ArticlePDF AvailableLiterature Review

Breakfast Habits, Nutritional Status, Body Weight, and Academic Performance in Children and Adolescents

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Abstract

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.
RESEARCH
Review
Continuing Education Questionnaire, page 761
Meets Learning Need Codes 3020, 4000, 4150, and 5070
Breakfast Habits, Nutritional Status, Body
Weight, and Academic Performance in Children
and Adolescents
GAIL C. RAMPERSAUD, MS, RD; MARK A. PEREIRA, PhD; BEVERLY L. GIRARD, MBA, MS, RD; JUDI ADAMS, MS, RD;
JORDAN D. METZL, MD
ABSTRACT
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 as-
sociation of breakfast consumption with nutritional ade-
quacy (nine studies), body weight (16 studies), and aca-
demic 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 qual-
ity 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 gener-
ally consumed more daily calories yet were less likely to
be overweight, although not all studies associated break-
fast 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. Par-
ents should be encouraged to provide breakfast for their
children or explore the availability of a school breakfast
program. We advocate consumption of a healthful break-
fast on a daily basis consisting of a variety of foods,
especially high-fiber and nutrient-rich whole grains,
fruits, and dairy products.
J Am Diet Assoc. 2005;105:743-760.
Current dietary behaviors and practices observed
in children and adolescents may have detrimental
consequences on their health. The adverse health
consequences that may result from excessive intake of
soda and sweetened beverages; fast-food consumption;
inadequate intakes of fresh fruits, vegetables, fiber-
rich foods, and dairy and other calcium-rich foods; re-
duced levels of physical activity; and increasing obesity
rates indicate a need to revisit the diet and lifestyle
characteristics of this age group (1,2). The consumption
of breakfast is often recommended (3-7). In this age of
evidence-based practice, a logical question is whether
there is evidence to support the health benefits of this
recommendation. Past reviews of the health or cogni-
tive benefits of breakfast consumption in adults or chil-
dren were published before 1999 (5,8-17) and do not
include the results of more recent studies. Several
studies have identified a possible role for breakfast
consumption in maintaining normal weight status in
children and adolescents, which may have important
public health implications. We present an updated re-
view and summary of the literature examining the
associations between breakfast consumption and three
important issues regarding children’s health and life-
G. C. Rampersaud is an assistant in Nutrition Research
and Education, Food Science and Human Nutrition De-
partment, Institute of Food and Agricultural Sciences,
University of Florida, Gainesville. M. A. Pereira is an
assistant professor, Division of Epidemiology, University
of Minnesota, Minneapolis. B. L. Girard is director of
Food and Nutrition Services, The School Board of Sara-
sota County, Osprey, FL. J. Adams is president, Grain
Foods Foundation, Ridgway, CO; at the time of the
study, she was president, Wheat Foods Council, Parker,
CO. J. D. Metzl is an assistant professor, Department of
Pediatrics, and medical director, The Sports Medicine
Institute for Young Athletes, Hospital for Special Sur-
gery, Cornell Medical College, New York, NY.
Address correspondence to Gail C. Rampersaud, MS,
RD, Food Science and Human Nutrition Department,
Institute of Food and Agricultural Sciences, University
of Florida, PO Box 110720, SW 23rd Dr, FETL Build-
ing 685, Gainesville, FL 32611-0720. E-mail: gcr@ifas.
ufl.edu
Copyright © 2005 by the American Dietetic
Association.
0002-8223/05/10505-0001$30.00/0
doi: 10.1016/j.jada.2005.02.007
©2005 by the American Dietetic Association Journal of the AMERICAN DIETETIC ASSOCIATION 743
style: nutritional adequacy, body weight, and cognitive
and academic performance.
An inherent problem with evaluating breakfast stud-
ies is how breakfast consumption is defined, particu-
larly with regard to frequency, but also the types of
foods consumed and time of day. A variety of definitions
were used to characterize breakfast consumers in the
studies in this review, including consuming breakfast
every day, every school day, on the dietary survey day,
a minimum number of days per week, or usual or
habitual consumption. These inconsistencies present a
challenge when evaluating and comparing studies, and
the reader should bear these in mind throughout this
review.
METHODS
Literature was initially gathered through the investi-
gators’ personal research files, then by scanning the
references of the articles on hand, and finally by con-
ducting a Medline search from 1970 through February
2004. All articles that included the word breakfast
together with children or adolescents were considered
for inclusion in this review. The primary articles re-
viewed were those that reported characteristics of reg-
ular breakfast consumers compared with irregular con-
sumers with regard to the three primary review topics.
A total of 47 articles were reviewed: nine related to
nutritional adequacy, 16 related to body weight, and 22
related to cognitive or academic performance. Twenty-
two studies were conducted in the United States. Ad-
ditional articles were included to contribute pertinent
information to the subject.
RESULTS
Breakfast Consumption in Children and Adolescents
Breakfast consumption by children and adolescents in
the United States has declined over time. Between
1965 and 1991, breakfast consumption in preschoolers,
children ages 8 to 10 years old, and adolescents de-
clined by 5%, 9%, and 13% to 20%, respectively (18).
Children and adolescents skipped breakfast more than
any other meal (19-25). Based on a nationally repre-
sentative sample from 1991 (18), the approximate per-
cent of children and adolescents in each age group who
skipped breakfast on the day of the survey (ie, any
given day) was 8% (1 to 7 years), 12% (8 to 10 years),
20% (11 to 14 years), and 30% (15 to 18 years). The
breakfast-skipping prevalence (day of survey) reported
in other studies ranged from 12% to 34% (21,26-30).
Fifty-nine percent of high school students indicated
that they skipped breakfast more than three times the
previous week (31). Twenty-one percent of 8- to 9-year-
old children and 42% of 12- to 13-year-old children
indicated that they do not eat breakfast every day (5).
Four percent of children and adolescents reported that
they habitually skip breakfast (32,33).
Skipping breakfast is typically more prevalent in
girls (18,22,25,26,29-31,34-40), children from lower so-
cioeconomic backgrounds (41-43), older children and
adolescents (18,20,23,24,28,30,32,34,36,44), and some
black (25,27) and Hispanic (25) youth, although this is
not always supported (18). Breakfast-skipping behav-
ior has been associated with other lifestyle factors such
as smoking (39,40,45,46), infrequent exercise (39,47),
and dieting or concerns about body weight (38,45,48).
Common reasons cited by children for skipping break-
fast include lack of time, lack of hunger, or dieting to
lose weight (20,35,49). Overall, the literature to date
suggests that breakfast skipping is common in children
and adolescents, increases with age, may be more com-
mon among certain minority ethnic or low socioeco-
nomic groups, and seems to be associated with other
lifestyle factors that may be detrimental to health.
NUTRITIONAL ADEQUACY
Energy and Macronutrient Intake in Habitual Breakfast
Consumption
Children require optimal nutrient intake to meet the
basic demands of growth and development. However, mi-
cronutrient intakes also may play an important role in
chronic disease risk (50,51), and recent nutrient intake
recommendations take into account amounts that may be
associated with disease risk reduction (52). Nutrient in-
adequacy or particular dietary patterns during childhood
may be associated with adverse health outcomes during
childhood, adolescence, and adulthood (53-56).
Reported energy and macronutrient intakes from ha-
bitual breakfast consumption vary widely and are influ-
enced by demographic characteristics of the study popu-
lation, foods consumed, and where breakfast is eaten (eg,
home or school). Based on studies in US populations of
children from 5 to 18 years of age, mean energy intake at
breakfast ranged from 275 to 669 calories, and percent-
age contributions to total energy from carbohydrate, pro-
tein, and total fat ranged from 49% to 72%, 11% to 16%,
and 14% to 40%, respectively (21,25,27,29,57-60). Euro-
pean studies of subjects 2 to 18 years of age reported
remarkably similar findings (41,61-67). Overall, boys
tended to have higher total energy, carbohydrate, pro-
tein, and fat intakes at breakfast compared with girls
(21,41,61,62). However, when expressed relative to total
energy, the differences were not statistically significant
(21,61). When comparing breakfast quality in a group of
Spanish children (ie, inclusion of foods from the cereal,
dairy, and fruit food groups), scores were higher in
younger compared with older children, and boys com-
pared with girls (41).
The types of foods consumed at breakfast were similar
across various population groups. Milk is one of the most
commonly consumed foods by children at breakfast in the
United States, Canada, and Europe (21,34,41,57,68-74).
Breakfast cereals, which usually are consumed with milk,
also are popular in the United States (34), Canada
(68,70,73), the United Kingdom (61), Spain (71), and
Croatia (72). Various breads also are commonly con-
sumed (32,57,69,74,75). In the United States, changes
observed in breakfast consumption patterns over a 26-
year period include the increased consumption of low-fat
milk, ready-to-eat cereals, and juices, and the decreased
consumption of high-fat milk, whole-grain breads, and
eggs (18).
744 May 2005 Volume 105 Number 5
Energy and Nutrient Intake of Breakfast Eaters and Breakfast
Skippers
Figure 1 summarizes studies evaluating energy and nu-
trient intakes in breakfast eaters vs skippers. Breakfast
eaters tended to have a higher total daily intake of energy
compared with breakfast skippers (21,27-29,40,76,77),
suggesting that skippers did not consume more calories
at other meals to compensate for the deficit. Correspond-
ingly, breakfast eaters tended to have higher daily in-
takes of total carbohydrate (21,29), total protein
(21,28,29,40,76,77), total fat (21,34), and saturated fat
(29). However, daily fat intakes expressed as the percent-
age of daily energy were lower in breakfast consumers in
some (28,29) but not all (27) studies. Higher-energy
breakfasts (25% of daily energy allowance) were asso-
ciated with a higher mean daily intake of carbohydrates
and a lower intake of lipids (as percent of energy) com-
pared with lower-energy breakfasts (15% of daily en-
ergy allowance) (62). In preschool children, consuming a
breakfast with more than 50% of energy as carbohydrates
was associated with lower whole-diet fat intakes com-
pared with breakfasts with less than 50% of energy sup-
plied as carbohydrate, and a breakfast with higher fat
intake (35% of energy) was associated with higher total
and saturated fat intakes throughout the day (78). How-
ever, mean fat intake in breakfast consumers often ex-
ceeds current dietary recommendations for children and
adolescents (79) (ie, 25% to 35% of daily energy intake)
(21,41,60).
Fiber intake was significantly higher in breakfast eat-
ers vs skippers (29,37,40,80), and the inclusion of a ready-
to-eat cereal seemed to contribute to daily fiber intake
(61,81). Daily sugar intake was higher in breakfast eaters
in some studies (29,34), but lower in others (27,40). As-
sociations of breakfast habits on serum lipids have been
inconsistent. Children and adolescents who skipped
breakfast had lower total cholesterol intakes compared
with breakfast eaters (27-29,34). However, mean plasma
cholesterol concentrations were significantly higher in
schoolchildren (ages 9 to 19 years) who skipped breakfast
compared with children eating breakfast, although these
results may have been attributable to higher body
weights in breakfast skippers (32). Similarly, adults who
skipped breakfast had higher serum cholesterol levels
than those consuming breakfast (82).
Breakfast eaters have higher daily intakes of micronu-
trients and are more likely to meet nutrient intake rec-
ommendations compared with breakfast skippers (21,27-
29,34,40,76,77). Nutrients that seem to be particularly
affected across a variety of studies and population groups
include vitamins A and C, riboflavin, calcium, zinc, and
iron. Data related to the effects of breakfast on micronu-
trient status (ie, blood or tissue concentrations) are not
widely reported except with regard to ready-to-eat cereal
consumption (see below). Preziosi and colleagues (62) re-
ported that only blood concentrations of thiamin were
significantly higher in consumers of higher-energy break-
fasts compared with consumers of low-energy breakfasts.
The positive impact of breakfast consumption on micro-
nutrient intake is supported by studies in adults
(62,83,84).
Mean daily intakes of calcium were higher in breakfast
eaters compared with skippers (21,27-29,34,40,76,77).
The frequency of eating breakfast was significantly and
positively associated with calcium intake in Asian-Amer-
ican adolescents (85), and calcium intake at breakfast
predicted a higher calcium intake throughout the day in
Spanish schoolchildren (86). Calcium intake is a critical
nutritional issue for children and adolescents because
bone calcium accretion is highest during adolescence (87).
A significant number of children, particularly female ad-
olescents, do not meet the Adequate Intake (established
when a Recommended Dietary Allowance cannot be de-
termined) recommendations for calcium (4,88-91).
Children and adolescents who skipped breakfast did
not, on average, make up the nutrient deficits at other
meals during the day (21,27-29,34,40,76,77), which has
also been observed in adults (83,84). Population-based
survey data indicate that children and adolescents tend
to have similar nutrient intakes from daily meals other
than breakfast, regardless of whether they skip or con-
sume breakfast (34). However, female adolescents who
skipped breakfast had lower intakes of nutrients at other
meals compared with female adolescent breakfast con-
sumers (34). This is of particular concern because key
nutrients such as calcium may be missed not only at
breakfast but throughout the day in this population
group.
The inclusion of ready-to-eat cereals in the diet has a
positive impact on total macronutrient and micronutrient
intakes in adults (83,92,93) and children. Ready-to-eat
cereals are commonly consumed in the United States.
Eighty-six percent of children ages 5 to 12 years con-
sumed cereal at least once in a 7-day period (57), over
90% of children ages 4 to 12 years consumed ready-to-eat
cereals at least once during a 2-week period (94), and 30%
of ninth graders (60) and 40% of low-income children in
grades 2 through 5 (28) consumed ready-to-eat cereals on
a particular day. In Canada, 45% to 55% of eighth graders
consumed ready-to-eat cereals during the previous week
(36), and cereal contributed over 25% to daily energy
intake in 4-year-old children (73). Consumption of ready-
to-eat cereals in Europe ranges from 77% to 95% in var-
ious population groups (61,64,81), whereas the 1-day con-
sumption prevalence was 34% in Spanish children and
adolescents (95). A study of Swiss teenagers reported that
breakfast cereals were not commonly consumed (96).
Compared with children and adolescents consuming
lower amounts of ready-to-eat cereals or with noncon-
sumers, ready-to-eat cereal consumers had higher whole-
day intakes of carbohydrates (61,62,81,97) and sugars
(61) (percent of total energy), lower whole-day intakes of
fat (percent of total energy) (28,61,62,81,97,98), enhanced
micronutrient intakes or a greater likelihood of meeting
micronutrient intake recommendations (34,57,60-
62,81,92,94,97-100), improved nutrient status based on
biochemical measures (62,97,100), lower daily cholesterol
intakes (28,34,57,94,99), and lower serum total choles-
terol concentrations (32,100,101). Daily calcium intake
was higher in ready-to-eat cereal consumers (34,62,81,
94,98-100), although this was not observed in all studies
(28,57,61,92,97). Observed increases in calcium intakes
are partly caused by increased milk consumption (100).
Iron intake also seems to be enhanced with the inclusion
of ready-to-eat cereals in the diet (28,34,57,61,62,81,92,
94,98-100).
May 2005 Journal of the AMERICAN DIETETIC ASSOCIATION 745
Reference Study subjects
a
Data collection
instruments and
methods
b
Definitions of
skipping breakfast
Prevalence of
skipping
breakfast (%)
Key characteristics of breakfast
consumers vs breakfast skippers
US studies
Steele and
colleagues, 1952
(76)
N316
11-20 y
57% female
Maine, New York,
Rhode Island
Self-reported 7-d food
record
Skippermissed at least
one breakfast during
the 7-d survey
3-20 Higher mean daily intake (as percent
of RDA
c
) of energy, protein, Ca, P,
Fe, vitamins A and C, thiamine,
riboflavin, and niacin
Hanes and
colleagues, 1984
(77)
N6,301
Grades 1-12
24-h recall (National
Evaluation of School
Nutrition Programs)
Skippermissed a school
or other breakfast on
day of survey
Unknown Higher daily intake of energy;
protein; vitamins A, C, and B-6;
thiamin; riboflavin; niacin; Ca; P;
Mg; and Fe
Skinner and
colleagues, 1985
(21)
N225
16-18 y
49% female
94% white
Tennessee
Self-reported 24-h food
record and written
questionnaire
Skippermissed breakfast
on day that food record
was completed
34 Higher mean daily intakes of energy,
protein, fat, carbohydrate, Ca, Fe,
vitamins A and C, thiamin,
riboflavin, and niacin
Morgan and
colleagues, 1986
(34)
N11,082
1-17 y
3-d food record
(Nationwide Food
Consumption Survey,
1977-1978)
Nonconsumerate
breakfast 1 time
during the 3-d reporting
period
3.4-18.4
(depending on
age group)
Higher mean daily intakes of fat,
total sugars, total cholesterol, Na,
vitamins A and B-6, Fe, Cu, Zn,
Ca (except children 1-4 y), and
Mg (except male subjects 13-17 y)
Higher percentage met the RDA for
many nutrients
Nicklas and
colleagues, 1993
(27)
N467
10 y
50% female
59% white
Bogalusa Heart Study
Louisiana
24-h recall Skippermissed breakfast
on the day of the
survey
16 Higher mean daily intakes of energy,
fat (as percent energy), mixed
protein, fructose, lactose, total
cholesterol, Na, and P
Lower mean daily intake of
carbohydrate (as percent energy),
total sugar
More consumed at least two thirds
of the RDA for vitamins A, E, D,
and B-6; Ca; P; and Mg
Sampson and
colleagues, 1995
(28)
N1,151
Low income
Grades 2-5
49% female
97% African
American
New Jersey
Self-reported eating
behavior survey on 4
random days during
a 2-wk period plus
24-h recalls
Skippermissed breakfast
on the day of the 24-h
recall
12 Fewer had daily intakes 50% of
the RDA for calories; protein;
vitamins A, D, E, C, B-6, and
B-12; thiamin; riboflavin; niacin;
folate; Ca; Mg; and Fe
Fewer had 30% of daily energy
from fat
Higher median total cholesterol, Na
intake
(continued )
746 May 2005 Volume 105 Number 5
Reference Study subjects
a
Data collection
instruments and
methods
b
Definitions of
skipping breakfast
Prevalence of
skipping
breakfast (%)
Key characteristics of breakfast
consumers vs breakfast skippers
Nicklas and
colleagues, 2000
(29)
N711
Grade 9
4.8 y (mean)
60% female
84% white
Louisiana
24-h recall Skippermissed breakfast
on the day of survey
19 Higher mean daily intakes of energy,
protein, saturated fat, total
cholesterol, total carbohydrate,
sucrose, dietary fiber, and starch
Lower percent of daily energy from
fat
Higher percent of daily energy from
carbohydrate
More consumed at least two thirds
of the RDA for B vitamins (except
niacin) and vitamins A, C, and D;
Mg; Fe; Zn; P; and Ca
Non-US studies
Serra-Majem and
colleagues, 2002
(95)
N2,855
2-24 y
Spain
Questionnaires
24-h dietary recalls
Food frequency
questionnaire
Height and weight
measured
Breakfastyes/no
High nutritional risk up
to three nutrients falling
below two thirds of the
recommended nutrient
intakes
Unknown Decreased odds for high nutritional
risk (not significant after
controlling for age, sex, and social
class)
Sjoberg and
colleagues, 2003
(40)
N1,245
15-16 y
51% female
Sweden
Diet history and
interview
Skipper (irregular
breakfast eater)
missed breakfast at
least once per week
18 Higher mean daily intake of energy,
protein, fiber, Ca, Zn
Higher mean daily intake of vitamin
C, and Fe (females)
Lower mean daily intake of sucrose
(females)
Higher mean daily intake of protein
and lower of sucrose (as percent
of energy)
a
All studies were cross-sectional in design and included both male and female subjects unless otherwise noted.
b
All interviews and/or dietary intake data were collected by professionals unless indicated as self-reported.
c
RDARecommended Dietary Allowance.
Figure 1. Studies evaluating nutritional intake characteristics in children and adolescents who consume or skip breakfast.
May 2005 Journal of the AMERICAN DIETETIC ASSOCIATION 747
Breakfast and Other Dietary Factors
Eating breakfast is associated overall with more health-
ful food choices or diet habits in children and adolescents.
Breakfast skippers are more likely to have overall diets
defined as poor or inadequate (95,102). Breakfast con-
sumers tended to make better food choices throughout
the day (21,37), such as consumption of more vegetables
and milk, fewer soft drinks, and a lower intake of french
fries (36). Breakfast consumers had better diet quality
based on the US Department of Agriculture’s Healthy
Eating Index scores (103). Breakfast skipping also has
been associated with increased snacking (40) or higher
intakes of high-fat snacks (32). Omitting breakfast was
associated with omission of other meals by adolescents
(40), which may directly result in or exacerbate inade-
quate intake.
BODY WEIGHT
Although research strongly supports a relationship be-
tween breakfast consumption and nutritional adequacy,
the relationship between breakfast consumption and
body weight is less well established. The prevalence of
overweight has doubled in children and has nearly tripled
in adolescents over the past 2 decades (104), and is espe-
cially prevalent among non-Hispanic black and Hispanic
youth (105-107). Overweight and obesity in children and
adolescents pose significant health risks. Concurrent
with increasing obesity rates, type 2 diabetes is now
being documented in children and adolescents at alarm-
ing rates (108,109), thought to be attributable in large
part to the increase in obesity in this age group (108-111).
Overweight children are more likely to have one or sev-
eral cardiovascular risk factors (112-115) and to become
overweight adults (116-119).
Figure 2 presents studies that evaluated breakfast
consumption habits with regard to overweight and obe-
sity in children and adolescents. Some (18,39,40,120),
but not all (32,75,121), cross-sectional studies reported
that the body mass indexes (BMIs) or weights of chil-
dren and adolescents who skipped breakfast were
higher than of those who consumed breakfast. A large
cross-sectional study (N24,000) reported that a one-
unit increase in BMI was associated with decreased
breakfast consumption in adolescents 11 to 18 years of
age (18). Usual breakfast consumption (eating break-
fast on school days) was associated with approximately
30% lower odds of being overweight or obese in boys
and of being obese in girls (122). Children in two-
parent families who skipped breakfast were almost two
times more likely to be overweight than were breakfast
consumers (120). Overweight or obese children and
adolescents are more likely to skip breakfast than their
normal or underweight peers (25,31,42,43,71,122,123),
particularly female subjects (31,42,71). A recent longi-
tudinal study (33) reported that overweight breakfast
skippers lost BMI over time compared with overweight
breakfast eaters (eating breakfast 5 to 7 days per week)
(P.01). In normal-weight subjects, the BMI of break-
fast skippers tended to increase compared with that of
breakfast eaters, although the differences were not
statistically significant. Data were adjusted for various
confounding factors, including physical activity, al-
though the dieting habits or behaviors of study subjects
were unknown. Interestingly, a cross-sectional analy-
sis of these data indicated that overall, breakfast skip-
pers were heavier. Significant associations between
breakfast consumption and body weight have been re-
ported in some (124-126) but not all (127,128) studies
in adults. To our knowledge, there have been no ran-
domized controlled trials investigating breakfast con-
sumption and weight control in children or adolescents.
The possible relationship between skipping breakfast
and overweight and obesity cannot be explained by en-
ergy intake from self-reported diet. Daily energy intake is
often reported to be lower in breakfast skippers than
breakfast eaters, as reported herein. A higher energy
intake at breakfast was associated with lower BMI in a
small group of British adolescents (129), although break-
fast energy intake was not related to BMI in a small
group of Spanish children (63). Breakfast skippers had a
lower daily energy intake compared with breakfast con-
sumers, regardless of body weight status (33). Although
total daily energy intake was similar, the percent of daily
energy supplied by breakfast was lower in obese com-
pared with average-weight or leaner French children
(130). Ortega and colleagues (71) reported that over-
weight schoolchildren had a lower intake of energy at
breakfast compared with normal-weight children.
Although research strongly supports
a relationship between breakfast
consumption and nutritional
adequacy, the relationship between
breakfast consumption and body
weight is less well established.
Two studies report an association between body weight
and ready-to-eat cereal consumption such that higher
intakes are associated with lower BMIs (94,98), although
other studies report no association (81,97,100). Again,
these results could not be explained by energy intake,
which is often higher in ready-to-eat cereal consumers vs
nonconsumers or subjects consuming lower amounts of
ready-to-eat cereals (81,98,99). Ready-to-eat cereal con-
sumption may be associated with breakfast consumption
in general, which may be a marker for other dietary
habits that result in more healthful food choices, higher
physical activity levels, and lower BMIs. It is possible
that overweight children or adolescents tend to underre-
port their dietary intake relative to their normal-weight
peers who are more likely to eat breakfast. Several stud-
ies showed such systematic bias in self-reported diet by
body weight status (131-134). Dieting behaviors may play
an important role because skipping breakfast is a popular
method of losing weight among adolescents, especially
female subjects (35,37,45,48,135). Adolescents who per-
ceive their body weight as being too high (30,40)orwho
are concerned about their weight (38) may be more likely
to skip breakfast. Breakfast skipping also has been asso-
ciated with lower levels of physical activity in adolescents
(38,39,47), which could affect energy balance and contrib-
748 May 2005 Volume 105 Number 5
Reference Study subjects
a
Data collection
instruments and methods
b
Definitions and prevalence
of overweight/obesity Results
US studies
Resnicow, 1991
(32)
N530
9-19 y
55% white
Long Island, NY;
Atlanta, GA
Self-reported food checklist
for usual breakfast habits
Height and weight measured
Skipperusually skip breakfast No difference in BMI
c
between
breakfast consumers and skippers
when controlling for age
Wolfe and
colleagues, 1994
(120)
N1,797
Grades 2 and 5
6-12 y
50% female
New York
24-h recall
Questionnaire completed by
parents
Height and weight measured
Skippermissed breakfast on day of
dietary recall
OW
d
90
th
percentile of BMI or arm
fat area
UW
e
10
th
percentile of BMI or arm
fat area
Prevalence of OW, OB
f
: 16.9%, 9.8%
Association between breakfast
skipping and higher BMI and arm
fat area in two-parent famillies
(P.05)
In two-parent families, skippers
almost two times more likely to be
OW (OR
g
1.95, 95% CI
h
1.17,
3.25) compared with consumers
Sampson and
colleagues, 1995
(28)
N1,151,
Low income
Grades 2-5
49% female
97% African
American
New Jersey
Self-reported eating behavior
survey on 4 random days
during a 2-week period
24-h recalls
Height and weight measured
Skippermissed breakfast on day of
dietary recall
OBBMI 85
th
-95
th
percentile
Super-OBBMI 95
th
percentile
Prevalence of OB: 36%
No significant association between the
prevalence of OB or super-OB and
breakfast eating behavior
Pastore and
colleagues, 1996
(31)
N1,001
66% black,
23% Hispanic
16 y (mean)
55% female
New York, NY
Self-reported questionnaires
Height and weight measured
Skippermissed breakfast more
than three times the prior week
OW110%-119% of IBW
i
OB 120% of IBW
UW 85% of IBW
Prevalence of OW, OB: 18%, 25%
Significantly more OB subjects
skipped breakfast (72%) compared
with UW subjects (30%) (P.001)
Siega-Riz and
colleagues, 1998
(18)
N24,363
1-18 y
1 day of intake from the
NFCS
j
(1965, 1977-1978)
and CSFII
k
(1989-1991)
Self-reported height and
weight
Consumerate breakfast the day of
the survey
A BMI increase of one unit was
associated with decreased
likelihood of eating breakfast
(P.01)
Dwyer and
colleagues, 2001
(25)
N1,493
Grade 8
14.1 y (mean)
51% female
70% white
San Diego, CA
New Orleans, LA
Minneapolis, MN
Austin, TX
24-h recall
Height and weight measured
Consumerate breakfast on day of
dietary recall
OWBMI 85
th
percentile as
defined by NHANES I
l
Prevalence of OW: 34%
Significantly fewer OW subjects
consumed breakfast (70%)
compared with non-OW subjects
(80%) (P.0004)
(continued )
May 2005 Journal of the AMERICAN DIETETIC ASSOCIATION 749
Reference Study subjects
a
Data collection
instruments and methods
b
Definitions and prevalence
of overweight/obesity Results
Boutelle and
colleagues, 2002
(122)
N8,330
Grades 7, 9, 11
51% female
74% white
Connecticut
Self-reported questionnaire
Self-reported height and
weight
Usual breakfast
consumptionusually eating
breakfast on school days
OWBMI 85
th
to 95
th
percentile
OBBMI 95
th
percentile
Prevalence of OW: 10.8% (females),
18.4% (males)
Prevalence of OB: 5.1% (females),
9.2% (males)
Significantly lower percentage of OW
or OB males and females have
usual breakfast consumption
(P.05)
Usual breakfast consumption was
significantly associated with lower
odds for being OB in females
(OR0.72, 95% CI0.53, 0.97);
OW in males (OR0.72, 95%
CI0.60, 0.86); OB in males
(OR0.68, 95% CI0.54, 0.86)
Berkey and
colleagues, 2003
(33)
N14,586
9-17 y
56% female
95% white
Children of Nurses’
Health Study II
participants
Series of three annual self-
reported questionnaires
Self-reported height and
weight
Skippernever or almost never eat
breakfast
OWBMI 85
th
percentile of CDC
m
growth curves
Prevalence of OW: 23.2% (males),
17.4% (females)
In OW subjects, breakfast skippers
lost BMI over time compared with
breakfast eaters (P.01)
In normal-weight subjects, the BMI of
breakfast skippers tended to
increase over time compared with
breakfast eaters (NS
n
)
Non-US studies
Walker and
colleagues, 1982
(75)
N4,717
16-18 y
51% female
Racial mix (white,
rural black, urban
black, Indian,
European-African-
Malay)
South Africa
Questionnaire
Height and weight measured
No solid breakfastno solid food as
a usual breakfast habit
No difference between mean weight
and height by breakfast
consumption pattern (solid food
breakfast vs no solid breakfast)
Ortega and
colleagues, 1998
(71)
N200
9-13 y
41% female
Madrid, Spain
Self-reported consecutive
7-d food record
Height and weight measured
OW (including OB)BMI 75
th
percentile
Prevalence of OW: 28.0% (females),
25.4% (males)
OW subjects, especially female
subjects, omitted breakfast more
frequently over the 7-d survey
period than did normal-weight
subjects (P.05)
O’Dea and Caputi
2001 (42)
N1,126
6-19 y
54% female
New South Wales,
Australia
Self-reported questionnaires
Height and weight measured
Skipperskip breakfast most days
OWBMI 85
th
percentile
Prevalence of OW: 15.7% (females),
13.8% (males)
A higher percentage of OW children
are breakfast skippers compared
with normal weight children
OW female subjects most likely to
regularly skip breakfast (18%) and
normal-weight male subjects least
likely to skip (10%)
(continued )
750 May 2005 Volume 105 Number 5
Reference Study subjects
a
Data collection
instruments and methods
b
Definitions and prevalence
of overweight/obesity Results
Kovarova and
colleagues, 2002
(123)
N3,362
7-11 y
50% female
Czech Republic
Self-reported questionnaires
Height and weight measured
Breakfast consumptionhabitual
breakfast consumption
UWBMI 10
th
percentile
OWBMI 90
th
-97
th
percentile
OBBMI 97
th
percentile
Prevalence of OW and OB
(combined): 11.9% (females) and
13.1% (males)
Lower percentage of OW children
consume breakfast (54.1%)
compared with UW children
(75.3%) (P.001)
Abalkhail and
Shawky, 2002
(121)
N800
9-21 y
53% female
Saudi Arabia
In-person interviews
Height and weight measured
Regular breakfasthabitual
OWBMI 85
th
to 95
th
percentile
OBBMI 95
th
percentile
Prevalence of OW, OB: 14.3%,
17.1%
No significant association between
regular breakfast intake and BMI
Cartwright and
colleagues, 2003
(43)
N4,320
11-16 y
40% female
62% white
South London, UK
Self-reported questionnaire
Height and weight measured
Consumerusually eats breakfast
OWincludes OB as categorized by
growth curves
Prevalence of OW: 24%
OW subjects less likely to eat
breakfast every day (OR0.72,
95% CI0.64, 0.81; P.01)
Keski-Rahkonen
and colleagues,
2003 (39)
N5,448
16 y
52% female
Finland
Self-reported questionnaire
Self-reported height and
weight
Skippereating breakfast 1
time/wk
BMI 254.3%
Breakfast skippers two times more
likely to have a BMI 25
(OR2.00, 95% CI1.32, 3.01;
P.001)
Sjoberg and
colleagues, 2003
(40)
N1,245
15-16 y
51% female
Sweden
Diet history (habitual) and
interview
Height and weight measured
Irregular breakfast intakeomitting
breakfast at least once per week
OWBMI 23.60 (males), 24.17
(females)
Prevalence of OW: 12.0% (males),
10.8% (females)
BMI significantly higher for boys with
irregular breakfast intake compared
with males eating breakfast
regularly (P.0006; NS for
females)
a
All studies were cross-sectional in design except that of Berkey and colleagues (33), which was longitudinal. Studies included both male and female subjects unless otherwise noted.
b
All interviews and/or dietary intake data were collected by professionals unless indicated as self-reported.
c
BMIbody mass index.
d
OWoverweight.
e
UWunderweight.
f
OBobese or obesity.
g
ORodds ratio.
h
CIconfidence interval.
i
IBWideal body weight.
j
NFCSNationwide Food Consumption Surveys.
k
CSFIIContinuing Survey of Food Intakes by Individuals.
l
NHANES IFirst National Health and Nutrition Examination Survey.
m
CDCCenters for Disease Control and Prevention.
n
NSnot significant.
Figure 2. Studies evaluating body weight characteristics in children and adolescents who consume or skip breakfast.
May 2005 Journal of the AMERICAN DIETETIC ASSOCIATION 751
ute to excess body weight. Several observational studies
did not seem to control for physical activity levels while
reporting significant associations between breakfast hab-
its and body weight (18,40).
Differences in study results also may be attributed to
statistical methods. Four (32,39,120,122) of eight studies
controlled for various combinations of confounding fac-
tors (eg, age, race, grade in school, parental socioeconomic
status). Three of these studies reported significant asso-
ciations between body weight and breakfast consumption
(39,120,122), whereas none of the studies reporting a null
association seemed to statistically control for confounding
factors.
COGNITIVE AND ACADEMIC PERFORMANCE
The role of breakfast in enhancing cognitive and aca-
demic performance, psychosocial function, and school at-
tendance has been studied widely. Breakfast consump-
tion could impact cognitive performance by alleviating
hunger (8,136), the prevalence of which is well docu-
mented (137,138) and has been associated with emo-
tional, behavioral, and academic problems in children
and adolescents (139,140). Breakfast may modulate the
short-term metabolic responses to fasting conditions to
maintain a supply of nutrients to the central nervous
system, or through long-term effects on nutrient intake
and status that may positively affect cognition (17). The
effects might be attributable to enhanced blood glucose
concentrations (17,141). However, several experimental
studies have shown no significant overall association be-
tween test performance and blood glucose concentrations
(142-145), suggesting that other mechanisms, possibly
changes in neurotransmitter concentrations (146), may
play a role. Cognitive and academic performance in chil-
dren is linked to various socioeconomic status (SES) in-
dicators. Indicators such as family income and parental
education often predict academic achievement in children
(147,148). It is important to account for these variables in
cognitive or academic performance studies. Experimental
and observational studies of the effects of breakfast on
various performance variables are presented in Figure 3.
Cognitive Performance
There is some support for beneficial effects of breakfast
on aspects of memory in short-term experimental studies
conducted in a research center (145,149,150) or school
environment (143,151,152), although several studies re-
port no such effect (142,144,149,151,153,154). Positive
effects were reported in various age groups using a vari-
ety of standardized or customized tests (see individual
studies for descriptions of the testing instruments). Ben-
efits have been reported regarding several aspects of
memory function including recall (152), episodic memory
(150), and both short-term (143,149,155) and long-term
(151) memory. A randomized intervention study of 569
students ages 11 to 13 years reported that a school break-
fast consumed 30 minutes before testing was helpful to
recall even when subjects had eaten breakfast at home
earlier in the morning, suggesting that the timing of
breakfast may be important (152). However, breakfast
enhanced memory function several hours after consump-
tion compared with a fasting or lower-energy breakfast
condition in randomized studies (143,145,150). Only one
randomized controlled trial evaluated the longer-term (ie,
3 months) effects of a school breakfast program on as-
pects of memory and reported that breakfast provided no
enhancement to memory function in Peruvian children
(N352; controlling for SES) (154). The positive effects of
breakfast on aspects of memory function also has been
shown in experimental studies in adults (156-159). Over-
all, data are less supportive for the effects of breakfast
consumption on other cognitive variables, such as atten-
tion, problem solving, and reading or listening compre-
hension.
Breakfast consumption significantly
contributes to whole-diet nutrient
adequacy.
Children at nutritional risk were reported to especially
benefit from breakfast consumption in randomized con-
trolled studies conducted in a research center (145,149)
and school environment (151). However, these studies
were designed as short-term intervention trials. Random-
ized intervention trials conducted over two semesters
(136) and 1 year (160) in a school environment reported
that undernourished children gained no additional bene-
fits from breakfast consumption compared with ade-
quately nourished children with regard to achievement
test scores (controlling for SES). In contrast, a controlled
crossover trial conducted at a research center and with a
similar population group (ie, rural, low-income Jamaican
children with similar SES) found that breakfast benefited
undernourished children on memory and fluency (idea
generation) tests, but had no effect on adequately nour-
ished children (149). These data suggest that undernour-
ished children might preferentially benefit from break-
fast in the short term, but not on a long-term basis.
Analyses of long-term effects can be complicated by the
various social, family, and academic factors that can af-
fect school performance (160), including the effects of
SES.
Academic Performance, School Attendance, and Tardiness
Two randomized controlled trials report the positive ef-
fects of a school breakfast on achievement test scores and
school attendance rates in rural Jamaican children
(136,160). Groups of children were followed up for two
semesters (n115) (136) or 1 year (n814) (160) during
the intervention and showed improved performance com-
pared with the control group (ie, children not receiving a
school breakfast). School attendance rates were improved
in a trial of Peruvian children randomized to receive a
school breakfast or no school breakfast for a period of 3
months (154). Both studies controlled for SES. The re-
sults of controlled trials are confirmed by observational
studies, which consistently show a beneficial effect of
breakfast consumption on academic and achievement test
scores (161,162), grades (163-165), school attendance
(161,163,164), and tardiness rates (161,163).
752 May 2005 Volume 105 Number 5
General cognitive or academic
parameter measured
Studies reporting a significant effect
of breakfast treatment (reference)
Studies reporting no significant effect
of breakfast treatment (reference)
Attention, concentration Conners and Blouin, 1982-1983, exp
a
(172)
Michaud and colleagues, 1991, exp (143)
b
Wesnes and colleagues, 2003, exp (150)
Pollitt and colleagues, 1981, exp (155)
Dickie and Bender, 1982, exp (153)
Pollitt and colleagues, 1982-1983, exp (141)
Simeon and Grantham-McGregor, 1989, exp (149)
Cromer and colleagues, 1990, exp (142)
Lopez and colleagues, 1993, exp (144)
Chandler and colleagues, 1995, exp (151)
Memory Pollitt and colleagues, 1981, exp (155)
c
Pollitt and colleagues, 1982-1983, exp (141)
c
Simeon and Grantham-McGregor, 1989, exp (149)
de
Michaud and colleagues, 1991, exp (143)
Chandler and colleagues, 1995, exp (151)
d
Vaisman and colleagues, 1996, exp (152)
g
Cueto and colleagues, 1998, exp (145)
h
Wesnes and colleagues, 2003, exp (150)
Dickie and Bender, 1982, exp (153)
Simeon and Grantham-McGregor, 1989, exp (149)
f
Cromer and colleagues, 1990, exp (142)
Lopez and colleagues, 1993, exp (144)
Chandler and colleagues, 1995, exp (151)
f
Jacoby and colleagues, 1996, exp (154)
Impulsivity Pollitt and colleagues, 1981, exp (155)
i
Pollitt and colleagues, 1982-1983, exp (141)
Cromer and colleagues, 1990, exp (142)
Simeon and Grantham-McGregor, 1989, exp (149)
Reasoning Lopez-Sobaler and colleagues, 2003, obs
j
(65)Wyon and colleagues, 1997, exp (166)
Creativity, idea generation Simeon and Grantham-McGregor, 1989, exp (149)
d
Wyon and colleagues, 1997, exp (166)
Simeon and Grantham-McGregor, 1989, exp (149)
f
Problem solving, addition, math Conners and Blouin, 1982-1983, exp (172)
Simeon and Grantham-McGregor, 1989, exp (149)
cf
Wyon and colleagues, 1997, exp (166)
k
Dickie and Bender, 1982, exp (153)
Simeon and Grantham-McGregor, 1989, exp (149)
d
Lopez and colleagues, 1993, exp (144)
Jacoby and colleagues, 1996, exp (154)
Cueto and colleagues, 1998, exp (145)
Lopez-Sobaler and colleagues, 2003, obs (65)
Learning Vaisman and colleagues, 1996, exp (152)
g
Cromer and colleagues, 1990, exp (142)
Vocabulary Jacoby and colleagues, 1996, exp (154)
l
Reading, listening comprehension Simeon and Grantham-McGregor, 1989, exp (149)
Jacoby and colleagues, 1996, exp (154)
Discrimination Cueto and colleagues, 1998, exp (145)
h
Physical endurance Wyon and colleagues, 1997, exp (166)
Academic or achievement test scores Powell and colleagues, 1983, exp (136)
Meyers and colleagues, 1989, obs (161)
Powell and colleagues, 1998, exp (160)
Boey and colleagues, 2003, obs (162)
Academic grades Murphy and colleagues, 1998, obs (163)
Kleinman and colleagues, 2002, obs (164)
m
Kim and colleagues, 2003, obs (165)
School attendance Powell and colleagues, 1983, exp (136)
Meyers and colleagues, 1989, obs (161)
Jacoby and colleagues, 1996, exp (154)
Powell and colleagues, 1998, exp (160)
Murphy and colleagues, 1998, obs (163)
Kleinman and colleagues, 2002, obs (164)
School tardiness Meyers and colleagues, 1989, obs (161)
Murphy and colleagues, 1998, obs (163)
Kleinman and colleagues, 2002, obs (164)
Psychosocial function Murphy and colleagues, 1998, obs (163)
Kleinman and colleagues, 2002, obs (164)
a
expexperimental.
b
Higher-energy breakfast negatively impacted measures of concentration.
c
The control (fasting, no breakfast) group performed better than the treatment (breakfast) group on some aspects of testing.
d
Children at nutritional risk or undernourished children.
e
Children classified as wasted.
f
Adequately nourished children.
g
Effect of breakfast timing. Children eating breakfast at school 30 minutes before testing performed better than children eating breakfast at home 2 hours before testing.
h
Children at nutritional risk or undernourished children. In adequately nourished children, the control (fasting, no breakfast) group performed better than the treatment (breakfast) group
on some aspects of testing.
i
Low-intelligence quotient group only.
j
obsobservational.
k
Effect of breakfast on addition but not multiplication skills.
l
Children with higher body weights scored better after breakfast treatment. No other significant effects of breakfast treatment.
m
Math only.
Figure 3. Experimental and observational studies evaluating breakfast intake and cognitive and academic variables in children and adolescents.
May 2005 Journal of the AMERICAN DIETETIC ASSOCIATION 753
Psychosocial Issues and Mood
Two observational studies investigated the effects of par-
ticipation in the school breakfast program on psychoso-
cial issues (163,164). Both studies used the Pediatric
Symptom Checklist, which was completed by parents
(163,164) or children (164). Based on youth-reported
(164) and parent-reported (163) Pediatric Symptom
Checklist surveys, psychosocial function improved signif-
icantly in participants whose nutritional status improved
with a school breakfast (164) or in those whose participa-
tion in the breakfast program increased (163). Changes in
measures of child depression and hyperactivity were im-
proved in children with increased school breakfast pro-
gram participation (163). Breakfast was reported to have
a positive effect on aspects of mood, including alertness
(150,166) and contentment (150), but had no significant
effect on alertness and feelings of tranquility (143)or
anxiety (142).
CONCLUSIONS
Breakfast consumption significantly contributes to whole-
diet nutrient adequacy. Breakfast consumers are more
likely to have better overall diet quality, and micronutrient
and macronutrient and fiber intakes that more often align
with current dietary recommendations (79). Benefits may
especially be enhanced with the inclusion of ready-to-eat
cereals as part of a healthful breakfast. Although study
results are inconsistent, breakfast consumption may be as-
sociated with more healthful body weights in children and
adolescents, despite possibly higher daily energy intakes in
breakfast consumers. Skipping breakfast is a common be-
havior observed in overweight or obese children and adoles-
cents and may be related to dieting and disordered eating
habits. Breakfast skippers may be less likely to engage in
physical activity, which may contribute to positive energy
balance and weight gain. Breakfast consumption may pos-
itively benefit cognitive function, particularly memory; aca-
demic performance; school attendance rates; psychosocial
function; and mood. However, interpretation of results can
be complicated by confounding factors such SES or other
social or educational variables.
Several studies support the benefits of ready-to-eat cere-
als as reviewed herein. Because of their nutrient fortifica-
tion levels and increased consumption, one could postulate
that the health benefits observed with breakfast consump-
tion may be mostly attributed to ready-to-eat cereals. How-
ever, most studies comparing breakfast consumers vs non-
consumers have not presented data in such a way to
determine whether ready-to-eat cereal consumption is re-
sponsible for the observed benefits. Only Morgan and col-
leagues (34) reported that non–ready-to-eat cereal break-
fast consumers had higher daily intakes of many nutrients
compared with breakfast skippers. In contrast, ready-to-eat
cereal consumers have the potential for higher daily intakes
of refined grains and sugars found in many ready-to-eat
cereals, especially those marketed to children. Most of the
studies reviewed herein report that breakfast consumption
in general was associated with favorable nutritional and
health benefits. However, to maximize the potential bene-
fits of breakfast consumption, it is important to distinguish
between simply promoting breakfast vs the consumption of
a healthful breakfast. Breakfast should include a variety of
healthful foods that are high in nutritive value yet do not
provide excess energy.
There is substantial evidence that breakfast consump-
tion is associated with the health and well-being of chil-
dren and adolescents, and the benefits seem to apply to a
wide range of age, demographic, and socioeconomic
groups. We propose the following recommendations for
breakfast habits in children and adolescents.
Children and adolescents should consume a healthful
breakfast, at home or at school, on a daily basis, while
not exceeding daily energy requirements.
For a healthful breakfast, children should include foods
from a variety of food groups (eg, whole grain, fruit, and
dairy) to ensure that they receive a variety of nutrients
and fiber (79). Longitudinal data indicate that as chil-
dren age they tend to include fewer food groups at
breakfast (44). Consumption of a high-fiber, low-sugar,
fortified, ready-to-eat cereal likely will provide addi-
tional benefits to nutrient and fiber intakes.
For children with low intakes of dairy products, alter-
native sources of calcium such as calcium-fortified
100% juices or other foods should be offered with the
awareness that a decreased consumption of milk prod-
ucts could result in low consumption of other nutrients
such as vitamin A and riboflavin (87). Children from
populations with a higher prevalence of lactose intoler-
ance (African Americans, Asian Americans) should be
counseled concerning dairy foods that may be tolerated
(eg, limited amounts of milk, certain cheeses) or alter-
native sources of calcium.
Choice of dairy or meat products should include lower-
fat versions of these foods to help reduce total fat and
saturated fat intakes. An important exception is chil-
dren between 1 and 2 years of age, who should consume
whole milk instead of reduced-fat milk. Current dietary
recommendations suggest that by age 4, healthy chil-
dren should aim to consume between 25% and 35% of
daily calories from fat (79), which is sufficient for nor-
mal growth and sexual maturity (167). This recommen-
dation is supported by several organizations, such as
the American Heart Association (168) and the Ameri-
can Academy of Pediatrics (169).
Children who tend to skip breakfast because of a lack of
time in the morning should eat breakfast either at
school or on their way to school. Many breakfast foods
can be consumed while on the go, for example, dry
cereal, whole-grain toast or bagel, 100% juice in a to-go
container, and fresh fruit.
When appropriate, health practitioners who work with
children should encourage parents to investigate the
availability of school feeding programs, which seem to
be underused (163,170).
Breakfast consumption should be encouraged in groups
who may be more likely to skip breakfast: older chil-
dren and adolescents, especially teenage girls, and pos-
sibly black and Hispanic children. Practitioners should
counsel adolescents who are dieting to ensure that they
follow healthful and appropriate eating and exercise
behaviors.
Parents can have a significant impact by planning for
and encouraging family breakfasts that include healthful
754 May 2005 Volume 105 Number 5
foods from a variety of food groups. Parental breakfast
eating was a significant predictor of adolescent breakfast
eating (39). The frequency of family meals increased the
likelihood that children (171) and adolescents (30) made
more healthful food choices and was the most significant
parental influence on adolescent eating habits (30). Fi-
nally, breakfast should be viewed as an important com-
ponent of an overall preventive strategy aimed at reduc-
ing disease risk by enhancing the health of children and
adolescents. This strategy should include a healthful diet,
increased physical activity, and the reduction or elimina-
tion of other lifestyle factors (eg, tobacco use, time spent
on sedentary activities) that may negatively impact
health.
Future research needs include identifying the mag-
nitude of the potential nutritional risks associated with
skipping breakfast, especially in diverse populations.
Current studies suffer from methodologic differences
regarding collection of dietary intake data, how break-
fast skipping is defined, and how breakfast is defined
(types or amounts of foods eaten, time of day food is
eaten). Studies should evaluate the composition of the
breakfast meal in general, and for ready-to-eat cereals,
studies should differentiate between the benefits of
those high in whole grains and fiber from those high in
refined grain and sugar. Reasons for breakfast skipping
in different population groups should be elucidated to
identify the best ways to promote breakfast consump-
tion in children. Current studies regarding breakfast
and body weight are almost entirely cross-sectional in
nature, and more longitudinal studies are needed. The
potential confounding effect of overweight children and
adolescents who are dieting to lose weight should be
investigated along with other lifestyle factors that
might contribute to unhealthful weight, particularly
physical activity levels. Regarding cognitive and aca-
demic performance, controlled trials using similar and
age-appropriate cognitive tests should be conducted so
that studies can be compared more readily. Interven-
tion trials are needed to examine the long-term benefits
of breakfast consumption on academic performance,
especially in the school setting, while accounting for
socioeconomic variables. The physiologic mechanisms
that contribute to or are responsible for the observed
effects should be explored more extensively.
Special thanks to Cristin Cuozzo for providing technical
assistance.
This work was supported in part by the Florida Depart-
ment of Citrus (FDOC), which assembled the Breakfast
Advisory Board (of which all investigators are members),
including consulting fees and travel reimbursement. The
FDOC reviewed and approved the final version of the
manuscript, but did not influence, or contribute anything
to, its content. In addition, the lead investigator’s position
is funded jointly by the Institute of Food and Agricultural
Sciences at the University of Florida, Gainesville, and the
FDOC.
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... A recent systematic review (children aged 2-18 years) that included 39 studies in 33 countries concluded that most of the investigations reported that 10-30% of children and adolescents skipped breakfast (with a large variability from 0.7 to 74.7%) [4]. This may be due to the age of the children studied, as the literature suggests that skipping breakfast is common in children and adolescents and increases with age [75]. ...
... The association between breakfast quality and IR in children may be due to the implication that a good breakfast quality helps to maintain an adequate weight status and prevent comorbidities associated with excess weight. However, in our sample, children with a higher-quality breakfast did not have a lower zBMI, and other researchers have demonstrated this association between a higher-quality breakfast and a better weight status [28,75]. It may also be due to the consumption of different foods included in a quality breakfast, such as dairy products, cereals and fruit. ...
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Background: Breakfast has traditionally been considered one of the most important meals of the day; however, there is little evidence for the influence of breakfast quality and insulin resistance (IR). This study aimed to assess the quality of breakfast in a group of schoolchildren, and its association with IR. Methods: A cross-sectional study with 852 children (8-13 years) was carried out. Fasting plasma glucose, insulin and anthropometric parameters were measured. A three-day dietary record was used to assess their diet and to calculate the Breakfast Quality Index (BQI). The sample was divided into tertiles according to the BQI (tertile 3: better breakfast quality). The homeostatic model was used to assess insulin resistance (HOMA-IR), and IR was defined as HOMA-IR > 3.16. Results: The prevalence of IR was 5.2%. The mean BQI score was 4.50 ± 1.25, and boys had lower scores than girls. Children in the BQI tertile 3 had a better global diet quality. In boys, being in the BQI tertile 3 was associated with a lower risk of IR (OR [95% CI]: 0.10 [0.01-0.77], p < 0.05). Conclusions: A higher-quality breakfast was associated with better overall diet quality and a lower risk of IR, especially in boys.
... These are in fact the effects on which the marketing of the drinks is based [40,41]. However, as our results indicate, energy drink consumption is associated with short sleep and skipping breakfast, both of which may lead to poorer cognitive functioning [42]. ...
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Background The purpose of this study was to identify how various negative health indicators are associated with energy drink consumption frequency among 13- and 15-year-old Finnish adolescents. Methods Data (N = 2429) from the nationally representative international Health Behaviour in School-aged Children study (2018) were analyzed via descriptive analysis and logistic regression analyses, with control for salient covariates. Relative risks (RR) were derived from the adjusted odds ratios. Results Even infrequent energy drink consumption was associated with various negative health indicators. Moreover, as compared to non-users, frequent energy drink consumers were more likely to report several health-compromising behaviors: current smoking (RR = 9.85, 95% CI: 5.68–16.02), current snus use (RR = 3.62, 95% CI: 1.80–6.85), cannabis use (RR = 3.42, 95% CI: 1.69–6.52), alcohol consumption (RR = 3.08, 95% CI: 2.49–3.71), problematic social media use (RR = 2.53, 95% CI:1.68–3.72), short sleep (RR = 2.12, 95% CI: 1.69–2.60), skipping breakfast (RR = 1.87, 95% CI: 1.51–2.29), drunkenness (RR = 1.59, 95% CI: 1.11–2.23), inadequate tooth brushing (RR = 1.28, 95% CI: 1.05–1.54). In addition, frequent energy drink consumption was associated with perceived negative health indicators: feelings of insufficient sleep (RR = 1.56, 95% CI: 1.11–2.15), low self-rated health (RR = 1.48, 95% CI: 1.15–1.87), and multiple health complaints (RR = 1.31, 95% CI: 1.07–1.56). Conclusions Energy drink consumption, even infrequent, was associated with several negative health indicators, and the reporting of these increased with the frequency of energy drink consumption. The findings support the concerns of health authorities regarding the negative associations between energy drink consumption and health, even among persons as young as 13 years. There is evidence to support specific policy level actions, including restrictions on the sale of energy drinks to adolescents. This measure has been proposed in a Finnish government program, but implementation has yet to occur. Moreover, marketing of these beverages in platforms that are popular among adolescents (e.g., the social media) should be rigorously evaluated, and comprehensive interventions and actions implemented to ensure that adolescents, parents/guardians, and professionals working with adolescents (e.g., in schools) have a good understanding of the links between energy drink consumption and health.
... Furthermore, insulin secretion resulting from eating breakfast has the effect of resetting the liver's internal clock [80], suggesting that moderate carbohydrate and protein intake at breakfast can promote the resetting of the internal clock. Therefore, regular breakfast intake [81], one of the key indicators of a healthy lifestyle, should be recommended in order to have a fulfilling social life. ...
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There is a physiological link between sleep and eating. Insufficient sleep is a risk factor for overeating and excess body weight gain, and molecules such as orexin and insulin play a role in the control of sleep and energy intake. The effects of dietary timing on sleep and energy metabolism were examined in this review. First, we examined sleep energy metabolism and sleep quality under time-restricted eating, including skipping breakfast or dinner. Second, the mechanisms, benefits, and translational potential of the effects of time-restricted diets on sleep were discussed. Time-restricted eating under controlled conditions, in which daily caloric intake was kept constant, affected the time course of energy metabolism but did not affect total energy expenditure over 24 h. In free-living conditions, time-restricted eating for extended durations (4–16 weeks) decreased energy intake and body weight, and the effects of early time-restricted eating were greater than that of midday time-restricted eating. Although assessment of sleep by polysomnographic recording remains to be performed, no negative effects on the subjective quality of sleep have been observed.
... Students were asked to rate the number of times they ate breakfast per week (0-7). Additionally, a five-point Likert scale rating (1)(2)(3)(4)(5) was created specifically to measure other parameters of their diet and well-being. To get a better understanding of students' breakfast-eating habits, they were asked to rate their likelihood of eating breakfast on the day of an exam. ...
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Background Due to its nutritious, metabolic, and overall energy-providing benefits, studies have emphasized the value of breakfast, resulting in support of breakfast as “the most important meal of the day,” and subsequently, essential for academic success. However, limited research exists on the impact of habitual breakfast consumption on medical students. How does eating breakfast contribute to the academic success and well-being of medical students? Methods A voluntary survey was distributed to preclinical medical students to gather information on their breakfast-eating habits as well as other indicators of well-being, including mental health, physical health, and stress. Participants indicated the average number of times per week they consumed breakfast. They also recorded the likelihood of eating breakfast on the day of an exam and various components of well-being on a five-point Likert scale. Subjects also provided student identification (ID) numbers. To measure academic success, grade point averages (GPAs) were then extracted using each student's ID number. A correlation analysis was performed between the breakfast-eating habits of medical students and their GPA. Results 121 surveys met the inclusion criteria. A correlation analysis showed that frequency of eating breakfast was positively correlated with GPA (r=0.35, p<0.001). Eating breakfast on the day of an exam was also positively correlated with GPA (r=0.32, p<0.001). Eating breakfast had no significant correlation with indices of well-being. Conclusion Consistently eating breakfast may contribute to greater academic performance among medical students. However, eating breakfast appears to have no impact on well-being. Based on this research, eating breakfast regularly may help preclinical medical students boost their academic performance.
... Palabras clave. Niño; desayuno; ejercicio físico; función ejecutiva para rotinas fisicamente inativas, baixa adesão ao consumo do café da manhã (CM) e aumento da ingestão de alimentos mentais de curto prazo podem fornecer orientações efetivas a respeito dessa temática, devido ao efeito potencial da qualidade da dieta em atenuar o declínio energético e cognitivo nas primeiras horas do dia[16][17][18] .A ingestão diária do CM possui relação positiva com um crescimento e desenvolvimento ideal na infância, incluindo o potencial aprimoramento cognitivo e acadêmico que a ciência tem procurado diligentemente consolidar13,14,30,37 .Diferenças abrangentes no desempenho cognitivo entre crianças que consumiram o CM e aqueles que não consumiram foram observadas em um estudo com 1386 escolares com média de idade de 11 anos. A capacidade de evitar a distração, focar a atenção e de se manter atento foi comprometida em 7% das crianças que permaneceram em jejum, além de um declínio na velocidade e acurácia das respostas em comparação ao grupo que consumiu o CM 38 . ...
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Introdução. A má alimentação e o sedentarismo estão entre os fatores que mais contribuem para o agravo do estado de saúde na infância, sendo associados a dificuldades e problemas de aprendizagem durante o período de escolarização. Estudos sugerem que crianças em idade escolar podem ter desempenho cognitivo aprimorado pelo consumo regular do café da manhã, bom condicionamento físico e da prática de exercícios físicos. Objetivo. Partindo do princípio de que muitas crianças em idade escolar não consomem o café da manhã todos os dias e, também não atingem as metas de exercício recomendadas por diretrizes de saúde, no presente estudo realizou-se uma revisão narrativa da literatura acerca do consumo do café da manhã, do envolvimento em práticas corporais de crianças, e a sua capacidade de manter e aprimorar as funções cognitivas na infância. Método. A investigação englobou aspectos de consumo, resposta glicêmica e a comparação de carboidratos alimentares presentes no café da manhã, além disso, o envolvimento em aulas de educação física, intervalos ativos e programas de exercício físico e a sua relação com a cognição de crianças em idade escolar. Conclusão. Após revisão de artigos e as suas respectivas contribuições científicas para as temáticas, assume-se uma associação positiva entre o consumo adequado do café da manhã e das práticas de exercício físico com o funcionamento cognitivo ideal para crianças em idade escolar. Sendo sugerido pelos autores pesquisados, a adoção e o incentivo dessas práticas para a rotina das crianças durante o período de escolarização.
... Adequate breakfast is connected to both psychological and physiological health benefits (Ferrer-Cascales, Sanchez-SanSegundo, Ruiz-Robledillo, et al., 2018). Breakfast is foundational to academic achievement and a higher cognitive performance (Rampersaud, Pereira, Girard, et al., 2005) which is measured by the ability to read, write, and reason. Breakfast eaters with adequate nutrients showed lower levels of stress and depression than breakfast eaters who ate a poor or very poor quality breakfast (Ferrer-Cascales, Sánchez-SanSegundo, Ruiz-Robledillo, et al., 2018). ...
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PURPOSE: We had three purposes for this study: 1) to introduce 2nd and 3rd grade children to the concepts of breakfast and food groups in the MyPlate nutrition model while using an interactive constructivist approach; 2) to evaluate what foods children ate for breakfast over two days and to assess the visual-textual-lexical representations that they constructed to show their thinking about the MyPlate food model; and 3) to explore functional health literacy and inventive spellings from children who learned about food groups over two class sessions. METHODS: Pre to post student assessments focused on self-reported breakfast eating and ability to represent the MyPlate food model during the learning process. Student thinking about those topics were also elicited by multimodal approaches: oral language (conversations), written language (visual-textual-lexical illustrations), and body language (making nutritious snacks). For the latter, students constructed a snack to eat on both days at school and were encouraged to make the food at home to model nutritious eating behavior. RESULTS: Most children who participated in the lesson ate breakfast either at home or at school. Some students chose to communicate in words and pictures when asked to write about the foods they ate for breakfast. Many students illustrated and labeled food groups by drawing and using inventive spellings about their early understandings of the MyPlate food model. From the first to the second day of instruction, breakfasts with three food groups increased from 3% to 7% but breakfasts with two food groups declined from 55% to 41% due to more children (n = 60) eating breakfasts with only one food group on the second day. CONCLUSIONS: Some of the food items that students ate were not sufficient to produce an adequate nutritional benefit. The constructivist pedagogical approach assisted children with multimodal ways to communicate their understanding, including making two different snacks when planning a breakfast with multiple food groups. Functional health knowledge about a nutritious breakfast made with three food groups should be further aligned with functional health literacy skills of speaking and writing in multimodal ways in order to improve health behaviors. Inventive spellings demonstrated a developmental step in learning a vocabulary in a new domain. Use of written words and pictures reflected a positive way to learn health and nutrition, because children represented their understanding in more than one way. RECOMMENDATIONS: By adding fruit to the breakfasts of children who participated in the lessons, almost one-half of the children would be able to increase their consumption from two food groups to three food groups when consuming an ideal breakfast. Future work should elaborate on the role of interactive health literacy in school and home contexts when children are learning about breakfast eating and food groups. Future integration of the MyPlate food model with the National Health Education Standards can foster new classroom assessments that will support students to practice observable nutrition behaviors that can lead to consistent health habits for personal, family, and school health.
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Background and objectives: Obesity among adolescents is a significant public health concern in the United States. The prevalence of obesity has increased from 13.0% in 2011 to 15.5% in 2019. The association between breakfast skipping and obesity is still controversial, and a mediator role of depression in this association is limited. The purpose of this study was to investigate the independent association between breakfast skipping and obesity and to investigate the mediator role of depressive symptomology between breakfast skipping and obesity prevalence. Materials and methods: In this cross-sectional study, data were extracted from the CDC's Youth Risk Behavior Surveillance System (YRBSS) for 9th to 12th graders from 2011 through 2020. SAS version 9.4 was used to analyze the data using proc survey frequency and proc survey logistic regression models. The adjusted odds ratios (aORs) with 95% confidence intervals (CI) were estimated. The Sobel test also was performed to test the mediator role of self-reported depression. Results: Of the 56,320 adolescents, 13.7% did not eat breakfast, 14.1% were obese, and 15.1% had depressive symptomology. Breakfast non-eaters was associated with a 24% increased odds of obesity (aOR: 1.24; 95% CI: 1.14 to 1.36) after adjusting for race/ethnicity, gender, grade level, and behavioral risk factors. A mediator role of self-reported depression was noted using the regression model and Sobel test (z = 3.90, S.E. = 0.02, p< 0.0001) between breakfast skipping and obesity. Conclusions: Breakfast skipping was independently associated with obesity. Self-reported depression was identified as a mediator factor. Therefore, the mental health condition also needs to be addressed in the prevention of obesity among adolescents. IMC J Med Sci 2022; 16(2): 001 *Correspondence: Azad R. Bhuiyan, Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Jackson State University, Jackson, MS 39213, USA. Email: azad.r.bhuiyan@jsums.edu
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The exposome paradigm through an integrated approach to investigating the impact of perinatal exposure to metals on child neurodevelopment in two cohorts carried out in Slovenia (PHIME cohort) and Greece (HERACLES cohort) respectively, is presented herein. Heavy metals are well-known neurotoxicants with well-established links to impaired neurodevelopment. The links between in utero and early-life exposure to metals, metabolic pathway dysregulation, and neurodevelopmental disorders were drawn through urinary and plasma untargeted metabolomics analysis, followed by the combined application of in silico and biostatistical methods. Heavy metal prenatal and postnatal exposure was evaluated, including parameters indirectly related to exposure and health adversities, such as sociodemographic and anthropometric parameters and dietary factors. The primary outcome of the study was that the identified perturbations related to the TCA cycle are mainly associated with impaired mitochondrial respiration, which is detrimental to cellular homeostasis and functionality; this is further potentiated by the capacity of heavy metals to induce oxidative stress. Insufficient production of energy from the mitochondria during the perinatal period is associated with developmental disorders in children. The HERACLES cohort included more detailed data regarding diet and sociodemographic status of the studied population, allowing the identification of a broader spectrum of effect modifiers, such as the beneficial role of a diet rich in antioxidants such as lycopene and ω-3 fatty acids, the negative effect the consumption of food items such as pork and chicken meat has or the multiple impacts of fish consumption. Beyond diet, several other factors have been proven influential for child neurodevelopment, such as the proximity to pollution sources (e.g., waste treatment site) and the broader living environment, including socioeconomic and demographic characteristics. Overall, our results demonstrate the utility of exposome-wide association studies (EWAS) toward understanding the relationships among the multiple factors that determine human exposure and the underlying biology, reflected as omics markers of effect on neurodevelopment during childhood.
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We conducted in-class written surveys of fourth to eighth grade children's eating and smoking behaviours in southwestern Ontario (n=870) and Charlottetown (n=423) in order to facilitate local school boards' and health units' planning of health education initiatives. Using chi-square analysis, we examined sex, grade, provincial and rural-urban differences in behaviours. No rural-urban differences emerged. While students reported few gender differences in food group consumption, more PEI students consumed French fries, snack foods, cakes and cookies, and regular soft drinks daily. Only 60.1% (3791630) of girls and 70.0% (4621660) of boy's (chi(2) = 13.8; p<0.001) ate breakfast every day, falling to 53.2% (115/216) among eighth grade girls, and 32.9% (25/76) among students who smoked. The prevalence of smoking was 4.8% (n=40) in Ontario and 8.5% (n=36) in PEI (chi(2) = 6.8; p<0.01). Compared to nonsmokers, a higher proportion of students who smoked consumed snack foods and regular soft drinks daily. The results emphasize the need to promote healthy eating behaviours and anti-smoking messages among school children.
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We examined the effects of omitting breakfast on the cognitive functions of three groups of children: stunted, nonstunted controls, and previously severely malnourished. They were admitted to a metabolic ward twice. After an overnight fast half the children received breakfast on their first visit and a cup of tea the second time. The treatment order was reversed for the other half. When breakfast was omitted, both the stunted and previously malnourished groups responded similarly. The malnourished groups had lower scores in fluency and coding whereas the control group had higher scores in arithmetic. The children were divided into wasted and nonwasted groups. Wasted children were adversely affected in the digit span backwards tests, and wasted members of the malnourished groups were adversely affected in efficiency of problem solving and those in the control group in digit span forwards. These results indicate that cognitive functions are more vulnerable to missing breakfast in poorly nourished children.
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Approximately 40 micronutrients are required in the human diet. Deficiency of vitamins B-12, folic acid, B-6, niacin, C, or E, or iron, or zinc, appears to mimic radiation in damaging DNA by causing single- and double-strand breaks, oxidative lesions, or both. The percentage of the US population that has a low intake (< 50% of the RDA) for each of these eight micronutrients ranges from 2% to greater than or equal to 20%; half of the population may be deficient in at least one of these micronutrients. Folate deficiency occurs in approximately 10% of the US population, and in a much higher percentage of the poor. Folate deficiency causes extensive incorporation of uracil into human DNA (4 million/cell), leading to chromosomal breaks. This mechanism is the likely cause of the increased cancer risk, and perhaps the cognitive defects associated with low folate intake. Same evidence, and mechanistic considerations, suggest that vitamin B-12 and B-6 deficiencies also cause high uracil and chromosome breaks. Micronutrient deficiency may explain, in good part, why the quarter of the population that eats the fewest fruits and vegetables (five portions a day is advised) has approximately double the cancer rate for most types of cancer when compared to the quarter with the highest intake. Eighty percent of American children and adolescents and 68% of adults do not eat five portions a day. Common micronutrient deficiencies are likely to damage DNA by the same mechanism as radiation and many chemicals, appear to be orders of magnitude more important, and should be compared for perspective. Remedying micronutrient deficiencies is likely to lead to a major improvement in health and an increase in longevity at low cost. Aging appears to be due, in good part, to the oxidants produced by mitochondria as by-products of normal metabolism. In old rats mitochondrial membrane potential, cardiolipin levels, respiratory control ratio, and overall cellular O-2 consumption are lower than in young rats, and the level of oxidants (per unit O-2) is higher. The level of mutagenic aldehydes from lipid peroxidation is also increased. Ambulatory activity declines markedly in old rats. Feeding old rats the normal mitochondrial metabolites acetyl carnitine and lipoic acid for a few weeks, restores mitochondrial function, lowers oxidants to the level of a young rat, and increases ambulatory activity. Thus,these two metabolites can be considered necessary for health in old age and are therefore conditional micronutrients. This restoration suggests a plausible mechanism: with age-increased oxidative damage to proteins and lipid membranes causes a deformation of structure of key enzymes, with a consequent lessening of affinity (K-m) for the enzyme substrate; an increased level of the substrate restores the velocity of the reaction, and thus restores function.
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A randomized, controlled trial measured the short-term impact of the Peruvian school breakfast programme on the diet, school attendance, and cognition of fourth- and fifth-graders. Ten schools on the rural outskirts of the Andean city of Huaraz were randomly assigned to a control or a treatment group. The programme significantly increased (p < .01) dietary in-takes of energy by 15.2%, protein by 16.1%, and iron by 60%, and improved rates of attendance. Analysis of covariance also showed improved performance on a vocabulary test among heavier children, as indicated by a positive and significant weight × treatment interaction (parameter = 0.37; F = 4.97; < .05). It is plausible that among stunted children, being relatively overweight (by the weight-for-height index) poses a cognitive risk that can be partially reversed by a school breakfast.