Is breakfast the most important meal of the day? Proc Nutr Soc. 2016;75:464-474. [PMID: 27292940 DOI: 10.1017/s0029665116000318]

Socioeconomic inequality in breakfast skipping among Norwegian adolescents

BACKGROUND

Skipping breakfast is associated with negative health-related and school-related outcomes. Breakfast is the most frequently skipped meal among adolescents. Thus, there is a need to explore the reasons for breakfast skipping across population subgroups to better inform policy makers. The purpose of this study was to present the prevalence of adolescents skipping breakfast on schooldays, analyse the reasons for skipping breakfast and assess associations between the prevalence of skipping breakfast and the reasons for skipping breakfast according to sociodemographic variables.

METHODS

The data of a random sample of 10 000 upper secondary school students (aged 16-18 years) from Viken County, Norway, were collected. Students completed a questionnaire measuring breakfast skipping, reasons for skipping breakfast, and sociodemographic variables. Chi-square tests were used to assess differences between the independent groups (family affluence scale (FAS), parental education, and gender) and skipping breakfast and reasons for skipping breakfast.

RESULTS

22% of adolescents reported that they usually skipped breakfast on all schooldays. Skipping breakfast was more prevalent among females, older students, students with lower socioeconomic status and students in vocational education programmes. The difference in breakfast skipping between students with low and high FAS scores was 31% versus 16%, respectively. The most common self-reported reasons for skipping breakfast were time (59%) and not wanting to eat breakfast (48%). Furthermore, 9% reported health issues, and 3% reported economic constraints as a reason for skipping breakfast. Not wanting to eat breakfast was related to a higher FAS score, health issues were more common among girls, and economic constraints were more common among those with low socioeconomic status.

CONCLUSIONS

Skipping breakfast was common among Norwegian upper secondary school students. Lack of time and not wanting breakfast were clearly the most cited reasons for skipping breakfast. Health issues and economic constraints were also cited but were less common. The results showed diverging associations between different demographic characteristics and reasons for skipping breakfast. These results are important for developing effective programs to improve diet among adolescents.

No Effect of Breakfast Consumption Observed for Afternoon Resistance Training Performance in Habitual Breakfast Consumers and Nonconsumers: A Randomized Crossover Trial

BACKGROUND

Pre-exercise meal frequency is commonly believed to impact exercise performance, but little is known about its impact on resistance training.

OBJECTIVE

This study investigated the impact of breakfast consumption on afternoon resistance training performance in habitual breakfast consumers and nonconsumers.

DESIGN

A randomized, crossover study was conducted in Lubbock, TX between November 2021 and May 2022.

PARTICIPANTS

Thirty-nine resistance-trained male (n = 20) and female (n = 19) adults (mean ± SD age 23.0 ± 4.7 years) who habitually consumed (≥5 d/wk; n = 19) or did not consume (≥5 d/wk; n = 20) breakfast completed the study.

INTERVENTION

After the establishment of 1-repetition maximums at the first visit, participants completed 2 additional visits, each of which included 4 sets of barbell back squat, bench press, and deadlift, using 80% of their 1-repetition maximum after either consuming breakfast and lunch or the same food at lunch only.

MAIN OUTCOME MEASURES

Repetitions, along with average and peak average concentric velocity and power, were measured for all repetitions throughout each exercise session. Visual analog scales were used to assess feelings of fatigue, energy, focus, hunger, desire to eat, and fullness throughout each exercise session.

STATISTICAL ANALYSES PERFORMED

Data were analyzed using linear mixed-effects models.

RESULTS

No interactions or main effects involving condition or habitual breakfast consumption were observed for resistance training outcomes, although sex differences were noted. Male participants performed significantly fewer repetitions on sets 2, 3, and 4 (P < .014) for total repetitions, on sets 2 and 4 for barbell back squat (P < .023), and set 4 for deadlift (P = .006), with no observed differences between sexes for bench press repetitions. Male participants displayed reductions in average power across all sets and exercises except deadlift.

CONCLUSIONS

These data suggest that alterations in pre-exercise meal frequency may not influence afternoon resistance training performance provided similar total nutritional intake is consumed.

Evaluation of the nutritional quality of French children breakfasts according to the Breakfast Quality Score (BQS)

Background

Breakfast meals provide essential nutrients and energy to children and adolescents. Based on recommendations from the International Breakfast Research Initiative (IBRI), the Breakfast Quality Score (BQS) was developed to assess breakfast nutritional value among the French adult population. However, its application to children remains unexplored.

Objective

This study aimed to evaluate the BQS in assessing the nutritional quality of breakfasts consumed by French children aged 4-17 years.

Methods

A total of 4,015 breakfasts, obtained from dietary recalls provided by 1,448 children participating in the French representative dietary survey (INCA3), were analyzed. As for adults, the performance of the BQS was tested through correlations with other nutritional indicators and comparison of nutrients and dietary components between tertiles of scores. The study examined the regularity of breakfast consumption and compared the BQS of children's breakfasts across socio-demographic modalities and breakfast categories distinguished by their primary grain component. Additionally, a predictive modeling using Partial Least Squares (PLS) regression identified influential INCA3 food groups.

Results

The majority of children consumed solid breakfasts regularly. Socio-professional category, household income and food insecurity influenced BQS, revealing contradictory disparities. Ready-to-eat cereal (RTEC) breakfasts had the highest BQS (73.5% for children and 73.1% for adolescent), while biscuits and viennoiseries scored the lowest (52% for children and 49.1% for adolescent). PLS highlighted RTECs, milk, and hot beverages (mainly containing chocolate milk) as being positively associated with BQS, while sweet beverages and viennoiseries were negatively associated.

Conclusion

The study demonstrates the effectiveness of the BQS in assessing children's breakfast quality, with RTEC breakfasts showing the highest nutritional value. The findings provide insights into factors influencing breakfast nutritional quality and underscore the importance of promoting healthier breakfast choices among all children.

Time of eating and mortality in U.S. adults with heart failure: Analyses of the National Health and Nutrition Examination Survey 2003-2018

BACKGROUND AND AIMS

Promising associations have been demonstrated between delayed last eating occasion and cardiorespiratory fitness in adults with heart failure (HF), however, it is unknown if time of eating is associated with clinical endpoints such as mortality. This study aimed to examine associations between time of eating variables and all-cause and cardiovascular mortality in the National Health and Nutrition Examination Survey (NHANES).

METHODS AND RESULTS

Participants self-disclosed HF diagnosis. Two dietary recalls were obtained and categorical variables were created based on mean time of first eating occasion (8:31 AM), last eating occasion (7:33 PM) and eating window (11.02 h). Mortality was obtained through linkage to the National Death Index. Covariate-adjusted Cox proportional hazard regression models were created examining the association between time of eating and mortality. Participants (n = 991) were 68 (95 % CI 67-69) years of age, 52.6 (95 % CI 49.0-56.3)% men and had a body mass index of 32.5 (95 % CI 31.8-33.2) kg/m2 with follow up time of 68.9 (95 % CI 64.8-72.9) person-months. When models were adjusted for time of eating variables and all other covariates, extending the eating window beyond 11.02 h was associated with decreased risk of cardiovascular (HR 0.36 [95 % CI 0.16-0.81]), but not all-cause mortality. Time of first and last eating occasions were not associated with mortality.

CONCLUSIONS

In adults with HF, an extended eating window is associated with reduced risk for cardiovascular mortality. Randomized controlled trials should examine if extending the eating window can improve prognostic indicators such as cardiorespiratory fitness in this population.

Source apportionment of heavy metals in PM2.5 samples and effects of heavy metals on hypertension among schoolchildren in Tianjin

The prevalence of hypertension in children has increased significantly in recent years in China. The aim of this study was to provide scientific support to control ambient heavy metals (HMs) pollution and prevent childhood hypertension. In this study, ambient HMs in PM2.5 were collected, and 1339 students from Tianjin were randomly selected. Positive matrix factorization (PMF) was used to identify and determine the sources of HMs pollution. The generalized linear model, Bayesian kernel machine regression (BKMR) and the quantile g-computation method were used to analyze the relationships between exposure to HMs and the risk of childhood hypertension. The results showed that HMs in PM2.5 mainly came from four sources: soil dust, coal combustion, incineration of municipal waste and the metallurgical industry. The positive relationships between As, Se and Pb exposures and childhood hypertension risk were found. Coal combustion and incineration of municipal waste were important sources of HMs in the occurrence of childhood hypertension. Based on these accomplishments, this study could provide guidelines for the government and individuals to alleviate the damaging effects of HMs in PM2.5. The government must implement policies to control prime sources of HMs pollution.

Trend in Breakfast Consumption among Primary School Children in Italy

Eating breakfast daily improves cognitive function, may contribute to learning and academic performance in children and can decrease the risk of childhood obesity. The aim of this study was to analyse how breakfast consumption changed in the period from 2008/9 to 2019 in Italy among children aged 8-9 years old participating in the OKkio alla SALUTE surveys and to explore the associations with some socio-demographic and lifestyle factors. Information about children's daily breakfast consumption (adequate, inadequate, and no breakfast) and the socio-demographic characteristics of the children and their mothers was collected through four questionnaires addressed to parents, children, teachers and head teachers. Data were analysed for the 272,781 children from 21 Italian regions from 2008/9 to 2019. The prevalence of adequate breakfast decreased from 60.7% in 2008/9 to 55.7% in 2019 and no breakfast from 10.9 to 8.7%; conversely, inadequate breakfast increased from 28.4 to 35.6%. Logistic regression models showed that the occurrence of inadequate or no breakfast consumption was significantly higher among girls, children living in the southern regions and children with less educated mothers. These findings highlight the need for effective interventions to increase daily breakfast consumption and its adequacy among children.

Whey Protein-Enriched and Carbohydrate-Rich Breakfasts Attenuate Insulinemic Responses to an ad libitum Lunch Relative to Extended Morning Fasting: A Randomized Crossover Trial

BACKGROUND

Typical breakfast foods are rich in carbohydrate, so they not only elevate blood glucose during the morning, but also elicit a second-meal effect that can attenuate blood glucose responses in the afternoon.

OBJECTIVES

To determine whether a reduced-carbohydrate protein-enriched breakfast can elicit similar effects on glucose control later in the day but without hyperglycemia in the morning.

METHODS

In a randomized crossover design, 12 healthy men and women (age 22 ± 2 y, BMI 24.1 ± 3.6 kg·m-2; Mean ± SD) completed 3 experimental conditions. In all conditions, participants consumed an ad libitum lunch at 1200 ± 1 h but differed in terms of whether they had fasted all morning (control) or had consumed a standardized porridge breakfast at 0900 ± 1 h (320 ± 50 kcal; prescribed relative to resting metabolic rate) that was either carbohydrate-rich (50 ± 10 g CHO) or protein-enriched (that is, isoenergetic substitution of carbohydrate for 15 g whey protein isolate).

RESULTS

The protein-enriched breakfast reduced the morning glycemic response (iAUC 87 ± 36 mmol·L-1·180 min) relative to the carbohydrate-rich breakfast (119 ± 37 mmol·L-1·180 min; P = 0.03). Despite similar energy intake at lunch in all 3 conditions (protein-enriched 769 ± 278 kcal; carbohydrate-rich 753 ± 223 kcal; fasting 790 ± 227 kcal), postlunch insulinemic responses were markedly attenuated when breakfasts had been consumed that were either protein-enriched (18.0 ± 8.0 nmol·L-1·120 min; P = 0.05) or carbohydrate-rich (16.0 ± 7.7 nmol·L-1·120 min; P = 0.005), relative to when lunch was consumed in an overnight fasted state (26.9 ± 13.5 nmol·L-1·120 min).

CONCLUSIONS

Breakfast consumption attenuates insulinemic responses to a subsequent meal, achieved with consumption of energy-matched breakfasts typically high in carbohydrates or enriched with whey protein isolate relative to extended morning fasting.

TRIAL REGISTRATION NUMBER

NCT03866720 (clinicaltrials.gov).

Investigating the quality of breakfast for female adolescents using a multi-method approach in Saudi Arabia: A cross-sectional study

Breakfast has been shown to provide nutritional adequacy and improve the healthy lifestyle status of adolescents. However, limited information is available on the quality of breakfast among adolescents. Thus, this study aimed to evaluate the quality of breakfast among adolescents using a multiple-method approach in Saudi Arabia. This cross-sectional, school-based study was conducted in 3 public high schools in Al-Jumum, Saudi Arabia. High school females (n = 174) aged 15 to 18 years old were selected considering the regularity of consuming breakfast (≥ 4 d/wk and not after 10:00 a.m.). The quality of breakfast was assessed using 3 approaches: the modified Saudi food frequency questionnaire, the adapted method of breakfast quality, and the nutrient profile model. Sweet food items were consumed most frequently (64.9%, n = 113), followed by drinks (57.4%, n = 100), while the least frequently consumed items were sandwiches and burgers (43.52%, n = 76), snacks (41.9%, n = 72), and dairy and fats (41.8%, n = 71). The majority of breakfast eaters were classified as eating breakfasts of poor quality (50.6%), while the rest ate breakfasts of either good quality (38.1%) or very poor breakfast quality (10.8%). Based on the nutrient profile model of breakfast, high fat salt sugar (HFSS) food/drink items and non-HFSS items were consumed by 44.4% and 55.5% of the participants, respectively. This study showed that the majority of female adolescents consume poor-quality breakfast, mostly sweets and sweetened beverages. The nutrient content analysis emphasized these results by presenting a similar consumption of non-HFSS and HFSS breakfast foods. Future education programs on healthy breakfast options should be implemented among this population.

Association between lifestyle behaviors and health-related quality of life among primary health care physicians in China: A cross-sectional study

Background

Primary health care (PHC) serves as the gatekeeper of health system and PHC physicians take on significant obligations to provide health care services in the pursuit of Universal Health Coverage (UHC). PHC physicians' health-related quality of life (HRQoL) can have a strong impact on patients, physicians and the health care system. Lifestyle interventions are found to be effective to improve HRQoL. The purpose of this study was to evaluate the association between lifestyle behaviors and HRQoL among PHC physicians, so that lifestyle intervention can be tailored by policy makers for health promotion.

Methods

A survey covering 31 provinces and administrative regions in China was conducted in 2020 using a stratified sampling strategy. Data on sociodemographic characteristics lifestyle behaviors and HRQoL were collected by a self-administered questionnaire. HRQoL was measured through EuroQol-five dimension-five level (EQ-5D-5L) instrument. A Tobit regression model was performed to evaluate the association between sociodemographic characteristics, lifestyle behaviors and HRQoL.

Results

Among 894 PHC physicians who completed the survey, Anxiety/Depression (AD) was the dimension with the most problems reported (18.1%). Regular daily routine (β = 0.025, 95%CI 0.004 to 0.045) and good sleep quality (β = 0.049, 95% CI = 0.029 to 0.069) were protective factors for HRQoL, while smoking (β = −0.027, 95% CI = −0.079 to −0.003) and frequency of eating breakfast (β = −0.041, 95%CI = −0.079 to −0.003) were negatively associated with HRQoL. Physical activity and alcohol drinking were not significantly associated with HRQoL.

Conclusion

These findings suggest that tailored interventions on daily routine, improving sleep quality, and tobacco control among PHC physicians may be effective strategies to improve their HRQoL.

Effects of Differences of Breakfast Styles, Such as Japanese and Western Breakfasts, on Eating Habits

A balanced diet and protein source intake are reportedly good for health. However, many people skip breakfast or have a light breakfast. Thus, this study aimed to examine the influence of breakfast styles on eating habits among Japanese workers, including traditional Japanese-style breakfast (JB), a pattern in which Japanese foods are eaten; Japanese-Western-style breakfast (J-W B), a pattern in which Japanese and Western foods are eaten alternately; Western-style breakfast (WB), a pattern in which Western foods are eaten; and cereal-style breakfast (CB), a pattern in which cereal is eaten. We hypothesized that breakfast style may be related to good eating habits. Data from 4274 respondents (67.97% male, 33.03% female, age 48.12 ± 0.19 years), excluding night shift workers and breakfast absentees out of a total of 5535 respondents, were analyzed. The results suggest that Japanese food is linked to the intake of protein sources such as fish, eggs, and soy. Furthermore, it was suggested that Japanese food breakfast is effective for good eating habits, such as not eating irregular amounts of food, not eating snacks, not drinking sweet juices, and having a balanced diet.

Thirty Obesity Myths, Misunderstandings, and/or Oversimplifications: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of 30 common obesity myths, misunderstandings, and/or oversimplifications.

Methods

The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

This CPS discusses 30 common obesity myths, misunderstandings, and/or oversimplifications, utilizing referenced scientific publications such as the integrative use of other published OMA CPSs to help explain the applicable physiology/pathophysiology.

Conclusions

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on 30 common obesity myths, misunderstandings, and/or oversimplifications is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Knowledge of the underlying science may assist the obesity medicine clinician improve the care of patients with obesity.

Skipping breakfast and excess weight among young people: the moderator role of moderate-to-vigorous physical activity

The present study aimed to test whether the daily minutes of moderate-to-vigorous physical activity (MVPA) engaged moderate the relationship between breakfast status and excess weight (i.e., overweight and/or obesity) in a Spanish sample of young people. A cross-sectional study involving a total sample of 2890 Spanish schoolchildren (46% girls) aged 6-17 years (M = 12.3 ± 2.6) was conducted. To determine the habit of having breakfast, a dichotomous item about breakfast status (yes/no) from the Mediterranean Diet Quality Index for children and teenagers (KIDMED) was used. Physical Activity Questionnaire for Older Children and the Physical Activity Questionnaire for Adolescents were fulfilled to offer an estimation of the minutes of MVPA that individuals had in the last seven days. Body mass index (BMI) was converted into z-scores and, therefore, excess weight status (i.e., overweight and/or obesity) was established according to World Health Organization criteria for sex and age. Skipping breakfast was positively related with BMI (z-score) and excess weight. Moderation analyses suggested that daily MVPA minutes moderated the association between skipping breakfast and BMI (boys: β =  - 0.175; girls: β =  - 0.073) or the excess weight (boys: OR = 1.10; CI 95%, 1.02 to 1.07; girls: OR = 1.14; CI 95%, 1.04 to 1.24), meaning that physical activity of sufficient intensity seems to reduce the effect of skipping breakfast on the body weight status of young people.

CONCLUSION

Our results indicate that promotion of having breakfast should be accompanied by daily MVPA, as young participants who have breakfast and with higher daily MVPA seem to be more likely to have no excess weight.

WHAT IS KNOWN

• Some of the well-studied factors associated with childhood obesity have been skipping breakfast and insufficient physical activity. • Some studies have pointed out the association between having breakfast and both body mass index and physical activity level, in isolation.

WHAT IS NEW

• Daily minutes of moderate-to-vigorous physical activity moderate the association between skipping breakfast and excess weight. • Breakfast promotion as a healthy eating habit should be accompanied by increases in moderate-to-vigorous physical activity, since participants who have breakfast and with higher moderate-to-vigorous physical activity seem to be more likely to have no excess weight.

Nutrient timing and metabolic regulation symposium review from "Novel dietary approaches to appetite regulation, health and performance (2021)"

Daily (circadian) rhythms coordinate our physiology and behaviour with regular environmental changes. Molecular clocks in peripheral tissues (e.g. liver, skeletal muscle and adipose) give rise to rhythms in macronutrient metabolism, appetite regulation and the components of energy balance such that our bodies can align the periodic delivery of nutrients with ongoing metabolic requirements. The timing of meals both in absolute terms (i.e. relative to clock time) and in relative terms (i.e. relative to other daily events) is therefore relevant to metabolism and health. Experimental manipulation of feeding–fasting cycles can advance understanding of the effect of absolute and relative timing of meals on metabolism and health. Such studies have extended the overnight fast by regular breakfast omission and revealed that morning fasting can alter the metabolic response to subsequent meals later in the day, whilst also eliciting compensatory behavioural responses (i.e. reduced physical activity). Similarly, restricting energy intake via alternate‐day fasting also has the potential to elicit a compensatory reduction in physical activity, and so can undermine weight‐loss efforts (i.e. to preserve body fat stores). Interrupting the usual overnight fast (and therefore also the usual sleep cycle) by nocturnal feeding has also been examined and further research is needed to understand the importance of this period for either nutritional intervention or nutritional withdrawal. In summary, it is important for dietary guidelines for human health to consider nutrient timing (i.e. when we eat) alongside the conventional focus on nutrient quantity and nutrient quality (i.e. how much we eat and what we eat).

Effect of the perception of breakfast consumption on subsequent appetite and energy intake in healthy males

Purpose

This study aimed to assess the effects of consuming a very-low-energy placebo breakfast on subsequent appetite and lunch energy intake.

Methods

Fourteen healthy males consumed water-only (WAT), very-low-energy, viscous placebo (containing water, low-calorie flavoured squash, and xanthan gum; ~ 16 kcal; PLA), and whole-food (~ 573 kcal; FOOD) breakfasts in a randomised order. Subjects were blinded to the energy content of PLA and specific study aims. Venous blood samples were collected pre-breakfast, 60- and 180-min post-breakfast to assess plasma acylated ghrelin and peptide tyrosine tyrosine concentrations. Subjective appetite was measured regularly, and energy intake was assessed at an ad libitum lunch meal 195-min post-breakfast.

Results

Lunch energy intake was lower during FOOD compared to WAT (P < 0.05), with no further differences between trials (P ≥ 0.132). Cumulative energy intake (breakfast plus lunch) was lower during PLA (1078 ± 274 kcal) and WAT (1093 ± 249 kcal), compared to FOOD (1554 ± 301 kcal; P < 0.001). Total area under the curve (AUC) for hunger, desire to eat and prospective food consumption were lower, and fullness was greater during PLA and FOOD compared to WAT (P < 0.05). AUC for hunger was lower during FOOD compared to PLA (P < 0.05). During FOOD, acylated ghrelin was suppressed compared to PLA and WAT at 60 min (P < 0.05), with no other hormonal differences between trials (P ≥ 0.071).

Conclusion

Consuming a very-low-energy placebo breakfast does not alter energy intake at lunch but may reduce cumulative energy intake across breakfast and lunch and attenuate elevations in subjective appetite associated with breakfast omission.

Trial registration

NCT04735783, 2nd February 2021, retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02727-5.

Breakfast: A Crucial Meal for Adolescents' Cognitive Performance According to Their Nutritional Status. The Cogni-Action Project

This study aimed to determine whether pupils who have breakfast just before a cognitive demand, do not regularly skip breakfast, and consume a high-quality breakfast present higher cognitive performance than those who do not; furthermore, to establish differences according to their nutritional status. In this study, 1181 Chilean adolescents aged 10–14 years participated. A global cognitive score was computed through eight tasks, and the body mass index z-score (BMIz) was calculated using a growth reference for school-aged adolescents. The characteristics of breakfast were self-reported. Analyses of covariance were performed to determine differences in cognitive performance according to BMIz groups adjusted to sex, peak height velocity, physical fitness global score, and their schools. A positive association was found in adolescents’ cognitive performance when they had breakfast just before cognitive tasks, did not regularly skip breakfast, presented at least two breakfast quality components, and included dairy products. No significant differences were found between breakfast components, including cereal/bread and fruits/fruit juice. Finally, pupils who were overweight/obese who declared that they skipped breakfast regularly presented a lower cognitive performance than their normal-BMIz peers. These findings suggest that adolescents who have breakfast just prior to a cognitive demand and regularly have a high quality breakfast have better cognitive performance than those who do not. Educative nutritional strategies should be prioritized, especially in “breakfast skippers” adolescents living with overweight/obesity.

Skipping breakfast among preschoolers: associated factors and its dose-response relationship with overweight/obesity

ABSTRACT Objective To investigate factors associated with skipping breakfast in preschoolers and test a dose-dependent relationship between the frequency of breakfast consumption and the prevalence of overweight/obesity. Methods This is a cross-sectional study, carried out with 463 children (24 to 59 months of age) who live in the urban location of Goiânia, Goiás, Brazil. Sociodemographic data, maternal and child nutritional status, lifestyle, and dietary practices were collected using a standardized questionnaire and Habitual Food Recall during a home-based interview. Skipping breakfast was defined as a frequency of consumption “less than seven days a week”. Based on body mass index by age, children were classified as overweight/obese if Z-score ≥2. Multiple logistic regression was used to assess the association between the variables surveyed and skipping breakfast. The dose-dependent relationship between breakfast frequency and overweight/obesity was determined by the trend test. Results The prevalence of skipping breakfast was 8.42% (95%IC: 6.1-11.3). There was an association between the habit of substituting dinner for a sandwich/snack (adjusted OR: 2.61, 95%IC: 1.25-5.46; p=0.010) and the mother’s overweight (adjusted OR: 2.63; 95%CI: 1.29-5.37; p=0.008) with the habit of skipping breakfast. The trend test shows that the prevalence of overweight/obesity decreases as the frequency of breakfast consumption increases (p=0.035). Additionally, when assessing the quality of breakfast, frequent consumption of foods considered unhealthy was observed. Conclusion There is a dose-response association between overweight/obesity and skipping breakfast. Children who substitute traditional dinner for a sandwich/snack and whose mothers are overweight are more likely to skip breakfast.

[Role of breakfast and its quality in the health of children and adolescents in Spain]

Introduction

Eating breakfast is a healthy habit that should be encouraged since childhood. When it provides nutritional quality, it is an important daily meal. The consumption of dairy products, cereals, and fruits at breakfast is associated with healthier dietary patterns, with a beneficial impact on the overall quality of the diet. In Spain, as in many other countries, the proportion of children who eat breakfast daily is very high, decreasing somewhat in adolescence. However, the quality of breakfast leaves room for improvement, with a low proportion of children/adolescents with high nutritional quality breakfasts. Children/adolescents who eat breakfast regularly have a higher intake of various nutrients (especially vitamins and minerals) than those who do not eat breakfast. Although the evidence is not entirely conclusive, numerous studies have shown various benefits when comparing the population that eats breakfast regularly versus those who do not, such as cardiometabolic risk parameters (obesity, diabetes, blood pressure and lipid profile) and cognitive functions. Breakfast should be included in healthy eating plans, since it allows incorporating foods that are difficult to consume in other meals and may contribute to reducing the risk of developing cardiometabolic diseases. In order to promote the intake of a healthy breakfast, it is essential to act on the sociodemographic and cultural factors that influence compliance and quality, such as age, nutritional education (mainly parents and children/adolescents, but also other family members, school mates, friends...), carrying it out as a family, adapting it to the tastes of each population and balancing quality and costs.

Emulsifiers Impact Colonic Length in Mice and Emulsifier Restriction is Feasible in People with Crohn's Disease

There is an association between food additive emulsifiers and the prevalence of Crohn’s disease. This study aimed to investigate: (i) the effect of different classes of emulsifiers on markers of intestinal inflammation in mice and (ii) the feasibility, nutritional adequacy and symptom impact of restricting all emulsifier classes in Crohn’s disease. Mice were exposed to different classes of emulsifiers (carboxymethycellose, polysorbate-80, soy lecithin, gum arabic) in drinking water for 12-weeks, after which markers of inflammation and metabolism were measured. A low emulsifier diet was developed to restrict all classes of emulsifiers and its feasibility measured over 14-days in 20 participants with stable Crohn’s disease. Crohn’s disease-related symptoms, disease control, body weight and composition, nutrient intake and food-related quality of life (QoL) were measured. All emulsifiers resulted in lower murine colonic length compared with control (mean 9.5 cm (SEM 0.20)), but this only reached significance for polysorbate-80 (8.2 cm (0.34), p = 0.024) and carboxymethylcellulose (8.0 cm (0.35), p = 0.013). All 20 participants completed the feasibility study. The frequency of consuming emulsifier-containing foods decreased by 94.6% (SD 10.3%). Food-related QoL improved between habitual (median 81.5 (IQR 25.0)) and low emulsifier diet (90.0 (24.0), p = 0.028). Crohn’s disease-related symptoms reduced (median 3.0 (IQR 5.3) vs. 1.4 (3.9), p = 0.006), and disease control scores improved (13.5 (IQR 6.0) vs. 15.5 (IQR 3.0), p = 0.026). A range of emulsifiers may influence intestinal inflammation in mice, and dietary restriction of emulsifiers is feasible. Trials investigating the efficacy of a low emulsifier diet in Crohn’s disease are warranted.

The Future of Shift Work: Circadian Biology Meets Personalised Medicine and Behavioural Science

Shift work is commonplace in modern societies, and shift workers are predisposed to the development of numerous chronic diseases. Disruptions to the circadian systems of shift workers are considered important contributors to the biological dysfunction these people frequently experience. Because of this, understanding how to alter shift work and zeitgeber (time cue) schedules to enhance circadian system function is likely to be key to improving the health of shift workers. While light exposure is the most important zeitgeber for the central clock in the circadian system, diet and exercise are plausible zeitgebers for circadian clocks in many tissues. We know little about how different zeitgebers interact and how to tailor zeitgeber schedules to the needs of individuals; however, in this review we share some guidelines to help shift workers adapt to their work schedules based on our current understanding of circadian biology. We focus in particular on the importance of diet timing and composition. Going forward, developments in phenotyping and "envirotyping" methods may be important to understanding how to optimise shift work. Non-invasive, multimodal, comprehensive phenotyping using multiple sources of time-stamped data may yield insights that are critical to the care of shift workers. Finally, the impact of these advances will be reduced without modifications to work environments to make it easier for shift workers to engage in behaviours conducive to their health. Integrating findings from behavioural science and ergonomics may help shift workers make healthier choices, thereby amplifying the beneficial effects of improved lifestyle prescriptions for these people.

Future Directions for Integrative Objective Assessment of Eating Using Wearable Sensing Technology

Established methods for nutritional assessment suffer from a number of important limitations. Diaries are burdensome to complete, food frequency questionnaires only capture average food intake, and both suffer from difficulties in self estimation of portion size and biases resulting from misreporting. Online and app versions of these methods have been developed, but issues with misreporting and portion size estimation remain. New methods utilizing passive data capture are required that address reporting bias, extend timescales for data collection, and transform what is possible for measuring habitual intakes. Digital and sensing technologies are enabling the development of innovative and transformative new methods in this area that will provide a better understanding of eating behavior and associations with health. In this article we describe how wrist-worn wearables, on-body cameras, and body-mounted biosensors can be used to capture data about when, what, and how much people eat and drink. We illustrate how these new techniques can be integrated to provide complete solutions for the passive, objective assessment of a wide range of traditional dietary factors, as well as novel measures of eating architecture, within person variation in intakes, and food/nutrient combinations within meals. We also discuss some of the challenges these new approaches will bring.

Breakfast Skipping, Body Composition, and Cardiometabolic Risk: A Systematic Review and Meta-Analysis of Randomized Trials

OBJECTIVE

The objective of this study was to evaluate the effect of skipping breakfast on body composition and cardiometabolic risk factors.

METHODS

This study conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating breakfast skipping compared with breakfast consumption. Inclusion criteria included age ≥ 18, intervention duration ≥ 4 weeks, ≥ 7 participants per group, and ≥ 1 body composition measure. Random-effects meta-analyses of the effect of breakfast skipping on body composition and cardiometabolic risk factors were performed.

RESULTS

Seven RCTs (n = 425 participants) with an average duration of 8.6 weeks were included. Compared with breakfast consumption, breakfast skipping significantly reduced body weight (weighted mean difference [WMD] = -0.54 kg [95% CI: -1.05 to -0.03], P = 0.04, I²  = 21.4%). Percent body fat was reported in 5 studies and was not significantly different between breakfast skippers and consumers. Three studies reported on low-density lipoprotein cholesterol (LDL), which was increased in breakfast skippers as compared with breakfast consumers (WMD = 9.24 mg/dL [95% CI: 2.18 to 16.30], P = 0.01). Breakfast skipping did not lead to significant differences in blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, C-reactive protein, insulin, fasting glucose, leptin, homeostatic model assessment of insulin resistance, or ghrelin.

CONCLUSIONS

Breakfast skipping may have a modest impact on weight loss and may increase LDL in the short term. Further studies are needed to provide additional insight into the effects of breakfast skipping.

The effects of skipping a meal on daily energy intake and diet quality

OBJECTIVE

To examine whether skipping breakfast or lunch increased the next meal's energy content and changed total daily energy content and the quality of food intake measured by the 2010 Healthy Eating Index (HEI-2010).

DESIGN

Means were compared across intake days and meal patterns. Multivariate individual fixed-effects model was used to account for individual food intake and diet quality preferences.

SETTING

National Health and Nutrition Examination Survey, 2007-2016.

PARTICIPANTS

Adults aged 18 years or older who reported 2 d (24-h periods) of dietary intake and were not pregnant or lactating (n 23 488).

RESULTS

Adults consumed 193 more kJ at lunch after skipping breakfast and 783 more kJ at dinner after skipping breakfast and lunch. Skipping at least one meal reduced total daily intake between 1053 (breakfast) and 1464 (dinner) kJ and reduced the daily HEI score. Skipping breakfast or skipping lunch reduced the HEI component scores for fruit, whole grains, dairy and empty energy; skipping lunch reduced the component scores for fruit, vegetables, whole grain, dairy, seafood and plant protein, and empty energy. Skipping dinner reduced component scores for vegetables, greens and beans, dairy, protein food, seafood and plant proteins, and empty energy. Skipping one or more meals increased component scores for total vegetables (breakfast), whole grains (dinner), Na (lunch or dinner) and refined grains (breakfast, lunch or dinner).

CONCLUSIONS

Skipping meals (particularly dinner) reduces daily energy intake, but the reduction in daily diet quality (particularly when skipping breakfast) may impact health negatively over time.

Calorie Restriction and Intermittent Fasting: Impact on Glycemic Control in People With Diabetes

Intermittent fasting has been suggested as an option for managing overweight and obesity. The purpose of this article is to present a balanced review of the practice of intermittent fasting and its impact on glycemic control in people with diabetes.

Breakfast size is associated with daily energy intake and diet quality

OBJECTIVES

The aim of this study was to investigate the role of breakfast consumption and breakfast size on daily energy, nutrient intakes, and diet quality.

METHODS

One-day 24-h recall data from the 2011 to 2012 National Nutrition and Physical Activity Survey (n = 9341, adults ≥ 19 y) were analyzed, and respondents were classified into breakfast consumers or skippers. Breakfast consumers were further classified into quartile of breakfast size (energy intake [EI] from breakfast × 100%/daily EI). Diet quality was assessed using the Healthy Eating Index for Australian Adults. General linear modeling was undertaken to compare groups, adjusting for potential confounders.

RESULTS

Overall, 85.9% of adults consumed breakfast, contributing a mean of 19.9 ± 10.9% of daily EI for consumers. Among breakfast consumers, obtaining a higher proportion of daily EI from breakfast was associated with lower daily intakes of energy, added sugars, saturated fat, and alcohol (%E); higher intakes of dietary fiber (%E) and most micronutrients (per 1000 kJ); and better Healthy Eating Index for Australian Adults scores (P_trend < 0.0001). Additionally, those in the highest quartile of breakfast size (>25.5% EI) had higher diet quality scores (P < 0.001) but similar daily EI (P = 0.751) compared with breakfast skippers.

CONCLUSIONS

These findings indicate that obtaining a higher proportion of daily EI from breakfast may result in more favorable dietary profiles and lower daily EI. Further research is needed to confirm this.

Viscous placebo and carbohydrate breakfasts similarly decrease appetite and increase resistance exercise performance compared with a control breakfast in trained males

Given the common view that pre-exercise nutrition/breakfast is important for performance, the present study investigated whether breakfast influences resistance exercise performance via a physiological or psychological effect. Twenty-two resistance-trained, breakfast-consuming men completed three experimental trials, consuming water-only (WAT), or semi-solid breakfasts containing 0 g/kg (PLA) or 1·5 g/kg (CHO) maltodextrin. PLA and CHO meals contained xanthan gum and low-energy flavouring (approximately 122 kJ), and subjects were told both 'contained energy'. At 2 h post-meal, subjects completed four sets of back squat and bench press to failure at 90 % ten repetition maximum. Blood samples were taken pre-meal, 45 min and 105 min post-meal to measure serum/plasma glucose, insulin, ghrelin, glucagon-like peptide-1 and peptide tyrosine-tyrosine concentrations. Subjective hunger/fullness was also measured. Total back squat repetitions were greater in CHO (44 (sd 10) repetitions) and PLA (43 (sd 10) repetitions) than WAT (38 (sd 10) repetitions; P < 0·001). Total bench press repetitions were similar between trials (WAT 37 (sd 7) repetitions; CHO 39 (sd 7) repetitions; PLA 38 (sd 7) repetitions; P = 0·130). Performance was similar between CHO and PLA trials. Hunger was suppressed and fullness increased similarly in PLA and CHO, relative to WAT (P < 0·001). During CHO, plasma glucose was elevated at 45 min (P < 0·05), whilst serum insulin was elevated (P < 0·05) and plasma ghrelin suppressed at 45 and 105 min (P < 0·05). These results suggest that breakfast/pre-exercise nutrition enhances resistance exercise performance via a psychological effect, although a potential mediating role of hunger cannot be discounted.

Importance of Health Claims in the Adoption of New Breakfast Cereal Products in the UK

Regular breakfast consumption has the potential to prevent the prevalence of NCDs and to improve the nutritional profile of diets. Given consumers' interest in improving their diets, food suppliers are interested in introducing new cereal products making different health claims to capture consumers' attention. The purpose of this study is threefold: first, it aims to understand whether UK food suppliers are working to increase the availability of breakfast cereals with healthy and nutritious attributes; second, it explores which companies are leading the launch of these products; and third, it assesses to what extent health and nutrition claims made by breakfast cereals have an impact on their market success. The study employs an assembled database combining data from Mintel Global New Products Database (GNPD) and Kantar Worldpanel Dataset (KWDS) for the UK. A hazard-based duration model was used to analyse the success of the new products launched in the UK market in 2011 following them up to 2015. Our results reveal that UK suppliers broadened the number of breakfast cereals on offer in the period 2000 to 2018, with a particular focus on multigrain cereals, porridge and granola. Health and nutrition claims were added to 27% of these products. Although consumers welcome healthy alternatives such as muesli, the impact of positional claims on the success of newly developed breakfast cereals is claim-specific. No clear pattern regarding the impact of health and nutrition claims is identified. However, other elements such as celiac-friendly ingredients and UK origin do have a positive impact on the success of breakfast cereals.

Association between breakfast skipping and postprandial hyperglycaemia after lunch in healthy young individuals

Breakfast skipping has become an increasing trend in the modern lifestyle and may play a role in obesity and type 2 diabetes. In our previous studies in healthy young individuals, a single incident of breakfast skipping increased the overall 24-h blood glucose and elevated the postprandial glycaemic response after lunch; however, it was difficult to determine whether this response was due to breakfast omission or the extra energy (i.e. lunch plus breakfast contents). The present study aimed to assess the postprandial glycaemic response and to measure their hormone levels when healthy young individuals had identical lunch and dinner, and the 24-h average blood glucose as a secondary outcome. Nine healthy young men (19−24 years) participated in two-meal trials: with breakfast (three-meal condition) or without breakfast (breakfast skipping condition). During the meals, each individual’s blood glucose was continuously monitored. Skipping breakfast resulted in a significantly higher (P &lt; 0·001) glycaemic response after lunch as compared with the glycaemic response after an identical lunch when breakfast was consumed. Despite the difference in the total energy intake, the 24-h average blood glucose was similar between the two-meal conditions (P = 0·179). Plasma NEFA level was significantly higher (P &lt; 0·05) after lunch when breakfast was omitted, and NEFA level positively correlated with the postprandial glycaemic response (r 0·631, P &lt; 0·01). In conclusion, a single incident of breakfast skipping increases postprandial hyperglycaemia, and associated impaired insulin response, after lunch. The present study showed that skipping breakfast influences glucose regulation even in healthy young individuals.

Breakfast Nutritional Quality and Cognitive Interference in University Students from Mexico City

Skipping breakfast might have an impact on cognitive functions, such as interference, which is a basic capacity of executive functions that denotes the possibility of controlling an automated response. This study aimed to analyze the association between nutritional quality of breakfast and cognitive interference in a sample of university students. A cross-sectional study was conducted, a total of 422 students between 18 and 25 years participated. Cognitive interference was assessed with the Stroop Test. Breakfast was assessed with a questionnaire assigning a score for each serving of each food group that was consumed. Logistic regression models were performed. The performance in cognitive tasks was slower in those who had a poor breakfast (32.9 ± 6 vs 29.3 ± 6 s, p < 0.050). Poor cognitive interference was greater in students with poor breakfast (53% versus 23%, p = 0.001). A slower word reading was associated with skipping vegetables (OR: 2.78, 95% CI: 0.09-2.13), and cereals (OR: 1.70, 95% CI: 1.03-2.81). Wrong color identification was associated with skipping fruits (OR: 1.55, 95% CI: 1.43-1.99) and animal protein sources (OR: 1.63, 95% CI: 1.07-2.49). Skipping fat-rich cereals was a protector factor (OR: 0.55, 95% CI: 0.36-0.85). Difficulty in the ability to inhibit interference was associated with skipping vegetables (OR: 2.72, 95% CI: 1.25-4.80) and cereals (OR: 2.65, 95% CI: 1.28-4.68). The nutritional quality of breakfast was associated with the time spent answering the Stroop test, but not with cognitive interference.

Nutritional Quality of Breakfast Consumed by the Low-Income Population in Brazil: A Nationwide Cross-Sectional Survey

Objective: This study aimed to characterize the nutritional quality of breakfast consumed by the low-income Brazilian population. Methods: A cross-sectional study was conducted with a sample of 1547 low-income individuals attending 36 Community Restaurants (CRs) in Brazil. Food consumption was analyzed by the frequency of food groups presented in the 24 h recall for three days. The nutritional consumption consisted of the analysis of the total energetic value (TEV) and the macronutrients, fibers, monounsaturated fatty acids, saturated fatty acids, trans fatty acids, calcium, and sodium. The nutrients were evaluated considering the percentage of contribution concerning the daily recommendation of consumption. Results: Among the 4641 breakfasts expected to be consumed and reported, 17.2% (n = 797) of the consumers did not consume breakfast. Therefore, we analyzed the 3844 breakfasts. The analysis of food groups showed a high consumption of dairy and cereals, and low consumption of fruits, roots/tubers, and meat/eggs. The percentages of energy contribution of the macronutrients in the TEV were adequate for a balanced diet. The mean intake of monounsaturated fatty acids was low, and the contribution percentages of saturated fatty acids and trans fatty acids were within the recommendations. The mean fiber intake of the breakfast was low, agreeing with the result of low fruit consumption. Calcium intake covered 73.49% of that expected for this meal, and sodium intake was adequate in breakfast. Conclusion: The individuals studied consumed a nutritionally balanced breakfast. Although dairy was one of the most consumed groups, calcium consumption was low, indicating the need to consume higher portions of food sources of this nutrient.

Designing Optimal Breakfast for the United States Using Linear Programming and the NHANES 2011-2014 Database: A Study from the International Breakfast Research Initiative (IBRI)

The quality of dietary patterns can be optimized using a mathematical technique known as linear programming (LP). LP methods have rarely been applied to individual meals. The present LP models optimized the breakfast meal for those participants in the nationally representative National Health and Nutrition Examination Survey 2011-2014 who ate breakfast (n = 11,565). The Nutrient Rich Food Index (NRF9.3) was a measure of diet quality. Breakfasts in the bottom tertile of NRF9.3 scores (T1) were LP-modeled to meet nutrient requirements without deviating too much from current eating habits. Separate LP models were run for children and for adults. The LP-modeled breakfasts resembled the existing ones in the top tertile of NRF9.3 scores (T3), but were more nutrient-rich. Favoring fruit, cereals, and dairy, the LP-modeled breakfasts had less meat, added sugars and fats, but more whole fruit and 100% juices, more whole grains, and more milk and yogurt. LP modeling methods can build on existing dietary patterns to construct food-based dietary guidelines and identify individual meals and/or snacks that need improvement.

Six Weeks of Morning Fasting Causes Little Adaptation of Metabolic or Appetite Responses to Feeding in Adults with Obesity

OBJECTIVE

The aim of this study was to determine the effects of sustained morning fasting or breakfast consumption on metabolism, energy intake, and appetite in healthy adults with obesity.

METHODS

An independent-measures randomized controlled trial with baseline and follow-up laboratory assessment days separated by a 6-week intervention of either morning fasting (0 kcal until 12:00 pm) or daily breakfast (> 700 kcal by 11:00 am) was performed. Measures included metabolic outcomes (glucose, insulin, nonesterified fatty acids), hormones regulating appetite (total/acylated ghrelin, peptide YY, leptin), and energy expenditure (diet-induced thermogenesis) parameters throughout a laboratory test day and ad libitum intake following a fixed breakfast.

RESULTS

Allocation to fasting versus breakfast resulted in minimal adaptation as reflected by the metabolic outcomes or the majority of appetite regulatory outcomes for either area under curve or time-course-based measures (P > 0.05). Ad libitum lunch intake was not different (P = 0.13), nor was diet-induced thermogenesis or a composite appetite score (both P > 0.10). However, there was a reduced total area under the curve for peptide YY (P = 0.05) and increased postprandial hunger ratings (P = 0.05) in the breakfast group.

CONCLUSIONS

There was little evidence of metabolic adaptation to acute feeding or negative consequences from sustained morning fasting. This indicates that previously observed differences between breakfast consumers and skippers may be acute effects of feeding or may have resulted from other lifestyle factors.

The role of intermittent fasting and meal timing in weight management and metabolic health

Obesity remains a major public health concern and intermittent fasting is a popular strategy for weight loss, which may present independent health benefits. However, the number of diet books advising how fasting can be incorporated into our daily lives is several orders of magnitude greater than the number of trials examining whether fasting should be encouraged at all. This review will consider the state of current understanding regarding various forms of intermittent fasting (e.g. 5:2, time-restricted feeding and alternate-day fasting). The efficacy of these temporally defined approaches appears broadly equivalent to that of standard daily energy restriction, although many of these models of intermittent fasting do not involve fed-fasted cycles every other 24 h sleep-wake cycle and/or permit some limited energy intake outside of prescribed feeding times. Accordingly, the intervention period therefore may not regularly alternate, may not span all or even most of any given day, and may not even involve absolute fasting. This is important because potentially advantageous physiological mechanisms may only be initiated if a post-absorptive state is sustained by uninterrupted fasting for a more prolonged duration than applied in many trials. Indeed, promising effects on fat mass and insulin sensitivity have been reported when fasting duration is routinely extended beyond sixteen consecutive hours. Further progress will require such models to be tested with appropriate controls to isolate whether any possible health effects of intermittent fasting are primarily attributable to regularly protracted post-absorptive periods, or simply to the net negative energy balance indirectly elicited by any form of dietary restriction.

The Influence of Meal Frequency and Timing on Health in Humans: The Role of Fasting

The influence of meal frequency and timing on health and disease has been a topic of interest for many years. While epidemiological evidence indicates an association between higher meal frequencies and lower disease risk, experimental trials have shown conflicting results. Furthermore, recent prospective research has demonstrated a significant increase in disease risk with a high meal frequency (≥6 meals/day) as compared to a low meal frequency (1⁻2 meals/day). Apart from meal frequency and timing we also have to consider breakfast consumption and the distribution of daily energy intake, caloric restriction, and night-time eating. A central role in this complex scenario is played by the fasting period length between two meals. The physiological underpinning of these interconnected variables may be through internal circadian clocks, and food consumption that is asynchronous with natural circadian rhythms may exert adverse health effects and increase disease risk. Additionally, alterations in meal frequency and meal timing have the potential to influence energy and macronutrient intake.A regular meal pattern including breakfast consumption, consuming a higher proportion of energy early in the day, reduced meal frequency (i.e., 2⁻3 meals/day), and regular fasting periods may provide physiological benefits such as reduced inflammation, improved circadian rhythmicity, increased autophagy and stress resistance, and modulation of the gut microbiota.

Breakfast eating patterns and drivers of a healthy breakfast composition

Breakfast has long been described as the most important meal of the day. While breakfast habits and their consequences on children's health and performance are well documented, studies on the adult population are lacking. The present study will fill this gap, providing a comprehensive picture of the Swiss breakfast habits and insights into the determinants of a healthy breakfast composition. Data were collected through a postal survey sent out to a randomly selected sample of 1917 German-speaking Swiss residents, yielding a final sample size of N = 460. Breakfast habits were disclosed, and individual breakfast healthiness scores were assessed by two nutrition specialists. A multiple regression analysis was then performed to investigate the influence of several motivational, socio-demographic, health- and knowledge-related determinants on breakfast healthiness. The sample showed recommendable habits in terms of consumption frequency and quite traditional eating patterns, illustrated by the prevalence of continental breakfasts and equally marked by the frequent consumption of dairy products. Overall, the Swiss breakfast composition is moderately healthy, lacking fruits and whole grain products. Paying attention to healthy food choices in general, higher education level, being a woman and reporting to be fit are factors linked to a healthier breakfast composition; while preferences for low-fat, familiar or convenient foods are correlated to less healthy patterns. Given the parallel between the determinants of a healthy breakfast composition and those of a healthy diet and taking some limiting factors, such as consumers preference for convenience and strong habits, into account, we support the current nutritional advice focusing on balancing the diet over the day or the week rather than on recommendations dedicated to specific meals.

Unhealthy eating habits around sleep and sleep duration: To eat or fast?

Traditionally, breakfast skipping (BS), and recently late-night dinner eating (LNDE), have attracted attention in public health because they can predispose to cardiometabolic conditions such as obesity and type 2 diabetes. Intriguingly, it has become evident that short duration of sleep elicits similar health risks. As LNDE, BS, and short sleep can be closely related and can aggravate each other, these three should not be considered separately. In this context, LNDE (or its equivalents, snacking or heavy alcohol consumption after dinner) and BS may be representative unhealthy eating habits around sleep (UEHAS). While it is important to take energy in the early morning for physical and intellectual activities, attaining a fasting state is essential for metabolic homeostasis. Our previous UEHAS studies have shown that BS without LNDE, i.e., BS alone, is not associated with obesity and diabetes, suggesting the possibility that BS or taking a very low energy breakfast, which could yield fasting for a while, may prevent obesity and diabetes in people with inevitable LNDE. Further studies considering UEHAS and short sleep simultaneously are needed to elucidate the effects of these unhealthy lifestyles on cardiometabolic diseases.

Preexercise breakfast ingestion versus extended overnight fasting increases postprandial glucose flux after exercise in healthy men

The aim of this study was to characterize postprandial glucose flux after exercise in the fed versus overnight fasted state and to investigate the potential underlying mechanisms. In a randomized order, twelve men underwent breakfast-rest [(BR) 3 h semirecumbent], breakfast-exercise [(BE) 2 h semirecumbent before 60 min of cycling (50% peak power output)], and overnight fasted exercise [(FE) as per BE omitting breakfast] trials. An oral glucose tolerance test (OGTT) was completed after exercise (after rest on BR). Dual stable isotope tracers ([U-¹³C] glucose ingestion and [6,6-²H₂] glucose infusion) and muscle biopsies were combined to assess postprandial plasma glucose kinetics and intramuscular signaling, respectively. Plasma intestinal fatty acid binding (I-FABP) concentrations were determined as a marker of intestinal damage. Breakfast before exercise increased postexercise plasma glucose disposal rates during the OGTT, from 44 g/120 min in FE {35 to 53 g/120 min [mean (normalized 95% confidence interval)] to 73 g/120 min in BE [55 to 90 g/120 min; P = 0.01]}. This higher plasma glucose disposal rate was, however, offset by increased plasma glucose appearance rates (principally OGTT-derived), resulting in a glycemic response that did not differ between BE and FE ( P = 0.11). Plasma I-FABP concentrations during exercise were 264 pg/ml (196 to 332 pg/ml) lower in BE versus FE ( P = 0.01). Breakfast before exercise increases postexercise postprandial plasma glucose disposal, which is offset (primarily) by increased appearance rates of orally ingested glucose. Therefore, metabolic responses to fed-state exercise cannot be readily inferred from studies conducted in a fasted state.

Is exercise best served on an empty stomach?

The objective of this review paper is to evaluate the impact of undertaking aerobic exercise in the overnight-fasted v. fed-state, in the context of optimising the health benefits of regular physical activity. Conducting a single bout of aerobic exercise in the overnight-fasted v. fed-state can differentially modulate the aspects of metabolism and energy balance behaviours. This includes, but is not limited to, increased utilisation of fat as a fuel source, improved plasma lipid profiles, enhanced activation of molecular signalling pathways related to fuel metabolism in skeletal muscle and adipose tissue, and reductions in energy intake over the course of a day. The impact of a single bout of overnight-fasted v. fed-state exercise on short-term glycaemic control is variable, being affected by the experimental conditions, the time frame of measurement and possibly the subject population studied. The health response to undertaking overnight-fasted v. fed-state exercise for a sustained period of time in the form of exercise training is less clear, due to a limited number of studies. From the extant literature, there is evidence that overnight-fasted exercise in young, healthy men can enhance training-induced adaptations in skeletal muscle metabolic profile, and mitigate against the negative consequences of short-term excess energy intake on glucose tolerance compared with exercising in the fed-state. Nonetheless, further long-term studies are required, particularly in populations at-risk or living with cardio-metabolic disease to elucidate if feeding status prior to exercise modulates metabolism or energy balance behaviours to an extent that could impact upon the health or therapeutic benefits of exercise.

Nature and Cognitive Perception of 4 Different Breakfast Meals Influence Satiety-Related Sensations and Postprandial Metabolic Responses but Have Little Effect on Food Choices and Intake Later in the Day in a Randomized Crossover Trial in Healthy Men

Background

Regular breakfast consumption is associated with better health status and healthier food intake throughout the day, but this association is a complex interaction of several factors.

Objective

This study aimed to investigate the effect of nutritional and cognitive-perceived characteristics of breakfast on metabolic and behavioral variables related to food intake.

Methods

The study was a randomized, crossover, controlled trial, with 4 experimental conditions consisting of 3 iso-energetic breakfasts and 1 energy-free control meal. Breakfasts had similar nutritional profiles but differed for glycemic index (GI), glycemic load (GL), and perceived healthiness, satiety, palatability, or energy content. Fifteen healthy normal-weight men [means ± SDs; age: 24 ± 2 y; body mass index (BMI; kg/m2) 23.4 ± 1.6] underwent each experimental condition in random order during 4 different weeks, separated by ≥1-wk washout. On the third day of each intervention week, postprandial blood variables (with insulin as primary outcome), satiety ratings, and food intake during an ad libitum lunch consumed 4 h after breakfast (secondary outcomes) were measured for each experimental condition.

Results

A main effect of time, treatment, and time × treatment was found for postprandial insulin, glucose, and nonesterified fatty acids (P < 0.001 for all) after having the 3 iso-energetic breakfasts or the energy-free control one. Postprandial satiety was similar for the 3 energy-containing breakfasts, but higher when compared with the energy-free control (P < 0.001). No difference in energy intake was observed for the ad libitum lunch, whereas prolonged breakfast skipping was compensated by an increase (around +10%) in the average energy intake during the rest of the day, resulting in no differences in the total daily energy intake among the 4 conditions.

Conclusions

Although other advantages might exist for breakfasts based on low-GI/low-GL foods, our findings support the hypothesis that minor differences in nutritional and perceived characteristics of breakfast are of limited importance regarding medium-term energy intake in healthy men. This trial was registered at clinicaltrials.gov as BRNN-014 NCT02516956.

Breakfast in the United States: Food and Nutrient Intakes in Relation to Diet Quality in National Health and Examination Survey 2011⁻2014. A Study from the International Breakfast Research Initiative

The contribution of breakfast to diet quality (DQ) can inform future dietary guidelines. This study examined breakfast nutrition in relation to overall DQ, using dietary data from the first reported day of the National Health and Examination Survey (NHANES) 2011–2014 (n = 14,488). Relative DQ was assessed using the Nutrient Rich Foods Index (NRF9.3) and the USDA Healthy Eating Index 2015 (HEI 2015). The sample was stratified by NRF9.3 tertiles and by age and socioeconomic groups. Four out of 5 NHANES participants had breakfast on the day of the interview. Breakfast provided 19–22% of dietary energy depending on age. Breakfast intakes of complex carbohydrates and total sugars were proportionately higher and intakes of protein and fats were lower relative to breakfast energy intakes. Breakfast provided more that 20% of daily intakes of B vitamins, vitamins A and D, folate, calcium, iron, potassium and magnesium. Eating breakfast was associated with higher NRF9.3 DQ scores. Breakfasts associated with the top tertile of NRF9.3 scores had less added sugars and fats than those associated with the bottom tertile. Such breakfasts had more fruit and juices, more whole grain products, more milk and yogurt and less meat and eggs. Breakfast patterns and food choices that favored fruit, whole grains and dairy were associated with healthiest diets.

Breakfast Consumption in French Children, Adolescents, and Adults: A Nationally Representative Cross-Sectional Survey Examined in the Context of the International Breakfast Research Initiative

This study examines the consumption of breakfast on the basis of a 7-day dietary record (Comportements et Consommations Alimentaires en France 2012–2013) in a representative sample of French children (n = 426), adolescents (n = 250), and adults (n = 1045). A large majority of the participants were regular consumers of breakfast (5–7 times per week). Breakfast accounted for 17.6% of total daily energy (339.4 kcal). Breakfast was rich in carbohydrates (24% of total daily intake) and simple sugars (31% of total daily intake). Relative to its contribution in daily energy intake, breakfast contributed higher proportions in the daily intake of many vitamins (B, C), and minerals (calcium, iron, iodine, manganese, phosphorus, potassium, magnesium). The main foods/beverages contributing to breakfast changed with age, with increasing contributions of non-wholegrain “bread and toasts” and “fruits”, and a decreasing contribution of milk. Better quality of the diet, as measured by tertiles of the Nutrient Rich Food Index 9.3, was associated with higher intakes of cereal products (bread and breakfast cereals, particularly wholegrain), dairy (milk, fresh dairy), and fruit at breakfast. In conclusion, breakfast is regularly consumed in France and contributes significantly to diet quality but could be improved in terms of content in fiber and protein.

The relevance of restrained eating behavior for circadian eating patterns in adolescents

Background

Restrained Eating, i.e. the tendency to restrict dietary intake to control body-weight, often emerges during adolescence and may result in changes in circadian eating patterns.

Objective

The objective of the present investigation was to determine the cross-sectional relevance of restrained eating for characteristics of circadian eating pattern in adolescents and whether changes in restrained eating are accompanied by concurrent changes in circadian eating pattern over the course of adolescence.

Methods

Two questionnaires assessing restrained eating (Score 0–30) with parallel 3-day weighed dietary records from two different time points were available from 209 (♂:101, ♀:108) 11–18 year old adolescents of the DONALD study. Mixed linear regression models were used to analyze whether restrained eating was associated with eating occasion frequency, snack frequency and morning and evening energy intake [in % of daily energy intake, %E]. Linear regression models were used to examine whether changes in restrained eating were associated with changes in the mentioned variables.

Results

Among girls, greater restrained eating was cross-sectionally associated with higher morning energy intake (p = 0.03). Further, there was a tendency towards lower evening energy intake with higher levels of restrained eating for the whole sample (p = 0.06). No cross-sectional associations were found with eating occasion or snack frequency. Each one-point increase in restrained eating during adolescence was related to a concurrent decrease in eating occasion frequency by 0.04 (95% CI -0.08; -0.01, p = 0.02) and in evening energy intake by 0.36%E (95% CI -0.70; -0.03, p = 0.04). A tendency towards decreasing snack frequency with increasing restrained eating was observed (β = -0.03, 95% CI -0.07; 0.00, p = 0.07). No association was found between changes in restrained eating and concurrent changes in morning energy intake.

Conclusion

We found indications for cross-sectional and prospective associations between restrained eating and chronobiological aspects of food intake in adolescents. Our results suggest that restrained eating should be considered a relevant determinant of circadian eating patterns.

Postprandial Metabolism and Appetite Do Not Differ between Lean Adults that Eat Breakfast or Morning Fast for 6 Weeks

Background

It remains unknown whether sustained daily feeding-fasting patterns modify the acute response to specific feedings on a given day.

Objective

We conducted a randomized controlled trial to establish if daily breakfast consumption or fasting until noon modifies the acute metabolic and appetitive responses to a fixed breakfast and ad libitum lunch.

Methods

With the use of a parallel group design, we randomly assigned 31 healthy, lean men and women (22-56 y) to 6 wk of either consuming ≥700 kcal of self-selected items before 1100 or fasting (0 kcal) until 1200 daily. Following 48 h of diet and physical activity standardization, we examined metabolic and appetite responses to a standardized breakfast and ad libitum lunch before and after the intervention. Data were analyzed using 3- and 2-way ANCOVA.

Results

Systemic concentrations of energy balance regulatory hormones total and acylated ghrelin, leptin, and peptide tyrosine-tyrosine) responded similarly to breakfast and lunch before and after 6 wk of either morning fasting or regular breakfast, with the exception of a tendency for increased glucagon-like peptide-1 concentrations from baseline to follow-up in the Breakfast Group compared with a decrease over that period in the Fasting Group [P = 0.06, partial eta squared value (ƞ2) = 0.16]. Subjective appetite sensations also did not differ over the course of the day, and ad libitum energy intake at lunch was not systematically affected by either intervention, decreasing by 27 kcal (95% CI: -203, 149 kcal) with fasting and by 77 kcal (95% CI: -210, 56 kcal) with breakfast. Similarly, glycemic, insulinemic, lipemic, and thermogenic responses to breakfast and lunch were very stable at baseline and follow-up and, thus, did not differ between treatment groups.

Conclusions

Our results indicate that a sustained period of either extended morning fasting or eating a daily breakfast has minimal effect upon acute metabolic and appetite responses in lean adults. This trial was registered at www.isrctn.org as ISRCTN31521726.

Breakfast consumption and nutrient intakes in 4-18-year-olds: UK National Diet and Nutrition Survey Rolling Programme (2008-2012)

Although breakfast consumption is widely considered to be an important component of a healthy lifestyle, few UK studies have examined differences in nutrient intakes between breakfast consumers and breakfast skippers among children and adolescents. We investigated associations between breakfast skipping in 4-18-year-olds and their nutrient intakes using data from the UK's National Diet and Nutrition Survey Rolling Programme. Dietary data were derived from 4-d estimated food diaries of 802 children aged 4-10 years and 884 children aged 11-18 years (1686 in total). Daily nutrient intakes of children with different breakfast habits were compared by one-way ANCOVA adjusting for relevant covariates (sex, age, ethnicity, equivalised household income and BMI). Within-person analysis was carried out on children with an irregular breakfast habit (n 879) comparing nutrient intakes on breakfast days with those on non-breakfast days using repeated measures ANCOVA. We observed that the overall nutritional profile of the children in terms of fibre and micronutrient intake was superior in frequent breakfast consumers (micronutrients: folate, Ca, Fe and I (P<0·01)) and, for the 4-10 years age group, on breakfast days (micronutrients: folate, vitamin C, Ca and I (P<0·01)). Also, significantly higher proportions of breakfast-consuming children met their reference nutrient intakes of folate, vitamin C, Ca, Fe and I compared with breakfast skippers (χ 2 analysis, P<0·001). Our study adds to the body of data linking breakfast consumption with higher quality dietary intake in school-age children, supporting the promotion of breakfast as an important element of a healthy dietary pattern in children.

Metabolic Effects of Intermittent Fasting

The objective of this review is to provide an overview of intermittent fasting regimens, summarize the evidence on the health benefits of intermittent fasting, and discuss physiological mechanisms by which intermittent fasting might lead to improved health outcomes. A MEDLINE search was performed using PubMed and the terms "intermittent fasting," "fasting," "time-restricted feeding," and "food timing." Modified fasting regimens appear to promote weight loss and may improve metabolic health. Several lines of evidence also support the hypothesis that eating patterns that reduce or eliminate nighttime eating and prolong nightly fasting intervals may result in sustained improvements in human health. Intermittent fasting regimens are hypothesized to influence metabolic regulation via effects on (a) circadian biology, (b) the gut microbiome, and (c) modifiable lifestyle behaviors, such as sleep. If proven to be efficacious, these eating regimens offer promising nonpharmacological approaches to improving health at the population level, with multiple public health benefits.