Association between breakfast consumption and educational outcomes in 9-11 year old children in Wales

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1 Association between breakfast consumption and educational outcomes in 9-11 year old children in Wales Hannah Littlecott, Graham Moore, Ronan Lyons, Laurence Moore, Simon

2 Background Many schoolchildren, particularly those from poorer families, do not eat breakfast every day Breakfast consumption has been consistently associated with health outcomes, and cognitive functioning Evidence of direct links with educational outcomes remains equivocal. Examining educational benefits of health behaviours may help to achieve buy-in from schools into health improvement efforts

3 Aims The current study presents a longitudinal analysis of data collected as part of a cluster randomised control trial of the Welsh Assembly Government s Primary School Free Breakfast Initiative, focusing on the link between breakfast consumption, in terms of both whether children eat breakfast, and the quality of foods children eat for breakfast, and educational outcomes.

4 Methods 111 schools (58 Communities First schools) One Year 5 and one Year 6 class from each school completed the attitudes and dietary recall questionnaires 4350 students at baseline and 4472 at 12 month follow-up

5 Methods Participants were assigned an Anonymised Linking Field and linked to the National Pupil Database for Wales, a version of which is held on the SAIL (Secure Anonymised Information Linkage) databank Individual-level free school meal entitlement data and educational outcomes data were obtained for 3055 (68.3%) A nested cohort of 1216 children provided data at baseline and follow-up trial data collections. A secondary analysis examines links between breakfast consumption at these two time points

6 Measures Deprivation: data on free school meal entitlement Dietary recall questionnaire: modified version of the Day in the Life Questionnaire. Outcome variables: proportion of children consuming less than 2 breakfasts over 2 days number of healthy items consumed for breakfast number of unhealthy items consumed for breakfast number of fruit and vegetables consumed during the rest of the day number of unhealthy items consumed during the rest of the day. SATs: mandatory tests taken by all year six students in Wales and England in mid-may

7 Statistical analysis Multi-level modelling was conducted to assess the association between breakfast consumption and SATs results Whole sample analyses using follow up data on dietary behaviour (approximately 6 months before SATs were taken) Nested cohort analysis conducted (n=1215) to assess the association between SATs scores and breakfast consumption, and consumption of other dietary outcomes at both baseline (approximately 18 months prior to SATs) and follow-up (approximately 6 months prior to SATs)

8 Results: Whole sample analysis Variables Odds ratio Lower CI Upper CI ICC Individual level demographics Individual level demographics & school-level FSM Individual level demographics & school-level FSM & breakfast Gender FSM Gender FSM School FSM Gender FSM School level FSM Breakfast

9 Individual level demographics & school-level FSM & healthy breakfast items Individual level demographics & school-level FSM & unhealthy breakfast items Results: Whole sample analysis Variables Odds ratio Lower CI Upper CI ICC Gender FSM School level FSM Healthy breakfast items Gender FSM School level FSM Unhealthy breakfast items

10 Results: Nested cohort analysis Consumptio n of breakfast Healthy breakfast items Unhealthy breakfast items Odds ratio Lower CI Upper CI Baseline Follow up Baseline Follow up Baseline Follow up

11 Discussion Results demonstrate the association between consumption of healthy breakfast items and academic outcomes among primary school children There are several possible explanations for the link between breakfast consumption and academic performance: Hunger prevalence among children of a low SES Breakfast consumption linked to better overall diet Modulation of short term metabolic responses to fasting, modulating blood glucose concentration Maintenance of a healthy weight Increased energy for physical activity

12 Conclusions We have previously shown that the scheme reduced breakfast skipping for children from poorer backgrounds Hence, universal as opposed to targeted free breakfast programmes could play a role in reducing health and educational inequalities

13 Conclusions Emphasising links between health and educational attainment could help to align health improvement with the core business of schools For example, working with regulatory bodies to improve the importance placed upon health for school inspections Future research should aim to explore causal mechanisms linking breakfast consumption to education understand whether improvements achieved by breakfast schemes are sufficiently large to affect educational outcomes

14 Acknowledgement The work was funded via the National Prevention Research Initiative (grant number 87122). Funding from the British Heart Foundation, Cancer Research UK, the Department of Health, Diabetes UK, the Economic and Social Research Council, the Medical Research Council, the Research and Development Office for the Northern Ireland Health and Social Services, the Chief Scientist Office, the Scottish Executive Health Department, The Stroke Association, the Welsh Assembly Government and the World Cancer Research Fund is gratefully acknowledged.

15 'The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research: Centre of Excellence. DECIPHer gratefully acknowledges funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES ), Medical Research Council, the Welsh Government and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration.'