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Improving breakfast patterns of portuguese children—an evaluation of ready-to-eat cereals according to the European nutrient profile model

European Journal of Clinical Nutrition (2018) | Download Citation



Ready-to-eat cereal (RTEC) breakfasts have been increasing in Portugal, among children. Eat Mediterranean (EM), a Portuguese comprehensive community-based intervention, proposed to improve breakfast patterns of children and adolescents and to evaluate the healthiness of RTEC according to WHO/Europe nutrient profile model (Euro-NP).


EM Program was developed during two scholar years (15/16 and 16/17) toward 2333 students (pre to secondary education). Data on breakfast was provided using a family record form. The intervention consisted of 257 educational sessions addressing the principles of Mediterranean Diet, and promoting a “healthy breakfast at home”. To check for compliance with Euro-NP, RTEC package food labels’ nutritional composition was used.


After intervention 92.9% of children/adolescents had breakfast daily with no report of breakfast skippers. RTECs were one of the most frequent (66.5%) breakfasts. Statistically significant improvements were showed for: daily qualitative and complete breakfast frequency (5.6%) and fruit (11.2%). Consumption of RTEC decreased 28%. According to Euro-NP, 84.6% of the RTECs were non-compliant, regarding sugar content. Children’s RTECs presented 5% more of energy and 26% more sugar than the “non-children’s” RTECs.


EM strategy showed to be a successful program to improve patterns and quality of breakfast of the children and adolescents, reinforcing the importance of school-based nutritional programs in changing lifestyles.

Nutrient profiling can be a useful tool to provide a selection of foods to be part of a healthy diet and can be used by policy-makers to design policies to identify the foods to which marketing restrictions to children, will apply.

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The authors wish to acknowledge all the nutritionists, psychologists and other health professionals, children, parents, educators, teachers, school cooking staff, and municipality technicians for their contribution on the field work, as well as the following institutions for their partnership and support: Agrupamentos de Escolas Dr. Ginestal Machado; Sá da Bandeira e de José Relvas; Hospital Distrital de Santarém; CEIDSS—Centro de Estudos e Investigação em Dinâmicas Sociais e Saúde; ISCTEIUL– Instituto Universitário de Lisboa; Municipalities of Alpiarça; and Santarém and Instituto Nacional de Saúde Doutor Ricardo Jorge.

Financial disclosure

Eat Mediterranean program (2015–2017) was coordinated by the Regional Health Administration of Lisbon and Tagus Valley (ARSLVT), Portugal co-funded by the Public Health Initiatives Program (PT06) of the EEA Grants, to the grant application 171NU2.

Author information


  1. Department of Food and Nutrition, National Health Institute Dr. Ricardo Jorge (INSA, IP), Av Padre Cruz, 1649-016, Lisboa, Portugal

    • Ana Isabel Rito
    •  & Mariana Santos
  2. Center for Studies and Research In Social Dynamics and Health (CEIDSS), Fabrica da Pólvora de Barcarena, 2730-036, Oeiras, Portugal

    • Ana Isabel Rito
    • , Inês de Carvalho Martins
    • , Sofia Mendes
    •  & Joana Padrão
  3. Regional Health Administration of Lisbon and Tagus Valley (ARSLVT), Av. Estados Unidos da América, No 77, Piso 8, 1749-096, Lisboa, Portugal

    • Ana Dinis
    • , Carla Rascôa
    • , António Maia
    • , João Lima
    •  & Camila Stein-Novais
  4. National School of Public Health, Av. Padre Cruz, 1600-560, Lisboa, Portugal

    • Mariana Santos


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The authors declare that they have no conflict of interest.

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Correspondence to Ana Isabel Rito.

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