The causal role of breakfast in energy balance and health: a randomized controlled trial in lean adults

James A Betts, Judith D Richardson, Enhad A Chowdhury, Geoffrey D Holman, Kostas Tsintzas, Dylan Thompson, James A Betts, Judith D Richardson, Enhad A Chowdhury, Geoffrey D Holman, Kostas Tsintzas, Dylan Thompson

Abstract

Background: Popular beliefs that breakfast is the most important meal of the day are grounded in cross-sectional observations that link breakfast to health, the causal nature of which remains to be explored under real-life conditions.

Objective: The aim was to conduct a randomized controlled trial examining causal links between breakfast habits and all components of energy balance in free-living humans.

Design: The Bath Breakfast Project is a randomized controlled trial with repeated-measures at baseline and follow-up in a cohort in southwest England aged 21-60 y with dual-energy X-ray absorptiometry-derived fat mass indexes ≤11 kg/m² in women (n = 21) and ≤7.5 kg/m² in men (n = 12). Components of energy balance (resting metabolic rate, physical activity thermogenesis, energy intake) and 24-h glycemic responses were measured under free-living conditions with random allocation to daily breakfast (≥700 kcal before 1100) or extended fasting (0 kcal until 1200) for 6 wk, with baseline and follow-up measures of health markers (eg, hematology/biopsies).

Results: Contrary to popular belief, there was no metabolic adaptation to breakfast (eg, resting metabolic rate stable within 11 kcal/d), with limited subsequent suppression of appetite (energy intake remained 539 kcal/d greater than after fasting; 95% CI: 157, 920 kcal/d). Rather, physical activity thermogenesis was markedly higher with breakfast than with fasting (442 kcal/d; 95% CI: 34, 851 kcal/d). Body mass and adiposity did not differ between treatments at baseline or follow-up and neither did adipose tissue glucose uptake or systemic indexes of cardiovascular health. Continuously measured glycemia was more variable during the afternoon and evening with fasting than with breakfast by the final week of the intervention (CV: 3.9%; 95% CI: 0.1%, 7.8%).

Conclusions: Daily breakfast is causally linked to higher physical activity thermogenesis in lean adults, with greater overall dietary energy intake but no change in resting metabolism. Cardiovascular health indexes were unaffected by either of the treatments, but breakfast maintained more stable afternoon and evening glycemia than did fasting.

Figures

FIGURE 1.
FIGURE 1.
Components of energy balance under free-living conditions with either ingestion of ≥700 kcal before 1100 daily (breakfast group) or abstinence from all energy-providing nutrients until at least 1200 daily (fasting group). Values are means ± SEs. Estimated energy intake values for comparison of relative differences between groups are the average of the first [breakfast (n = 16) compared with fasting (n = 17): 2715 ± 565 compared with 2169 ± 490 kcal/d; P = 0.01] and last [breakfast (n = 16) compared with fasting (n = 17): 2745 ± 658 compared with 2214 ± 584 kcal/d; P = 0.02] week of intervention. Resting metabolic rate values (breakfast group, n = 16; fasting group, n = 16) were recorded at follow-up; diet-induced thermogenesis values (breakfast group, n = 16; fasting group, n = 17) were estimated from reported energy intake; physical activity values are the average of the first [breakfast (n = 15) compared with fasting (n = 15): 1455 ± 676 compared with 1015 ± 433 kcal/d; P = 0.04] and last [breakfast (n = 15) compared with fasting (n = 15): 1443 ± 705 compared with 998 ± 423 kcal/d; P = 0.05] week of intervention. The P value above the bar pertains to the overall comparison between groups; P values between the bars pertain to the specific comparison for the relevant component.
FIGURE 2.
FIGURE 2.
Physical activity thermogenesis under free-living conditions with either ingestion of ≥700 kcal before 1100 daily (breakfast group, n = 15) or abstinence from all energy-providing nutrients until at least 1200 daily (fasting group, n = 15). Values are means ± SEs partitioned by the time of day and intensity of energy expenditure. The P value above the bar pertains to the overall comparison between groups; P values between the bars pertain to the specific comparison for the relevant component. MET, metabolic equivalent.
FIGURE 3.
FIGURE 3.
Rates of [U-14C]-d-glucose uptake in adipocytes under basal, physiologic (50 pmol insulin/L), and supraphysiologic (20 nmol insulin/L) conditions, measured at baseline and after 6-wk ingestion of ≥700 kcal before 1100 daily (breakfast group; n = 13) or abstinence from all energy-providing nutrients until at least 1200 daily (fasting group; n = 16). Values are means ± SEs. Three-factor ANOVA (treatment × time × insulin) showed a significant effect of treatment (F = 4.2, P = 0.05) and insulin (F = 17.3, P < 0.001) with no significant effect of time nor any interaction of these factors. Ins, insulin.
FIGURE 4.
FIGURE 4.
Glucose variability before and after 1200 (expressed as CVs) derived from subcutaneous glucose concentrations continuously monitored during the first and last week of either ingesting ≥700 kcal before 1100 daily (breakfast group; n = 16) or abstaining from all energy-providing nutrients until at least 1200 daily (fasting group; n = 16). Values are means ± SEs. Two-factor ANOVA (treatment × time) showed a nonsignificant trend for treatment (F = 3.9, P = 0.06) with no significant effect of time nor any interaction of these factors during the morning (left side of panel) and a significant effect of treatment (F = 6.2, P = 0.02) with nonsignificant trends for time (F = 3.8, P = 0.06) and treatment × time (F = 3.6, P = 0.07) during the afternoon/evening (right side of panel).

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