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 EAT THIS NOT THAT

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 & adolescents and School Breakfast Program 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 Fats and Oil Protein Carbohydrates 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 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 Problem solving Hierarchal organization Attention Collating memories Translation/transposition Long term memory Decision making Short-term memory

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