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Breakfast like a king: how important is the first meal?

Sarah Schenker
BSc SRD PhD
Nutrition Scientist British Nutrition Foundation
London
E:S.schenker@nutrition.org.uk

To many breakfast is considered the most important meal of the day. This is because of the long period since the previous meal - as the name implies - most individuals would not have eaten for the previous 10-15 hours, compared with the usual maximum of 4-5 hours between other meals.
This relatively prolonged fast results in a fall in several blood constituents, particularly those associated with energy provision. For example, blood glucose and insulin fall, while there may be an increase in lactate, free fatty acids and plasma glucagon. For clinical purposes a number of blood parameters that rise after a meal are measured in the fasting state, which in practice is before breakfast (eg, blood triglyceride, glucose).

Breakfast habits
Despite the term "most important meal of the day", breakfast is usually the smallest meal of the day, supplying around 15% of total daily energy, compared with 30% each from midday and evening meals and about 25% eaten between meals. Many countries are characterised by the composition of their traditional breakfast. For example, traditionally the English breakfast is based on bacon and eggs, the Scottish breakfast includes porridge, the French or Continental breakfast includes a croissant and coffee, German breakfasts are associated with cold sausage, Dutch with cheese and Canadian with pancakes and maple syrup.
However, in many countries over the last 50 years there have been changes towards a smaller meal incorporating cereal, milk, fruit juices, yoghurt and toast. Furthermore surveys have shown that increased numbers of people skip breakfast. A recent survey by the British Nutrition Foundation of over 5,200 schoolchildren in the UK found that on average nearly 25% of boys did not eat breakfast and up to 50% of teenage girls skipped breakfast (www.nutrition.org.uk/foodquiz 2003.htm). The recent National Diet and Nutrition Survey of UK adults has revealed an increase in the number of people who eat breakfast cereal, but this could suggest that it has become more popular as a snack and is not always eaten at breakfast.(1) The growth of fast-food outlets and coffee shops has led to increased numbers of people eating breakfast out of home. There is also a greater variety of breakfast-style snacks available to eat "on the run", while eating breakfast at work has also become more popular.
A number of reasons have been cited for not eating breakfast, such as the morning rush, lack of time and domestic and family changes arising from the increased number of working mothers. Another popular reason is the belief that skipping breakfast helps would-be ­slimmers control their food intake.

Effects of omitting breakfast
There have been a number of studies investigating the effects of breakfast intake on mental abilities and academic achievement in school-aged children.(2) Research in this area has concentrated predominantly on younger individuals, although the results have implications for adults also.
Breakfast typically follows the longest period of fasting during the 24-hour daily cycle; therefore omission of breakfast may alter metabolism, which could lead to decreased nutrient availability to the brain. Results of other studies have supported the conviction that breakfast intake can moderate performance on cognitive tasks.(3,4) In her studies, Pollitt observed that not having breakfast impaired the problem-solving abilities of well-nourished 9-11-year-old American children.(3,4) When tested in the late morning, the children made significantly more errors on a task when they had not eaten breakfast than when they had eaten breakfast. Similarly, Conners and Blouin found that the same-age children made significantly more errors on a test and did more poorly on an attention task when they had not had breakfast than when they had consumed the meal.(2)
Although most studies on the effect of breakfast on mood and cognitive performance have been conducted in children, a small number have been conducted in adults. Benton and Sargent reported that university students who did not eat breakfast did more poorly on memory tests than students who consumed a morning meal.(5) In comparison, Smith et al, using a similar group of subjects, found that not eating breakfast impaired performance on free recall and recognition memory tasks, but did not alter performance on sustained attention tasks.(6,7) More recently, Holt et al confirmed these finding by studies in which breakfast types were compared for their effect on alertness.(8) Alertness ratings increased immediately after breakfast was consumed, and the high-fibre, carbohydrate-rich meal was associated with the highest postbreakfast alertness rating. A larger study found an association between breakfast cereal consumption and subjective reports of health, with those adults who ate breakfast cereal every day reporting better mental and physical health, compared with those who consumed it less frequently.(9)
In conclusion, experimental evidence suggests that omitting breakfast impairs cognitive performance.(10) However, it is important to note that there are a number of variables that can interact with the effect of breakfast intake, such as timing and the nature of the cognitive task. At present, there is little information available on the influence of these variables.

Effects of omitting breakfast on nutritional status
Research has shown that people who eat breakfast are more likely to have more nutritionally balanced diets, which are lower in fat and higher in carbohydrate, compared with those who miss breakfast; skipping the first meal of the day may lead to an unhealthy pattern of snacking on high-fat foods throughout the morning.(10) New research on breakfast has shown that rates of obesity and insulin resistance (a disorder that can lead to diabetes) were up to 50% lower in people who ate breakfast every day compared with those who ­usually skipped it.(11)
Many people choose to eat cereal for breakfast, which is low in fat and high in carbohydrate, promotes the feeling of being full for longer, so reducing mid-morning cravings for fatty snacks. Fortified breakfast cereals also provide important vitamins such as the ­B vitamins and minerals such as iron. Milk is an important source of protein, B vitamins such as riboflavin and B12, and minerals such as zinc, magnesium and particularly calcium. Breakfast is one of the easiest meals in which to get calcium into the diet through the consumption of milk and dairy products such as yoghurt. A serving of milk on cereal can provide up to a third of the daily calcium requirement.
 
Effects on slimming
It has been shown that those who habitually go without breakfast do not eat less food overall and so have a similar or higher energy intake than those who regularly eat this meal.(12) Weight control is often cited as a reason for omitting breakfast, yet studies suggest that breakfast consumers tend to be leaner,(13) and weight is inversely related to the number of eating occasions during the day.(14) It has been suggested that energy taken early in the day is used inefficiently and that larger breakfasts could benefit weight reducers.
 
Conclusion
It is clear that many people skip breakfast most or all days of the week without measurable detriment to their health. However, studies have shown that eating a regular breakfast could benefit mental performance and weight control and can improve nutritional status, both directly through the intake of nutrients provided from typical breakfast foods, and indirectly through a healthier pattern of eating throughout the day.

References

  1. NDNS. National diet and nutrition survey: adults aged 19 to 64 years. London: The Stationery Office; 2003.
  2. Conners CK, Blouin AG. Nutritional effects on behaviour in ­children. J Psychiatr Res 1982;17:193-201.
  3. Pollitt E, Leibel RL, Greenfield D. Brief fasting, stress and cognition in ­children. Am J Clin Nutr 1981;34:1525-33.
  4. Pollitt E, Lewis NL, Garza C, Shulman RJ. Fasting and cognitive ­function. J Psychiatr Res 1982;17:169-74.
  5. Benton D, Sargent J. Breakfast, blood glucose and memory.Biol Psychol 1992;33:207-10.
  6. Smith AP, Kendrick AK, Maben AL. Effects of breakfast and caffeine on performance and mood in the morning and after lunch. Neuropsychobiology 1992;26:198-204.
  7. Smith AP, Kendrick AM, Maben AL, Salmon J. Effects of breakfast and caffeine on cognitive performance, mood and cardiovascular functioning. Appetite 1994;22:39-55.
  8. Holt SH, Delargy HJ, Lawton CL, Blundell JE. The effects of high-­carbohydrate vs high-fat breakfasts on feelings of fullness and alertness and subsequent food intake. Int J Food Sci Nutr 1999;50:13-28.
  9. Smith AP. Breakfast cereal consumption and subjective reports of health. Int J Food Sci Nutr 1999;50:445-9.
  10. Ruxton CHS, Kirk TR. Breakfast: a review of associations with measures of dietary intake, physiology and biochemistry. Br J Nutr 1997;78:199-213.
  11. Pereira MA, Jacobs DR Jr, Pins JJ, et al. Effect of whole grains on insulin sensitivity in overweight ­hyperinsulinaemic adults. Am J Clin Nutr 2002;75:848-55.
  12. Blundell JE, Gillet A. Control of food intake in the obese. Obes Res 2001;9:263-70S.
  13. Gibson SA, O'Sullivan KR. Breakfast cereal and consumption patterns and nutrient intakes of British schoolchildren. J R Soc Health 1995;115:336-70.
  14. Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C. Relationship between feeding pattern and body mass index in 220 free-living people in four age groups. Eur J Clin Nutr 1996;50:513-9.

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