the role of breakfast in promoting weight...
TRANSCRIPT
The role of breakfast in promoting weight management
Dr Carrie Ruxton
Freelance Dietitian
More people are skipping breakfast
• Around 1/3 schoolchildren and adults
• Men more than women
• Younger adults and teenagers more than young children and older people
• Children from lower socio-economic groups more than better off children
Barriers to consumption
• Not hungry or don’t feel like eating
• Too busy
• Feeling pushed for time/sleeping in
• Dieting
• Growing trend of breakfast on the move impacting on food choice
Breakfast is marker of a better lifestyle
Ref: CARDIA study, Odegaard et al, 2013
Nutritional consequences of skipping breakfast
Breakfast skippers have lower intakes of:
• Fibre
• Certain vitamins and minerals
Higher intakes of:
• Fat
• Saturated fat
Could impact on weight
management
The impact of breakfast skipping on weight management
Increased risk of:
• Overweight and obesity
• Abdominal obesity and high waist circumference
• Faster weight gain in children
Evidence – observational 1
• Association with reduced body weight in adult men in regular breakfast consumers (Bazzano et al. 2005)
• US study of 10,000 children: breakfast skippers had higher BMI and waist circumference than breakfast consumers. Also, risk obesity higher in breakfast skippers vs. cereal consumers (Deshmukh-Taskar et al. 2010)
• BMI 0.24 points lower in high vs. low breakfast consumers (De la Huntley et al. 2013)
Evidence – observational 2
• Greek study 700 children: risk obesity 46% lower in boys and 59% lower in girls when cereal breakfast eaten regularly vs. skipping (Panagiotakos et al. 2008)
• US study of 625 low income children: signif lower BMI & higher intake of nutrients when cereal breakfast consumed over 3y period (Balvin Frantzen et al. 2013)
• US study of 660 children: higher breakfast cereal consumption associated with lower total and low-density lipoprotein cholesterol levels and lower BMI (Albertson et al. 2009).
Evidence – observational 3
• Polish study 1700 teenagers: risk obesity 83% higher when breakfast skipped. Intakes of sugary soft drinks were higher when breakfast skipped (Wüenstel et al. 2015)
• Iranian study 13,486 children 6-18 years; 20% skipped breakfast. Regular breakfast consumption was significantly associated with lower body fatness and healthier dietary habits (Ahadi et al. 2015)
Obesity risk higher when breakfast skipped
0
0.5
1
1.5
2
2.5
Boys Girls
Od
ds r
ati
o f
or
ob
esit
y
Always
Sometimes
Never
N=4,326 English children 10-16y; Sandercock et al (2010) EJCN
More older men with BMI >25 when cereal breakfasts eaten 0-3 times weekly
N=1759; US 55 years+; Albertson et al (2012) J Ageing Res
Evidence – RCT cereal
• N=70 overweight adults asked to consume breakfast cereal at night for 6 weeks instead of usual snack
• Trend for lower body weight and waist circumference in intervention group vs. control but P>0.05
Matthews et al (2012) IJFSN
Evidence – RCT protein
• N=57 overweight adolescents who normally skipped breakfast consumed a normal or high protein breakfast for 12 weeks
• Body fat gain, voluntary reductions in daily calorie intake, and reductions in daily hunger were all improved when adolescents ate a high protein breakfast daily.
Leidy et al (2015) Obesity
Reasons for results
• Eating breakfast may help to prevent snacking later in the morning or the wrong choice of foods
• Cereal breakfasts boost fibre consumption and this may help to prolong satiety
• Protein at breakfast may also prolong satiety
• Breakfast has been linked with increased physical activity ?association or cause
• Breakfast may simply be a marker of healthier lifestyles in general which promote weight management.
Not all studies agree
• N=283 overweight adults completed 16-wk weight loss study where participants either skipped or ate breakfast while trying to lose weight by dieting
• No significant difference in weight loss between the two groups
• Suggests that dieting can over-ride any negative effects of skipping breakfast.
Dhurandhar et al (2014) AJCN
Other health consequences
Increased risk of:
• Higher blood pressure
• Higher or raised LDL and total cholesterol levels
• Higher blood glucose and insulin levels
Evidence
• 24% skipped breakfast
• Breakfast skippers more likely to have raised chol, LDL, BP, glucose
• Breakfast cereal consumers had the best cardiometabolic status
US study NHANES n=5,316 20-39 yrs Public Health Nutrition (2012) 16: 2073–2082.
Summary from key studies
Source: Ruxton (2014) NHD magazine
Is sugar an issue?
Source: NDNS (2014)
Breakfast cereal contribution 5-8%
Holistic approach needed
• Weigh up sugar content against:
– Calorie/fat content of alternatives e.g. croissant, fry up, muffin, toast & butter
– Micronutrient contribution of breakfast cereals; around 15% of B vitamins and iron
– New role of RTEC in providing vitamin D
– High fibre content of many varieties
– Sugar can come from dried fruit as well as free sugars e.g. in muesli
Conclusions
• Breakfast skipping is common, especially in teenagers and young adults
• Breakfast skipping is associated with:
– a lower micronutrient and fibre intake
– a greater risk of obesity and excess weight gain
– raised blood pressure, lipids and glucose
• In contrast, regular breakfast consumption associated with better weight management, especially cereal breakfasts. Reason unknown but could be less snacking/soft drinks later.
• For more information see www.breakfastcereal.org