Reformulation of children’s breakfast cereals: repeated cross-sectional analysis of products in the UK from 2020 to 2023

Excessive calorie, sugar and salt intake in children’s diets is a public health concern (1) . The UK government introduced voluntary salt (2) and sugar (3) reduction programmes to improve the nutritional content of key food categories. Breakfast cereals are an important breakfast choice in children’s diet and are frequently marketed using child-appealing packages (4) . This study aims to assess the impact of these initiatives on improving breakfast cereals with child-appealing packaging from 2020 to 2023. We conducted repeated cross-sectional surveys yearly from 2020 to 2023, collecting data on energy, total sugars, fibre, and salt content per 100g from the nutrition information panel of breakfast cereals available in nine major UK retailers and meeting the child-appealing packaging (e.g. cartoons) criteria (5) . Statistical analysis, including the Friedman test and χ 2 tests, was performed to assess changes in nutritional content over time and compliance with the salt and sugar reduction programmes. Total number of breakfast cereals surveyed each year were n=119, n=126, n=138, and n=133, respectively, with 80 products consistently surveyed (matched) across all four years. Matched breakfast cereals (n=80) showed statistically significant reductions in median total sugars and salt content in 2023 compared to 2020: median (Interquartile Range) total sugars reduced from 22g/100g (15.6-25.9) in 2020 to 19.9g/100g (15.5-22.6) in 2023 (P<0.001), and median (IQR) salt reduced from 0.50g/100g (0.28-0.70) in 2020 to 0.43g/100g (0.24-0.65) in 2023, (P=0.037). No significant changes were observed in energy or fibre contents, (p>0.05). Despite the modest reductions, 81% of breakfast cereals (n=133) collected in 2023 continued to exceed the recommended sugar reduction guideline (12.3g/100g), while only 6% exceeded the maximum salt target (0.90g/100g). Additionally, around 40% of breakfast cereals cereals in 2023 contained a third (per 30g) of a 4-6-year-old’s maximum daily recommendation of free sugars (19 g/d). There were significant variations in sugar, fibre and salt content between and across different retailers and manufacturers (P<0.05). Our findings show modest yet ongoing reductions in sugar and salt content since 2020, demonstrating the potential feasibility of reformulating breakfast cereals. However, breakfast cereals with child-appealing packaging continue to be a major source of sugar in children’s diets. These findings demonstrate the urgent need for mandatory and comprehensive sugar reduction policies to effectively reduce children’s sugar consumption. Additionally, regulatory measures should be introduced to ensure companies use child-appealing tactics on their healthiest breakfast cereals to improve children’s food preferences, and diet. These steps are essential, building on the potential impact of the UK voluntary reduction programmes to improve children’s health and help reduce childhood obesity.