A Review of the Evidence Surrounding the Effects of Breakfast Consumption on Mechanisms of Weight Management

Effects of sleep on breakfast behaviors in recently unemployed adults

OBJECTIVES

Skipping meals is linked to negative cardiometabolic health outcomes. Few studies have examined the effects of breakfast skipping after disruptive life events, like job loss. The present analyses examine whether sleep timing, duration, and continuity are associated with breakfast eating among 186 adults who recently (past 90 days) experienced involuntary unemployment from the Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study.

METHODS

We conducted both cross-sectional and 18-month longitudinal analyses to assess the relationship between actigraphic sleep after job loss and breakfast eating.

RESULTS

Later sleep timing was associated with a lower percentage of days breakfast was eaten at baseline (B = -0.09, SE = 0.02, P < .001) and longitudinally over 18 months (estimate = -0.04; SE = 0.02; P < .05). No other sleep indices were associated with breakfast consumption cross-sectionally or prospectively.

CONCLUSIONS

Unemployed adults with a delay in sleep timing are more likely to skip breakfast than adults with an advancement in sleep timing. Future studies are necessary to test chronobiological mechanisms by which sleep timing might impact breakfast eating. With the understanding that sleep timing is linked to breakfast eating, the advancement of sleep timing may provide a pathway for the promotion of breakfast eating, ultimately preventing cardiometabolic disease.

Parental practices and children's lifestyle correlates of childhood overweight/obesity in Europe: The Feel4Diabetes study

BACKGROUND

Parental influences on children's eating and physical activity (PA) and consequently on their weight are fundamental. The present study aimed to identify the predominant correlates of childhood overweight/obesity among a variety of parental practices and children's lifestyle indices in a large sample of children in Europe.

METHODS

Families from low socio-economic status regions were recruited through schools, located in six European countries (Belgium, Finland, Greece, Spain, Bulgaria and Hungary). Seven thousand three hundred ninety-seven children 4-12 years old and their parents were selected using the FINDRISC-questionnaire. Parental practices assessed included parental role modelling, permissiveness and reward. Children's dietary intake and lifestyle behaviours were assessed through parent-reported questionnaires.

RESULTS

Regarding parental practices, it was revealed that being sometimes (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.10-1.43) or rarely (OR = 1.43; 95% CI = 1.21-1.69) physically active with the child was associated with greater overweight/obesity risk, whereas rare permission of computer/mobile/tablet (OR = 0.81; 95% CI = 0.67-0.98) and sometimes (OR = 0.77; 95% CI = 0.68-0.88) or rare (OR = 0.77; 95% CI = 0.66-0.91) reward with PA were associated with lower risk. Regarding children's lifestyle factors, consuming > 3 cups/week fresh fruit juices (OR = 1.28; 95% CI = 1.13-1.45), skipping breakfast (OR = 1.37; 95% CI = 1.17-1.61), absence of 1 h of daily PA (OR = 1.40; 95% CI = 1.24-1.58) and increased daily screen time (ST) (OR = 1.23; 95% CI = 1.09-1.39) were associated with greater overweight/obesity risk. All the variables were adjusted for maternal education, child's sex and age.

CONCLUSIONS

These findings emphasize the necessity of family-centered approaches in health promotion and obesity prevention programs for children. Such programs should focus on parents as the primary role models in exerting positive influence and encouraging healthy eating habits, PA, and ST behaviors in their children, which in turn, may have a substantial impact on children's overall weight status.

Effect of skipping breakfast on cardiovascular risk factors: a grade-assessed systematic review and meta-analysis of randomized controlled trials and prospective cohort studies

Skipping breakfast is one of the most prevalent irregular eating habits. Several pieces of evidence have reported the association between breakfast omission and a higher risk of cardiovascular diseases. Numerous publications have focused on the impact of skipping breakfast on various cardiovascular risk factors. Therefore, the current systematic review and meta-analysis aimed to assess this impact, especially with regard to anthropometric measurements, serum lipid profiles, blood pressure, and glycemic control indicators. A comprehensive search was performed in PubMed, Web of Science, Embase, Scopus, and the Cochrane Central Register of Controlled Trials up to 1 April 2023. A total of 11 eligible trials were identified to evaluate the combined effects of skipping breakfast. Final integrated results demonstrated that breakfast omission significantly decreased the body weight (mean difference = -0.66, 95% CI: -1.09 to -0.24, p = 0.002, I2 = 0.0) and increased the level of serum low-density lipoprotein cholesterol (LDL-C) (mean difference = 9.89, 95% CI: 5.14 to 14.63, p = 0.000, I2 = 17.3). Subgroup analysis also revealed potential factors that may affect the outcomes, for example, the physiological condition of participants, duration, gender, and type of breakfast. In conclusion, skipping breakfast may reduce body weight while increasing the level of serum LDL-C at the same time. In view of the limited trials, further studies are needed to expound the role of breakfast omission in cardiovascular diseases.

Association between frequency of breakfast consumption and cardiometabolic risk in Peruvian university teachers, 2019-2020

Background

Although the relationship between health status and dietary intake has been extensively studied in the general population, there is a lack of research that has specifically examined the association between frequency of breakfast consumption and cardiometabolic risk in university teachers.

Objective

To determine the association between the frequency of breakfast consumption and cardiometabolic risk in university teachers.

Methods

A cross-sectional study was conducted in 176 teachers from a private university located in the eastern region of Lima, Peru (Mage: 37.0 years; SD: 0.8, range: 24-59 years). The study was conducted during the period from December 2019 to February 2020. Information was collected on anthropometric and biochemical parameters and frequency of breakfast consumption. Multinomial logistic regression models were used to explore the association between frequency of breakfast with sociodemographic, anthropometric, and biochemical variables.

Results

The highest prevalence of excess body weight (44.4%) was observed in those who consumed breakfast 0 to 2 days/week, but without statistical differences. Those who reported Low-density lipoprotein cholesterol (LDL-C) < 160 mg/dL were 77% less likely to fall into the 3-5 day/week breakfast frequency category than those who reported a regular frequency of breakfast (6 to 7 days/week) (Adjusted OR = 0.23, 95% CI 0.08 to 0.73; p < 0.05). In addition, teachers who reported a breakfast frequency of 3 to 5 days/week were 83% more likely to have a glucose concentration < 110 mg/dL compared to those who consumed breakfast of 6 to 7 days/week (Adjusted OR = 0.17, 95% CI 0.04 to 0.75; p < 0.05).

Conclusion

Skipping breakfast for an extended period of time can have detrimental effects on cardiometabolic health. Promoting the benefits of breakfast could be a health message of great public health interest.

A hypothetical intervention of the timing of dietary intake on weight and body composition after initial weight loss

OBJECTIVE

This study estimated the effect of hypothetical interventions of higher and lower frequency of breakfast and post-dinner snack consumption (breakfast consumption 0-4 vs. 5-7 times/week and post-dinner snack consumption 0-2 vs. 3-7 times/week) on changes in body weight and composition over 18 months after a successful 6-month standard behavioral weight-loss program.

METHODS

The study analyzed data from the Innovative Approaches to Diet, Exercise and Activity (IDEA) study.

RESULTS

If all participants consumed a breakfast meal 5 to 7 times/week over 18 months, they would have regained 2.95 kg of body weight on average (95% CI: 2.01 to 3.96), which is 0.59 kg (95% CI: -0.86 to -0.32) lower than if all participants consumed breakfast 0 to 4 times/week. If all participants consumed a post-dinner snack 0 to 2 times/week, they would have regained 2.86 kg of body weight on average (95% CI: 0.99 to 5.25), which is 0.83 kg (95% CI: -1.06 to -0.59) lower than if all consumed a post-dinner snack 3 to 7 times/week.

CONCLUSIONS

Regular breakfast consumption and minimizing post-dinner snacking may modestly mitigate weight and body fat regain over 18 months after initial weight loss.

Frequency of Consuming Breakfast Meals and After-Dinner Snacks Is not Associated with Postmenopausal Breast Cancer Risk: Women's Health Initiative Observational Study

BACKGROUND

There has been little investigation into how the timing of meals and eating occasions associates with postmenopausal breast cancer risk.

OBJECTIVE

We examined the association between the frequency of consuming breakfast meals and after-dinner snacks with the risk for postmenopausal breast cancer.

METHODS

A prospective analysis of 74,825 postmenopausal women aged 49 to 81 y from the Women's Health Initiative Observational Study cohort. Breakfast and after-dinner snack intake were assessed at year 1 examination. Risk for invasive and in situ breast cancer diagnosed before 28 February 2020 was modeled with multivariable Cox proportional hazards regression models according to breakfast and after-dinner snack consumption frequencies. The models were adjusted for age, self-identified race/ethnicity, education, income, physical activity, smoking, alcohol intake, diet quality score (Healthy Eating Index 2015), energy intake, diabetic status, hormone therapy, and BMI.

RESULTS

During the follow-up period, 5313 participants were diagnosed with invasive breast cancer and 1197 participants with in situ breast cancer. Compared with participants who did not eat breakfast, those with daily breakfast consumption was not associated with invasive breast cancer (HR: 1.04; 95% CI: 0.9, 1.19) nor in situ (HR: 1.25; 95% CI: 0.91, 1.74) breast cancer. There were monotonic higher point estimates of in situ breast cancer for each higher category of breakfast intake from 0 to 7 times per week (P-trend = 0.04, Wald test). Compared with consumption of daily after-dinner snacks, avoidance of after-dinner snacks was not associated with invasive breast cancer (HR: 0.97; 95% CI: 0.87, 1.08) nor in situ (HR: 1.12; 95% CI: 0.89, 1.42) breast cancer.

CONCLUSIONS

There was no association between intake frequency of breakfast meals or after-dinner snack habits and with risk of breast cancer in postmenopausal women.

When should I eat: A circadian view on food intake and metabolic regulation

The circadian clock is a hierarchical timing system regulating most physiological and behavioral functions with a period of approximately 24 h in humans and other mammalian species. The circadian clock drives daily eating rhythms that, in turn, reinforce the circadian clock network itself to anticipate and orchestrate metabolic responses to food intake. Eating is tightly interconnected with the circadian clock and recent evidence shows that the timing of meals is crucial for the control of appetite and metabolic regulation. Obesity results from combined long-term dysregulation in food intake (homeostatic and hedonic circuits), energy expenditure, and energy storage. Increasing evidence supports that the loss of synchrony of daily rhythms significantly impairs metabolic homeostasis and is associated with obesity. This review presents an overview of mechanisms regulating food intake (homeostatic/hedonic) and focuses on the crucial role of the circadian clock on the metabolic response to eating, thus providing a fundamental research axis to maintain a healthy eating behavior.

Prevalence of Breakfast Skippers among Tunisian Preschool and School Children and Association with Weight Status: A Cross-Sectional Study

Breakfast is considered the most important meal of the day. This study aimed to assess breakfast frequency and quality in Tunisian children and to determine the relationship between breakfast skipping and the weight status of the children. A total of 1200 preschool and school children aged 3 to 9 years were randomly selected under a cross-sectional design. Breakfast habits and socio-economic characteristics were collected using a questionnaire. Participants who consumed breakfast less than five times the previous week were categorized as breakfast skippers. The other breakfast consumers were considered as non-skippers. The overall prevalence of breakfast skipping in Tunisian children was 8.3% and 83% of them consumed breakfast all the weekdays. At least two out of three children had a poor breakfast quality. Only 1% of children consumed breakfast in accordance with the composition guidelines. No relationships between breakfast skipping and weight status were detected in this study after adjustment for age, sex and all socio-economic factors (OR = 1.16, 95% CI = 0.72-1.89, p = 0.541). Further school-based interventions should be implemented to improve breakfast quality and to promote a healthy weight in Tunisian children.

Slim larks and overweight owls? A two years dietary intervention in shift workers

Previous studies have shown that shift workers are more prone to non-communicable diseases. The aim of the present crossover study is to investigate whether it is possible to improve the health status of shift workers. Nineteen male shift workers (38.5 years ± 7.4) received every other month a dietary counseling for one year. All subjects kept a seven-day diet diary during a night shift, received bioelectrical impedance analysis, and a laboratory examination was performed at the beginning of the study, after one year and at the end of the study. The laboratory blood test included the main metabolic parameters, melatonin and serotonin. Beside subjects were also motivated to incorporate more physical training into their daily routine. After the intervention period, participants reduced energy intake, mean portion size, table salt, consumption of sugar and saturated fat. C-reactive protein (CRP), mean corpuscular volume (MCV), liver enzymes, triglycerides, and uric acid decreased, while melatonin level increased. Participants lost body weight and reduced waist circumference after the intervention. Lifestyle modification and dietary information could contribute to the health of shift workers. However, further studies are needed to investigate whether this can prevent disease and whether melatonin production can be influenced by diet.

Consuming a Protein and Fiber-Based Supplement Preload Promotes Weight Loss and Alters Metabolic Markers in Overweight Adults in a 12-Week, Randomized, Double-Blind, Placebo-Controlled Trial

BACKGROUND

Higher protein and fiber diets promote weight management and metabolic health.

OBJECTIVES

This study aimed to determine if greater weight loss and positive changes in metabolic outcomes could be achieved with twice-daily consumption of a high-protein and fiber-based multi-ingredient nutritional shake (HPF) compared with an isocaloric low-protein, lower fiber-based placebo (LPF).

METHODS

Study procedures were conducted by an independent research organization under clinicaltrials.gov registration NCT03057873. Healthy overweight and obese adults [n = 206; BMI (kg/m2): 27-35; 70% female] were randomly assigned to HPF or LPF. All participants were prescribed an energy-restricted diet (500 kcal/d less than energy needs) and consumed a HPF (17 g protein, 6 g fiber) or LPF (1 g protein, 3 g fiber) shake 30 min before breakfast and lunch for 12 wk. Primary outcomes included body weight and total body fat percentage. Blood samples were collected at days (D) 0, 28, 56, and 84 for secondary analyses related to metabolic markers of health.

RESULTS

Although weight loss occurred in both groups, HPF had greater weight loss at D84 compared with LPF (-3.3 kg vs. -1.8 kg, P < 0.05). Percentage body fat decreased in both groups (HPF: -1.33%, LPF: -1.09%; P < 0.001) with no differences between groups. Serum total cholesterol, LDL cholesterol, and oxidized LDL decreased between -5.1% to -8.3%, whereas adiponectin increased over time in both groups; these changes occurred to a greater extent in HPF compared with LPF (all P < 0.05).

CONCLUSIONS

A multi-ingredient HPF nutritional supplement shake consumed as a preload before breakfast and lunch positively influenced weight management and metabolic outcomes in overweight adults compared with an LPF placebo. These findings suggest that specific nutrient factors (i.e., potentially including protein, fiber, and bioactive content) other than calorie reduction alone influence the success of a weight-loss regimen. This trial was registered at www.clinicaltrials.gov as NCT03057873.

Frequency of Breakfast Eating and Obesity Prevalence in Primary School Teachers

There is a lack of research using objective measures about teachers’ physical characteristics and lifestyle. The purpose of the study was to evaluate the relationship between frequency of breakfast consumption and body size, body composition, blood pressure and lifestyle factors in teachers from Hungary. The study analyzed data collected from 99 female primary school teachers (50.6 ± 6.6 year) before the COVID-19 pandemic. Anthropometric and resting blood pressure measurements were taken for each participant. Questionnaires were used to assess lifestyle factors (i.e., physical activity level, smoking status and eating breakfast). The frequency of eating breakfast was classified as rarely or never (0–2 days), some days (3–5 days) and regularly (6–7 days). Sixty-five percent of female teachers consumed breakfast 6–7 days/week, and this regular eating habit was positively associated with a lower risk of obesity (OR 0.29; CI: 0.10–0.80). In our sample, a higher frequency of breakfast consumption was not significantly associated with smoking (OR 2.65; CI: 0.17–1.37), hypertension (OR 0.61; CI: 0.23–1.65) and inactivity (OR 2.80; CI: 0.26–1.84). A beneficial effect of eating breakfast regularly was found on body composition in female teachers. Further studies should focus on the health behaviors of teachers and their relationship with physical activity or diagnosed diseases in urban and rural areas.

Effects of regular breakfast habits on metabolic and cardiovascular diseases: A protocol for systematic review and meta-analysis

BACKGROUND

Breakfast, which is considered as an important meal of the day, is being ignored by an increasing number of people as the pace of modern life accelerates. Although a large number of previous studies have reported the relationship between skipping breakfast and type 2 diabetes mellitus, most of them were cross-sectional studies. It remains unclear how skipping breakfast affects such specific cardio-metabolic diseases as hypertension, strokes and hypercholesterolemia.

METHODS

The protocols and reports of this meta-analysis are based on a meta-analysis of observational studies in epidemiological guidelines (MOOSE). Relevant studies were systematically retrieved from PubMed, Embase, Web of Science and the Cochrane Library, and were restricted to English from the inception to May 10, 2019. All the results were obtained by RRs, and outcomes of interests should include the occurrence of cardiovascular and metabolic diseases.

RESULTS

Fourteen cohort studies in total were eventually included. Compared with people having breakfast frequency≦3times/week, those with a frequency>3 times/week have reduced the risk of type 2 diabetes mellitus, obesity, Metabolic Syndrome, Low high-density lipoprotein cholesterolemia, Cardiovascular Diseases, cardiovascular Mortality, hypertension and strokes, with (RR = 0.8 [95% CI: 0.7-0.91], P = .142, I2 = 37.6%), (RR = 0.74 [95% CI: 0.59-0.94], P < .001, I2 = 89%), (RR = 0.86 [95% CI:0.75-0.99], P = .512, I2 = 0%), (RR = 0.75 [95% CI:0.61-0.93], P = .643, I2 = 0%), (RR = 0.87 [95% CI:0.81-0.93], P = .479, I2 = 0%), (RR = 0.63 [95% CI:0.51-0.78], P = .396, I2 = 0%), (RR = 0.92 [95% CI:0.86-0.98], P = .419, I2 = 0.7%), and (RR = 0.89 [95% CI:0.79-0.99], P = .238, I2 = 29%), respectively.

CONCLUSIONS

A regular daily breakfast habit benefits the cardio-metabolism to a great extent, reducing the risk of Cardiovascular Diseases, type 2 diabetes mellitus, obesity, hypertension, strokes, Metabolic Syndrome, cardiovascular Mortality, Low high-density lipoprotein cholesterolemia, and Abdominal obesity, while it is not significantly related to hypercholesterolemia and coronary heart disease regardless of gender. Nevertheless, skipping breakfast once a week may greatly reduce the benefits of cardio-metabolism. Therefore, public institutions should promote and encourage citizens to cultivate regular daily breakfast habits.

Effect of Protein-Rich Breakfast on Subsequent Energy Intake and Subjective Appetite in Children and Adolescents: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Breakfast has been labeled “the most important meal of the day”, especially for children and adolescents. Dietary protein intake may benefit and regulate appetite and energy balance. However, few meta–analyses have been conducted to examine the effect of protein–rich (PR) breakfast on both children and adolescents. This meta–analytic study was conducted to examine the effect of consuming a PR breakfast on short–term energy intake and appetite in children and adolescents. PubMed, Embase, Cochrane Central Register of Controlled Trials, China Biology Medicine disc (CBM), and China National Knowledge Infrastructure (CNKI) were searched for randomized controlled trials (RCTs) published in January 1990–January 2021. The inclusion criteria applied were RCTs in children and adolescents (7–19 year) comparing PR breakfast consumption with normal protein (NP)/traditional breakfast consumption. Finally, ten studies were included in the analysis, eight studies examined the effect of consuming PR breakfast on SEI (n = 824), and nine studies examined the effect on appetite (fullness = 736, hunger = 710). Our meta-analysis using the random–effects model shows that participants assigned to consume PR breakfast had lower SEI (MD, −111.2 kcal; 95% CI: −145.4, −76.9), higher fullness (MD, 7.4 mm; 95% CI: 6.0, 8.8), and lower hunger (MD, −8.5 mm; 95% CI: −9. 7, −7.3) than those assigned to consume NP/traditional breakfast. However, there was considerable inconsistency across the trial results. Our review suggests that the consumption of PR breakfast could be an excellent strategy for weight management by declining SEI and suppressing appetite, and provides new evidence of the relationship between energy balance and obesity. However, since most eligible studies were of low quality, the results ought to be interpreted cautiously.

Trajectories of Eating Behaviour Changes during Adolescence

Adolescence represents a critical transition phase during which individuals acquire eating behaviours that can track into adulthood. This study aims to characterise trends in eating behaviours throughout adolescence by investigating the presence of sub-groups of individuals presenting distinct trajectories of vegetable and fruit, sugary beverage, breakfast and fast-food consumption. Data from 744 MATCH study Canadian participants followed from 11 to 18 Years old (2013-2019) were included in the analyses. Participants reported how often they ate breakfast and consumed vegetables and fruits, sugary beverages and fast foods. Trajectories of eating behaviours over seven years were identified using group-based multi-trajectory modelling. For girls, three different groups were identified, namely 'stable food intake with a decline in daily breakfast consumption' (39.9%), 'moderate food intake and worsening in overall eating behaviours' (38.0%) and 'stable high food intake' (22.1%). For boys, five different groups were identified, namely 'low food intake with stable daily breakfast consumption' (27.3%), 'breakfast-skippers and increasing fast food intake' (27.1%), 'low food intake with a decline in daily breakfast consumption' (23.9%), 'high food intake with worsening of eating behaviours' (13.3%) and 'average food intake with consistently high breakfast consumption' (8.4%). Eating behaviours evolve through various distinct trajectories and sub-group-specific strategies may be required to promote healthy eating behaviours among adolescents.

Association between Breakfast Skipping and Body Weight-A Systematic Review and Meta-Analysis of Observational Longitudinal Studies

Globally, increasing rates of obesity are one of the most important health issues. The association between breakfast skipping and body weight is contradictory between cross-sectional and interventional studies. This systematic review and meta-analysis aims to summarize this association based on observational longitudinal studies. We included prospective studies on breakfast skipping and overweight/obesity or weight change in adults. The literature was searched until September 2020 in PubMed and Web of Science. Summary risk ratios (RRs) or β coefficients with a 95% confidence interval (CI), respectively, were estimated in pairwise meta-analyses by applying a random-effects model. In total, nine studies were included in the systematic review and three of them were included in the meta-analyses. The meta-analyses indicated an 11% increased RR for overweight/obesity when breakfast was skipped on ≥3 days per week compared to ≤2 days per week (95% CI: 1.04, 1.19, n = two studies). The meta-analysis on body mass index (BMI) change displayed no difference between breakfast skipping and eating (β = −0.02; 95% CI: −0.05, 0.01; n = two studies). This study provides minimal evidence that breakfast skipping might lead to weight gain and the onset of overweight and obesity.

Nutritional breakfast quality and cardiometabolic risk factors: Health Survey of São Paulo, a population-based study

OBJECTIVE

To evaluate the association between nutritional quality of breakfast and cardiometabolic risk factors.

DESIGN

Cross-sectional study, 2015 Health Survey of São Paulo (2015 ISA-Capital) with Focus on Nutrition Study (2015 ISA-Nutrition).

SETTINGS

Population-based study, with a representative sample of adults and elderlies living in São Paulo, Brazil.

PARTICIPANTS

The sample included 606 adults (aged 20-59 years) and 537 elderlies (aged ≥60 years) from the 2015 Health Survey of São Paulo. Dietary intake was assessed by at least one 24-h recall. Breakfast quality was evaluated using the proposed Brazilian Breakfast Quality Index (BQI), ranging scores from 0 to 10. BQI associations with sociodemographic, lifestyle, dietetic and cardiometabolic variables were estimated using survey-weighted multiple logistic regression models.

RESULTS

Being ≥60 years of age, self-identifying as White or Asian, having a per capita family income with ≥1 minimum wage, being sufficiently active at leisure time and non-smoker were associated with better scores of BQI. A higher BQI score was inversely associated with elevated blood pressure (OR 0·81, 95 % CI 0·70, 0·94), fasting glucose (OR 0·85, 95 % CI 0·73, 0·98), HOMA-IR (OR 0·86, 95 % CI 0·74, 0·98), total cholesterol (OR 0·87, 95 % CI 0·76, 0·99), LDL-C (OR 0·85, 95 % CI 0·74, 0·97), metabolic syndrome (OR 0·82, 95 % CI 0·72, 0·93) and being overweight (OR 0·87, 95 % CI 0·76, 0·99).

CONCLUSIONS

Breakfast quality of Brazilian adults needs improvement with disparities across some sociodemographic factors. BQI was associated with lower odds of cardiometabolic risk factors, suggesting a beneficial effect in this population and emphasising the role of breakfast in reducing the risk of CVD.

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.

Association of Skipping Breakfast With Cardiovascular and All-Cause Mortality

BACKGROUND

Skipping breakfast is common among U.S. adults. Limited evidence suggests that skipping breakfast is associated with atherosclerosis and cardiovascular disease.

OBJECTIVES

The authors sought to examine the association of skipping breakfast with cardiovascular and all-cause mortality.

METHODS

This is a prospective cohort study of a nationally representative sample of 6,550 adults 40 to 75 years of age who participated in the National Health and Nutrition Examination Survey III 1988 to 1994. Frequency of breakfast eating was reported during an in-house interview. Death and underlying causes of death were ascertained by linkage to death records through December 31, 2011. The associations between breakfast consumption frequency and cardiovascular and all-cause mortality were investigated by using weighted Cox proportional hazards regression models.

RESULTS

Among the 6,550 participants (mean age 53.2 years; 48.0% male) in this study, 5.1% never consumed breakfast, 10.9% rarely consumed breakfast, 25.0% consumed breakfast some days, and 59.0% consumed breakfast every day. During 112,148 person-years of follow-up, 2,318 deaths occurred including 619 deaths from cardiovascular disease. After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, body mass index, and cardiovascular risk factors, participants who never consumed breakfast compared with those consuming breakfast everyday had hazard ratios of 1.87 (95% confidence interval: 1.14 to 3.04) for cardiovascular mortality and 1.19 (95% confidence interval: 0.99 to 1.42) for all-cause mortality.

CONCLUSIONS

In a nationally representative cohort with 17 to 23 years of follow-up, skipping breakfast was associated with a significantly increased risk of mortality from cardiovascular disease. Our study supports the benefits of eating breakfast in promoting cardiovascular health.

Habitual Breakfast Patterns Do Not Influence Appetite and Satiety Responses in Normal vs. High-Protein Breakfasts in Overweight Adolescent Girls

Differences in postprandial insulin, glucose, and/or free fatty acid concentrations, following the consumption of breakfast, have been demonstrated to be dependent on habitual breakfast patterns. This study examined the effects of habitual breakfast patterns on postprandial appetite, satiety, and hormonal responses along with daily food intake following the consumption of normal-protein (NP) vs. higher-protein (HP) breakfasts in overweight adolescents. Thirty-seven girls (age: 19 ± 1 year; BMI: 29.0 ± 3.4 kg/m²) participated in the semi-randomized crossover design study. Participants were grouped according to whether they habitually skipped (SKIP, n = 18) or consumed breakfast (CONSUME, n = 19), and consumed a NP (350 kcal; 13 g protein) or HP (350 kcal; 35 g protein) breakfast for 3 days/pattern. On day 4, breakfast was provided, and appetite questionnaires and blood samples were collected throughout an 8 h testing day. Daily food intake was also assessed. Regardless of habitual breakfast patterns, the consumption of HP breakfast led to greater daily fullness (29,030 ± 6,010 min × mm) vs. NP breakfast (26,910 ± 5580 min × mm; p = 0.03). Daily protein consumption was greater (98 ± 15 g vs. 78 ± 15 g), and carbohydrate consumption was lower (331 ± 98 g vs. 367 ± 94 g) with HP vs. NP (both, p < 0.001). No other differences were observed. These data suggest that the recommendation to consume a HP breakfast for improved satiety and ingestive behavior is appropriate for overweight adolescent girls, regardless of habitual breakfast patterns.

Dietary modifications for weight loss and weight loss maintenance

Worldwide obesity rates remain at a rise, and to treat obesity is at the top of the global public health agenda. In 2013, the AHA/ACC/TOS obesity management guidelines were published, in essence suggesting that any dietary scheme seems to be effective for weight loss, as long as it can induce a sustainable energy deficit. In the present review, we update and critically discuss available information regarding dietary modifications for weight loss and weight loss maintenance, published after the 2013 guidelines. Regarding weight loss, we found no proof to support that a single dietary scheme, be it nutrient-, food group- or dietary pattern- based, is more efficacious of the other for achieving weight loss. For weight loss maintenance, published interventions point towards the same direction, although inconclusively. Most research explores the effect of weight loss regimes on weight loss maintenance and not the effect of the diet during weight loss maintenance, and this literature gap should be more thoroughly investigated.

Dietary behaviors throughout childhood are associated with adiposity and estimated insulin resistance in early adolescence: a longitudinal study

BACKGROUND

Despite the growing prevalence of excess weight and prediabetes in children, the contributing role of dietary behaviors throughout childhood remains poorly understood. We examined longitudinal associations of dietary behaviors throughout childhood with adiposity and estimated insulin resistance (HOMA-IR) in adolescence.

METHODS

Among 995 children from Project Viva, a pre-birth cohort, we examined associations of child dietary behaviors (frequency of eating breakfast, fast food, family dinner, and eating meals while watching television) reported annually throughout childhood (from ages 4 to 11 years) with body mass index z-score (BMI-z; n = 991), waist circumference (WC; n = 995), DXA overall and central adiposity measurements (n = 721), and HOMA-IR (n = 579) in early adolescence (13.2 ± 0.9 years old). We used mixed effects models adjusted for potential confounders.

RESULTS

Eating breakfast daily throughout childhood was associated with lower BMI-z and DXA-measured overall and central adiposity in boys and girls (e.g. for whole-body fat %: β - 1.43% [95% CI: -2.42, - 0.45] and - 1.47% [- 2.25, - 0.68]), and with lower HOMA-IR in boys (% difference - 15.6% [- 22.7, - 7.9]). Daily family dinner and eating fast food less than once per week throughout childhood were both associated with lower BMI-z and adiposity in girls (for BMI-z: β - 0.17 units [- 0.24, - 0.11] and β - 0.09 units [- 0.17, - 0.02]) and lower insulin resistance in boys (% difference - 7.3% [- 12.4,- 1.8] and - 7.6% [- 13.2, - 1.7]). Finally, eating meals while watching television < 1/week throughout childhood was associated with lower adolescent adiposity (e.g. WC: - 1.55 cm [- 2.39, - 0.71]) and HOMA-IR (% difference: - 10.7% [- 15.8, - 5.2]) in boys.

CONCLUSION

Healthful dietary behaviors throughout childhood are associated with less adiposity and lower estimated insulin resistance in early adolescence.

TRIAL REGISTRATION

NCT02820402.

Breakfast Consumption Augments Appetite, Eating Behavior, and Exploratory Markers of Sleep Quality Compared with Skipping Breakfast in Healthy Young Adults

BACKGROUND

Observational studies show associations between breakfast skipping, reduced satiety, and poor sleep quality; however, intervention studies are lacking.

OBJECTIVE

The purpose of this study was to examine the effects of consuming breakfast compared with breakfast skipping on appetitive, hormonal, and neural markers of appetite and satiety; ad libitum food intake; and exploratory measures of sleep health in young adults.

METHODS

Thirteen adults [aged 23.5 ± 0.9 y (mean ± SEMs); body mass index (kg/m2): 23.6 ± 0.6] completed the following randomized crossover-design study. Participants consumed a high-protein breakfast ("Breakfast"; 340 kcal, 30 g protein, 36 g carbohydrate, 9 g fat) or skipped breakfast ("Skip") for 7 d/treatment. On day 7, an 8-h clinical testing day was completed including assessments of hunger, fullness, desire to eat, prospective food consumption (PFC), related hormones, food cue-stimulated functional magnetic resonance imaging brain scans, and ad libitum evening food intake. Sleep quantity and quality were assessed with 7-d actigraphy, 7-d sleep diaries, and sleep-related hormones.

RESULTS

Morning and daily hunger, desire to eat, PFC, and ghrelin decreased, whereas fullness increased after the Breakfast pattern compared with after the Skip pattern (all, P < 0.05). No difference in peptide YY (PYY) concentrations were detected. Hippocampal, parahippocampal, and middle frontal gyrus activations were reduced after the Breakfast pattern compared with the Skip pattern (all, P < 0.01). Although no differences in daily food intake were observed, the Breakfast pattern reduced evening intake of high-carbohydrate and high-fat foods (P < 0.05), whereas evening sugar intake tended to be reduced compared with the Skip pattern (P = 0.085). Although Breakfast led to shorter total sleep time (TST) compared with Skip (P < 0.05), no difference in sleep efficiency (TST/sleep period) was detected. Perceived sleep quality and sleep onset tended to improve after Breakfast compared with after Skip (P = 0.060 and P = 0.07, respectively).

CONCLUSION

Breakfast consumption improved appetite, satiety, and diet quality and may support some aspects of sleep health in healthy young adults. This trial was registered at clinicaltrials.gov as NCT03031132.