Caloric Intake

Nutritional Pearl: For Breakfast, It's Not How Much You Eat, But What You Eat

Author
Timothy S. Harlan, MD
  • Most dietitians and culinary medicine specialists will advise their patients to eat a healthy breakfast of whole grains (carbohydrates), quality protein, and a moderate amount of fats. A good example is peanut butter on whole wheat toast or a scrambled egg on whole wheat toast.

    But why is eating breakfast important? Some research suggests that having a quality breakfast meal means consuming fewer calories throughout the day, while other studies might not see an effect on total caloric intake but rather a much higher diet quality overall. There is also little agreement on how much people should be eating at breakfast. Most Western societies have their smallest meal in the morning, a slightly larger meal around noon, and the largest meal of the day in the evening, at dinner time.

    The Research

    But a large nutritional survey study in Australia found that consuming a larger breakfast relative to daily energy intake was associated with better dietary profiles.1

    The authors utilized data from 2011 and 2012 gathered through the Australian National Nutrition and Physical Activity Survey. More than 9000 adult men and women responded to detailed, Australia-specific dietary questionnaires conducted in person, by professionals, as well as providing health and demographic information.

    Specifically, the researchers focused on breakfast, allowing the participants to describe the time and content of what they considered "breakfast,” noting if they felt they consumed such a morning meal at all. The authors allowed the participants to decide what "breakfast" meant to them in terms of timing, but generally, this was a meal of about 300 calories or so, consumed in the morning.

    About 86% of the Australians surveyed said that they consumed breakfast. Of those, the researchers grouped the breakfast-eaters into four increasing levels of consumption by the percentage of each participant's total daily calories. The first quartile consumed less than 12% of their daily calories at breakfast, the second quartile consumed at least 12% and up to 17.9% of their daily calories at breakfast, the third quartile consumed 18% to 25.5% of their daily calories at breakfast, and the highest quartile consumed at least 25.5% of their daily calories at breakfast.

    What's interesting is that the researchers could find no relationship between the participants' breakfast habits and their BMI—those who ate breakfast, regardless of how many of their daily calories were consumed in the morning, were equally likely to be overweight or obese as those who skipped breakfast.

    Still, when the authors considered the participants' overall nutritional profile, they found that those who did eat breakfast tended to have a healthier diet, as measured by the Healthy Eating Index for Australian Adults (HEIFA-2013), with greater intakes of protein, fiber, and micronutrients and lower intakes of saturated fat, added sugars, and alcohol.

    Further, those who consumed the greatest percentage of their calories from breakfast and those who skipped breakfast altogether seemed to have the lowest daily caloric intakes. That said, those who skipped breakfast had the lowest overall dietary quality.

    What’s the Take Home?

    The research is a practical, if incremental, addition to the evidence for consuming breakfast. As we've seen in other research, eating breakfast may help you reduce overall caloric intake later in the day—perhaps by helping you to avoid eating fast foods or other junk. As the authors note, "... although omitting breakfast may achieve an energy deficit, it may be detrimental to health in the long term."

    Once again, while it's helpful to work on your maintaining weight, it's far more important for your health to improve the quality of the calories you consume.

    Reference:

    1. Wang W, Grech A, Gemming L, Rangan A. Breakfast size is associated with daily energy intake and diet quality. Nutrition. 2020(75-76):110764. doi:10.1016/j.nut.2020.110764

    Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance. 

    Timothy S. Harlan, MD, FACP, CCMS, is a practicing, board-certified Internist. He is currently an Associate Professor of Medicine at George Washington University and Director of the GW Culinary Medicine Program.

    Health meets Food: the Culinary Medicine Curriculum, is an innovative program teaching medical students about diet and lifestyle that bridges the gap between the basic sciences, clinical medicine, the community, and culinary education. Medical students work side-by-side in the kitchen with culinary students to teach each other, and most importantly, teach the community and patients how to return to their kitchens and transform their health. 

    He served as Associate Dean for Clinical Services at Tulane University School of Medicine and is the founder and Senior Advisor of the Goldring Center for Culinary Medicine, the first-of-its-kind teaching kitchen operated by a medical school.

    Dr Harlan attended medical school at Emory University School of Medicine in Atlanta, Georgia, and pursued his residency at Emory University School of Medicine Affiliated Hospitals in Atlanta, GA.