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1 Effect of skipping breakfast on subsequent energy intake

2 David A. Levitsky , Carly R. Paconowski

3 Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, United States

4

5

a b s t r a c ta r t i c l e i n f o

6 Article history:

7 Received 14 November 2012

8 Accepted 3 May 2013

9 Available online xxxx

101112

13 Keywords:

14 Skipping breakfast

15 Control of energy intake

16 Energetic compensation

17 Weight control

18 Obesity

19The objective was to examine the effect of consuming breakfast on subsequent energy intake.

20Participants who habitually ate breakfast and those who skipped breakfast were recruited for two studies.

21Using a randomized crossover design, the first study, examined the effect of having participants consume

22either (a) no breakfast, (b) a high carbohydrate breakfast (335 kcals) or (c) a high fiber breakfast (360) kcals23on three occasions and measured ad libitum intake at lunch. The second study again used a randomized cross-

24over design but with a larger, normal carbohydrate, breakfast consumed ad libtum. Intake averaged 624 kcals

25and subsequent food intake was measured throughout the day. Participants ate only foods served from the

26Cornell Human Metabolic Research Unit where all foods were weighed before and after consumption.

27In the first study, neither eating breakfast nor the kind of breakfast consumed had an effect on the amount

28consumed at lunch despite a reduction in hunger ratings. In thesecond study,intake at lunch as well as hunger

29ratings was significantly increasedafter skipping breakfast, by 144 kcal,leaving a net caloric deficitof 408 kcal

30by the end of the day. These data are consistent with published literature demonstrating that skipping a meal

31does not result in accurate energy compensation at subsequent meals and suggests that skipping breakfast

32may be an effective means to reduce daily energy intake in some adults.

33 2013 Published by Elsevier Inc.

3435

36

37

38 1. Introduction

39 Despite many scientific publications demonstrating nutritional

40 benefits of eating breakfast [1,34,55,58,64,65,69,73,80,81,85], skip-

41 ping breakfast is one of the first changes in feeding habits people

42 make when they want to lose weight [8,1214,101,104]. About 25%

43 of American adults report regularly not eating breakfast, a statistic

44 that has increased from 14% observed in 1965 [37]. The major reason

45 given for skipping breakfast is to control body weight [78,104].

46 Skipping breakfast as a means of losing weight appears to contra-

47 dict the scientific literature. Wyatt and colleagues found that one of

48 the most consistent characteristics of people who were part of the

49 National Weight Control Registry, a group of successful dieters who

50 have maintained at least a 13.6 kg (30 lb) weight loss for one year

51 or more, is that only 4% of the nearly 3000 participants reported

52 that they skipped breakfast, [102] a frequency considerably lower

53 than the 25% observed in the population [37].

54 Scientific evidence supporting the contention that skipping break-

55 fast is ineffective as a means of restricting energy intake is inferred

56 from the frequently published observation that people who skip

57 breakfast either have a higher Body Mass Index (BMI) or gain weight

58 at a greater rate than people who regularly eat breakfast [24,6,7,

59 9,10,12,13,15,16,18,2226,30,35,40,42,46,47,52,53,56,59,68,70,79,80,

6082,87,89,90,93

97,100], although there are reports where such rela-61tionships were not observed [1,30,31,54,76,83,86,98,99]. Despite

62the preponderance of studies demonstrating the inverse relationship

63between BMI and the frequency of eating breakfast, these observations

64have been correlational. It is equally plausible to interpret these asso-

65ciations as indicating that a high BMI causes one to skip breakfast as

66it is to suggest that skipping breakfast causes an increased BMI. It is

67also possible that breakfast eaters engage in other healthy behaviors,

68such as reducing snacking, lowering total fat intake and engaging in

69regular exercise, all of which will lead to a reduced BMI [38,102].

70From this correlational evidence alone, we cannot conclude that eating

71breakfast results in a reduced BMI or that skipping breakfast results in a

72higher BMI.

73To establish whether skipping breakfast results in an increase in

74energy intake at succeeding meals to compensate for the lost energy

75consumed at breakfast requires breakfast consumption to be experi-

76mentally manipulated and its effects on resulting intake measured.

77In one of the few studies that directly tests this idea, Kral and col-

78leagues [57] demonstrated that when children skip breakfast, despite

79increased hunger ratings, they do not compensate for the caloric def-

80icit by eating more later in the day. To further investigate whether

81skipping breakfast results in subsequent energetic compensation in

82adults, the following two experimental studies were performed. The

83first study examined the effect of skipping breakfast on the amount

84consumed at lunch. The second study examined the effect of eating

85a larger breakfast on the amount consumed at lunch and during the

86rest of the day.

Physiology & Behavior xxx (2013) xxxxxx

Corresponding author at: 112 Savage Hall.

E-mail address: [email protected] (D.A. Levitsky).

PHB-10041; No of Pages 8

0031-9384/$ see front matter 2013 Published by Elsevier Inc.

http://dx.doi.org/10.1016/j.physbeh.2013.05.006

Contents lists available at SciVerse ScienceDirect

Physiology & Behavior

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / p h b

Please cite this article as: Levitsky DA, Paconowski CR, Effect of skipping breakfast on subsequent energy intake, Physiol Behav (2013), http://dx.doi.org/10.1016/j.physbeh.2013.05.006
http://dx.doi.org/10.1016/j.physbeh.2013.05.006http://dx.doi.org/10.1016/j.physbeh.2013.05.006http://dx.doi.org/10.1016/j.physbeh.2013.05.006mailto:[email protected]://dx.doi.org/10.1016/j.physbeh.2013.05.006http://www.sciencedirect.com/science/journal/00319384http://dx.doi.org/10.1016/j.physbeh.2013.05.006http://dx.doi.org/10.1016/j.physbeh.2013.05.006http://dx.doi.org/10.1016/j.physbeh.2013.05.006http://dx.doi.org/10.1016/j.physbeh.2013.05.006http://www.sciencedirect.com/science/journal/00319384http://dx.doi.org/10.1016/j.physbeh.2013.05.006mailto:[email protected]://dx.doi.org/10.1016/j.physbeh.2013.05.006

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2. Study I

2.1. Material and methods

Participants were recruited from the undergraduate student

population at Cornell University through posters and class announce-

ments. The participants were told that the researchers were studying

the cognitive effects of breakfast consumption. Volunteers were

screened using a health questionnaire and the Stunkard Three FactorEating Questionnaire. From this pool, twenty-four participants were

selected on the basis that (a) they exhibited low restraint scores

(b15), (b) they did not have any aversions to the foods that would

be served, (c) they were in good physical health (self-report), and

(d) they did not take any medications. All participants were between

18 and 23 years old (mean age of 21) with BMIs greater than 20 and

less than 25. The study was approved by the Cornell Institutional

Review Board.

Participants were divided into three groups matched for age,

restraint score, and gender. A randomized cross-over design was

used. They were instructed to eat breakfast and lunch in the Cornell

Human Metabolic Research Unit (HMRU) on three consecutive

Wednesdays. They were instructed not to eat any food after 11:00 pm

the night before and to arrive at the Unit between 7:45 and 9:20

the next morning. According to which group the participants were

assigned, they were given either (a) no breakfast, (b) a high carbohy-

drate breakfast consisting of a plain bagel with1 tbs of strawberry or

grape jelly and 1 cup of orange or apple juice, or (c) a high fiber break-

fast consisting of 1 cup of Raisin Bran cereal with 1 cup of 1% milk. The

energy content of the high carbohydrate breakfast was 335 kcals and

the high fiber breakfast was 338 kcals. The nutrient composition of

the two meals is provided in Table 1. The participants were asked to

eat all the food given to them. At each testing session 1/3 of the partic-

ipants received each of the three breakfasts. For each succeeding week,

each group was rotated through the remaining treatments according

to a balanced Latin square design.

Participants were not permitted to eat anything between break-

fast and lunch. One hour before lunch the participants, completed a

6-point hunger rating scale. Lunch was served in the HMRU between11:30 am and 12:30 pm. When the participants arrived for lunch, they

were given a 10 minute paper-and-pencil cognitive test to complete.

Lunch was served from a buffet table (nutrient composition is

presented in Table 2). The participants were instructed to eat as

much or little as they wanted. After placing each food on separate

paper plates, the participants carried the food to a weighing station

where the investigators recorded the weight of each item. Data were

recorded to the nearest gram. Just before eating, participants complet-

ed a second hunger rating scale. After finishing the meal, the amount

of food remaining on the plate was recorded. Energy values of the

foods consumed were determined from standard food tables [50].

134Amount consumed was the major dependent variable of interest.

135Statistical analyses were performed on both the amount consumed (g)

136and energy consumed (kcal). The results were identical.

137Data were analyzed using a General Linear Model (GLM) with re-

138peated measures in SPSS version 14. Gender, body weight and BMI

139were included in the model as subject variables. Amount consumed

140and hunger ratings were dependent variables and the kind of break-

141fast was entered as the independent variable. The Bonferroni correc-

142tion was used in the case of multiple comparisons and Tukey's HSD

143were used to test differences between breakfast conditions.

1442.2. Results

145Characteristics of the participants are presented in Table 3. Eighteen

146of the 24 participantswere regularbreakfast eaters and 19 of the partic-

147ipants were female. Neither gender, body weight, BMI, nor whether

148or not the participants were regular breakfast eaters had a statistically

149significant effect on hunger ratings or energy consumption.

150Fig. 1 displays the primary outcomes of Study 1. Panel A shows the

151mean hunger ratings that were taken prior to eating lunch. Skipping

152breakfast resulted in participants rating themselves significantly

153more hungry(p b 0.01) than after eatingeither the high carbohydrate

154or the highfiber breakfast. Consuming either the high carbohydrate or

155the high fiber breakfast had no significant effect on the participant's

156ratings of hunger just before lunch. The type of breakfast (high carbo-

157hydrate or high fiber) did not have a significant effect on any parame-158ters measured.

159Despite increased hunger ratings at lunch, when participants

160skipped breakfast the amount of energy consumed at lunch was not

161statistically different from the energy consumed on those days when

162they atebreakfast, as shown in Panel B. Theinability to detectan effect

163of skipping breakfaston lunch intakewas notdue to a lack of statistical

164power.A power calculation of thesample indicatedthat a difference of

16535 kcals could be statistically detected with an alpha set at 0.05 and

166with a power of 0.8.

167The energetic consequence of skipping breakfast on total daily

168intake is depicted by Panel C. The accumulated energy consumed by

169the end of lunch was significantly greater after having eaten the

170high carbohydrate 955 42 kcal or the high fiber breakfast 930

17165 kcal than when breakfast was skipped 600 50 kcal. Energetic172compensation at lunch failed to balance the reduction in energy

173intake resulting from not eating breakfast.Table 1

Composition of foods consumed at breakfast for Study 1.

Breakfast Study 1 Weight Calories Protein Carbohydrate Fat Fiber

Low fiber breakfast

Plain bagel 125 200 12 68 1 1.6

1 tbs of strawberry

or grape jelly

10 25 0 6.5 0 0

1 cup of orange or

apple juice

249 110 1 30 0.5 0.3

Total 335 13 104.5 1.5 1.9

0 High fiber breakfast

1 1 cup of raisin bran cereal 56 210 4 45 1.5 6

2 1 cup of 1% milk 305 128 10.3 15 3 0

3 Total 338 14.3 0 0 6

Table 2 t2:1

t2:2Composition of foods offered at lunch for Study 1.

t2:3Lunch Study 1 Weight Calories Protein Carbohydrate Fat Fiber

t2:4Fruit cocktail 248 181 1.0 46.9 1 2.5

t2:5Plain yogurt 245 149 8.5 11.4 8 0

t2:6Tuna sandwich 121.8 322 14.2 31.6 0.4 2.3

t2:7Turkey sandwich 255 476 23 39 15.6 5

t2:8Cheese sandwich 119 399 17.2 30 23.2 1.3

t2:9Pasta & marinara sauce 226.8 168 7.2 34 3.2 3.2

t2:

10Iced tea 226.8 0 0 0 0 0

Table 3 t3:1

t3:2Study 1 Subject characteristics.

t3:3Subject Characteristics

t3:4Mean age (years) 22.1 2.7

t3:5Mean height (m) 1.7 0.08

t3:6Mean weight (kg) 61 17

t3:7Mean BMI 21 5.2

t3:8Female/Male 19/5

t3:9Mean restraint score 8.8 0.89

t3:10Number of regular breakfast eaters 18/24

2 D.A. Levitsky, C.R. Paconowski / Physiology & Behavior xxx (2013) xxxxxx

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174 Neither gender, body weight, BMI, nor the participant's habitual175 breakfast eating pattern had any statistically significant effect on

176 either the amount consumed or hunger ratings.

177 2.3. Discussion

178 This study demonstrated that skipping breakfast did not result in a

179 significant increase in energy intake at the subsequent meal approxi-

180 mately three hours later. This resulted in a caloric deficit on the occa-

181 sions when breakfast was not eaten. However, the mean amount of

182 energy consumed at breakfast was about 350 kcals. It is possible that

183 the size of the breakfast used in this study was not sufficient to affect

184 intake at lunch. It is also possible that energetic compensation for

185 skipping breakfast may not occur at lunch, but later in the day. There-

186 fore, the following study was performed to examine the effect of skip-187 ping an ad libitum breakfast on the energy consumed throughout the

188 rest of the day.

189 3. Study 2

190 3.1. Material and methods

191 Similar to Study 1, participants were undergraduate students at

192 Cornell University. Eighteen healthy volunteers who showed no aver-

193 sions or allergies to foods that would be served were chosen. BMIs

194 ranged from 22 to 27 and the average age was 24. Eleven were regular

195 breakfast eaters, five regularly skipped breakfast, and two ate break-

196 fast irregularly. This study differed from the first in that one breakfast

197 was served or not served and food intake was measured after lunch,

198after mid-afternoon snack, after dinner, and after late night snack.199The study was approved by the University Institutional Review

200Board. Participants consumed all breakfasts and lunches in the Cornell

201Human Metabolic Research Unit (HMRU), but could take snacks and

202dinners out from the unit. The snack and its weight were recorded

203before the subject left the HMRU and the subject was asked to return

204the wrapper along with any uneaten food. They were also asked to re-

205cord the time when they ate the snack. Because of time constraints,

206some participants ate their dinner meal outside the unit. They were

207provided with more than ample food and asked to return all uneaten

208food to the unit the next day.

209Participants were recruited and screened in a manner similar to

210that of the previous study. They were divided into two groups

211matched on the basis of body weight. They were instructed to eat

212only food provided by the HMRU on two consecutive Mondays.213They were asked not to eat anything after 11:00 pm the night before.

214Breakfast was served buffet style between 8:45 am and 10:00 am.

215Nutrient composition of the food offered is presented in Table 4.

216After participants placed their food on separate plastic dishes and

217bowls and took it to a weighing station, staff recorded the weights

218of all their selected foods. At the end of the meal, plates were again

219weighed and weights were recorded by the staff. Lunch was served

220between 11:00 am and 1:00 pm. Like breakfast, the food was served

221buffet style and weighed before and after eating. Dinner was served

222between 5:00 and 7:00 pm. Nothing could be eaten between break-

223fast and lunch. The diet composition of the food offered at lunch,

224dinner and snacks is presented in Table 5.

225All participants were tested twice, on the same day of the week

226but one week apart. On the first testing session, half the participants

Fig. 1. Panel A. Mean and standard error of hunger rating measured just prior to eating lunch. Groups designated by difference letters are significantly different (p b 0.001). Panel B.

Mean and standard error of energy intake at lunch following no breakfast (NB), high carbohydrate breakfast (CB), and high fiber breakfast (FB). Panel C. Mean and standard error

total energy intake (breakfast + lunch) following no breakfast (NB), high carbohydrate breakfast (CB), and high fiber breakfast (FB). Groups designated by different letters are

significantly different (p b 0.001).

3D.A. Levitsky, C.R. Paconowski / Physiology & Behavior xxx (2013) xxxxxx


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were given breakfast while the other half were not given breakfast

and asked not to eat until lunch. On the second testing session, the

situations were reversed.

Participants were asked to complete a 6-point hunger rating scale

at mid-morning, just prior to eating lunch, mid-afternoon, prior to

eating dinner, and just before going to bed. Energy intake was calcu-

lated by multiplying the amount of food removed from the partici-

pants plate by the energetic value taken from the food item's label.

Paired t-tests (one-tailed) were used to test the statistical significance

of the within participants difference in caloric intake on the day when

participants ate breakfast compared with the day when breakfast was

skipped. Hunger ratings were also analyzed as a dependent variable.

3.2. Results

Eighteen participants began the study. One discontinued because

of time conflicts, and one was removed for not following directions,

leaving thirteen women and three men to complete the study. Partic-ipant characteristics are presented in Table 6. Similar to the previous

study, neither gender, body weight, BMI, nor whether or not the par-

ticipants were regular breakfast eaters had any statistically signifi-

cant effect on either the amount consumed or hunger ratings. On

one occasion, three participants ate dinner outside the unit, but

food was prepared and measured in the laboratory under the same

conditions as the meals served in the HMRU. Because their intake

250out of the unit at dinner was within the range of the intake of the

251other participants who ate dinner in the unit, their data was com-

252bined with the other intake values for statistical analysis.

253Unlike in Study 1, participants were served breakfast ad libitum.

254Results of Study 2 are displayed in Fig. 2. The mean energy intake

255at breakfast was 624 72 kcal. Panel A shows the hunger ratings

256throughout the test day for both the day when participants ate break-

257fast and on the day when breakfast was skipped. Skipping breakfast

258produced significantly higher hunger ratings mid-morning (p b 0.01)

259than when breakfast was consumed. This difference in hunger level

260was still evident at the beginning of lunch (p b 0.05) though smaller.

261By mid-afternoon, any difference in hunger ratings due to skipping

262breakfast had disappeared.

263Panel B of Fig. 2 displays the amount of food eaten throughout

264the rest of the day categorized into different eating occasions. The

265amount of energy consumed at lunch was statistically greater (p =

2660.04) when breakfast was skipped than when it was eaten. However,

267no significant effect of eating breakfast could be detected at any other

268eating occasion.

269The total daily energetic consequence of skipping breakfast can be

270seen in panel C of Fig. 2. This figure shows that, despite the small in-

271crease in consumption at lunch, total energy intake was significantly

272depressed after skipping breakfast compared to when breakfast was

273eaten. By the end of the day, the participants had consumed about

274450 kcals fewer calories (p b 0.01) when they skipped breakfast

275than when they ate it. Similar to the previous study, neither gender,

276body weight, BMI, nor the participants' regular breakfast eating277pattern had any statistically significant effect on either the amount

278consumed or hunger ratings.

2793.3. Discussion

280The results from these two studies demonstrate that skipping

281breakfast does not result in an increase in energy intake sufficient to

282counterbalance the energy deficit by not eating breakfast. In Study 1,

283breakfast for all participants was limited to about 350 kcal and no in-

284crease in intake at lunch was observed despite the increase in hunger

285ratings. In study 2, the breakfast ingested was increased to 624 kcal

286and skipping it resulted in a statistically significant increase in energy

287intake at lunch. However, energy intake at lunch increased by only

288174 kcal, leaving the participants with a net energy intake deficit of289450 kcal by the end of the day.

290It is unlikely that the lack of compensation of energy intake at

291lunch for skipping breakfast was due to the participants eating break-

292fast outside the unit. The hunger ratings, in both studies, confirm

293that skipping breakfast resulted in a significant increase in feelings

294of hunger, indicating that the participants had, indeed, refrained

295from eating prior to eating lunch. Moreover, participant debriefings

296affirmed their high compliance with the protocol of the study.

297Although this lack of energetic compensation after skipping break-

298fast may contradict our intuition, it is consistent with published liter-

299ature describing meals that were experimentally varied. In a study

300close in design to the present one (study 2), ten healthy men were

301given either a low-energy breakfast 100 kcal or high-energy breakfast

302700 kcal for a two week period and energy consumed was observed

Table 4

Composition of foods offered at breakfast for Study 2.

Breakfast Study 2 Weight

(g)

Calories

(kcal)

Protein

(g)

Carbohydrate

(g)

Fat

(g)

Fiber

(g)

Kix cereal 22.6 85 1.4 19.4 0.5 0.7

All bran cereal 60 156 7.9 44.5 2.9 17.6

Corn flakes cereal ALC 28 101.1 1.9 24.4 0.2 0.7

Frosted flakes cereal

ALC

41.3 151.7 1.4 37.3 0.2 1.3

Grape nuts cerealAFT.PC

116 416.4 12.5 94.3 2.2 10.1

Raisin bran cereal

CMI.AR

56 210 4 45 1.5 6

0 Orange juice SHB.EF 236.4 120 0 29 0 0

1 Apple juice HCG.WA. 248 110 0 29 0 0

2 Plain bagel 125 330 12 68 1 3

3 Cream cheese 85.1 296.8 6.4 2.3 29.7 0

4 Jelly 6.3 16.9 0 4.4 0 0.7

5 skim milk 245 83.3 8.3 12.2 0.2 0

6 1%, milk 244 102.5 8.2 12.2 2.4 0

7 Coffee 237 2.37 0.3 0 0 0

Table 5

Composition of foods offered at lunch, snack, and dinner for Study 2.

Weight

(g)

Calories

(kcal)

Protein

(g)

Carbohydrate

(g)

Fat

(g)

Fiber

(g)

Lunch Study 2

Plain yogurt 245 149.5 8.5 11.4 8 0Fruit cocktail 248 181 0.97 46.9 0.9 2.5

Tuna sandwich 121.8 321.8 14.2 31.6 0.4 2.3

Turkey sandwich 255 476 23 39 15.6 5

Lemonade drink SBG 251.7 120 0 30 0 0

0

1 Snack study 2

2 Plain yogurt 245 149.5 8.5 11.4 8 0

3 Apple 110 57 0.3 15.2 0.2 2.6

4 Animal crackers 85.1 379.3 5.9 63 11.7 0.9

5 Pretzels 18 68.6 1.6 14.3 0.6 0.6

6 Juice 250 130 0 34 0 0

7

8 Dinner Study 2

9 Pasta & marinara sauce 226.8 168 7.2 34.4 3.2 0

0 Dinner rolls 47 120 5 22 1.5 2

1 Tossed Salad & dressing 99.2 80 3 6 5 1

2 Lemonade drink SBG 251.7 120 0 30 0 0

Table 6 t6:1

t6:2Study 2 subject characteristics.

t6:3Subject characteristics

t6:4Mean age (years) 24.0 2.8

t6:5Mean height (m) 1.7 0.16

t6:6Mean weight (kg) 69 7.2

t6:7Mean BMI 24.1 2.2

t6:8Female/male 13/3

t6:9Mean restraint score 8.2 0.93



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303 throughout the day using self-reported diaries [66]. No effect of the

304 size of the breakfast was evident in the amount of energy consumed

305 at lunch.1 In a study of the effects of skipping breakfast and of exer-

306 cise on energy intake at lunch, Hubert et al. [48] found that reducing

307 breakfast by about 450 kcals increased intake at lunch by about

308 120 kcals, compensating for only 25% of the energy lost by not eating

309 breakfast. Interestingly, the compensation in energy intake at lunch

310 observed in the present study was very similar, about 20%.

311 Halsey et al. [41] examined the effect of feeding or not feeding

312 breakfast on young adults for a one week period. Although eating

313 breakfast increased to total energy intake in both participants who

314 regularly did not eat breakfast and those that did, only the effect in

315 regular breakfast eaters reached statistical significance in those who

316 regularly ate breakfast probably because of the small sample size317 and because intake was based on self-reported intake rather than

318 measured intake.

319 Although primarily concerned with fiber, Delargy et al. [21] exam-

320 ined the effects of eating a small 390 kcal and large breakfast 555 kcal

321 on subsequent intakeat lunch.They, too, observed no significant effect

322 of the amount consumed at breakfast on the amount eaten at lunch.

323 De Graff et al. [20] and Hulshof et al. [49] examined the effects of

324feeding different levels of macronutrients at breakfast. Both studies

325failed to find a change in energy intake at lunch despite the fact that

326the amount of energy consumed at breakfast was 8 kcal, 100 kcal,

327250 kcal, and 400 kcal in the de Graaf et al. [19] study and 100 kcal,

328400 kcal, and 800 kcal in the Hulshof et al. [49] study. In a study

329designed to examine the similarities and differences between fat and

330carbohydrate, sixteen healthy young men were given either a small

331breakfast (440 kcal) or the same breakfast supplemented with fat

332(803 kcal) or carbohydrate (803 kcal). Again, no statistical difference

333in theamount of energy consumed at lunch wasobserved [17]. Similar

334findings were reported by Blundell et al. [11]. Finally, Holt et al. [45]

335found no relationship between the energy consumed at breakfast

336composed of different foods and the energy consumed at lunch.

337Taylor and Garrow [91] performedone of themost intensiveexam-338inations of skipping breakfast on both subsequent ad libitum energy

339intake and energy expenditure in the whole body calorimeter. Similar

340to the studies cited above, skipping breakfast had no effect on subse-

341quent energy intake (or energy expenditure) through the remaining

34224 h in the calorimeter.

343One of the few studies that tested the effects of skipping breakfast

344in a clinical weight loss trial was performed by Schlundt et al. [88].

345They divided a group of participants who wanted to lose weight into

346people who regularly ate breakfast and those who skipped breakfast.

347They further divided each of these two groups into a group that re-

348ceived two meals a day (lunch and dinner) and those who received

349three meals a day (breakfast, lunch, and dinner) for 12 weeks. Those

350who regularly ate breakfast, who were then asked to skip breakfast

351did not lose as much weight as those who ate breakfast, although

1 Unlike the present study, the participants in this study were allowed to eat a

midmorning snack. After eating the smaller breakfast, participants ate an average of

138 kcal whereas they ate only 28 kcal after eating the larger breakfast. This is a differ-

ence of 110 kcal whereas the difference in energy consumed between the different

breakfasts was 600 kcal. A suppression of midmorning snack intake following the con-

sumption of a breakfast supplemented with carbohydrate was also observed by

Blundell et al. [11].

Fig. 2. Panel A. Mean and standard error of hunger ratings measured at mid-morning, just prior to lunch, mid-afternoon, just prior to dinner, and during the evening following

breakfast and without breakfast. **p b 0.01; *p b 0.05. Panel B. Mean and standard error of energy intake at lunch, mid-afternoon snack, dinner, and at the evening snack following

breakfast and without breakfast. *p = 0.04. Panel C. Mean and standard error to total energy intake following breakfast and without breakfast. *p b 0.01.


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the differences were not statistically significant. Those who regularly

ate breakfast, however, lost more weight (though not statistically sig-

nificant) when switched to the skip breakfast condition than those

who were asked to eat breakfast. The interaction was marginally

significant (p = 0.06). If eating breakfast impairs weight loss, it wasnot evident in this study.

One exception to these findings is a recent study where Astbury

et al. [5] observed an increase in energy intake at lunch that totally

compensated for skipping a 200 kcal breakfast. However, because

the study was primarily concerned with gastrointestinal hormones,

the protocol incorporated the consumption of a 250 kcal pre-load

consisting of a liquid diet between the breakfast and the testing

at lunch. Consequently, it is difficult to compare the results of this

study with the studies cited above because the increase in intake in

the breakfast skippers could have occurred because of a counter-

regulation effect of the preload [44] or the unusual effects of con-

suming liquid preloads [92].

Data from Studies 1 and 2, though collected in the laboratory, are

consistent with 24-hour food recall data from the20032004 NationalHealth and Nutrition Examination Survey [74]. NHANES is a multi-

stage probability sample of the US non-institutionalized population

representing a broader population than those of Studies 1 and 2. The

amount of energy consumed from lunch through the rest of the day

was calculated for cases where the first meal of the day was breakfast

andcomparedto thecaseswhere thefirst mealof the day was lunch.

The results are shown in Fig. 3. Breakfast eaters consumed signifi-

cantly more energy at each succeeding eating occasion than breakfast

skippers (p b 0.001). However, as indicated by the upper right inset

in Fig. 3, despite the fact that the breakfast eaters ate less than the

breakfast skippers at each eating occasion, the cumulative daily intake

of breakfast skippers was significantly less than that of breakfast

eaters (p = 0.025). Similar results were found in other epidemio-

logical studies [16,22,51,71,72,75,77]. As in Studies 1 and 2, breakfast

385skippers in the NHANES dataset consumed more energy at lunch

386than breakfast eaters.

387If the results of the present studies can be confirmed in a more re-

388alistic eating situation, skipping breakfast may be an effective way of

389reducing daily energy intake. However, skipping breakfast has been390found to increase the risk of consuming an insufficient supply of

391daily nutrients important for health [1,33,36,55,58,64,65,69,80,81,85].

392The public's search for a clear answer as to whether or not to eat break-

393fast can be expected to mount as the prevalence of overweight and obe-

394sity increases [2729,32]. Health practitioners have expressed concern

395that breakfast foods contain nutrients that are not consumed at eating

396occasion later in the day (e.g. fiber). However, there is no reason why

397foods that are usually consumed at breakfast, particularly whole grain,

398fiber rich, cereals, and milk cannot be substituted for lunch or dinner.

399In fact, there is evidence that substituting a ready-to-eat cereal for

400lunch or dinner may result in a further decrease in total energy intake

401[67].

402These data are also consistent with recent research that shows

403that a reduction in portion size at one meal does not result in an in-404crease in energy intake at subsequent meals[63]. There appears to

405be accumulating evidence that human feeding behavior is less driven

406by internal regulatory mechanisms such as small energy deficits

407or surfeits [6062], but rather is vulnerable to external cues such as

408advertising [39,43] or large portion sizes [84,103].

409Although the data presented above are consistent with the scien-

410tific literature on the effects of skipping breakfast, they challenge the

411common belief that consumption of breakfast daily is essential for

412good health and weight management. If skipping breakfast produces

413a chronic deficit in daily energy intake, then the health benefits

414derived from consuming a lower daily energy intake may be substan-

415tially greater than consuming breakfast. Future research is needed to

416investigate the effects of skipping breakfast on energy intake over

417multiple days.

Fig. 3. Data from the NHANES 20032004. The mean and standard error of the amount of energy consumed at lunch, dinner, snacks, or drinks as function of whether breakfast was

consumed as the first meal of the day (Breakfast Eater) or lunch was the first meal (Breakfast Skipper). Inset represents the total daily energy consumed by Breakfast Eaters or

Breakfast Skippers. All differences between pairs of bars are significant, p b 0.001.



7/28/2019 1-s2.0-S0031938413001479-main

7/8

UNCORRE

CTEDPR

OOF

418 4. Conclusion

419 The data collected from two experimental studies and an analysis

420 of the HANES epidemiological data set indicate that skipping breakfast

421 does not lead to overconsumption at lunch or any other eating occa-

422 sion later in the day. Thesefindings suggest that occasionally skipping

423 breakfast may be an effective strategy to reduce total daily energy

424 intake.

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