Consumption of breakfast is often considered one of the important health-related behaviour. Many of the studies have been concerned with physical health and the effects of breakfast consumption on subjective well-being. Breakfast is often recognized as the “most important meal of the day,” yet there is limited consensus as to what defines the breakfast meal and a lack of science-based guidance on what is considered to be a nutrient-dense or “quality” breakfast.
History demonstrates that early development of meal patterns and customary meal composition, including breakfast, varies across cultures, geography, and time, giving rise to different definitions and perceptions of the breakfast meal that persist.
Definition of breakfast
Breakfast is defined literally as the meal that breaks the fast. Ideally, it is viewed as the meal that bridges an extended period of fasting, occurring as a result of the longest period of daily sleep, with performance and productivity. As such, breakfast serves as the foundation for a pattern of eating for the day. The baseline definition of breakfast:
Breakfast is the first meal of the day that breaks the fast after the longest period of sleep and is consumed within 2 to 3 hours of waking; it is comprised of food or beverage from at least one food group, and maybe consumed at any location.
Although breakfast is generally consumed in the morning by most people, it might be consumed later in the day by shift workers or others who sleep during the day, and there is no definition for the length of the period of sleep.
Therefore, a range of times for the breakfast meal in relation to waking is provided, which also serves as a cutoff point to help differentiate breakfast from a snack or lunch meal. Specifying at least one food group precludes consumption of coffee, water, or other noncaloric beverages from qualifying as breakfast.
Criteria of a quality breakfast
Establishing criteria for a quality breakfast, including types and amounts of foods, nutrients, and energy, was recognized as a critical component for maximizing the potential benefits of the breakfast meal.
Evidence that intake of food groups or nutrients can be insufficient depending on food choices, or if breakfast is skipped reinforces the importance of consuming a quality breakfast.
In Spain, a breakfast quality index based on guidelines for the Mediterranean diet was proposed as a tool to measure overall quality of breakfast for children and adolescents.
In Italy, proposed characteristics of an ideal breakfast, with the recognition that there is also an ideal breakfast environment in which a family eats together, with parents serving as role models and palatable and appealing foods served.
The studies outlined nutrition characteristics of an ideal breakfast meal as a balanced daily intake of 20% to 35% of daily energy and inclusive of choices from three food groups, including milk and milk-derived products (low-fat), cereals (preferably whole-grain, unrefined), and fruit (fresh fruit or natural juices, no added sugar).
A standardized breakfast model that identifies specific food groups or types of foods was deemed impractical because eating patterns can vary day to day, and food choices are dependent on individual tastes and preferences, habits, availability, and accessibility, including cost, health goals, and cultural traditions.
Energy requirement from breakfast
The ideal amount of energy that should be provided by a breakfast meal is dependent on the total number of eating occasions throughout the day. The proposed range of 15% to 25% of total energy allows for customization based on snacking habits. This range is slightly lower than suggested by other sources (eg, 20% to 35%) to account for the common practice of snacking without exceeding total daily energy requirements.
According to What We Eat in America data tables, 63% of Americans 2 years of age and older who consumed breakfast, lunch, and dinner also consumed at least one snack on the day of the recall. A snack occasion was defined as a distinct eating occasion consisting of one or more food and beverage items, including water, outside of breakfast, lunch, and dinner meals.
To allow for at least one snacking occasion without exceeding individual daily energy allowances, breakfast energy intake at the lower end of the proposed range, such as 15% of total daily energy, might be appropriate. The range is consistent with current intakes of approximately 17% of total daily energy consumed at breakfast for individuals 2 years of age and older within the general population.
Food groups at breakfast
The food choices should contribute to at least one food group, and ideally three or more food groups to help close nutrient gaps and improve overall eating patterns. The number of food groups and the amounts of food consumed at the breakfast meal should be customized to fit within a daily healthy eating pattern as recommended by MyPlate to stay within individual energy needs.
There is flexibility in selecting food groups to include at breakfast. however, protein-rich foods should be coupled with nutrient-dense, carbohydrate-rich foods, such as grains, fruit, or vegetables, which should be considered essential for providing the carbohydrates needed to supply energy and replenish glycogen stores after an extended period of fasting.
Protein-containing foods, such as eggs, lean meat, meat substitutes, legumes, nuts, and low-fat and fat-free dairy products, should be included in breakfast meals, with attention to type and amount of fat and levels of sodium.
Whole grains from cereals and breads are another food group that should be emphasized to meet the DGA recommendation of making half of all grain choices whole grains. Grains can be an important source of dietary fiber, a nutrient of public health concern.
Fruit and vegetables are the remaining food groups that should be encouraged at the breakfast meal. These foods are underconsumed by virtually every group in the United States and breakfast provides a way to include more of these foods in the diet.
People attitudes and behaviors toward breakfast
Among families, several factors have been found to correlate with regular breakfast consumption, especially by children and adolescents. These include having a home environment where parents model breakfast eating and where palatable and pleasant foods are available, as well as individuals having an understanding of the perceived positive benefits of consuming breakfast, such as satisfying hunger and having more energy.
Adolescents who reported being overweight or dissatisfied with their body shape were less likely to eat breakfast due to the false impression that skipping breakfast may promote weight loss or prevent weight gain.
Compared with their breakfast-skipping counterparts, adult breakfast eaters were more likely to believe that breakfast helps with weight control and participated in regular physical activity, suggesting that breakfast eating may be one of several factors that tend to cluster in a healthier overall lifestyle.
Barriers to eating breakfast reported by children and adults include absence of hunger in the morning, not having easy breakfast options available, time constraints, and lack of planning.
Breakfast intake data collected since 2001 have consistently shown that, on average, children tend to eat breakfast less often as they get older, adolescents and young adults typically have the lowest rates of breakfast consumption, and older adults typically have the highest rates of breakfast consumption.
Benefits of breakfast consumption
Researchers support the importance of breakfast in health and well being, with evidence of positive nutritional, functional, and metabolic roles. In addition, breakfast consumption is considered an important determinant of a healthful lifestyle through its association with other health-promoting behaviors.
1. Nutrient consumption and a quality diet
Breakfast consumption provides an opportunity to improve overall nutrient intake. The energy density of breakfast foods is inversely related to daily intakes of selected micronutrients, including vitamins A, C, and E; potassium; magnesium; and phosphorus, as well as dietary fiber.
In addition, breakfast meals that include more than noncaloric beverages improve the likelihood of improving intake of fruit, vegetables, whole grains, and dairy.
2. Weight Supervision
Findings from the National Weight Control Registry, an ongoing prospective investigation of long-term successful weight-loss maintenance, support the role of breakfast as a behavioral strategy for weight loss.
The moderate evidence suggests children who do not eat breakfast are at increased risk of overweight and obesity. This was based on a review of 15 studies, the majority of which found that breakfast intake was associated with lower body weight in children and adolescents.
3. Appetite and energy regulation
Precise mechanisms for how breakfast habits can reduce obesity risk are unclear, but the frequency of meal consumption through the day appears to bring about metabolic changes involved in regulating blood glucose and insulin levels, lipid metabolism, and appetite and energy balance.
Eating at least three meals per day is associated with improved energy regulation and weight control. Based on models of eating frequency and appetite regulation, breakfast and regular snacks may be key eating occasions important for energy regulation.
A breakfast containing a moderate level of protein (35 g) might be associated with improved food intake regulation, including a reduction in evening snacking, possibly resulting from the release of hormones that suppress appetite and signal satisfaction. Meal skipping, breakfast skipping in particular, has been linked to increased appetite with greater risk of weight gain over time, as well as risk for diabetes and cardiovascular disease.
4. Cognitive Function
Breakfast consumption, including school breakfast participation, has been linked with improvement in academic performance and psychosocial functioning as well as cognition among children and adolescents. Observed effects, including improved attention and behavior, and reduced absenteeism or tardiness, appear to be most pronounced for those at nutritional risk.
A systematic review of 45 studies found that breakfast consumption had generally positive effects on cognitive performance compared with breakfast skipping, with the effects most apparent in nutritionally vulnerable children.
Limited evidence suggests that children who eat breakfast have higher math or verbal fluency scores and perform better on standardized tests.
Conclusion
The following key concepts of breakfast consumption and need for guiding principles to help consumers build a quality breakfast:
- The lack of a consistent definition for breakfast and breakfast skipping is limiting the interpretation and application of breakfast research results.
- Eating breakfast regularly is associated with better overall health, including healthier body weight, better diet quality, reduced risk for chronic diseases, and cognitive benefits.
- Not all breakfasts are created equally in their contribution to nutrient adequacy, diet quality, or relationship to health. General criteria should guide the selection of a breakfast meal that fits within an overall healthful eating pattern, while allowing breakfast to be customized to include a wide variety of foods that may vary day to day according to individual preferences, habits, and cultural traditions.
- A quality breakfast should provide energy and essential nutrients balanced in proportion to daily needs, and meet individual tastes in a form that is accessible and affordable.
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