These foods have a major role in dietary guidelines the world over, guidelines that advise for 30% to 50% of daily calorie intake to come from bread and cereals. Additionally, it is recommended for half the grains to be whole grains and, likewise, for the total portions of cereals to contribute to daily energy needs. 

For instance, a woman living in a city with a sedentary life whose energy consumption is 2 000 kcal might need six 30-gram portions of foods made with cereals; three of them whole grain and the other three, refined and fortified. Epidemiological investigations suggest this grain mix is related to a risk reduction of suffering chronic diseases such as diabetes and coronary heart disease. 

This article will go over the consumption of foods elaborated with cereals all over Latin America, and the literature pointing at a connection between cereal consumption and better diets, health benefits, and disease reduction. 

Conclusions provide robust evidence for consumers to increase their whole grain intake in terms of:

• Meeting the right cereal portion number and size
• Choosing foods made with cereals at different processing levels 
• Addressing any unbalance in the intake of said foods, choosing a correct number and mix of foods whole grains and refined

Consumption of Foods Made With Cereals in Latin America

According to data from ELAN^1,2 surveys, urban consumers in Latin America eat ten 30-gram portions average on a daily basis. This exceeds, by far, the six portions recommended for almost all workers in cities with sedentary jobs.

The intake of more portions than suggested implies, at least, 300 extra kilocalories a day. Energy excess is even higher if portions are of products containing critical nutrients like cookies, snack cakes, pastries, and snacks–all rich in sugar, fat, and salt. Said surveys state that more than one fourth of the total energy comes from sweetened beverages and other indulgent foods^3,4.

Dietary guidelines advise these type of food products to be consumed far between, both for their energy excess and low-nutrient density as well as the possibility for them to end up replacing those foods which should be eaten more frequently. A high consumption of indulgent foods high in calories and low in nutrients–whether made with cereals or any other food group–contribute to a deficient intake of the nutrients necessary to preserve good health. 

Research has shown that more than 40% of the Latin American population doesn’t follow the region’s dietary guidelines.⁵

It is a fact that the consumption of products made with cereals, including those which should be eaten occasionally, is quite high. Conversely, intake of food products elaborated with whole grains is considerably below the amounts suggested, with an average 0.5 portions a day and not three (90g total) as advised for 2000-kcal diets.

People living in rural areas in Latin America, particularly those who follow more traditional diets, show a barely higher intake. However, they don’t meet the requirements in terms of whole grain consumption.

These foods contribute to less than 2% of the total energy in most Latin American diets and only a reduced number of people covers suggested portions of food products made with whole grains or meets the goal of making at least half the grains, whole grains. 

People not following a dietary pattern with whole grains and adequate fortified refined grain portions is the reason why most of the population has some nutrient deficiencies⁶– given that foods made with whole grains and fortified include nutrients like folic acid, calcium, iron, magnesium, and fiber are consumed less than the minimum required.

What’s more, results from surveys conducted in Mexico and Brazil back the use of foods made with fortified cereals (e.g. wheat and corn flours), since dietary patterns including small amounts of fortified rice and bread tend to exhibit vitamin and mineral deficiencies.^7,8,9

Go for Whole Grains to Prevent Chronic Diseases

Achieving a right nutrition is one of the strongest reasons to choose foods made with cereals. Additionally, the WHO estimastes¹⁰ that a proper combination of whole grains and fortified refined ones is connected to lower rates in disability and mortality in the region.

The evidence supporting these claims is massive. Large-scale research shows a daily intake of three portions of food products made with whole grains (two slices of wholemeal bread and a bowl of whole-grain cereal, for instance) is related to reduced risks of suffering cardiovascular diseases, cancer, diabetes, and mortality in general.

Furthermore, those who eat foods made with whole grains, compared to people with a minimal intake of them, have a lower mortality rate caused by respiratory and infectious diseases. The latter are considerably relevant since the world is still dealing with COVID and other respiratory viruses. 

Whole-grain products available in the market are associated with health and nutritional benefits. These studies demonstrate most of those foods contain a mix of whole and refined grains–although the amount of whole grains required for a product to be considered as whole-grain varies between 25 and 51 per cent. 

This suggests the intake of proper portions of fortified refined grains has no negative health effects like some argue when they labeled them as “foods to avoid”.

Whole Grains Rich in Fiber

Dietary fiber in cereals deserves special mention. It is found in whole grains (~2 g/slice of whole grain bread) and refined grains (~1 g/slice).

A study conducted in Mexico showed diets high in dietary fiber are linked to a larger energy intake¹¹. Fiber consumption in Latin America varies significantly–Mexicans having the highest intake and Brazilians, the lowest.

The National Survey of Health and Nutrition (ENSANUT, by its acronym in Spanish) in Mexico concluded that the average dietary fiber intake in adults is 27 g/day–with higher consumption levels in rural areas and lower in urban ones. More than 80% of city inhabitants doesn’t meet the amount recommended (25 g/day). On the other hand, for people in the countryside it represents 53%.¹² Even in Mexico, only 18% of total energy comes from foods made with cereals high in fiber.

Balanced Intake of Foods Made With Cereals

Consumption of food products made with cereals is not balanced due to three reasons:

1. Most people eat more portions of products made with cereals than advised. 
2. Few follow the combination recommended of whole and fortified refined grains.
3. Many eat too many indulgent foods–including products made with cereals–which should be consumed sporadically given the sugar, fat, and excess calories they have. What’s more, they might even displace other foods rich in nutrients.

Carbohydrates and Gluten Are Not to Blame

Many point fingers at foods made with cereals and gluten as risk factors regarding chronic diseases; however, this might prevent consumers from addressing the real problems.

1. Too many calories and too large portions¹³, specially of indulgent products.
2. A lack of balance between food groups in a diet, as well as an unbalance when it comes to whole and refined grains intake.
3. High consumption of added sugars along with a low intake of fortified foods and dietary fiber (including that from cereals).
4. Poor quality diets as those recorded in research conducted in most Latin American countries.¹⁴ 

A deficient intake of food products made with whole grains, together with an excessive total consumption of foods made with cereals (desserts and pastries in particular), is a problem that needs to be addressed. Blaming cereals and not recommending their consumption isn’t the path towards better nutrition and risk reduction of chronic diseases.

Better Food Choices

A better health comes with varied food choices which include all food groups according to what is recommended in dietary guidelines. For cereal-based products, it is recommended to:

• Choose the cereal portions needed to meet your individual energy needs.
• Focus on basic foods made with cereals and for half of them to be whole grains.
• Every now and then, enjoy a snack made with cereals but not on a daily basis.

Advice to Select Foods Made With Cereals and Products Elaborated With Whole Grains 

1. Being whole grain means none of the parts of the seed (bran, germ, endosperm) have been removed.
2. Check ingredient lists and make sure whole grains are at the top of the list. This ensures the product is actually made with whole grains. You should also review refined flours have been fortified. 
3. Remember, multigrain products might be made with whole grains but it isn’t the rule. “Multigrain” simply means it includes more than one grain. Go over the ingredient list and look for a reference to “whole grain”.
4. Remember, color is not a reliable indicator. Cereals might have different shades and there are certain ingredients (sorghum and colorants, for instance) which might make foods look darker.
5. The presence of seeds or oats on top of a loaf doesn’t necessarily mean the product is made with whole grains.
6. Choose whole grains in foods you enjoy and make them part of your everyday diet–bread, breakfast cereal, tortillas, cookies, pita bread, etc.

-------------------------

¹ Estudio Latinoamericano de Nutrición y Salud (ELANS), n= 9128 participantes urbanos. Ingesta promedio del total de alimentos elaborados con cereales y alimentos con granos enteros donde 318.6 g/d y 14.7 g/d, respectivamente.

² Fisberg RM, Fontanelli MM, Kowalskys I, Gómez G, Rigotti A, Cortés LY, García MY, Pareja RG, Herrera-Cuenca M,Fisberg M; ELANS Study Group. Total and whole grain intake in Latin America: findings from the multicenter cross-sectional Latin American Study of Health and Nutrition (ELANS). Eur J Nutr. 2022 Feb;61(1):489-501. doi:10.1007/s00394-021-02635-8. Epub 2021 Jul 7. Erratum in: Eur J Nutr. 2021 Nov 8: PMID: 34232375; PMCID: PMC8783851.

³ Kovalskys, I., Fisberg, M., Gómez, G., Pareja, R., Yépez García, M., Cortés Sanabria, L., . . . Koletzko,B. (2018). Energy intake and food sources of eight Latin American countries: Results from the Latin American Study of Nutrition and Health (ELANS). Public Health Nutrition, 21(14), 2535-2547. doi:10.1017/S1368980018001222

⁴ Fisberg M, Kovalskys I, Gómez G, Rigotti A, Sanabria LYC, García MCY, Torres RGP, Herrera-Cuenca M, Zimberg IZ, Koletzko B, Pratt M, Aznar LAM, Guajardo V, Fisberg RM, Sales CH, Previdelli ÁN; ELANS Study Group. Total and Added Sugar Intake: Assessment in Eight Latin American Countries. Nutrients. 2018 Mar 22;10(4):389. doi: 10.3390/nu10040389. PMID: 29565308; PMCID: PMC5946174.

⁵ Leme ACB, Hou S, Fisberg RM, Fisberg M, Haines J. Adherence to Food-Based Dietary Guidelines: A Systemic Review of High-Income and Low- and Middle-Income Countries. Nutrients. 2021 Mar 23;13(3):1038. doi: 10.3390/nu13031038. PMID: 33807053; PMCID: PMC8004702.

⁶ Barco Leme AC, Fisberg RM, Veroneze de Mello A, Sales CH, Ferrari G, Haines J, Rigotti A, Gómez G, Kovalskys I, Cortés Sanabria LY, Herrera-Cuenca M, Yépez Garcia MC, Pareja RG, Fisberg M. Food Sources of Shortfall Nutrients among Latin Americans: Results from the Latin American Study of Health and Nutrition (ELANS). Int J Environ Res Public Health. 2021 May 7;18(9):4967. doi: 10.3390/ijerph18094967. PMID: 34067018; PMCID: PMC8125540.

⁷ Sales CH, Fontanelli MM, Vieira DA, Marchioni DM, Fisberg RM. Inadequate dietary intake of minerals: prevalence and association with socio-demographic and lifestyle factors. Br J Nutr. 2017 Jan;117(2):267-277. doi: 10.1017/S0007114516004633. Epub 2017 Jan 23. PMID: 28112081.

⁸ López-Olmedo N, Carriquiry AL, Rodríguez-Ramírez S, Ramírez-Silva I, Espinosa-Montero J, Hernández-Barrera L, Campirano F, Martínez-Tapia B, Rivera JA. Usual Intake of Added Sugars and Saturated Fats Is High while Dietary Fiber Is Low in the Mexican Population. J Nutr. 2016 Sep;146(9):1856S-65S. doi: 10.3945/jn.115.218214. Epub 2016 Aug 10. PMID: 27511932.j

⁹ Sales CH, Rogero MM, Sarti FM, Fisberg RM. Prevalence and Factors Associated with Iron Deficiency and Anemia among Residents of Urban Areas of São Paulo, Brazil. Nutrients. 2021 May 31;13(6):1888. doi: 10.3390/nu13061888. PMID: 34072813; PMCID: PMC8226555.

¹⁰ Micha R, Khatibzadeh S, Shi P, Andrews KG, Engell RE, Mozaffarian D; Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE). Global, regional and national consumption of major food groups in 1990 and 2010: a systematic analysis including 266 country-specific nutrition surveys worldwide. BMJ Open. 2015 Sep 24;5(9):e008705. doi: 10.1136/bmjopen-2015-008705. PMID: 26408285; PMCID: PMC4593162.

¹¹ Sánchez-Pimienta TG, Quezada-Sánchez AD, Rivera JA, Shamah T, Batis C. Nutrient composition of mealtimes and its association with the energy intake of subsequent meals among Mexican adults. Appetite. 2021 Sep 1;164:105288. doi: 10.1016/j.appet.2021.105288. Epub 2021 May 5. PMID: 33964396.

¹² Fontanelli MM, Sales CH, Castro MA, Fisberg RM. Healthful grain foods consumption by São Paulo residents: a 12-year analysis and future trends. Public Health Nutr. 2021 Jul;24(10):2987-2997. doi: 10.1017/S1368980020001342. Epub 2020 Jul 1. PMID: 32605681.

¹³ Pereira JL, Mendes A, Crispim SP, Marchioni DM, Fisberg RM. Association of Overweight with Food Portion Size among Adults of São Paulo - Brazil. PLoS One. 2016 Oct 5;11(10):e0164127. doi: 10.1371/journal.pone.0164127. PMID: 27706222; PMCID: PMC5051931.

¹⁴ Gómez G, Fisberg RM, Nogueira Previdelli Á, Hermes Sales C, Kovalskys I, Fisberg M, Herrera-Cuenca M, Cortés Sanabria LY, García MCY, Pareja Torres RG, Rigotti A, Guajardo V, Zalcman Zimberg I, Chinnock A, Murillo AG, Brenes JC, Elans Study Group OBOT. Diet Quality and Diet Diversity in Eight Latin American Countries: Results from the Latin American Study of Nutrition and Health (ELANS). Nutrients. 2019 Jul 15;11(7):1605. doi: 10.3390/nu11071605. PMID: 31311159; PMCID: PMC6682987.