Breakfast Consumption Is Positively Associated with Usual Nutrient Intakes among Food Pantry Clients Living in Rural Communities

Abstract

Background: Breakfast consumption has declined over the past 40 y and is inversely associated with obesity-related diet and health outcomes. The breakfast pattern of food pantry clients and its association with diet is unknown.

Objective: The objective is to investigate the association of breakfast consumption with diet quality and usual nutrient intakes among food pantry clients (n = 472) living in rural communities.

Methods: This was an observational study using cross-sectional analyses. English-speaking participants ≥18 y (or ≥19 y in Nebraska) were recruited from 24 food pantries in rural high-poverty counties in Indiana, Michigan, Missouri, Nebraska, Ohio, and South Dakota. Participants were surveyed at the pantry regarding characteristics and diet using 24-h recall. A second recall was self-completed or completed via assisted phone call within 2 wk of the pantry visit. Participants were classified as breakfast skippers when neither recall reported breakfast ≥230 kcal consumed between 04:00 and 10:00; breakfast consumers were all other participants. The Healthy Eating Index-2010 was modeled with breakfast pattern using multiple linear regression. Mean usual intake of 16 nutrients was estimated using the National Cancer Institute Method and compared across breakfast pattern groups. Usual nutrient intake was compared with the Estimated Average Requirement (EAR) or Adequate Intake (AI) to estimate the proportion of population not meeting the EAR or exceeding the AI.

Results: A total of 56% of participants consumed breakfast. Compared with breakfast skippers, breakfast consumers had 10-59% significantly higher usual mean intakes of all nutrients (P ≤ 0.05), and had 12-21% lower prevalence of at-risk nutrient intakes except for vitamin D, vitamin E, and magnesium.

Conclusions: Adult food pantry clients living in rural communities experienced hardships in meeting dietary recommendations. Breakfast consumption was positively associated with usual nutrient intakes in this population. This trial was registered at clinicaltrials.gov as NCT03566095.

Keywords: Healthy Eating Index; breakfast; eating pattern; emergency food assistance; food insecurity; food pantry; low income; nutrient inadequacy; usual intake.

Copyright © The Author(s) 2019.

Figures

FIGURE 1

Percentage of adult food pantry clients living in rural communities with usual nutrient intakes below the EAR. Means of usual intake were estimated using the National Cancer Institute Method. The main predictor in the models (separate model for each nutrient) for estimating usual intake was breakfast pattern categories. Covariates in the usual nutrient intake models included total energy intake, sex (men, women), age (18–44 y, 45–64 y, ≥65 y), household food security status (food security, food insecurity), highest level of education (high school or less, above high school), household size (1, 2, ≥3), day of the week of dietary recall (weekday, weekend), and sequence of the dietary recall (first, second). The %DISTRIB SAS macro produced the mean usual intake for each breakfast pattern category and the proportions of participants consuming below the EAR for 14 nutrients. The cut-off approach was used for assessing the prevalence not meeting the EARs for women aged between 31 and 50 y, including vitamin A [500 μg retinol activity equivalents (RAE)/d], vitamin D (10 μg/d), vitamin E [12 mg α-tocopherol equivalents (ATE)/d], vitamin C (60 mg/d), folate (320 μg/d), vitamin B-6 (1.1 mg/d), vitamin B-12 (2.0 μg/d), riboflavin (0.9 mg/d), thiamin (0.9 mg/d), niacin (11 mg/d), calcium (800 mg/d), magnesium (265 mg/d), iron (8.1 mg/d), and zinc (6.8 mg/d). For nutrients without established EARs, the prevalence exceeding the Adequate Intake was calculated for potassium (4700 mg/d) and fiber (25 g/d, not shown in Figure 1). EAR, Estimated Average Requirement.