pizzas
Courtesy of HSC Cafeterias, Whole Grains Challenge Winner

Serves: Nine 7-inch pizzas

2 cups whole wheat flour
2 cups all-purpose flour
1/2 cup dry oats
1 T + 11/2 tsp active dry yeast
1/4 tsp salt
2 tsp honey
11/2 cups warm water

Mix 1 cup each white and whole wheat flour, oats, yeast, and salt. Heat water to 125°F, then add honey. Gradually add water to dry mixture. Mix for two minutes. Add remaining flour, mixing well after each addition. Knead dough for 10 minutes. Spray with Pam. Cover. Let rise in warm place until double. Punch down. Divide into equal parts. Roll and place in 7-inch pizza pans. Cover and let rise in warm place approximately 45 minutes.

Sauce and Toppings:

1 cup + 2 T pizza sauce
2 tsp minced garlic
1/4 cup fresh basil leaves, trimmed and chopped
11/2 cups spinach leaves, stems trimmed
1 cup + 2 T broccoli flowerets
1/2 cup + 1 T carrots, grated
1 cup + 2 T green peppers, diced
1 cup + 2 T fresh tomatoes, diced
21/4 cups part-skim mozzarella cheese

Mix pizza sauce with minced garlic and fresh basil. Top each dough with:

2 T pizza sauce
Spinach leaves
2 T broccoli flowerets
1 T carrots, grated
2 T green peppers
2 T fresh tomatoes, diced
1/4 cup part-skim mozzarella cheese

Bake in hot oven (375°F convection; 425°F conventional) approximately 10 minutes.

Nutrient Analysis

Calories: 326 Protein: 16 g; Carbs: 53 g; Total Fat: 6 g;
Sat Fat: 3 g; Trans Fat: 0 g; Cholesterol: 18 mg; Sodium: 372 mg; Fiber: 7 g

Italian Pasta Salad
Courtesy of Colorado Springs School District, Whole Grains Challenge Winner

Serves: Fifty 2-ounce servings

2 pounds multigrain penne pasta, cooked
13/4 cups + 2 T canned olives, sliced and drained
121/2 ounces pepperoni, sliced
3/4 cup + 1 T Italian salad dressing

Cook pasta according to package directions and drain well. Add sliced olives, sliced pepperoni, and Italian dressing to cooked pasta and toss to combine. Chill and serve.

Nutrient Analysis
Calories: 118; Protein: 4 g; Carbs: 15 g; Total Fat: 5 g; Sat Fat: 1 g; Trans Fat: 0 g
Cholesterol: 8 mg; Sodium: 237 mg; Fiber: 2 g

Kids’ Turkey Meatloaf With Whole Grain
Courtesy of Jesse Cool, Flea Street Café

Serves: 8

1 yellow onion
2 carrots, peeled
2 stalks celery
3 whole eggs, beaten
1 cup tomato ketchup
11/2 T dry Italian seasoning
1 T salt
1/2 tsp ground black pepper
2 pounds ground dark turkey meat
11/2 cups cooked bulgur

Preheat oven to 375°F. In a food processor or by hand, grate the onion, carrot, and celery and scrape into a large bowl. Add the eggs, 2/3 cup of the ketchup, the Italian seasoning, salt, and pepper. Add the ground meat and bulgur and mix thoroughly. Put the meatloaf in a baking pan and form into a loaf. Spread remaining ketchup on top of the meatloaf. Bake in the oven for approximately 45 minutes or until internal temperature when tested with a thermometer is 150°F.

Nutrient Analysis

Calories: 269; Protein: 24 g; Carbs: 18 g; Total Fat: 11 g; Sat Fat: 3 g; Trans Fat: 0 g; Cholesterol: 170 mg; Sodium: 1,367 mg; Fiber: 3 g

Optimum Power Organic Whole Grain Cookies
Courtesy of Nature’s Path Foods

1 cup butter or margarine
13/4 cup organic brown sugar
2 eggs
2 tsp vanilla
11/2 cups organic unbleached wheat flour
1 tsp baking soda
2 cups quick organic oats
2 cups Nature’s Path Optimum
1/2 cup dried cranberries

Preheat oven to 350°F. Cream butter/margarine and sugar until fluffy. Add eggs (or egg substitute) and vanilla. In a separate bowl, mix remaining ingredients. Add these to the butter mixture. Spoon drops of dough onto an ungreased cookie sheet. Bake for 10 to 12 minutes.

Nutrient Analysis

Based on 60 cookies

Calories: 67; Protein: 1 g; Carbs: 9 g; Total Fat: 4 g; Sat Fat: 2 g; Trans Fat: 0 g; Cholesterol: 15 mg; Sodium: 32 mg; Fiber: 1 g