1. 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

2. Breakfast---You are what you eat

3. Eating breakfast- Protection against child obesity

4. Eating breakfast- Benefits for learning, behavior and success in school

5. Wishful Thinking
Madison Avenue
VS.
Medicine

6. Wishful Thinking
EAT THIS
NOT THAT

7. Wishful Thinking

8. Lots of Research

9. Answers Lean in One Direction or Another

10. 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

11. Trends in children & adolescents and
School Breakfast
Program
Nicklas, …review of data Bogulusa Heart study, AJCN, Nutrition & Dietetics, 1998

12. and obesity the correlation

13. Obesity and
Those who skipped breakfast regularly had an obesity rate 4x those who didn’t
Ma, Assoc., Eating Patterns & Obesity, AmJ Epid 2003

14. Bogalusa Heart Study
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

15. 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

16. 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= CI: )
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

17. 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

18. and obesity—Why?
Increased hunger later in day with consumption of higher density foods
Hormonal influences
+ Link between eating breakfast and increased exercise

19. 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

20. 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

21. 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.

22. Cognition- One Brain- So Many Parts

23. Cognitive processes influencing academic performance
Problem solving
Hierarchal organization
Attention
Collating memories
Translation/transposition
Long term memory
Decision making
Short-term memory

24. 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

25. 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 & school, Jnl Sch Health,Vol 75, 2005

26. 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 & school, Jnl Sch Health,Vol 75, 2005

27. The more the better
Students who received > 20% of RDA had fewer errors on number checking and creativity vs. those with less
Wyon, Energy Breakfast and Test Perf 10 Y.O., Int Jrl Food Sci …, 48, 1997

28. 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

29. Low Iron Affects IQ

30. Other physical processes affecting cognition
Energy & Alertness- Children failing to eat breakfast also are known to have diminished energy which independently may affect cognition

31. 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 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

32. 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

33. 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

34. 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

35. 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