dept. nutrition & exercise physiology school of medicine...

of 33 /33
Dept. Nutrition & Exercise Physiology School of Medicine University of Missouri Columbia, MO

Author: others

Post on 30-Apr-2020

2 views

Category:

Documents


0 download

Embed Size (px)

TRANSCRIPT

  • Dept. Nutrition & Exercise Physiology

    School of Medicine

    University of Missouri

    Columbia, MO

    //upload.wikimedia.org/wikipedia/en/8/85/MU_logo.svg

  • 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: [email protected]

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