Dept. Nutrition & Exercise Physiology
School of Medicine
University of Missouri
Columbia, MO
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
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
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)
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
Breakfast Skipping & Other Outcomes
Weight Gain
?
Overeating
Hunger Cravings
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
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
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
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
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
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
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
