Digging into breakfast: serving up a better understanding of the effects on health of the "most important meal of the day"

Breakfast skipping and risk of all-cause, cardiovascular and cancer mortality among adults: a systematic review and meta-analysis of prospective cohort studies

Background: Numerous studies reported inconsistent association between breakfast skipping and all-cause, cardiovascular disease (CVD) and cancer mortality. Therefore, we conducted a systematic review and meta-analysis to elucidate these associations. Methods: PubMed, Embase, and Web of Science databases were searched up to July 2023 for prospective cohort studies that assessed the association between breakfast skipping and all-cause, CVD and cancer mortality in general adults. A random effect model was used to estimate the pooled hazard ratio (HR) and 95% confidence intervals (CIs), with subgroup analysis and sensitivity analysis performed. The Newcastle-Ottawa Scale (NOS) was used to assess the study and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to assess the risk of bias. Results: The final analysis included 9 cohort studies including 242 095 participants, with 6 studies for all-cause mortality, 4 studies for CVD mortality, and 2 studies for cancer mortality. Compared to regular breakfast consumption, skipping breakfast was associated with a higher risk of all-cause (HR: 1.27, 95% CI, 1.07-1.51, I2 = 77%), CVD (HR 1.28, 95% CI 1.10-1.50, I2 = 0), and cancer (HR: 1.34, 95% CI: 1.11-1.61, I2 = 0%) mortality. Sensitivity analysis revealed inconsistent results in all-cause and CVD mortality. Subgroup analysis showed significant association in studies with larger participants, longer follow-up, adjustments for energy intake, and high-quality articles. GRADE showed very low evidence for all-cause mortality and low evidence for CVD and cancer mortality. Conclusion: The findings underscore the importance of regular breakfast habits for health and longevity. However, these results require careful interpretation due to geographic limitations, potential heterogeneity, and instability.

Eating versus skipping breakfast has no discernible effect on obesity-related anthropometric outcomes: a systematic review and meta-analysis

Background: Eating or skipping breakfast for weight interests scientific and lay communities. Our objective was to systematically review and meta-analyze causal effects of eating versus skipping breakfast on obesity-related anthropometric outcomes in humans. Methods: Six databases were searched for obesity- and breakfast-related terms (final search: 02 JAN 2020). Studies needed to isolate eating versus skipping breakfast in randomized controlled trials. Mean differences were synthesized using inverse variance random effects meta-analysis for each outcome. Positive estimates indicate higher outcomes in breakfast conditions (e.g., weight gain). Leave-one-out sensitivity analysis, secondary baseline habit-by-breakfast assignment analysis, and study duration cumulative analysis were performed. Risk of bias was assessed using Cochrane risk of bias tool. Results: Ten articles (12 comparisons; 6d-12wk) were included. Conditions included recommendations to eat versus skip breakfast, or provision of some or all meals. 95% confidence intervals of all main analyses included the null value of no difference for each outcome: body weight (0.17 kg [-0.40,0.73], k=12, n=487, I 2=74.5), BMI (0.07 kg/m 2 [-0.10,0.23, k=8, n=396, I 2=54.1), body fat percentage (-0.27% [-1.01,0.47], k=6, n=179, I 2=52.4), fat mass (0.24 kg [-0.21,0.69], k=6, n=205, I 2=0.0), lean mass (0.18 kg [-0.08,0.44], k=6, n=205, I 2=6.7), waist circumference (0.18 cm [-1.77,2.13], k=4, n=102, I 2=78.7), waist:hip ratio (0.00 [-0.01,0.01], k=4, n=102, I 2=8.0), sagittal abdominal diameter (0.19 cm [-2.35,2.73], k=2, n=56, I 2=0.0), and fat mass index (0.00 kg/m 2 [-0.22,0.23], k=2, n=56, I 2=0.0). Subgroup analysis showed only one statistically significant result. The interaction effect for BMI (–0.36[-0.65,-0.07]) indicates assignment to conditions consistent with baseline habits had lower BMI. Leave-one-out analysis did not indicate substantial influence of any one study. Conclusions: There was no discernible effect of eating or skipping breakfast on obesity-related anthropometric measures when pooling studies with substantial design heterogeneity and sometimes statistical heterogeneity. Registration: PROSPERO CRD42016033290.

Breakfast on the go: Evaluating the nutritional content of supermarket products

OBJECTIVES

Breakfast consumption on the go is becoming an established food habit; this has been accompanied by a growing number of related products. Given the limited research on these products and the growing trend in breakfast consumption away from home and on the go, the aim of this cross-sectional study was to survey and scrutinize the nutritional composition of breakfast on-the-go products available in the UK.

METHODS

Field visits to supermarkets of the top seven grocery retailers (accounting for 88% of the UK market) were conducted in a large city in the UK. Breakfast on-the-go products (n = 128) were identified, and data (including price, energy, and nutrients) were collected. Products were categorized according to food format (i.e., breakfast biscuits, breakfast drinks, high-protein breakfast drinks, and porridge pots). Products were profiled according to front-of-pack nutrition labeling (i.e., low, medium, high) for fat, saturated fat, total sugars, and salt content. Nutrient content and profiles were examined across categories.

RESULTS

Significant associations were revealed between product type and nutrient profiles for total fat, saturated fat, and salt. Total sugar content varied from 11.8 g per portion observed in biscuits to high-protein breakfast drinks, which contained almost double this level (20.0 g). Notably, six of ten breakfast on-the-go items (60.2%) were profiled as high for total sugars (according to front-of-pack criteria). Most items were medium in total fat (87.5%), low in saturated fat (61.7%), and low in salt (56.3%).

CONCLUSIONS

Reformulation of breakfast on-the-go products, principally with respect to sugar content, is warranted. This is particularly relevant given the growing role of breakfast consumption on the go and ongoing developments in the sector as new product ranges and formats are introduced.

Energy balance-related factors associating with adolescent weight loss intent: evidence from the 2017 National Youth Risk Behavior Survey

BACKGROUND

The purpose of this study was to examine specific energy balance-related behaviors (sedentary behaviors, physical activity, and dietary) associating with adolescent weight loss intent using data from the 2017 US Youth Risk Behavior Survey (YRBS).

METHODS

This was a cross-sectional study that employed a multi-stage cluster sampling procedure to obtain a representative sample of US adolescents. The target population consisted of public and private high schoolers from grades 9 through 12. The number of sampled adolescents was 18,324 with 14,765 of the 18,324 sampled students (Mean age = 15.9 (1.3) years) submitting questionnaires with usable data (81% response rate). The outcome was intent to lose weight with specific energy-balance related behaviors examined as predictor variables. A weighted logistic regression model was employed to examine the associations between sedentary behaviors, physical activity, and dietary-related variables with weight loss intent controlling for age, sex, BMI percentile, and race/ethnicity.

RESULTS

Variables associating with adolescent intent to lose weight included 3 or more hours of video game playing (OR = 1.15, 95%CI: 1.01-1.31, p = 0.028), achieving 60 min of physical activity daily (OR = 0.66, 95%CI: 0.59-0.73, p < 0.001), daily breakfast consumption (OR = 0.76, 95%CI: 0.67-0.87, p < 0.001) and weekly salad consumption (OR = 1.30, 95%CI: 1.12-1.52, p = 0.001).

CONCLUSIONS

Meeting physical activity guidelines and regular breakfast consumption associated with lower odds of weight loss intent and video game playing and salad consumption associated with higher odds of weight loss intent in a representative sample of US adolescents. Therefore, there is a discordance between adolescent weight loss intent and the engagement in specific energy balance-related health behaviors, particularly physical activity.