The Breakfast Connection
Eating Breakfast
Your Child’s Ticket to Obesity Prevention
AND
School Performance
Robert Shayne, M.D.
Community Pediatrician
Chester, Virginia
Chairman, Obesity Committee for Virginia Chapter of AAP
April 12, 2013
Breakfast---You are what you eat
Eating breakfast- Protection
against child obesity
Eating breakfast- Benefits for
learning, behavior and success in
school
Wishful Thinking
Madison Avenue
VS.
Medicine
Wishful Thinking
Wishful Thinking
Lots of Research
Answers Lean in One Direction or
Another
Breakfast- Definition

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
Definition 1- Anything counts
Definition 2- > 10% of RDA for energy. 2
food groups. (200 calories= bowl of cereal +
milk.
Definition 3- Same except > 15%
Devaney & Stuart
Trends in children & adolescents
and
35
30
25
20
Series1
15
Series2
10
5
-7
19 4
76
-7
19 7
78
-7
19 9
81
-8
19 2
87
-8
8
19
73
Yr
.
0
Nicklas, …review of data Bogulusa Heart
study, AJCN, Nutrition & Dietetics, 1998
and obesity
the correlation
Obesity and
Those who skipped breakfast regularly had
an obesity rate 4x those who didn’t
Ma, Assoc., Eating Patterns & Obesity, AmJ Epid
2003
Bogalusa Heart Study



1973-1998
Collected dietary info from 10 yr. old children
and young adults
Not eating breakfast meant larger energy
intake at lunch especially from protein
NIcklas, Amer Jnl Clin Nut., 1998, 32-64
School breakfast program
(Bogalusa)- Positive impacts


Increases in protein and carbohydrate with
decreases in fat and cholesterol
Increases total daily intakes of all
represented vitamins and mineral intake
except for sodium
Protein
Fats
Carbohydrates
and
Oil
NIcklas, Amer Jnl Clin Nut., 1998; 32-64
BMI




Lowest BMI were those eating cooked
cereal, ready to eat cereals & Quick Breads.
Higher for fruit/vegetable eaters & skippers
Highest for meat & egg group
Adolescents with 1 obese parent more likely
to have healthy BMI with daily breakfast
intake (Odds Ratio= 3.99. CI: 1.87-8.56)
NHANES III 88-94
Cho, Breakfast Type, Energy & BMI, CAN, Vol 22, 2003
Affenito, Breakfast in adol girls Better Calcium & Fiber, Lower
BMI, J Am Diet Assn 2005
The more meals the better
Those who ate 4-5 times per day had a
lower BMI
Ma, Assoc. Eating Patterns & Obesity, Am J Epid 2003
and obesity—Why?



Increased hunger later
in day with
consumption of higher
density foods
Hormonal influences
+ Link between eating
breakfast and
increased exercise
Missing meals, ethnicity, and
socio-economic status



Missed breakfast rates
lowest for white
younger males
Missed rates increase
for black and Hispanic
homes
Also, increase for
homes where parents
work and adolescent
females more than
males
% Obese
25
20
15
% Obese
10
5
0
Nicklas, …Bogulusa, 1998
Caucas
(NH)
Bl ack
Hi spani c
Is milk and a donut the same as
eggs, toast and milk


Sugar, salt and food addiction
Low glycemic index breakfast reduces
energy intake at lunch vs. nml or high
Kessler, David, End of Overeating 2009
Warren, Low Glyc In breakfast & lunch in PreAdol
Pediatrics, 2003
Obesity and ADHD Problems-Ugh





Is There a Link Between Childhood Obesity and ADHD?
Posted on February 19, 2013 By Neuroscience News Featured,
Psychology
A University of Illinois study has established a possible link
between high-fat diets and such childhood brain-based
conditions as attention deficit hyperactivity disorder
(ADHD) and memory-dependent learning disabilities.
“We found that a high-fat diet rapidly affected dopamine
metabolism in the brains of juvenile mice, triggering anxious
behaviors and learning deficiencies. Interestingly, when
methylphenidate (Ritalin) was administered, the learning and
memory problems went away,” said Gregory Freund, a
professor in the U of I College of Medicine and a member of the
university’s Division of Nutritional Sciences.
The research was published in Psychoneuroendocrinology.
Cognition- One Brain- So Many
Parts

Cognitive processes influencing
academic performance
Types of Academic Consequences



School breakfast participation improves math
scores and behavior in inner city children
grade 3-8
Missed breakfast affects distinguishing visual
images, memory recall, error rate
Children better on vocabulary and matching
figures with breakfast
School breakfast partic improves math scores and behav
inner city children grade 3-8, Arch Ped & Adol, 1998
Pollitt, Fasting & Cognition, AJCN (67) 1998
Jacoby, Benefits Andean Children Food & Nut (17), 1996
Breakfast & Performance


Basic achievement skills improved Grade 3-6
with school breakfast program
Biggest benefit in IQ in those who are
malnourished, especially from iron
deficiency. Little evidence that vitamin
supplementation (except Iron) makes a
different of change in IQ
Meyers & Sampson, SBP & schoool performance, AJDC
(143), 1989
Taras, Nutrition & Performance@ school, Jnl Sch
Health,Vol 75, 2005
Breakfast-Components


Energy & protein impact on growth,
health and development
Macronutritients impact cognition,
behavior
–
–
Increased protein to carbohydrate ratios
better cognitive functioning
Slow release of glucose is likely mechanism
Meyers & Sampson, SBP & schoool performance, AJDC
(143), 1989
Fischer, Carb:Protein Ratio in cognitive performance in
AM. Phys & Behavior, 75, 2002
Taras, Nutrition & Performance@ school, Jnl Sch
Health,Vol 75, 2005
The more the better

Students who received > 20% of RDA had
fewer errors on number checking and
creativity vs. those with less
Wyon, Energy Intake @ Breakfast and
Test Perf 10 Y.O., Int Jrl Food Sci …, 48,
1997
Chemicals affecting brain



Glucose is only nutrient that can be used
by brain for fuel. Bloodstream must
constantly provide glucose. Other
nutrients= other functions
Micronutrients assist in enzymatic
reactions
Iron deficiency is linked to diminished IQ
Lozoff, Ped Adol Med 2006
Low Iron Affects IQ
Other physical processes
affecting cognition

Energy & AlertnessChildren failing to eat
breakfast also are
known to have
diminished energy
which independently
may affect cognition
Other mental processes affected
by
(Mood)



Fewer children report feeling badly, fewer
absences and tardiness
Behavior problems increase
Maryland-Less fatigue, aches, pains
Wyon, Energy Intake @ Breakfast and Test Perf 10
Y.O., Int Jrl Food Sci …, 48, 1997
Murphy Relationship of Breakfast to Psychosocial &
Academic Function, AJDC, 1998
Murphy Effects of break… Maryland, Md. Dept of ed,
1999
Evidence

Neural network activity for processing
numbers is improved with breakfast

Improved academic & psychosocial
functioning with breakfast intake
Pivik, Physical Behavior 2012
Kleinman, Diet, Breakfast and, Academic, Ann Nutr
Metab, 1998
Murphy, Break & Psychological Functioning, Arch Ped,
1998
Evidence

Boston Hunger Project
–
–
–
–
At Risk children (>2
deficient areas of RDA)
Absences 10.5 vs. 6.6
Tardy 5.1 vs. 1.9
Mental Health symptoms
18.8% verus 11.9
Kleinman …., Diet, Break, & Academics, Ann. Nutr.
Metab, 2002, 46
Advantages of Cereal

Students with ready to eat cereal had
superior functioning to no breakfast or other
options.
Kafatos
Ann Nutr Meetab 2005 Cereal Ready
to eat cereal Effect on health diet
Evidence

Boston Hunger Project (continued)
–
–
–
Intervention= Enroll children in universal breakfast
program.
After intervention 2/3 of deficient group improved
breakfast intake, better math grades, fewer
absent or tardy. Decreased emotional problems
Improved academic & psychosocial functioning
Kleinman, Diet, Break, Academ, Ann Nutr Metab 2002