The Breakfast Connection

Eating BreakfastYour Child’s Ticket to Obesity Prevention

ANDSchool Performance

Robert Shayne, M.D.Community Pediatrician

Chester, VirginiaChairman, 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

Medicine

Madison Avenue

VS.

Wishful Thinking

Wishful Thinking

Lots of Research

Answers Lean in One Direction or Another

Breakfast- Definition

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 & adolescentsand

Nicklas, …review of data Bogulusa Heart study, AJCN, Nutrition & Dietetics, 1998

0

5

10

15

20

25

30

35

Series1

Series2

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

NIcklas, Amer Jnl Clin Nut., 1998; 32-64

Protein

Carbohydrates

Fats

and

Oil

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

05

10

152025

Caucas

(NH)

Black Hispanic

% Obese

Nicklas, …Bogulusa, 1998

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 & Alertness- Children 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