Effects of eating breakfast on children and adolescents: A systematic review of potentially relevant outcomes in economic evaluations
Background: Breakfast is often described as the most important meal of the day. Several studies have focused on examining if breakfast habits have any short-term effects on school attendance, academic achievement, and general health in children and adolescents. Informed decisions of whether to promote eating breakfast or not require a more long-term perspective.
Objective: The aim of this study was to conduct a systematic review of scientific publications studying the effects identified as potentially relevant for the economic evaluation of eating breakfast in children and adolescents.
Design: A systematic literature review was conducted. Studies were identified by searching the electronic databases PubMed, CINAHL, Web of Science, and PsycINFO between January 2000 and October 2017. The inclusion criteria applied were published articles from peer-reviewed journals with full text in English, quantitative studies collecting primary data with school-aged children, and adolescents aged from 6 to 18 years as participants, performed entirely or partly in countries with advanced economies, except Japan and Taiwan.
Results: Twenty-six studies fulfilled the inclusion criteria, and studies that were judged to be of at least moderate quality were included in the analysis. The results of the review of eating breakfast studies showed positive and conclusive effects on cognitive performance, academic achievement, quality of life, well-being and on morbidity risk factors.
Conclusions: The overall assessment of the studies indicated positive effects of eating breakfast. How the identified effects influence societal costs and an individual’s quality-adjusted life years require further research.
- Riby L, Smith M, Foster JK. Nutrition and mental performance: a lifespan perspective. Basingstoke: Palgrave Macmillan; 2012.
- Blondin SA, Anzman-Frasca S, Djang HC, Economos CD. Breakfast consumption and adiposity among children and adolescents: an updated review of the literature. Pediatr Obes 2016; 11(5): 333–48. doi: 10.1111/ijpo.12082.
- Dye L, Adolphus K, Lawton C. Associations between habitual school-day breakfast consumption frequency and academic achievement in British adolescents. Ann Nutr Metab 2015; 67: 372.
- Kennedy S, Ryan L, Clegg ME. Associations between breakfast consumption, attitudes towards breakfast and physical activity in adolescents. Proc Nutr Soc 2015; 74(Oce1):E99. doi: 10.1017/S0029665115001147.
- Littlecott HJ, Moore GF, Moore L, Lyons RA, Murphy S. Association between breakfast consumption and educational outcomes in 9–11-year-old children. Public Health Nutr 2016; 19(9): 1575–82. doi: 10.1017/S1368980015002669.
- Adolphus K, Lawton CL, Dye L. The effects of breakfast on behavior and academic performance in children and adolescents. Front Hum Neurosci 2013; 7: 425. doi: 10.3389/fnhum.2013.00425.
- Lazzeri G, Pammolli A, Azzolini E, Simi R, Meoni V, de Wet DR, et al. Association between fruits and vegetables intake and frequency of breakfast and snacks consumption: a cross-sectional study. Nutr J 2013; 12:123. doi: 10.1186/1475-2891-12-123.
- Huang CJ, Hu HT, Fan YC, Liao YM, Tsai PS. Associations of breakfast skipping with obesity and health-related quality of life: evidence from a national survey in Taiwan. Int J Obesity 2010; 34(4): 720–5.
- Ahadi Z, Qorbani M, Kelishadi R, Ardalan G, Motlagh ME, Asayesh H, et al. Association between breakfast intake with anthropometric measurements, blood pressure and food consumption behaviors among Iranian children and adolescents: the CASPIAN-IV study. Public Health 2015; 129(6): 740–7. doi: 10.1016/j.puhe.2015.03.019.
- Mahoney CR, Taylor HA, Kanarek RB, Samuel P. Effect of breakfast composition on cognitive processes in elementary school children. Physiol Behav 2005; 85(5): 635–45. doi: 10.1016/j.physbeh.2005.06.023.
- Siega-Riz AM, Popkin BM, Carson T. Trends in breakfast consumption for children in the United States from 1965–1991. Am J Clin Nutr 1998; 67(4): 748s–56s. doi: 10.1093/ajcn/67.4.748S.
- Moore GF, Tapper K, Murphy S, Lynch R, Raisanen L, Pimm C, et al. Associations between deprivation, attitudes towards eating breakfast and breakfast eating behaviours in 9–11-year-olds. Public Health Nutr 2007; 10(6): 582–9. doi: 10.1017/s1368980007699558.
- Murray NG, Low BJ, Hollis C, Cross AW, Davis SM. Coordinated school health programs and academic achievement: a systematic review of the literature. J Sch Health 2007; 77(9): 589–600. doi: 10.1111/j.1746-1561.2007.00238.x.
- Adolphus K, Lawton CL, Champ CL, Dye L. The effects of breakfast and breakfast composition on cognition in children and adolescents: a systematic review. Adv Nutr (Bethesda, Md) 2016; 7(3): 590s–612s. doi: 10.3945/an.115.010256.
- Burrows T, Goldman S, Pursey K, Lim R. Is there an association between dietary intake and academic achievement: a systematic review. J Hum Nutr Diet 2017; 30(2): 117–40. doi: 10.1111/jhn.12407.
- National Foreign Assessment Center (U.S.), United States. Central Intelligence Agency. The world factbook. Washington, DC: Central Intelligence Agency. 2019 Mar [about 1 p.]. Available from: https://www.cia.gov/library/publications/the-world-factbook/appendix/appendix-b.html [cited 2019 Mar 12].
- Egger M, Smith GD, Altman DG. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Books; 2001.
- Riegelman R. Studying a study & testing a test: reading evidence-based health research. 6th ed: Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2012.
- Adolphus K, Lawton CL, Dye L. The relationship between habitual breakfast consumption frequency and academic performance in British adolescents. Front Public Health 2015; 3: 68. doi: 10.3389/fpubh.2015.00068.
- Benton D, Jarvis M. The role of breakfast and a mid-morning snack on the ability of children to concentrate at school. Physiol Behav 2007; 90(2–3): 382–5. doi: 10.1016/j.physbeh.2006.09.029.
- Karatzi K, Moschonis G, Barouti A-A, Lionis C, Chrousos GP, Manios Y. Dietary patterns and breakfast consumption in relation to insulin resistance in children. The healthy growth study. Public Health Nutr 2014; 17(12): 2790–7. doi: 10.1017/S1368980013003327.
- Kral TV, Heo M, Whiteford LM, Faith MS. Effects on cognitive performance of eating compared with omitting breakfast in elementary schoolchildren. J Dev Behav Pediatr 2012; 33(1): 9–16. doi: 10.1097/DBP.0b013e31823f2f35.
- Lopez-Sobaler AM, Ortega RM, Quintas ME, Navia B, Requejo AM. Relationship between habitual breakfast and intellectual performance (logical reasoning) in well-nourished schoolchildren of Madrid (Spain). Eur J Clin Nutr 2003; 57 Suppl 1:S49–53. doi: 10.1038/sj.ejcn.1601815.
- Maffeis C, Fornari E, Surano MG, Comencini E, Corradi M, Tommasi M, et al. Breakfast skipping in prepubertal obese children: hormonal, metabolic and cognitive consequences. Eur J Clin Nutr 2012; 66(3): 314–21. doi: 10.1038/ejcn.2011.206.
- McIsaac JL, Kirk SF, Kuhle S. The association between health behaviours and academic performance in Canadian elementary school students: a cross-sectional study. Int J Environ Res Public Health 2015; 12(11): 14857–71. doi: 10.3390/ijerph121114857.
- Overby NC, Ludemann E, Hoigaard R. Self-reported learning difficulties and dietary intake in Norwegian adolescents. Scand J Public Health 2013; 41(7): 754–60.
- Hjorth MF, Sorensen LB, Andersen R, Dyssegaard CB, Ritz C, Tetens I, et al. Normal weight children have higher cognitive performance – Independent of physical activity, sleep, and diet. Physiol Behav 2016; 165: 398–404. doi: 10.1016/j.physbeh.2016.08.021.
- Ptomey LT, Steger FL, Schubert MM, Lee J, Willis EA, Sullivan DK, et al. Breakfast intake and composition is associated with superior academic achievement in elementary schoolchildren. J Am Coll Nutr 2016; 35(4): 326–33. doi: 10.1080/07315724.2015.1048381.
- Papoutsou S, Briassoulis G, Wolters M, Peplies J, Iacoviello L, Eiben G, et al. No breakfast at home: association with cardiovascular disease risk factors in childhood. Eur J Clin Nutr 2014; 68(7): 829–34. doi: 10.1038/ejcn.2014.88.
- Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the childhood determinants of adult health study. Am J Clin Nutr 2010; 92(6): 1316–25. doi: 10.3945/ajcn.2010.30101.
- Hallstrom L, Labayen I, Ruiz JR, Patterson E, Vereecken CA, Breidenassel C, et al. Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr 2013; 16(7): 1296–305. doi: 10.1017/s1368980012000973.
- Marlatt KL, Farbakhsh K, Dengel DR, Lytle LA. Breakfast and fast food consumption are associated with selected biomarkers in adolescents. Prev Med Rep 2016; 3: 49–52. doi: 10.1016/j.pmedr.2015.11.014.
- Moschiano F, Messina P, D'Amico D, Grazzi L, Frediani F, Casucci G, et al. Headache, eating and sleeping behaviors and lifestyle factors in preadolescents and adolescents: preliminary results from an Italian population study. Neurol Sci 2012; 33 Suppl 1:S87–90. doi: 10.1007/s10072-012-1048-3.
- Sese MA, Jimenez-Pavon D, Gilbert CC, Gonzalez-Gross M, Gottrand F, de Henauw S, et al. Eating behaviour, insulin resistance and cluster of metabolic risk factors in European adolescents. The HELENA Study. Appetite 2012; 59(1): 140–7. doi: 10.1016/j.appet.2012.04.011.
- Walter S. Lifestyle behaviors and illness-related factors as predictors of recurrent headache in U.S. adolescents. J Neurosci Nurs 2014; 46(6): 337–50. doi: 10.1097/jnn.0000000000000095.
- Wennberg M, Gustafsson PE, Wennberg P, Hammarstrom A. Poor breakfast habits in adolescence predict the metabolic syndrome in adulthood. Public Health Nutr 2015; 18(1): 122–9. doi: 10.1017/s1368980013003509.
- Wennberg M, Gustafsson PE, Wennberg P, Hammarstrom A. Irregular eating of meals in adolescence and the metabolic syndrome in adulthood: results from a 27-year prospective cohort. Public Health Nutr 2016; 19(4): 667–73. doi: 10.1017/s1368980015001445.
- Wesnes KA, Pincock C, Richardson D, Helm G, Hails S. Breakfast reduces declines in attention and memory over the morning in schoolchildren. Appetite 2003; 41(3): 329–31. doi: 10.1016/j.appet.2003.08.009.
- Wesnes KA, Pincock C, Scholey A. Breakfast is associated with enhanced cognitive function in schoolchildren. An internet based study. Appetite 2012; 59(3): 646–9. doi: 10.1016/j.appet.20121.08.008.
- Widenhorn-Müller K, Hille K, Klenk J, Weiland U. Influence of having breakfast on cognitive performance and mood in 13- to 20-year-old high school students: results of a crossover trial. Pediatrics 2008; 122(2): 279–84. doi: 10.1542/peds.2007-0944.
- Page RM, Simonek J, Ihasz F, Hantiu I, Uvacsek M, Kalabiska I, et al. Self-rated health, psychosocial functioning, and other dimensions of adolescent health in Central and Eastern European adolescents. Eur J Psychiatry 2009; 23(2): 101–14. doi: 10.4321/S0213-61632009000200004.
- Richards G, Smith AP. Breakfast and energy drink consumption in secondary school children: breakfast omission, in isolation or in combination with frequent energy drink use, is associated with stress, anxiety, and depression cross-sectionally, but not at 6-month follow-up. Front Psychol 2016; 7: 106. doi: 10.3389/fpsyg.2016.00106.
- Boschloo A, Ouwehand C, Dekker S, Lee N, de Groot R, Krabbendam L, et al. The relation between breakfast skipping and school performance in adolescents. Mind Brain Educ 2012; 6(2): 81–8. doi: 10.1111/j.1751-228X.2012.01138.x.
- Burrows T, Goldman S, Olson RK, Byrne B, Coventry WL. Associations between selected dietary behaviours and academic achievement: a study of Australian school aged children. Appetite 2017; 116: 372–80. doi: 10.1016/j.appet.2017.05.008.
- Lien L. Is breakfast consumption related to mental distress and academic performance in adolescents? Public Health Nutr 2007; 10(4): 422–8. doi: 10.1017/s1368980007258550.
- Stea TH, Torstveit MK. Association of lifestyle habits and academic achievement in Norwegian adolescents: a cross-sectional study. BMC Public Health 2014; 14: 829. doi: 10.1186/1471-2458-14-829.
- Sampasa-Kanyinga H, Hamilton HA. Eating breakfast regularly is related to higher school connectedness and academic performance in Canadian middle- and high-school students. Public Health 2017; 145: 120–3. doi: 10.1016/j.puhe.2016.12.027.
- Faught EL, Gleddie D, Storey KE, Davison CM, Veugelers PJ. Healthy lifestyle behaviours are positively and independently associated with academic achievement: an analysis of self-reported data from a nationally representative sample of Canadian early adolescents. PLoS One 2017; 12(7):e0181938. doi: 10.1371/journal.pone.0181938.
- Defeyter MA, Russo R. The effect of breakfast cereal consumption on adolescents' cognitive performance and mood. Front Hum Neurosci 2013; 7: 789. doi: 10.3389/fnhum.2013.00789.
- Cooper SB, Bandelow S, Nevill ME. Breakfast consumption and cognitive function in adolescent schoolchildren. Physiol Behav 2011; 103(5): 431–9. doi: 10.1016/j.physbeh.2011.03.018.
- Smith AP. An investigation of the effects of breakfast cereals on alertness, cognitive function and other aspects of the reported well-being of children. Nutr Neurosci 2010; 13(5):230–6. doi: 10.1179/147683010x12611460764642.
- Song F, Parekh S, Hooper L, Loke YK, Ryder J, Kwok CS, et al. Dissemination and publication of research findings: an updated review of related biases. Health Technol Assess 2010; 14(8): 1–220. doi: 10.3310/hta14080.
- Mlinarić A, Horvat M, Smolčić VŠ. Dealing with the positive publication bias: why you should really publish your negative results. Biochem Med 2017; 27(3): 447–52. doi: 10.11613/BM.2017.030201.
- Skelly AC, Dettori JR, Brodt ED. Assessing bias: the importance of considering confounding. Evid Based Spine Care J 2012; 3(1): 9–12. doi: 10.1055/s-0031-1298595.
Authors retain copyright of their work, with first publication rights granted to SNF Swedish Nutrition Foundation. Read the full Copyright- and Licensing Statement.