The role of breakfast in promoting weight management Dr Carrie Ruxton Freelance Dietitian
More people are skipping breakfast Around 1/3 schoolchildren and adults Men more than women Younger adults and teenagers more than young children and older people Children from lower socio-economic groups more than better off children
Barriers to consumption Not hungry or don t feel like eating Too busy Feeling pushed for time/sleeping in Dieting Growing trend of breakfast on the move impacting on food choice
Breakfast is marker of a better lifestyle Ref: CARDIA study, Odegaard et al, 2013
Nutritional consequences of skipping breakfast Breakfast skippers have lower intakes of: Fibre Certain vitamins and minerals Higher intakes of: Fat Saturated fat Could impact on weight management
The impact of breakfast skipping on weight management Increased risk of: Overweight and obesity Abdominal obesity and high waist circumference Faster weight gain in children
Evidence observational 1 Association with reduced body weight in adult men in regular breakfast consumers (Bazzano et al. 2005) US study of 10,000 children: breakfast skippers had higher BMI and waist circumference than breakfast consumers. Also, risk obesity higher in breakfast skippers vs. cereal consumers (Deshmukh- Taskar et al. 2010) BMI 0.24 points lower in high vs. low breakfast consumers (De la Huntley et al. 2013)
Evidence observational 2 Greek study 700 children: risk obesity 46% lower in boys and 59% lower in girls when cereal breakfast eaten regularly vs. skipping (Panagiotakos et al. 2008) US study of 625 low income children: signif lower BMI & higher intake of nutrients when cereal breakfast consumed over 3y period (Balvin Frantzen et al. 2013) US study of 660 children: higher breakfast cereal consumption associated with lower total and lowdensity lipoprotein cholesterol levels and lower BMI (Albertson et al. 2009).
Evidence observational 3 Polish study 1700 teenagers: risk obesity 83% higher when breakfast skipped. Intakes of sugary soft drinks were higher when breakfast skipped (Wüenstel et al. 2015) Iranian study 13,486 children 6-18 years; 20% skipped breakfast. Regular breakfast consumption was significantly associated with lower body fatness and healthier dietary habits (Ahadi et al. 2015)
Odds ratio for obesity Obesity risk higher when breakfast skipped 2.5 2 1.5 1 Always Sometimes Never 0.5 0 Boys Girls N=4,326 English children 10-16y; Sandercock et al (2010) EJCN
More older men with BMI >25 when cereal breakfasts eaten 0-3 times weekly N=1759; US 55 years+; Albertson et al (2012) J Ageing Res
Evidence RCT cereal N=70 overweight adults asked to consume breakfast cereal at night for 6 weeks instead of usual snack Trend for lower body weight and waist circumference in intervention group vs. control but P>0.05 Matthews et al (2012) IJFSN
Evidence RCT protein N=57 overweight adolescents who normally skipped breakfast consumed a normal or high protein breakfast for 12 weeks Body fat gain, voluntary reductions in daily calorie intake, and reductions in daily hunger were all improved when adolescents ate a high protein breakfast daily. Leidy et al (2015) Obesity
Reasons for results Eating breakfast may help to prevent snacking later in the morning or the wrong choice of foods Cereal breakfasts boost fibre consumption and this may help to prolong satiety Protein at breakfast may also prolong satiety Breakfast has been linked with increased physical activity?association or cause Breakfast may simply be a marker of healthier lifestyles in general which promote weight management.
Not all studies agree N=283 overweight adults completed 16-wk weight loss study where participants either skipped or ate breakfast while trying to lose weight by dieting No significant difference in weight loss between the two groups Suggests that dieting can over-ride any negative effects of skipping breakfast. Dhurandhar et al (2014) AJCN
Other health consequences Increased risk of: Higher blood pressure Higher or raised LDL and total cholesterol levels Higher blood glucose and insulin levels
Evidence 24% skipped breakfast Breakfast skippers more likely to have raised chol, LDL, BP, glucose Breakfast cereal consumers had the best cardiometabolic status US study NHANES n=5,316 20-39 yrs Public Health Nutrition (2012) 16: 2073 2082.
Summary from key studies Source: Ruxton (2014) NHD magazine
Is sugar an issue? Breakfast cereal contribution 5-8% Source: NDNS (2014)
Holistic approach needed Weigh up sugar content against: Calorie/fat content of alternatives e.g. croissant, fry up, muffin, toast & butter Micronutrient contribution of breakfast cereals; around 15% of B vitamins and iron New role of RTEC in providing vitamin D High fibre content of many varieties Sugar can come from dried fruit as well as free sugars e.g. in muesli
Conclusions Breakfast skipping is common, especially in teenagers and young adults Breakfast skipping is associated with: a lower micronutrient and fibre intake a greater risk of obesity and excess weight gain raised blood pressure, lipids and glucose In contrast, regular breakfast consumption associated with better weight management, especially cereal breakfasts. Reason unknown but could be less snacking/soft drinks later. For more information see www.breakfastcereal.org