Association between Frequency of Ready-to-Eat Cereal Consumption, Nutrient Intakes, and Body Mass Index in Fourth- to Sixth-Grade Low-Income Minority Children

Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity-MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2-19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted.

Association between consumption of nonessential energy-dense food and body mass index among Mexican school-aged children: a prospective cohort study

BACKGROUND/OBJECTIVES

Obesity prevalence in Mexican children has increased rapidly and is among the highest in the world. We aimed to estimate the longitudinal association between nonessential energy-dense food (NEDF) consumption and body mass index (BMI) in school-aged children 5 to 11 years, using a cohort study with 6 years of follow-up.

SUBJECTS/METHODS

We studied the offspring of women in the Prenatal omega-3 fatty acid supplementation, child growth, and development (POSGRAD) cohort study. NEDF was classified into four main groups: chips and popcorn, sweet bakery products, non-cereal based sweets, and ready-to-eat cereals. We fitted fixed effects models to assess the association between change in NEDF consumption and changes in BMI.

RESULTS

Between 5 and 11 years, children increased their consumption of NEDF by 225 kJ/day (53.9 kcal/day). In fully adjusted models, we found that change in total NEDF was not associated with change in children's BMI (0.033 kg/m2, [p = 0.246]). However, BMI increased 0.078 kg/m2 for every 418.6 kJ/day (100 kcal/day) of sweet bakery products (p = 0.035) in fully adjusted models. For chips and popcorn, BMI increased 0.208 kg/m2 (p = 0.035), yet, the association was attenuated after adjustment (p = 0.303).

CONCLUSIONS

Changes in total NEDF consumption were not associated with changes in BMI in children. However, increases in the consumption of sweet bakery products were associated with BMI gain. NEDF are widely recognized as providing poor nutrition yet, their impact in Mexican children BMI seems to be heterogeneous.

Healthy eating habits and a prudent dietary pattern improve Nanjing international students' health-related quality of life

Purpose

Low-quality dietary practices, such as fast food consumption and skipping meals, deteriorate the quality of life. However, the available studies on diet and health-related quality of life (HRQoL) used matrices not specific to nutrition. Moreover, how diet affects the HRQoL of international students in China is unknown. Therefore, using a cross-sectional study, the effect of dietary patterns and habits on the HRQoL of international students in Nanjing, China, was examined.

Methods

The researchers collected dietary data using a food frequency questionnaire (FFQ) from February to March 2022. Then, the Food Benefit Assessment (FBA) was used to access HRQoL. Finally, the effect of eating habits and dietary patterns on HRQoL was explored using multilinear regression.

Results

Approximately 454 responses were obtained, with the responses mostly from male subjects (56.4%) and those aged 26 years and above (75.6%). The quality of life according to the food consumed was about average for all the constructs except for aesthetics and disease prevention, as 65.8% skipped meals, particularly breakfast (47.8%). Furthermore, three dietary patterns were identified: prudent, Western, and animal protein patterns. Consequently, by skipping breakfast, vitality (β = -2.362, p = 0.04), wellbeing (β = -3.592, p = 0.007), digestive comfort (β = -4.734, p = 0.008), and disease prevention (β = -5.071, p = 0.031) were all reduced. However, consuming at least three meals daily enhanced vitality (β = 2.254, p = 0.003) and disease prevention (β = 4.441, p = 0.019). Furthermore, aesthetics (β = 4.456, p = 0.05), physical appearance (β = 5.927, p = 0.003), and vitality (β = 3.323, p = 0.009) were also significantly increased by healthy dietary patterns. However, a more Westernized diet led to frequent snacking (β = -4.631, p = 0.032), a decline in wellbeing (β = -5.370, p < 0.001), and discomfort with digestion (β = -5.101, p = 0.01). Finally, increased frequency of snacking (β = -6.036, p = 0.012), a decrease in wellbeing (β = -4.494, p = 0.004), digestive comfort (β = -9.940, p < 0.001), physical appearance (β = -4.926, p = 0.027), and disease prevention (β = -5.835, p = 0.043) were all associated with an increase in animal protein patterns.

Conclusion

This research indicates that healthy eating habits and patterns positively impact international students' HRQoL. Therefore, the appropriate authorities should advise students to consume healthy foods regularly to improve their HRQoL.

Association between consumption of nonessential energy-dense food and body mass index among Mexican school-aged children: A prospective cohort study

BACKGROUND/OBJECTIVES

Obesity prevalence in Mexican children has increased rapidly and is among the highest in the world. We aimed to estimate the longitudinal association between nonessential energy-dense food (NEDF) consumption and body mass index (BMI) in school-aged children 5 to 11 years, using a cohort study with 6 years of follow-up.

SUBJECTS/METHODS

We studied the offspring of women in the Prenatal omega-3 fatty acid supplementation, child growth, and development (POSGRAD) cohort study. NEDF were classified into four main groups: chips and popcorn, sweet bakery products, non-cereal based sweets, and ready-to-eat cereals. We fitted fixed effects models to assess the association between change in 418.6 kJ (100 kcal) of NEDF consumption and changes in BMI.

RESULTS

Between 5 and 11 years, children increased their consumption of NEDF by 225 kJ/day (53.9 kcal/day). In fully adjusted models, we found that change in total NEDF was not associated with change in children's BMI (0.033 kg/m2, [p=0.246]). However, BMI increased 0.078 kg/m2 for every 418.6 kJ/day (100 kcal/day) of sweet bakery products (p=0.035) in fully adjusted models. For chips and popcorn, BMI increased 0.208 kg/m2 (p=0.035), yet, the association was attenuated after adjustment (p=0.303).

CONCLUSIONS

Changes in total NEDF consumption were not associated with changes in BMI in children. However, increases in the consumption of sweet bakery products were associated with BMI gain. NEDF are widely recognized as providing poor nutrition yet, their impact in Mexican children BMI seems to be heterogeneous.

Ready-to-eat cereal is an affordable breakfast option associated with better nutrient intake and diet quality in the US population

Background

Results from observational studies have reported ready-to-eat cereal (RTEC) consumers have higher dietary quality and nutrient intake compared to consumers of non-RTEC breakfasts or those who do not eat breakfast. Yet, there have been few investigations on the relationship of RTEC to meal costs at breakfast and across the day, which may be one reason some consumers choose to not consume breakfast.

Objective

The objective of this study is to evaluate the contribution of RTEC consumed at breakfast to nutrient intake and adequacy, diet quality and meal costs in a nationally representative sample of children and adults in the US.

Methods

Dietary data from 2,259 children (2-18 years) and 4,776 adults (≥19 years) in the National Health and Nutrition Examination Survey (NHANES) 2017-2018 were evaluated to compare nutrient intake, adequacy, dietary quality, and food costs in RTEC breakfast consumers, non-RTEC breakfast consumers and those who did not consume breakfast.

Results

RTEC breakfast consumers made up 28% of children and 12% of adults. Children and adults consuming RTEC for breakfast had higher intakes of carbohydrate, dietary fiber, calcium, magnesium, iron, zinc, phosphorus, potassium, B vitamins, vitamins A and D, whole grains, and total dairy compared to consumers of non-RTEC breakfast or no breakfast. There were no differences by breakfast status for sodium, saturated fat, or added sugar, except adults consuming RTEC had lower added sugar intake compared to those who did not consume breakfast. RTEC breakfast consumers were also more likely to meet estimated average requirements (EAR) for intake of several nutrients and had overall higher dietary quality. For children, breakfast meal costs were less for RTEC breakfast compared to non-RTEC breakfast, but total daily meal costs were similar for consumers of RTEC and non-RTEC breakfasts.

Conclusion

RTEC breakfasts may contribute to greater nutrient intake and diet quality in children and adults in the US without increasing total daily meal costs.

The Impact of Ready-to-Eat Cereal Intake on Body Weight and Body Composition in Children and Adolescents: A Systematic Review of Observational Studies and Controlled Trials

Results from observational studies suggest that children and adolescents consuming ready-to-eat cereals (RTECs) have a healthier BMI and lower odds of overweight and obesity than consumers of other breakfasts or breakfast skippers. However, randomized controlled trials in children and adolescents are few and have been inconsistent in demonstrating a causal relationship between RTEC intake and body weight or body composition. The objective of this study was to evaluate the effect of RTEC intake on body weight and body composition outcomes in children and adolescents. Prospective cohort, cross-sectional and controlled trials in children or adolescents were included. Retrospective studies and studies in subjects with disease, other than obesity, type-2 diabetes (T2D), metabolic syndrome, or prediabetes, were excluded. A search in PubMed and CENTRAL databases yielded 25 relevant studies, which were qualitatively analyzed. Fourteen of the 20 observational studies demonstrated that children and adolescents consuming RTEC have a lower BMI, lower prevalence and odds of overweight/obesity and more favorable indicators of abdominal obesity than nonconsumers or less frequent consumers. Controlled trials were few and only one reported a loss of 0.9 kg in overweight/obese children with RTEC consumption when accompanied by nutrition education. The risk of bias was low for most studies, but six had some concerns or high risk. The results were similar with presweetened and nonpresweetened RTEC. No studies reported a positive association of RTEC intake with body weight or body composition. Although controlled trials do not show a direct effect of RTEC consumption on body weight or body composition, the preponderance of observational data supports the inclusion of RTEC as part of a healthy dietary pattern for children and adolescents. Evidence also suggests similar benefits on body weight and body composition regardless of the sugar content. Additional trials are needed to determine the causality between RTEC intake and body weight and body composition outcomes. PROSPERO REGISTRATION: CRD42022311805.

Breakfast Characteristics and Its Association with Daily Micronutrients Intake in Children and Adolescents-A Systematic Review and Meta-Analysis

Breakfast is an important source of key nutrients in the diet. For this reason, the aim of this review was to investigate the associations between breakfast consumption and daily micronutrients intake in both children and adolescents (aged 2-18 years). A peer-reviewed systematic search was conducted in three datasets (PubMed, Scopus and Cochrane Library) in February 2020 in English and Spanish. Two independent reviewers evaluated 3188 studies considering the AXIS critical appraisal and PRISMA methodologies. Meta-analysis was carried out comparing results according to type of breakfast consumed (Ready to eat cereals (RTEC) breakfast or other types of breakfast) and breakfast skipping. Thirty-three articles were included in the systematic review (SR) and 7 in the meta-analysis. In the SR, we observed that those children and adolescents who usually consume RTEC at breakfast had a higher consumption of B-vitamins than those not consuming RTEC at breakfast. Breakfast consumers had a higher mineral intake (iron, calcium, magnesium, potassium, zinc, and iodine) than breakfast skippers. In the Meta-Analysis, RTEC consumers had significantly higher vitamin C intake than breakfast skippers (SMD, -4.12; 95% confidence intervals (CI): -5.09, -3.16). Furthermore, those children who usually consume breakfast had significantly higher daily intake of calcium than breakfast skippers (SMD, -7.03; 95%CI: -9.02, -5.04). Our review proposes that breakfast consumption seems to be associated with higher daily micronutrients intake than breakfast skippers.

Breakfast Characteristics and Their Association with Energy, Macronutrients, and Food Intake in Children and Adolescents: A Systematic Review and Meta-Analysis

Breakfast plays an important role in health because it has been associated with overall health, which includes a high daily nutrient intake and a low risk of chronic diseases. For this reason, we investigated the associations between breakfast consumption and daily energy, macronutrients, and food and beverage consumption. We systematically searched peer-reviewed articles in three datasets (Pubmed, Scopus, and Cochrane). Two independent reviewers evaluated 3188 studies against the inclusion criteria using the Appraisal tool for Cross-Sectional Studies (AXIS) critical appraisal and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) methodologies. The meta-analysis was performed by comparing results based on type of breakfast consumed (ready to eat cereal breakfasts or other types of breakfasts). Ultimately, 38 studies were included in the review and 7 of them in the energy and macronutrients intake meta-analysis. In the Systematic Review, breakfast consumers had higher energy intake (EI), fibre intake, and higher consumption of fruits and vegetables and lower consumption of soft drinks than breakfast skippers. In the Meta-Analysis, breakfast consumers had a higher carbohydrates intake (MD, -8.21; 95%CI: -11.37, -5.05) and fibre intake (MD, -8.43; 95%CI: -12.63, -4.23) than breakfast skippers. However, breakfast consumers had a lower fat intake (MD, 4.59; 95%CI: 2.04, 7.15). Our review suggests that breakfast consumption is associated with better macronutrient intake and healthier food and beverage consumption.

Ready-to-eat cereal fortification: a modelling study on the impact of changing ready-to-eat cereal fortification levels on population intake of nutrients

OBJECTIVE

Ready-to-eat (RTE) cereal is an important source of nutrients in the American diet. Recent regulatory changes to labelling requirements may impact the fortification of RTE cereal. We used an evidence-based approach to optimize the fortification of RTE cereal considering current dietary patterns and nutrition policy.

DESIGN

A US modelling study of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. The percentage of the population below the Estimated Average Requirement (EAR) and above the Upper Tolerable Intake Level (UL) was modelled under three scenarios: baseline, zero fortification and optimized fortification.

SETTING

USA.

PARTICIPANTS

Toddlers aged 1-3 years, n 559; children aged 4-12 years, n 1540; adolescents aged 13-18 years, n 992; and adults aged ≥19 years, n 576.

RESULTS

Comparing current with optimized fortification, nutrient/100 g RTE cereal decreased for vitamin A, thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, Ca and Fe (by 2-82 %). The amount of vitamins C and D increased (by 13 and 50 %, respectively). Among RTE cereal eaters, these changes resulted in modest increases in the percentage of the population aged ≥1 year below the EAR (+0·5 to +11·5 percentage points). Decreases were observed in the percentage of the population above the UL.

CONCLUSIONS

Fortification of RTE cereal can be optimized to provide key nutrients and minimize the percentage of the population below the EAR and above the UL. Dietary intake modelling is useful to ensure that RTE cereal continues to help the population meet their nutrient needs.

Breakfast and Breakfast Cereal Choice and Its Impact on Nutrient and Sugar Intakes and Anthropometric Measures among a Nationally Representative Sample of Australian Children and Adolescents

There is limited evidence in Australia that compares the nutritional impact of a breakfast cereal breakfast to a non-cereal breakfast, and includes the type of cereal. This study investigated the impact of breakfast choice and the total sugar content of breakfast cereal on nutrient intakes and anthropometric measures among Australian children and adolescents. Data from 2 to 18-year-old in the 2011–2012 National Nutrition and Physical Activity Survey were used (n = 2821). Participants were classified as breakfast cereal consumers (minimally pre-sweetened (MPS) or pre-sweetened (PS)), non-cereal breakfast consumers, or breakfast skippers. Foods consumed for breakfast, foods added to the cereal bowl, and the impact of breakfast choice on daily nutrient intakes and anthropometric measures were determined. Although only 9% of children skipped breakfast, 61% of skippers were aged 14–18 years. Among breakfast consumers, 49% had breakfast cereal, and 62% of these exclusively consumed MPS cereal. Breakfast skippers had a higher saturated fat intake than breakfast cereal consumers, and lower intakes of dietary fibre and most micronutrients (p < 0.001). Compared with non-cereal breakfast consumers, breakfast cereal consumers had similar added and free sugars intakes, lower sodium, and higher total sugars, carbohydrate, dietary fibre, and almost all other micronutrients (p < 0.001). The only difference in nutrient intakes between MPS and PS cereal consumers was higher folate among PS consumers. No associations between anthropometric measures and breakfast or breakfast cereal choice were found. The highest prevalence of breakfast skipping was among 14–18-year old. Breakfast cereal consumers had higher intakes of dietary fibre and most micronutrients compared with non-cereal breakfast consumers and skippers, and almost no differences were found between MPS and PS cereal consumers.

Breakfast Cereal Consumption and Obesity Risk amongst the Mid-Age Cohort of the Australian Longitudinal Study on Women's Health

Obesity affects 27.5% of Australian women. Breakfast cereal consumption has been proposed to be protective against obesity. This study investigated the association of breakfast cereal consumption with the risk of developing obesity (Body Mass Index (BMI) ≥ 30 kg/m²) over 12 years among mid-age participants in the Australian Longitudinal Study on Women’s Health (ALSWH). Dietary data were obtained at S3 and obesity incidence at S4–S7. Women were excluded if: dietary data were incomplete, energy intake was <4500 or >20,000 kJ/day, or they reported being overweight or obese at S3. Logistic regressions with discrete time survival analysis investigated the association between breakfast cereal intake and incident obesity and were adjusted for: area of residency, income, smoking, physical activity, hypertension, dietary intakes and a discrete measure of time. There were 308 incident cases of obesity. Any breakfast cereal intake was not associated with incident obesity (Odds Ratio (OR): 0.92; p = 0.68). Oat-based cereal (OR: 0.71; p = 0.01), muesli (OR: 0.57; p = 0.00) and All-Bran (OR: 0.62; p = 0.01) intakes were associated with a significant reduction in obesity risk. Among this cohort, muesli on its own, or as part of oat-based cereals, and All-Bran, were associated with a reduction in obesity. This effect may be due to particular characteristics of these cereal eaters, but the relationship warrants further investigation.

Effects of Ready-to-Eat-Cereals on Key Nutritional and Health Outcomes: A Systematic Review

BACKGROUND

In many countries breakfast cereals are an important component of breakfast. This systematic review assesses the contribution of consumption of ready-to eat cereal (RTEC) to the recommended nutrient intake. Furthermore, the effects of RTEC consumption on key health parameters are investigated as well as health promoting properties of RTEC.

METHOD

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL have been searched up till 16th of June 2015. Randomized controlled trials were excluded if RTEC were used during hypocaloric diets, if RTEC were eaten at other times than breakfast and if breakfasts included other products than RTEC, milk and fruit. Observational studies were excluded when "breakfast cereals" were not defined or their definition included cooked cereals. From cross-sectional studies only data concerning energy and nutrient intake as well as micronutrient status were used.

RESULTS

From 4727 identified citations 64 publications met the inclusion criteria of which 32 were cross-sectional studies, eight prospective studies and 24 randomized controlled trials. Consumption of RTEC is associated with a healthier dietary pattern, concerning intake of carbohydrates, dietary fiber, fat and micronutrients, however total sugar intake is higher. Persons consuming RTEC frequently (≥ 5 times/week) have a lower risk of inadequate micronutrient intake especially for vitamin A, calcium, folate, vitamin B 6, magnesium and zinc. Evidence from prospective studies suggests that whole grain RTEC may have beneficial effects on hypertension and type 2 diabetes. Consumption of RTEC with soluble fiber helps to reduce LDL cholesterol in hypercholesterolemic men and RTEC fortified with folate can reduce plasma homocysteine.

DISCUSSION

One of the review's strengths is its thorough ex/inclusion of studies. Limitations are that results of observational studies were based on self-reported data and that many studies were funded by food-industry.

CONCLUSION

Consumption of RTEC, especially of fiber-rich or whole grain RTEC, is implicated with several beneficial nutritional and health outcomes. The effect on body weight, intestinal health and cognitive function needs further evaluation. Of concern is the higher total sugar intake associated with frequent RTEC consumption.

Breakfast consumption and adiposity among children and adolescents: an updated review of the literature

BACKGROUND

Breakfast consumption has been associated with reduced risk of overweight and obesity among children, but previous evidence reviews fail to confirm a causal relationship.

OBJECTIVES

To review recent literature on breakfast consumption and adiposity among children and discuss potential underlying mechanisms.

METHODS

A comprehensive literature search of studies published since the 2010 US National Evidence Library review (January 2010-January 2015) was conducted.

RESULTS

Twelve studies met inclusion criteria. All were conducted in industrialized countries: six in Europe, four in the USA, one in China and one in Australia. Ten of the studies used observational longitudinal designs, with follow-up periods ranging from 1 to 27 years (median: 3, mean: 7.4); of these, eight reported inverse associations between breakfast consumption and excess adiposity, while two found no association. The other studies (1 case-control, 1 experimental) each reported a protective effect of breakfast consumption on overweight and obesity among children.

CONCLUSIONS

Findings corroborate results from previous reviews, adding support for a possible, protective role for breakfast consumption in preventing excess adiposity during childhood and adolescence. However, drawing a causal conclusion from the collective evidence is curtailed by methodological limitations and inconsistencies, including study design, follow-up duration and frequency, exposure and outcome assessment, as well as limited consideration of confounding, mediating and effect-modifying variables. More rigorous study designs employing valid and standardized measurement of relevant variables are needed.

Meal-Skipping Behaviors and Body Fat in 6-Year-Old Children

OBJECTIVE

To assess the prospective associations of breakfast, lunch, and dinner skipping at age 4 years with body fat (ie, percent fat mass, body mass index [BMI], and weight status) at age 6 years.

STUDY DESIGN

Data were analyzed from 5913 children participating in the Generation R Study, a population-based prospective cohort study in Rotterdam, The Netherlands. Meal-skipping behaviors were assessed through parent-report questionnaires. Children's weight and height were objectively measured and converted to BMI SDSs. Weight status (ie, overweight or normal weight) was defined according to age- and sex-specific cutoff points. At age 6 years, percent fat mass was assessed by dual-energy X-ray absorptiometry. Linear and logistic regression analyses were performed, adjusting for covariates and BMI at age 4 years.

RESULTS

Breakfast skipping at age 4 years was associated with a higher percent fat mass at age 6 years (β = 1.38; 95% CI, 0.36-2.40). No associations were found with BMI or weight status. Furthermore, no associations were found between lunch and dinner skipping at age 4 years and body fat at age 6 years.

CONCLUSION

Breakfast skipping at age 4 years is associated with a higher percent fat mass at age 6 years. Further prospective studies, including intervention studies, are warranted to extend the evidence base on the directionality and causality of this association.

Ready-to-Eat Cereal Consumption with Total and Cause-Specific Mortality: Prospective Analysis of 367,442 Individuals

BACKGROUND

Intakes of ready-to-eat cereal (RTEC) have been inversely associated with risk factors of chronic diseases such as cardiovascular disease (CVD), type 2 diabetes, and certain cancers; however, their relations with total and cause-specific mortality remain unclear.

OBJECTIVE

To prospectively assess the associations of RTEC intakes with all causes and disease-specific mortality risk.

DESIGN

The study included 367,442 participants from the prospective National Institutes of Health (NIH)-AARP Diet and Health Study. Intakes of RTEC were assessed at baseline.

RESULTS

Over an average of 14 years of follow-up, 46,067 deaths were documented. Consumption of RTEC was significantly associated with reduced risk of mortality from all-cause mortality and death from CVD, diabetes, all cancer, and digestive cancer (all p for trend < 0.05). In multivariate models, compared to nonconsumers of RTEC, those in the highest intake of RTEC had a 15% lower risk of all-cause mortality and 10%-30% lower risk of disease-specific mortality. Within RTEC consumers, total fiber intakes were associated with reduced risk of mortality from all-cause mortality and deaths from CVD, all cancer, digestive cancer, and respiratory disease (all p for trend < 0.005).

CONCLUSIONS

Consumption of RTEC was associated with reduced risk of all-cause mortality and mortality from specific diseases such as CVD, diabetes, and cancer. This association may be mediated via greater fiber intake.

Nutrient Intake, Diet Quality, and Weight Measures in Breakfast Patterns Consumed by Children Compared with Breakfast Skippers: NHANES 2001-2008

Most studies showing that children consuming breakfast have better nutrient intakes, diet quality, and lower weight than breakfast skippers have the incorrect premise that breakfast meals are homogeneous. The purpose of this study was to classify breakfast meals into patterns and determine the association of the breakfast patterns with daily and breakfast nutrient intakes, diet quality, and weight. Data from children (2-18 years of age; N = 14,200) participating in the National Health and Nutrition Examination Survey 2001-2008 were used. Intake was determined from one day 24-hour dietary recalls. Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005). Body mass index (BMI) z-scores were determined. Twelve patterns (including No Breakfast [∼19% of population]), explaining 63% of the variance in energy from breakfast, were examined. Covariate adjusted general linear models were used to compare outcome variables of consumers of different patterns with breakfast skippers. The p value was Bonferroni corrected (< 0.05/12 = < 0.0042). Consumers of the Eggs/Grain/Meat, Poultry, Fish (MPF)/ Fruit Juice (FJ) and MPF/ Grain/FJ patterns showed higher daily intakes of saturated fats, solid fats, and sodium and lower daily intakes of added sugars than breakfast skippers. Consumers of most breakfast patterns showed higher daily intakes of some nutrients of public health concern (dietary fiber, vitamin D, calcium, and potassium); however, those consuming the Grain or MPF/Grain/FJ pattern did not. Consumers of the Grain/Lower Fat Milk (LFM)/Sweets/FJ, Presweetened (PS) Ready-to-eat Cereal (RTEC)/ LFM, RTEC/LFM, Cooked Cereal/Milk/FJ, and Whole Fruit patterns had higher total HEI-2005 scores than breakfast skippers; those consuming the MPF/ Grain/FJ pattern had lower diet quality than breakfast skippers. Consumption of the Grain/ LFM/Sweets/FJ, PSRTEC/whole milk, Soft Drinks/ FJ/Grain/Potatoes, RTEC/whole milk, and Cooked Cereal/ Milk/ FJ patterns was associated with lower BMI z-scores than seen in breakfast skippers. There are dietary and weight advantages of consuming breakfast, especially breakfasts that include grains, cereals, LFM, and fruit/ FJ, in contrast to the potential adverse effects of skipping breakfast.

The benefits of breakfast cereal consumption: a systematic review of the evidence base

There have been no comprehensive reviews of the relation of breakfast cereal consumption to nutrition and health. This systematic review of all articles on breakfast cereals to October 2013 in the Scopus and Medline databases identified 232 articles with outcomes related to nutrient intake, weight, diabetes, cardiovascular disease, hypertension, digestive health, dental and mental health, and cognition. Sufficient evidence was available to develop 21 summary evidence statements, ranked from A (can be trusted to guide practice) to D (weak and must be applied with caution). Breakfast cereal consumption is associated with diets higher in vitamins and minerals and lower in fat (grade B) but is not associated with increased intakes of total energy or sodium (grade C) or risk of dental caries (grade B). Most studies on the nutritional impact are cross-sectional, with very few intervention studies, so breakfast cereal consumption may be a marker of an overall healthy lifestyle. Oat-, barley-, or psyllium-based cereals can help lower cholesterol concentrations (grade A), and high-fiber, wheat-based cereals can improve bowel function (grade A). Regular breakfast cereal consumption is associated with a lower body mass index and less risk of being overweight or obese (grade B). Presweetened breakfast cereals do not increase the risk of overweight and obesity in children (grade C). Whole-grain or high-fiber breakfast cereals are associated with a lower risk of diabetes (grade B) and cardiovascular disease (grade C). There is emerging evidence of associations with feelings of greater well-being and a lower risk of hypertension (grade D), but more research is required.

The effects of breakfast on behavior and academic performance in children and adolescents

Breakfast consumption is associated with positive outcomes for diet quality, micronutrient intake, weight status and lifestyle factors. Breakfast has been suggested to positively affect learning in children in terms of behavior, cognitive, and school performance. However, these assertions are largely based on evidence which demonstrates acute effects of breakfast on cognitive performance. Less research which examines the effects of breakfast on the ecologically valid outcomes of academic performance or in-class behavior is available. The literature was searched for articles published between 1950–2013 indexed in Ovid MEDLINE, Pubmed, Web of Science, the Cochrane Library, EMBASE databases, and PsychINFO. Thirty-six articles examining the effects of breakfast on in-class behavior and academic performance in children and adolescents were included. The effects of breakfast in different populations were considered, including undernourished or well-nourished children and adolescents from differing socio-economic status (SES) backgrounds. The habitual and acute effects of breakfast and the effects of school breakfast programs (SBPs) were considered. The evidence indicated a mainly positive effect of breakfast on on-task behavior in the classroom. There was suggestive evidence that habitual breakfast (frequency and quality) and SBPs have a positive effect on children's academic performance with clearest effects on mathematic and arithmetic grades in undernourished children. Increased frequency of habitual breakfast was consistently positively associated with academic performance. Some evidence suggested that quality of habitual breakfast, in terms of providing a greater variety of food groups and adequate energy, was positively related to school performance. However, these associations can be attributed, in part, to confounders such as SES and to methodological weaknesses such as the subjective nature of the observations of behavior in class.