A nutritional epidemiologic investigation of 642 New York City children

Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents

Breakfast has been labeled the most important meal of the day, but are there data to support this claim? We summarized the results of 47 studies examining the association of breakfast consumption with nutritional adequacy (nine studies), body weight (16 studies), and academic performance (22 studies) in children and adolescents. Breakfast skipping is highly prevalent in the United States and Europe (10% to 30%), depending on age group, population, and definition. Although the quality of breakfast was variable within and between studies, children who reported eating breakfast on a consistent basis tended to have superior nutritional profiles than their breakfast-skipping peers. Breakfast eaters generally consumed more daily calories yet were less likely to be overweight, although not all studies associated breakfast skipping with overweight. Evidence suggests that breakfast consumption may improve cognitive function related to memory, test grades, and school attendance. Breakfast as part of a healthful diet and lifestyle can positively impact children's health and well-being. Parents should be encouraged to provide breakfast for their children or explore the availability of a school breakfast program. We advocate consumption of a healthful breakfast on a daily basis consisting of a variety of foods, especially high-fiber and nutrient-rich whole grains, fruits, and dairy products.

Breakfast type, daily nutrient intakes and vitamin and mineral status of French children, adolescents, and adults

OBJECTIVE

To examine associations between the consumption of different types of breakfasts, dietary intakes, and selected indices of nutritional status.

METHODS

Dietary intakes were obtained using the dietary history method, and serum bioassays were used to assess vitamin and mineral status in a representative community-based sample of 1108 French children (ages 2 to 10 years), adolescents (ages 10 to 18 years), and adults (ages 18 to 65 years). Breakfasts were divided into three categories: low-energy (<15% of the energy RDA), medium-energy (15-25%) and high-energy (>25%).

RESULTS

High-energy breakfasts were associated with the consumption of ready-to-eat (RTE) cereals. High-energy breakfasts and cereal consumption, both more common among children and adolescents than among adults, were also associated with a greater proportion of daily energy from carbohydrate and lower proportion of energy from fat. High-energy breakfasts and cereal consumption were further associated with higher intakes of vitamins and minerals as measured by percent RDAs. High-energy breakfasts and cereal consumption were associated with lower serum cholesterols and improved biochemical indices of nutritional status. Serum concentrations of vitamin B1 (in children and adolescents), vitamin B2 and beta-carotene (in adults) were significantly linked to the level of energy provided by breakfast.

CONCLUSION

The consumption of breakfast cereals appears to have a positive impact on nutritional status regardless of age.

Fatty acid composition of adipose tissue in humans. Implications for the dietary fat-serum cholesterol-CHD issue

Interest in studies of the fatty acid composition of adipose tissue has arised from the dietary fat-serum cholesterol-CHD issue. The fatty acid composition of depot fat reflects that of the diet. Gas chromatography analysis of subcutaneous adipose tissue yield objective and reliable information of the fatty acid composition of the habitual diet of individuals. A relative linoleic acid deficiency, as depicted by low adipose tissue linoleate levels, has not convincingly been demonstrated to be of importance in the aetiology of atherosclerosis or related disorders. Inverse correlation between n-3 fatty acids and coronary artery disease has been reported. Dietary supplementation of n-3 fatty acids may be of relevance, however the risk of hazardous side-effects do exist. In conclusion, a simple reduction of the total fat content of the diet still seems to be the most important strategy for prevention of atherosclerosis.

Nutritional status of schoolchildren in an inner city area

Data were collected on the seven day weighed food intakes of 65 schoolchildren, aged 12-13 years, living in an inner city, socially deprived area in east London. Blood samples were collected during the week and analysed for cholesterol, serum ferritin, vitamins A, E, B-12, beta carotene, and folic acid. Boys generally fared better than girls with almost a quarter of the girls having intakes of calcium, magnesium, iron, zinc, vitamin A, and riboflavin less than the lower reference nutrient intake, an amount which, by definition, is enough for only the few people in a group who have low needs. Although the mean energy intake was close to the estimated average requirement for both boys and girls, 74% did not meet the recommended intake for fibre and a high proportion of children consumed more than 11% of their energy from saturated fat (85%) and added sugar (88%). Thirty seven per cent of the children ate no fresh fruit during the week they kept a diary and only 19% had vegetables (fresh or frozen), other than potatoes, on a daily basis. Their main sources of energy were chips, bread, and confectionery. No association was found between fat intakes and plasma cholesterol concentrations. Girls had significantly lower blood concentrations of folic acid, ferritin, and beta carotene. The findings of this study confirm the anxieties often expressed that many schoolchildren, particularly in less affluent areas, are eating diets which are unhealthy according to government recommendations.

Breakfast consumption affects adequacy of total daily intake in children

Breakfast consumption patterns were assessed for 467 10-year-old children (59% white, 50% girls), who were interviewed in 1984-1985 or in 1987-1988. Consumption patterns were then related to mean daily nutrient intake patterns. More whites (56%) and more girls (46%) ate breakfast at home, whereas more blacks (58%) and more boys (49%) ate breakfast at school. Results indicated that 16% of all children skipped breakfast; the highest percentage was in black girls (24%). Breakfast consumption made a significant contribution to the child's mean daily nutrient intake. The average total energy intake was significantly lower for children who did not consume breakfast (mean = 1,821 kcal) and for children who consumed breakfast at home (mean = 2,098 kcal) compared with children who consumed breakfast at school (mean = 2,326 kcal). A similar pattern was noted for macronutrient contribution. Percentage of total energy from fat was lower in children who did not eat breakfast (34%) compared with those who did (37% to 39%), yet percentage of energy from carbohydrate was higher (53%) in children who did not eat breakfast. Children who skipped breakfast did not make up the differences in dietary intakes at other meals. A higher percentage of children who did not consume breakfast compared with those who ate breakfast did not meet two thirds of the Recommended Dietary Allowance for vitamins and minerals. These data confirm the importance of breakfast to overall dietary quality and adequacy in school-age children.

The role of breakfast in diet adequacy of the U.S. adult population

Breakfast consumption patterns of the U.S. adult population were examined by using the U.S.D.A. Nationwide Food Consumption Survey. Results indicated that approximately one-quarter of the adult population skipped breakfast regularly. For those adults who consumed breakfast, the four most commonly consumed breakfasts were eggs, bread, and coffee; ready-to-eat cereal with milk; coffee and bread; and eggs, bread, and milk. The sample was partitioned by six age/sex classes and by four breakfast consumption patterns. Assessments of average intakes of seven frequently underconsumed nutrients showed that omission of the breakfast meal had a significant negative impact, particularly among adult females, on the diet quality. Findings indicated that for all age/sex classes, consumption of ready-to-eat cereal at breakfast, whether frequently or on a more limited basis, increased the average daily intake levels of the underconsumed nutrients. Further, groups of adults who regularly consumed ready-to-eat cereal at breakfast had, on average, lower average daily intakes of fat and cholesterol. It was concluded that regular breakfast consumption greatly enhanced the overall diet quality of the U.S. adult population.

The influence of ready-to-eat cereal consumption at breakfast on nutrient intakes of individuals 62 years and older

From 7-day food diaries of a cross-sectional sample of American elderly individuals (n = 561), breakfast consumption patterns were assessed and related to average daily nutrient intake patterns. Results indicated that, in general, breakfast consumption made a significant contribution to the average elderly individual's daily nutrient intake and, in particular, breakfasts containing ready-to-eat cereal had a greater impact on nutrient intake levels than did breakfasts not containing ready-to-eat cereal. More specifically, elderly individuals who had ready-to-eat cereal at breakfast 4-7 times during the week surveyed consumed significantly less (P less than or equal to 0.05) fat and cholesterol and significantly more fiber, carbohydrate, total sugar, protein, thiamin, niacin, riboflavin, vitamins B6, B12, and A, iron, calcium, phosphorus, potassium, magnesium, copper, and zinc at the breakfast meal than those who had no ready-to-eat cereal at breakfast. Fewer statistically significant differences between the two groups were evidenced when vitamin/mineral supplement usage was included in the analysis. Average daily intake levels of frequent consumers of ready-to-eat cereal were significantly (P less than or equal to 0.05) greater than those of nonconsumers for all dietary components except protein, fat, cholesterol, vitamin E, and sodium when supplement usage was excluded from the calculations. When supplements were included, significant differences between the two groups decreased to nine dietary components. Comparison of the average nutrient composition of breakfasts containing ready-to-eat cereal and those not containing ready-to-eat cereal revealed those including ready-to-eat cereal contained significantly greater quantities of all nutrients assessed regardless of whether or not vitamin/mineral supplements were included in the calculations.

Adipose tissue fatty acid composition of adolescents in a U.S.--Greece cross-cultural study of coronary heart disease risk factors

Adipose tissue fatty acid composition was studied in 139 boys, a subgroup of 1521 subjects aged 8-16 participating in the United States (New York City)--Greece cross-cultural study of coronary heart disease risk factor development. Adipose tissue was obtained by an aspiration technique, followed by transmethylation of fatty acids and gas-liquid chromatographic analysis. Statistically significant differences were found among different cohorts in their adipose tissue content of saturated, monounsaturated and polyunsaturated fatty acids. All United States cohorts had significantly higher (p less than 0.0001) levels of saturated and polyunsaturated fatty acids and significantly lower (p less than 0.0001) monounsaturated fatty acids compared to the Greece cohorts. These relationships held for all three types of fatty acids whether the non-Greek cohort from New York City or the cohorts of adolescents of Greek descent who reside in New York City alone, were compared to the cohorts residing in Greece. The differences in the adipose tissue fatty acids between the cohorts may be an important expression of the biochemical milieu which contributes to the development of relatively low coronary heart disease rates in Greece compared to those in the United States.