Breakfast is often referred to as the most important meal of the day. But for children it's essential, says dietitian Nicole Dos Santos and plays a vital role in brain growth and development rise1 

Nicole Dos Santos RDChief paediatric dietitian, St George's Healthcare NHS Trust 

Key points 

  • Statistics show increasing numbers of children miss breakfast - up to 42 per cent
  • Children's brains are twice as active as adult's brains with higher fuel (glucose) demands
  • Breakfast is critical if a child's brain fuel demands are to be met following an overnight fast
  • The ideal breakfast has yet to be identified - however, all the evidence highlights that any breakfast is better than no breakfast at all
  • The evidence clearly demonstrates that ready-to-eat breakfast cereals are vital and healthy breakfast options for children's active minds

Breakfast is always referred to as the most important meal of the day, particularly for mental health development in the young. But in an era where the emphasis is on evidence based medicine, does science support this notion and, furthermore, is any breakfast better than none?

Are children's breakfast habits a cause for concern?  

Although the majority of UK children eat breakfast, the number that miss breakfast is increasing with more than a tenth of 0 to10 year olds and almost one-fifth (19 per cent) of 11 to16 year olds regularly missing breakfast1,2. This mirrors global trends with 25 per cent of US children and 10-30 per cent of European children reported to miss breakfast3,4. A 2005 review of US and European studies has reported that up to 42 per cent of children and adolescents don't eat a regular breakfast5. But a greater concern is that older children - particularly adolescent girls and children of lower socio-economic backgrounds - are more likely to miss breakfast2,6. Moreover, children who don't eat breakfast tend to follow other less favourable lifestyle habits such as smoking, less physical activity and are more likely to be on self-imposed weight loss dietary regimens5. In contrast, regular breakfast consumers tend to follow healthier overall lifestyle habits, are more likely to meet dietary recommendations and have a healthier body weight7.

Bright minds...  

Children's brains are exceptionally active with a metabolic rate twice that of adults7,8,9. The preferred brain fuel is glucose, which means that during fasting periods when the child is asleep the brain has to rely heavily on glucose stores - muscle glycogen. Compared to adults, children's muscle mass is significantly smaller and they tend to sleep for longer periods - resulting in glycogen stores being more readily depleted by the morning7,9. The significantly greater cerebral metabolic demands for glucose fuel in children and the importance of optimum cognitive function for academic achievements highlights the importance of nutrients at breakfast times.

Fuelling the brain for higher IQs?  

The evidence to date clearly demonstrates an association between breakfast consumption in children and adolescents with improved cognitive function, school performance and mood5,7,8,10,11. This was confirmed by a review of 45 studies, which concluded that breakfast consumption had an overall positive effect on cognitive function compared to breakfast omission7. The improvement in cognitive function was demonstrated in short-term trials and longer-term school breakfast programme (SBP) studies. These findings reflect the conclusion of an earlier review of 47 studies5. The cognitive improvements consistently seen in studies comparing breakfast consumption with breakfast omission specifically relate to short- and longterm memory function - ability to acquire, store and recall information learnt - as well as greater vigilance with fewer errors in attention tasks5,7,10. The impact of breakfast consumption on cognition is more prevalent later on in the morning of tests (up to two hours after breakfast consumption).

School Breakfast Programmes (SBP)  

Thirteen studies investigating the impact of SBP demonstrate provision of breakfast in schools to improve significantly cognitive function, mood, school performance and attendance1,2,5,7. It is difficult to come to an overall conclusion from SBP studies as there are several confounding factors; individuals who attend SBPs will have a learnt association between breakfast consumption and learning, have better school attendance and less likely to be late for class, all of which will influence cognition and school performance7.

Low versus high GI choices  

To date, studies comparing the type of breakfast consumed rather than just consuming vs not consuming breakfast are few. Such studies have mainly compared breakfast of varying glycaemic index (GI) or glycaemic load (GL). GI reflects the rate at which glucose levels rise in the blood stream - low GI breakfasts result in a steady and longer rise in blood sugar whilst high GI breakfasts result in a rapid rise in blood sugar followed quickly by a rapid drop. Theoretically, low GI breakfasts, which provide a steady stream of fuel to the brain, are preferred. GL Index goes one step further and takes into consideration quality of carbohydrate and impact on blood glucose (GI) as well as the quantity (serving size) of carbohydrate consumed at breakfast (the higher the carbohydrate load the bigger the overall glucose rise)7,10,12. A 2011 randomised cross-over trial in 74 11 to 14 year olds demonstrated benefits of a low GI and high GI breakfast; a high GI breakfast improved speed of information processing and vigilance as well as alertness and happiness. But the low GI breakfast improved the ability to retain, store and recall information that may be more conducive for academic performance in children8. Despite a growing number of trials in this area, the evidence is inconclusive as to which type of breakfast is best for our young.

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Healthy breakfast options: 

● Fortified whole grain breakfast cereal served with a low fat milk or yogurt and a handful of berries 

● Wholemeal toast with peanut butter, a spoon of raisins and a small banana

● Bagel spread with an unsaturated margarine and served with a poached egg and a small glass of fruit juice

● Wholemeal pancakes served with stewed fruit and cinnamon sprinkled yogurt.

The overall research indicates that it is not the composition of breakfast that conveys benefits on cognitive function, but the act of consuming a solid  breakfast versus no breakfast at all or a glucose liquid breakfast7,10,11,13.  

Cognitive function in relation to breakfast The underlying mechanism for breakfast's impact on cognitive function remains unclear, but providing adequate glucose energy to meet children's high cerebral metabolic rate is important. Other factors resulting from an elevated blood glucose level through the provision of breakfast may also positively influence cognition: acetyl choline, insulin, serotonin, glutamate and cortisol levels which also impact on cognitive function7,9. It is important to recognise the impact of the long-term provision of nutrients on mental performance; especially adequate iron status in the early years of life. Other factors include:   

The physical action of consuming breakfast, which is associated with improved alertness and motivation to concentrate  

The learned behaviour association with feeling of wellness  

Reduced hunger  

Long-term impact of improved iron and other micronutrient status. Are ready-to-eat breakfast cereals credible brain fuel?   

Walking down the local supermarket breakfast cereal aisles, we cannot ignore the huge choice of brightly packaged cereals targeted at the young. And this is reflected in market data, where ready-to-eat (RTE) breakfast cereals are the most popular breakfast food for children, with 95 per cent of UK households spending some £1.8billion in 200814,15,16. For some time breakfast cereals have gained bad press for their sugar and salt content. However, looking at the evidence and continuing manufacturer product re-formulations, breakfast cereals are proving to be an increasingly credible breakfast option. Vitamin and mineral fortification and the increasing prevalence of whole grain RTE breakfast cerealsnow on the market has brought about significant improvements in children's nutrition intakes and overall status (see Table 1)6,17,18. Despite common misconceptions, most RTE breakfast cereals contribute little to overall salt, saturated fat and sugar (non-milk extrinsic sugars) intakes of UK children17,18. The most recent government National Diet and Nutrition Survey (NDNS, 2010) demonstrates that RTE breakfast cereals contribute; less than five per cent total sugar intakes; less than two per cent salt and saturated fat intakes while being the main whole grain, fibre, vitamin and mineral contributors to children's diets18. These findings are similar to the previous NDNS of 200017.    rise1t 

The extensive variety of whole grain fortified RTE breakfast cereals on the market provides parents with an easy and practical way to help their children meet their nutritional requirements and help toward their academic achievements (see Table 1). Conclusion Although we are still not certain of the perfect brain breakfast option, the scientific evidence is convincing that providing a solid breakfast is important for fuelling the minds of our nation's future generation. For parents and carers needing practical solutions for providing a well balanced breakfast for their children, whole grain RTE breakfast cereals are a good option, providing credible brain fuel and contributing significantly to the overall nutrition and health status of our young. 

This article is supported by an educational grant from Nestlé Cereal Partners. It represents the independent views of the author and has been independently peer reviewed by JFHC. For more Information please see www.wholegrain.co.uk or email info@ nutrilicious.co.uk. The information was correct at the time of publication (December 2011 / January 2012).

References 

1. Defeyter MA et al. (2010). Breakfast clubs: availability for British schoolchildren and the nutritional, social and academic benefits. Nutrition Bulletin 35, 245-253 

2. Ruxton C (2010). School and community breakfast clubs - it's not just the food! Dietetics Today, 36(12), 22-26 

3. Siega-Riz AM et al (1998). Trends in Breakfast Consumption for Children in the United States from 1965-1991. American Journal of Clinical Nutrition, 67(suppl), 748S-756S 

4. Mullen BA et al. (2010). A systematic review of the quality, content and context of breakfast consumption. Nutrition and Food Science, 40(1), 81-114 

5. Rampersaud GC et al. (2005). Breakfast habits, nutritional status, body weight and academic performance in children and adolescents. Journal American Dietetic Association, 105, 743-760 

6. Albertson AM et al. (2009). The relationship of RTE cereal consumption to nutrient intake, blood lipids and BMI of children as they age through adolescence. JAMA, 109(9), 1557-1565. 

7. Hoyland A et al. (2009). A systematic review of the effect of breakfast on the cognitive performance of children and adolescents. Nutrition Research Reviews, 32, 220-243 

8. Micha R et al. Glycaemic index and glycaemic load of breakfast predict cognitive function and mood in school children: a randomized controlled trial. British Journal Nutrition, 1-10 

9. Taki Y et al. (2010). Breakfast staple types affect brain gray matter volume and cognitive function in healthy children. PLoS ONE 5(12), e15213 

10. Ingwersen J et al. (2007). A low glycaemic index breakfast cereal preferentially prevents children's cognitive performance from declining throughout the morning. Appetite, 49, 240-244 

11. Wesnes KA et al. (2003). Breakfast reduced declines in attention and memory over the morning in schoolchildren. Appetite, 41, 329-331 

12.. Gilsenan MB, de Bruin EA and Dye L (2009). The influence of carbohydrate on cognitive performance: a critical evaluation from the perspective of glycaemic load. British Journal of Nutrition,101, 941-949 

13. Mahoney CR et al. (2005). Effect of breakfast composition on cognitive processes in elementaryschool children. Physiology & behaviour, 85, 635-645 

14.www.breakfastcereal.org RTE data 52 w/e 2004 [Accessed November 2011] 

15.www.breakfastcereal.org/Minteldata 2002 [Accessed November 2011] 

16. Global Mintel Report 2010 - UK breakfast cereals.www.eatoutmagazine.co.uk/online_article/Britsbowled-over-by-breakfast-cereals,-says-Mintel/10037 [Accessed November 2011] 

17. Gregory JR et al. (2000). National Diet and Nutrition Survey: young people aged 4-18 years. Vol 1: Report of the diet and nutrition survey. London: TSO 

18. Bates B, Lennox A, Swan G National Diet and Nutrition Survey headline results from year 1 of the rolling programme (2008-2009). London: FSA and DH, 2010http://www.food.gov.uk/science/dietarysurveys/ndnsdocuments/ndns0809year1[Accessed November 2011]