Dept. Nutrition & Exercise Physiology

School of Medicine

University of Missouri

Columbia, MO

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Disclosures for Heather Leidy

AFFILIATION/FINANCIAL INTERESTS

ORGANIZATION

Grants/Research Support:

The Beef Checkoff

Egg Nutrition Center

DuPont Nutrition & Health

Consultant: Hillshire Brands

Speakers Bureau: National Cattlemen’s Beef Association

National Dairy Council

“The Breakfast Controversy”

Common Belief about Breakfast Scientific Evidence

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=-44XQHmvRCzQTM&tbnid=VQ2Wm1swJTi8nM:&ved=0CAUQjRw&url=http://blog.friendseat.com/why-you-should-eat-breakfast-every-day/&ei=ue6dUvC3O6ep2gW6t4HYAQ&bvm=bv.57155469,d.b2I&psig=AFQjCNGDCtUBQZojBtX29ftaczREI4ECcA&ust=1386168349182354http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=gxmzWSWm9ovibM&tbnid=Ryyr-lAYZVTYmM:&ved=0CAUQjRw&url=http://www.lpm-adv.com/inciteatwork/HealthAndNutrition/ADAEatBreakfastChangeYourLifeClinicPoster1.aspx&ei=Oe2dUpCWMIbI2wXLmYHoAQ&bvm=bv.57155469,d.b2I&psig=AFQjCNGXjbHhods-T0WhKGIMn8RTRxFlIQ&ust=1386167935426027http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=jHtKnw-C9lo-PM&tbnid=4G6BK15rnmKgTM:&ved=0CAUQjRw&url=http://www.cerealbenefits.com/cereal-benefits-weight.html&ei=ZfCdUpu_GITC2QWN6YHYAQ&psig=AFQjCNHw5dhZAe4nvF-Z2trQLAV6_b35ZQ&ust=1386168713535840http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=aqv11X--Y9aCFM&tbnid=DHgQACGBbK1QVM:&ved=0CAUQjRw&url=http://www.hearthealthyonline.com/healthy-recipes/cooking-nutrition-tips/eat-breakfast_ss1.html&ei=Iu-dUpWwCITj2QWDwIGoAQ&bvm=bv.57155469,d.b2I&psig=AFQjCNHdmjGhKgS9zjEs4gfOc9h--JX5Jg&ust=1386168474508847http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=wfCw-eRGBHGQPM&tbnid=PRqGzs7UJvlS-M:&ved=0CAUQjRw&url=http://www.360nobs.com/category/lifestyle/food-drinks/page/4/&ei=6vidUs2dMKba2AXkjoHIAQ&bvm=bv.57155469,d.b2I&psig=AFQjCNECD3LzBdzHKrHbrCmrpXkl7o6tzg&ust=1386170975531444http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=1nLEbyGyDbE_HM&tbnid=sbiG4BnyhSSqjM:&ved=0CAUQjRw&url=http://umhsheadlines.org/07/kid-friendly-breakfast-ideas-fresh-takes-on-the-most-important-meal-of-the-day/&ei=IfydUsW-K4qU2gXh5oDYAg&psig=AFQjCNHbr9kPBafe4N0m8AKvCtWgbIyGvA&ust=1386171650772998

Objectives

• Explore the potential relationship

between breakfast skipping and obesity

-Body weight & composition

-Energy Intake

-Appetite Control & Satiety

• Examine the signals that control eating (over-eating)

• Identify whether the addition of breakfast leads to improvements

-Impact of dietary protein

Breakfast Skipping & Obesity: Background

Siegra-Riz , 1998; AJCN; 67(supp): 748S-756S; Haines, 1996; JADA; 96(5): 464-470; Deshmukh-Taskar, 2010; JADA; 110(6): 869-878; McLynn, 2011; Timlin, 2008; Pediatrics 121: e638

• Breakfast was a staple

in the American Diet 50

years ago

• Gradual decline has

mirrored the rise in

obesity

• Current trends: 30-60%

of young people skip

breakfast on a daily

basis

Breakfast Skipping & Obesity: Associations

5-yr Prospective Study in Young People • ~2,000 Adolescents

• Increased BMI (-) associated with

decreased breakfast frequency

(in a dose-dependent relationship)

Timlin, 2008; Pediatrics; 121: e638-e645

Brown AW et al, 2013; AJCN; doi: 10.3945/ajcn.113.064410

Meta-analysis (58 observational studies)

OR: 1.55 (1.45, 1.65) p=10-42

Breakfast Skipping & Obesity: Associations

Schlundt, 1992, Geliebter, 2000; Farshchi, 2005; Hirsch, 1975; Crepinsek, 2006; Powel, 1998; Ask, 2006; Rodado, 2008; Jakubowicz, 2013

Randomized Controlled Trials

Breakfast Skipping & Obesity: cause/effect

• 9 breakfast intervention studies & weight loss

- 6 studies were ≥ 12 wk; only 2 studies ≥ 1 y

- 5 studies were controlled feeding

-manipulated the size of the meal

-type of food consumed at breakfast

-4 studies incorporated a breakfast skipping arm/group

-only 1 included habitual breakfast skippers

Limited & conflicting scientific evidence re: effects of breakfast

(skipping) on weight loss and/or body composition

Breakfast Skipping & Other Outcomes

Adapted from Deshmukh-Taskar, 2010; JADA; 110: 869-878

Diet Quality

(Cross-sectional Study)

NHANES Data (1999-2006)

Breakfast Skippers (n=2,547)

RTE Cereal Breakfast (n=2,856)

13 Micronutrients (MAR) Vitamins A, E, B6, B12, C; Thiamin, Iron,

Riboflavin, Phosphorus, Zinc, Niacin, Folate, Magnesium

76 ± 2* 88 ± 2

5 Shortfall Nutrients (MAR) Vitamin E, Calcium, Magnesium,

Potassium, Fiber 53 ± 2* 59 ± 2

Dietary Fat (g) 85 ± 1* 78 ± 1

Added Sugars (g) 122 ± 3* 113 ± 3

Weight Gain

?

MAR: Mean Adequacy Ratio

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=EpHs2ElivrwIlM&tbnid=QiTfpOCG7giSDM:&ved=0CAUQjRw&url=http://www.attunefoods.com/blog/2011/07/e-a-t-3-tips-to-become-a-breakfast-eater/&ei=FwqeUqPgFcSF2QXMk4G4Ag&bvm=bv.57155469,d.b2I&psig=AFQjCNHi2wsQEshNqhOdGcjP79WeZJwcdw&ust=1386175352404341

Breakfast Skipping & Other Outcomes

Adapted from Sjoberg, 2003; European J Clin Nutrition; 57: 1569-1578; Haire-joshu, 2011; JADA: 111: 124-130

Breakfast skippers consume more:

Breakfast skippers consume less: Weight Gain

?

Food Choices

(Cross-sectional Studies)

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=EpHs2ElivrwIlM&tbnid=QiTfpOCG7giSDM:&ved=0CAUQjRw&url=http://www.attunefoods.com/blog/2011/07/e-a-t-3-tips-to-become-a-breakfast-eater/&ei=FwqeUqPgFcSF2QXMk4G4Ag&bvm=bv.57155469,d.b2I&psig=AFQjCNHi2wsQEshNqhOdGcjP79WeZJwcdw&ust=1386175352404341

Breakfast Skipping & Other Outcomes

Overeating Acute, Randomized Crossover Studies

REFS Breakfast

Intervention

Subsequent Food Intake

BS vs. B

Daily Intake

BS vs. B

Astbury, 2011

BS Breakfast

↑ Lunch (+200 kcal)

Ø Total Intake

Kral, 2011

BS Breakfast

Ø Lunch Ø Total Intake

Leidy, 2011

BS Normal Breakfast

High Protein Breakfast

↑ Lunch (+125 kcal)

(High Protein comparison only)

Levitsky, 2013

BS High CHO Breakfast High Fiber Breakfast

Ø Lunch

Levitsky, 2013

BS Ad Libitum Breakfast

↑ Lunch (+145 kcal)

↓ Total Intake

(-408 kcal)

Taylor, 2001

BS (2 meals/d) Breakfast

(6 meals/d)

Ø Total Intake

Weight Gain

?

Overeating

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=EpHs2ElivrwIlM&tbnid=QiTfpOCG7giSDM:&ved=0CAUQjRw&url=http://www.attunefoods.com/blog/2011/07/e-a-t-3-tips-to-become-a-breakfast-eater/&ei=FwqeUqPgFcSF2QXMk4G4Ag&bvm=bv.57155469,d.b2I&psig=AFQjCNHi2wsQEshNqhOdGcjP79WeZJwcdw&ust=1386175352404341

Breakfast Skipping & Other Outcomes

Weight Gain

?

Overeating

Hunger Cravings

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=EpHs2ElivrwIlM&tbnid=QiTfpOCG7giSDM:&ved=0CAUQjRw&url=http://www.attunefoods.com/blog/2011/07/e-a-t-3-tips-to-become-a-breakfast-eater/&ei=FwqeUqPgFcSF2QXMk4G4Ag&bvm=bv.57155469,d.b2I&psig=AFQjCNHi2wsQEshNqhOdGcjP79WeZJwcdw&ust=1386175352404341

Reward-driven ‘Hunger’

(Cravings)

Physiological Hunger

Reward-driven Satisfaction

Physiological Satiety

Physiologic vs. Hedonic Eating

Circulation

VagusNerve

Pancreas

Stomach

DuodenumIleum

Adipose

Hypothalamus

Brain Stem

Leptin

Ghrelin

Insulin

PYY

GLP-1

CCK

Hunger Fullness

‘drug-like’ properties

‘cheap’ / free

Food-centric ads

Taste/flavor

social eating

portion size

Physiologic vs. Hedonic Eating

http://www.google.com/url?sa=i&source=images&cd=&cad=rja&docid=hG2-XvibCOXLTM&tbnid=_G5YJHNidByiNM:&ved=0CAgQjRwwAA&url=http://blogs.villagevoice.com/runninscared/2012/09/big-gulp_ban_pa.php&ei=VrGSUaR8xratAb-xgYAE&psig=AFQjCNFzRbVR_b6fu0tnzWfDSW1ZXe_Yzw&ust=1368654550056342

Breakfast Skipping & Other Outcomes

REFS Breakfast

Intervention Hunger BS vs. B

Satiety BS vs. B

Cravings BS vs. B

Astbury, 2011

BS Breakfast

↑ Hunger ↓ Fullness

↓ PYY & GLP-1

Kral, 2011

BS Breakfast

↑ Hunger ↑ PFC

↓ Fullness

Leidy, 2011

BS Normal Breakfast

High Protein Breakfast

↑ Hunger

↓ Fullness (vs. High Protein) ↓ PYY

Levitsky, 2013

BS CHO Breakfast Fiber Breakfast

↑ Hunger

Levitsky, 2013

BS Ad Libitum Breakfast

↑ Hunger

Appetite & Food Cravings Acute, Randomized Crossover Studies

Weight Gain

?

Hunger Cravings

Overeating

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=EpHs2ElivrwIlM&tbnid=QiTfpOCG7giSDM:&ved=0CAUQjRw&url=http://www.attunefoods.com/blog/2011/07/e-a-t-3-tips-to-become-a-breakfast-eater/&ei=FwqeUqPgFcSF2QXMk4G4Ag&bvm=bv.57155469,d.b2I&psig=AFQjCNHi2wsQEshNqhOdGcjP79WeZJwcdw&ust=1386175352404341

State of the Research/Future Research

• Longer-term randomized controlled (clinical) trials

• Randomized cross-over trials focus on mechanisms-of-action throughout the day

• Subjects of interest (skippers? consumers?)

• Breakfast Characteristics Majority of breakfast skipping comparisons are with ready to eat cereals at breakfast

Weight Gain

?

Hunger Cravings

Overeating

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=EpHs2ElivrwIlM&tbnid=QiTfpOCG7giSDM:&ved=0CAUQjRw&url=http://www.attunefoods.com/blog/2011/07/e-a-t-3-tips-to-become-a-breakfast-eater/&ei=FwqeUqPgFcSF2QXMk4G4Ag&bvm=bv.57155469,d.b2I&psig=AFQjCNHi2wsQEshNqhOdGcjP79WeZJwcdw&ust=1386175352404341

Increased Dietary Protein

Increased Protein

(25% of intake)

Weight Loss

Fat Loss

‘Metabolism’ TEF

RMR

Lean Mass

Retention

Protein Synthesis

Food Reward/ Cravings

Satiety/ Satiation

Reduced Intake

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=7ubEnh0SjL261M&tbnid=rAImkxx56tl9MM:&ved=0CAUQjRw&url=http://www.optimumhealthmissoula.com/family-chiropractic/&ei=8RY7Upn0CfG42QXWwICgDw&psig=AFQjCNG1kBZ4CjQlq_UtgMsMmWbv5Ua4kg&ust=1379690259079509

Increased Dietary Protein @ Breakfast

Breakfast Lunch Dinner Snack Snack

Pro

tein

Inta

ke (

g)

10g

24g

45g

65g

6g

Timing of Protein Consumption

*

Adapted from Leidy HJ, Brit J Nutr; 101; 798-803

http://www.google.com/url?sa=i&rct=j&q=oatmeal&source=images&cd=&cad=rja&docid=sPvaZZ0V3lYo3M&tbnid=FkgdmHyqZRsTYM:&ved=0CAUQjRw&url=http://www.ihop.com/menus/main-menu/simple-and-fit/simple-and-fit-super-fruit-oatmeal&ei=91aVUeWXG8ffqAH3_4CoBQ&bvm=bv.46471029,d.aWM&psig=AFQjCNGP1sW1N-5e2OqtX_t8BsnMqvb3ug&ust=1368827956091347http://www.google.com/url?sa=i&rct=j&q=sandwich&source=images&cd=&cad=rja&docid=nGbHFtfpEsafXM&tbnid=9Sg3YYq7AP1JDM:&ved=0CAUQjRw&url=http://www.ihop.com/menus/main-menu/sandwiches/turkey-and-bacon-club-sandwich&ei=SFiVUYeyNMfiqAG334GYCw&bvm=bv.46471029,d.aWM&psig=AFQjCNESIrXmMwWCcQFb5iiQy70BaUMXnA&ust=1368828339003050http://www.google.com/url?sa=i&rct=j&q=granola+bar&source=images&cd=&cad=rja&docid=UOkLmH-VT3pqnM&tbnid=2J-Wk7vy3mwqkM:&ved=0CAUQjRw&url=http://www.quakeroats.com/products/oat-snacks/chewy-granola/chocolate-chip.aspx&ei=BlmVUeyeNoS_qQHBxoHYBA&bvm=bv.46471029,d.aWM&psig=AFQjCNGD3oherBns6IbBw5NK741RLpnvJQ&ust=1368828544378668http://www.google.com/url?sa=i&rct=j&q=banana&source=images&cd=&cad=rja&docid=v8bu1PQzAtum-M&tbnid=W1FivSEvpOW9JM:&ved=0CAUQjRw&url=http://watchpeoplejump.wordpress.com/2011/02/18/peeling-a-banana-this-way-will-make-your-life-slightly-better/&ei=p1mVUfv5DJDyqAHZ4YCQDQ&bvm=bv.46471029,d.aWM&psig=AFQjCNE508QopCMiylAA9c8yT_FCKA9xsQ&ust=1368828626407941

Increased Dietary Protein @ Breakfast

Study Aim:

To examine whether the addition of breakfast leads

to improvements in appetite control and body weight

management in overweight/obese, habitual

‘breakfast skipping’ young people

To determine whether a breakfast rich in protein

leads to greater improvements.

• Overweight /obese ‘breakfast-skipping’ late-adolescents/young adults • Acute (21 d) Randomized Crossover Study (7 d/pattern; 1 testing d/pattern) • Longer-term (12 weeks) Randomized Controlled Trial • 3 Breakfast Patterns (see below)

*Also matched for Energy Density (1.3g/kcal), Sugar (18g), & Fiber (6g)

Meal Characteristics

Breakfast Skipping

Normal Protein

High Protein

Meal Type N/A RTECs Home-cooked

Energy Content (kcal) 0 350 350

CHO/Protein/Fat (%) 0 65/15/20 40/40/20

Protein (g) 0 13 35

CHO (g) 0 57 35

Fat (g) 0 8 8

Increased Dietary Protein @ Breakfast

• Overweight /obese ‘breakfast-skipping’ late-adolescents/young adults • Acute (21 d) Randomized Crossover Study (7 d/pattern; 1 testing d/pattern) • Longer-term (12 weeks) Randomized Controlled Trial • 3 Breakfast Patterns (see below)

Increased Dietary Protein @ Breakfast

http://www.google.com/url?sa=i&rct=j&q=Cheerios+and+milk&source=images&cd=&cad=rja&docid=XYLWZNFlxI-fDM&tbnid=HPHRpWNBCHOnZM:&ved=&url=http://tastyplanner.com/recipes/bowl-of-cheerios&ei=nnZtUfXGLcrU8gGGjoHwBw&psig=AFQjCNEUhZPxviL7Ys3erFz753fLpROgTQ&ust=1366214687076445

Increased Dietary Protein @ Breakfast

Funded in part by The Beef Checkoff

• Overweight /obese ‘breakfast-skipping’ late-adolescents/young adults • Acute (21 d) Randomized Crossover Study (7 d/pattern; 1 testing d/pattern) • Longer-term (12 weeks) Randomized Controlled Trial • 3 Breakfast Patterns

8-h testing Day

Leidy, HJ, 2013; AJCN 97(4): 677-688

Breakfast Skipping Normal Protein High Protein

Hunger-stimulating hormone Ghrelin

Leidy, HJ, 2013; AJCN 97(4): 677-688

Breakfast Skipping Normal Protein High Protein

Perceived Fullness (Satiety)

Leidy, HJ, 2013; AJCN 97(4): 677-688

Satiety-stimulating hormone PYY

Breakfast Skipping Normal Protein High Protein

Leidy, HJ, 2013; AJCN 97(4): 677-688

Pre-Dinner Brain Activation to Food Stimuli

Food Reward & Food Cravings

a) Amygdala b) Hippocampus c) Middle Frontal Gyrus d) Hippocampus e) Parahippocampus

Pre-dinner Food Stimuli

Leidy, HJ, 2013; AJCN 97(4): 677-688

Evening Snacking (Food Choice)

Snack Foods BS NP HP

Desserts (g) 110 ± 23 104 ± 24 87 ± 20

Candy (g) 33 ± 13a 37 ± 12a 16 ± 6b

Salty (g) 45 ± 15 58 ± 17 51 ± 18

High Fat (g) 164 ± 29a 142 ± 28a 105 ± 24b

Chocolate (g) 94 ± 22 99 ± 24 82 ± 20

Leidy, HJ, 2013; AJCN 97(4): 677-688

Breakfast Skipping Normal Protein High Protein

b a a

Evening Snacking (Food Choice)

Leidy, HJ, 2013; AJCN 97(4): 677-688

Breakfast Skipping Normal Protein High Protein

b a a

a a

b

NP: +300 kcal vs. BS HP: +120 kcal vs. BS, NS

Increased Dietary Protein @ Breakfast

Funded in part by The Pork Checkoff

• Overweight /obese ‘breakfast-skipping’ late-adolescents/young adults • Acute (21 d) Randomized Crossover Study (7 d/pattern; 1 testing d/pattern) • Longer-term (12 weeks) Randomized Controlled Trial • 3 Breakfast Patterns

Leidy HJ; The FASEB Journal; 2013; 27: 249.7

Study Outcomes (Pre/Post)

• Body Weight • Body Composition (DXA) • Daily Food Intake (3-day dietary recalls) • Evening Snacking (ad libitum packouts) • Perceived Sensations (Computerized VAS questions, hourly)

CON NP HP

Daily Intake (Pre-Post Change (kcal))

(-412 ± 228 kcal)

Evening Snacking (Pre-Post Change (g))

Long-term Changes in Daily Intake

Leidy HJ; The FASEB Journal; 2013; 27: 249.7

Long-term Changes in Body Composition

Body Weight & Composition (Pre-Post Change (kg))

CON NP HP

Leidy HJ; The FASEB Journal; 2013; 27: 249.7

Conclusions

…there must be a better option

Questions/Comments

Heather J. Leidy, PhD

Assistant Professor

Nutrition & Exercise Physiology

University of Missouri

Phone: 573-825-2620

Email: leidyh@missouri.edu

Thanks to his pop-up fullness indicator, Andy was able to leave the table satisfied, not stuffed