How does breakfast help manage body weight? The observational evidence. Dr Margaret Ashwell, Anne de la Hunty and Sigrid Gibson

Transcription

1 How does breakfast help manage body weight? The observational evidence Dr Margaret Ashwell, Anne de la Hunty and Sigrid Gibson

2 2007

3 9 studies 5 in adults 3 cross sec@onal 1 prospec@ve 1 RCT 4 in children 3 cross sec@onal 1 prospec@ve

4 Differences in BMI - adults Study Breakfast categories Rela4onship with BMI Bazzano, 2005 Daily vs Rarely breakfast cereal consump@on AverageBMI Daily 24.2* Rarely 24.9 %BMI > 25 Daily 33%* Rarely 45% Bertrais, 2000 Cho, 2003 Song, days/12 vs 0-1 day/12 Assigned according to which category contributed more calories than any other category. Breakfast cereal consumers vs non breakfast cereal consumers Women 22.1 vs 23.0 Men 24.5 vs 25.4* Breakfast cereal 26.03* B fast skipper Meat and egg OR for BMI >25 Women Men 0.70 ( )* 0.99 ( )

5 Differences in weight gain after 8 and 13 years Study Breakfast categories Weight gain Risk of BMI >25 Bazzano, 2005 Daily vs Rarely breakfast cereal consump@on ADer 8 years Daily 1.07 kg* Rarely 1.66 kg ADer 8 years 0.78 ( )* ADer 13 years Daily 1.81kg* ADer 13 years 0.88 ( ) Rarely 2.27kg

6 Percentage of studies showing that people who regularly eat breakfast cereal are slimmer than those who don t (de la Hunty and Ashwell,2007)

7 Most recent observational evidence Updated review with meta- analysis 2012

8 Does regular breakfast cereal consump4on help children and adolescents stay slim? A systema4c review and meta- analysis (submined for publica4on, 2012) Anne de la Hunty MSc, Sigrid Gibson MSc and Margaret Ashwell PhD

9 Design review, and meta- analysis where possible Studies of breakfast cereal (with quality assessed) with mean BMI, BMI z- scores, prevalence of overweight or obesity and other measures of adiposity.

10 Results Seventeen papers ( 12 cross sec@onal, 4 prospec@ve and one interven@on) met the inclusion criteria, giving 25 study groups. Computed effect size for mean BMI between high consumers and low/non- consumers was kg/m 2 (95% CI , ) Adjustment for age and publica@on bias a]enuated the effect sizes somewhat but they remained sta@s@cally significant. The prevalence and the risk of overweight was lower in children and adolescents who consume breakfast cereals regularly compared to those who consume them infrequently or not at all. Energy intakes tended to be higher in regular breakfast cereal consumers.

11 12 cross- sec4onal studies Gibson, S., Micronutrient intakes, micronutrient status and lipid profiles among young people consuming different amounts of breakfast cereals: further analysis of data from the Diet and Survey of Young People aged 4 to 18 years. Public health nutri@on, (8): p Albertson, A., M., G. Anderson, Harvey, S. Crocke], J., and M. Goebel, T, Ready- to- eat cereal consump@on: its rela@onship with BMI and nutrient intake of children aged 4 to 12 years. Journal of the American Diete@c Associa@on, (12): p Albertson, A.M., D.R. Thompson, D.L. Franko, and N.M. Holschuh, Weight indicators and nutrient intake in children and adolescents do not vary by sugar content in ready- to- eat cereal: results from Na@onal Health and Nutri@on Examina@on Survey Nutr Res, (3): p Deshmukh- Taskar, P.R., T.A. Nicklas, C.E. O'Neil, D.R. Keast, J.D. Radcliffe, and S. Cho, The rela@onship of breakfast skipping and type of breakfast consump@on with nutrient intake and weight status in children and adolescents: the Na@onal Health and Nutri@on Examina@on Survey J Am Diet Assoc, (6): p Gibson, S.A. and K.R. O Sullivan, Breakfast cereal consump@on pa]erns and nutrient intakes of Bri@sh schoolchildren. Journal of the Royal Society of Health, (6): p Kafatos, A., M. Linardakis, G. Bertsias, I. Mammas, R. Fletcher, and F. Bervanaki, Consump@on of ready- to- eat cereals in rela@on to health and diet indicators among school adolescents in Crete, Greece. Annals of nutri@on & metabolism, (3): p Kos@, R., I., D. Panagiotakos, B., A. Zampelas, et al., The associa@on between consump@on of breakfast cereals and BMI in schoolchildren aged years: the VYRONAS study. Public health nutri@on, (10): p McNulty, H., J. Eaton- Evans, G. Cran, et al., Nutrient intakes and impact of for@fied breakfast cereals in schoolchildren. Arch Dis Child, (6): p Ortega, R.M., A.M. Requejo, A.M. Lopez- Sobaler, et al., Difference in the breakfast habits of overweight/obese and normal weight schoolchildren. Int J Vitam Nutr Res, (2): p Panagiotakos, D., B., G. Antonogeorgos, A. Papadimitriou, et al., Breakfast cereal is associated with a lower prevalence of obesity among year- old children: the PANACEA study. Nutri@on metabolism and cardiovascular diseases : NMCD, (9): p Vågstrand, K., B. Barkeling, H.B. Forslund, et al., Ea@ng habits in rela@on to body fatness and gender in adolescents- - results from the 'SWEDES' study. European journal of clinical nutri@on, (4): p Williams, B., M., N. O, Carol,E., D. Keast, R., S. Cho, and T. Nicklas, A., Are breakfast consump@on pa]erns associated with weight status and nutrient adequacy in African- American children? Public health nutri@on, (4): p prospec4ve studies Barton, B., A., A. Eldridge, L., D. Thompson, et al., The rela(onship of breakfast and cereal consump(on to nutrient intake and body mass index: the Na(onal Heart, Lung, and Blood Ins(tute Growth and Health Study. Journal of the American Diete@c Associa@on, (9): p Albertson, A., M., S. Affenito, G., R. Bauserman, N. Holschuh, M, A. Eldridge, L., and B. Barton, A., The rela(onship of ready- to- eat cereal consump(on to nutrient intake, blood lipids, and body mass index of children as they age through adolescence (DISC Study). Journal of the American Diete@c Associa@on, (9): p Albertson, A.M., D. Thompson, D.L. Franko, N.M. Holschuh, R. Bauserman, and B.A. Barton, Prospec(ve associa(ons among cereal intake in childhood and adiposity, lipid levels, and physical ac(vity during late adolescence. J Am Diet Assoc, (10): p Franko, D.L., A.M. Albertson, D.R. Thompson, and B.A. Barton, Cereal consump(on and indicators of cardiovascular risk in adolescent girls. Public Health Nutr, (4): p interven4on study Rosado, J., L., R. del, Arellano,María, K. Montemayor, O. García, P, and M. Caamaño, del,c., An increase of cereal intake as an approach to weight reduc(on in children is effec(ve only when accompanied by nutri(on educa(on: a randomized controlled trial. Nutri@on journal, : p. 28.

12 Reference Population Age Number Outcomes Gibson, 1995 Britain years 2705 Mean BMI, Energy intakes McNulty, 1996 Northern Ireland years 1015 Mean BMI, % body fat, Energy intakes Ortega, 1998 Spain 9-13 years 200 cereal consumption Albertson, 2003 USA 4-12 years 603 Mean BMI, % overweight, Energy intakes Gibson, 2003 Britain 4 18 years 1688 Mean BMI, Energy intakes Kafatos, 2005 Greece years 392 Mean BMI, WhtR, Energy intakes Vagstrand, 2007 Sweden years 474 % body fat Kosti, 2008 Greece years 2008 Mean BMI, OR for overweight Panagiotakos, 2008 Greece years 700 OR for overweight Williams, 2009 USA 1-12 years 1389 Mean BMI, BMI for age z score, % obese, WC, Energy intakes Deshmukh-Taskar, 2010 USA 9-18 years 9659 Mean BMI^, BMI z score, % obese, WC, Energy intakes Albertson, 2011 USA 6-18 years 9660 Mean BMI, BMI for age, % overweight, WHtR, energy intakes

13 Prospective studies - children Reference Population Age Number Years of follow-up Outcomes Barton, 2005 USA 9-10 years years BMI z-scores, OR for overweight Albertson, 2009 Albertson, 2009 USA 8-10 years USA 9-10 years years Mean BMI, BMI z score, Energy intakes years % body fat Franko, 2011 USA 9-10 years years WHtR

14 The evidence is that breakfast cereals regularly results in a lower BMI (and a reduced likelihood of being overweight) in children and adolescents. 25 study groups kg/m 2

15 Conclusions from the observational evidence There is consistent evidence of an associa4on between breakfast cereal consump4on and a healthy weight in adults and children. There is limited evidence for any proposed mechanism that would point to it being a causal rela4onship.

16 A causal relationship? Evidence of confounding? Evidence of a reduc@on in energy intakes? Evidence of an increase in energy expenditure?

17 Proposed Mechanisms? Energy intake Physiological reasons Circadian rhythms Energy expenditure metabolic rate Physical Thermic effect of food Other acute mechanisms

18 How does breakfast help manage body weight? The physiological reasons Jonathan Johnston Faculty of Health and Medical Sciences

19 Does breakfast help manage body weight? Drs Sue Reeves, Tina Smith, Lewis Halsey & Jorg Huber Satellite symposium