Breakfast—The Meal of Health

“The Breakfast of Champions,” one of the most memorable food slogans of the 20th century, has 21st century health implications. Reaching beyond sports and athletes, the global diversity in breakfast composition and the frequency of breakfast consumption appear to present significant public health challenges and personal health consequences including weight management and cognitive performance.

Breakfast composition around the globe is dependent on resources, culture, and tradition. Bao (steamed pork buns), Congee (rice porridge), and You Tiao (fried dough strips dipped in hot soy milk) are popular in China. A traditional breakfast in India often includes Aloo Poha (cooked rice with mustard seeds, curry and coriander leaves, and chilies) and Rawa Dosa (crepe from semolina and rice flour with buttermilk, coconut and cashew nuts, plus coconut chutney). Then there is Natto (bean condiment with rice) in Japan and, moving west, Kasha (grain-based porridge with fruit) in Russia, Ful Medames (fava beans with garlic) in Egypt, and churros and chocolate in Spain. Mexicans enjoy Huevos Rancheros (eggs on a flour tortilla plus salsa and cheese) or burritos, and Arepas (fried eggs, shredded beef, and black beans) is popular in Venezuela.

These breakfasts may be categorized as either carbohydrate-rich or protein- and fat-rich. These breakfast choices are often high in sugar and saturated fat and low in dietary fiber. Total protein is usually adequate. Incorporating legumes is common, as is the use of tree nuts. Further assessments of these meals suggest there are numerous inadequacies in most vitamins and minerals, but in many countries, the association of meal composition and health outcomes is seldom considered.

Numerous studies during the past decade indicate that breakfast composition, particularly protein quality, and breakfast frequency may influence weight management, especially among children and adolescents. Leidy and Racki (2010) demonstrated that high-protein breakfasts (~48 g protein primarily from whey and eggs), fed 5 times/week to adolescents who typically skipped the morning meal, contributed to greater postprandial fullness. Total plasma PYY (appetite-suppressing hormone) concentrations increased following the 4-hr postprandial assessment period in the protein-rich group and were significantly greater than concentrations detected among breakfast skippers and individuals eating a normal (~18 g protein) breakfast. Importantly, the active ghrelin (appetite-stimulating hormone) tended to decline during this period and was significantly lower than levels found in breakfast skippers yet greater than in those consuming normal protein breakfasts.

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Timlin et al. (2008) reported during a 5-year longitudinal study among adolescents (Project EAT) that increased breakfast frequency contributed to improved nutrient intake and decreased BMI. Alfenas et al. (2010) demonstrated that normal weight adult subjects fed high-quality protein (casein, whey, soy at ~25 g protein/meal) over 7-day periods tended to decrease total daily energy intake; satiety, postprandial thermogenesis, and respiratory quotient were also affected. Interestingly, satiety assessment indicated a greater sense of fullness with the dairy proteins vs the soy protein, even though the meals were isocaloric. Similarly, Vander Wal et al. (2008) demonstrated an egg-based breakfast was more effective than a bagel-based meal in leading to weight loss among obese adults without impacting typical blood lipid profiles. Grief and Miranda (2010) also demonstrated breakfast and exercise are important for weight management.

Breakfast consumption among children and adolescents is also associated with improved cognitive and physical performance. In a recent review, Benton (2010) noted the critical impact of nutrients such as iodine, iron, zinc, and folic acid during nutrient-sensitive periods of brain growth and neurodevelopment, particularly during the last third of pregnancy and the first two years of life. Pollitt and Mathews (2008) noted that in the absence of breakfast, there is impaired cognitive function and learning abilities, particularly among nutritionally at-risk children. Interestingly, Mathayya et al. (2007) observed that the introduction of mid-morning snacks to 7-to-9-year-old children often improved memory. Kelinman et al. (2002) reported similar improved academic performance as well as nutritional status among children participating in school breakfast programs.

These findings illustrate the importance of breakfast in improving cognitive function and the potential value of a protein-rich morning meal in maintaining or possibly reducing body weight. These outcomes are critical for school-age children and represent important factors in curbing obesity within this at-risk population.

References cited in this article are available from the author.

Roger Clemens, Dr.P.H., Contributing Editor, Chief Scientific Officer, ETHorn, La Mirada, Calif. [email protected]