Starting the Day Out Right

It's a well-known fact: Eating breakfast starts the day off right. Research shows that eating in the morning influences performance for schoolchildren as well as adults. Additional research shows those who skip breakfast commonly have nutritional deficits and suggests a link between obesity and breakfast-skipping behaviors.

Health, nutrition and school authorities all agree on the value of a good breakfast for children. The federally assisted School Breakfast Program (SBP) helps bridge the food gap for many economically challenged families. However, barriers to participating, including perceived social stigma of poverty, limit the number of children who benefit from the program.

Therefore, a 3-year pilot program to evaluate free breakfast for all children began in 2000. Schools in six districts were randomly assigned to the universal breakfast program or the SBP. An interim report on the first year showed increased participation by more students who normally would have had to pay and an apparent shift of breakfast from home to school. Compared to those in the regular SBP, more students in the experimental universal breakfast program were likely to eat a nutritionally substantial meal. But, because of the low rate of breakfast-skipping in both programs, the report indicated no differences in nutritional, scholastic or social parameters.

Overall, attempts to evaluate the full value of the SBP yielded inconsistent findings. However, in July 2004, the USDA Economic Research Service published a report that evaluated the impact of school nutrition programs using methodology that tried to address confounding variables in other studies. By using National Health and Nutritional Examination Survey III (NHANES III) data, it looked at a broad range of dietary outcomes over the entire school year and vacation time for the students and their families. Significant findings include evidence that children with an available SBP eat better, with fewer fat calories, and are less likely to have a low magnesium intake or low serum vitamin C and folate levels. In general, an SBP promotes better outcomes, and evidence suggests a positive impact on the overall dietary quality of adults with children who have an SBP available.

An analysis of NHANES III data for adults looked at the relationship among different types of breakfasts, body mass index (BMI) and energy intake independent of lifestyle factors associated with BMI and breakfast habits (Journal of the American College of Nutrition, 2003; 22, 4: 296-300). The study identified 10 breakfast-eating behavior categories: skippers (20%), dairy (5%), meat and eggs (11%), fruit and vegetables (4%), ready-to-eat (RTE) cereal (17%), cooked cereal (5%), breads (16%), quick breads (12%), fats and sweets (4%), and beverages (6%).

The meat and eggs group had a higher mean BMI and daily energy intake, while skippers had a high mean BMI with a lower daily energy intake. The RTE cereal, cooked cereal and quick breads groups had significantly lower BMI than both the meat and eggs group and the skippers group but were slightly higher or close to the mean energy intake of all groups. The dairy and fats group and sweets group had higher BMIs and similar or slightly higher energy intakes, but the fruit and vegetables group and beverages group had BMIs close to the overall mean with a lower calorie intake. The authors associated skippers, beverages, fats and sweets, dairy, and breads groups with "dysregulated" dietary patterns of those who eat nothing to little in the morning or eat "on-the-run," resulting in a disproportionate energy intake at night and higher BMIs. Other dietary factors that could influence BMI are fiber, fat and an organized meal pattern. While no solid answers emerge from this study, it provides more evidence that skipping breakfast negatively impacts weight loss and management.

Traditional breakfast foods offer a natural powerhouse of vital nutrients and phytochemicals. Whole grains and fruits provide much-needed fiber and antioxidants. And now that nutrient-dense eggs are out from under the cholesterol taboo that haunted them for decades, they can return to a place of prominence in a healthful breakfast. Dairy provides calcium and vitamin D along with high-quality protein and many other nutrients. Additionally, many of these foods are good mediums for vitamin and mineral fortification.

So just what constitutes a good breakfast? The SBP lays out nutritional guidelines for the meals served to children: no more than 30% calories from fat with less than 10% from saturated fat and one-quarter the RDA for protein, calcium, iron, vitamins A and C and calories. Local schools decide on the actual foods served and their preparation.

Today, many question the role of specific foods in regulating appetite and weight. A recent study on the glycemic index (GI) of breakfast meals indicated that low-GI foods eaten at breakfast lead to reduced intake at lunch in preadolescents (Pediatrics, 2003; 112, 5:414-419) and suggests that the GI of breakfast can influence subsequent eating behavior. However, predicting a meal's GI is an inexact science and research on long-term effects of using GI as a dietary strategy with children is needed.

For adults, no one has clearly defined the nutritional parameters or meal patterns of a good breakfast, but weight management is a frequent concern. Some studies indicate that calcium and vitamin D consumed at breakfast may suppress subsequent food intake and increase diet-induced thermogenesis. Since many breakfasts are high in carbohydrates, the GI effect of specific foods and meals generates much investigation without clear-cut answers. In fact, a recent study (British Journal of Nutrition, 2004; 91, 6: 979-989) found that the calculated GI of a breakfast meal did not predict its actual GI, which more closely correlated with fat, protein or energy content than carbohydrate content. The NHANES III study of adults' breakfast eating behaviors -- which suggests that a low-fat breakfast with cereals and quick breads is better for healthy weight management than high-fat or "on-the-run" choices -- provides the best clues on how to eat to start the day.

Angela M. Miraglio, M.S., R.D., ([email protected]) is a Fellow of the American Dietetic Association from Des Plaines, IL. Her firm, AMM Food & Nutrition Consulting, provides communications and technical support to the food and beverage industry.

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