RESEARCH
Guest Editorial
Defining Nutritious Breakfasts and Their
Benefits
Johanna Dwyer, DSc, RD
ARTICLE INFORMATION
Article history:
Accepted 3 October 2014
2212-2672/Copyright ª 2014 by the Academy of Nutrition and Dietetics.
http://dx.doi.org/10.1016/j.jand.2014.10.005
B
REAKFAST HAS LONG BEEN CONSIDERED THE MOST
important meal of the day, and recent research has
reaffirmed its nutritional benefits, as well as other
positive outcomes, including feelings of well-being
immediately after consumption and longer-term improve-
ments in overall diet quality. There is also intriguing, but less
conclusive, evidence of improved weight management,
reduced risk of cardiovascular disease and type 2 diabetes,
and better cognitive performance.1 However, despite com-
mon belief in and scientific support for its importance, break-
fast is frequently skipped, and the composition of a nutritious
breakfast is poorly defined.
The two articles in this supplement to the Journal of the
Academy of Nutrition and Dietetics address the need for a clear
definition of breakfast, including nutrient needs, timing, and
optimal components in terms of foods and beverages. The
first article, “The Role of Breakfast in Health: Definition and
Criteria for a Quality Breakfast,” is a commentary that brings
together the perspectives of nutrition researchers and com-
municators with expertise in community and public health,
education, child and school nutrition, Hispanic nutrition, and
pediatrics to provide a framework for determining what
constitutes a nutritious breakfast. The authors echo the 2010
Dietary Guidelines Advisory Committee in noting that the
definition of breakfast has not been consistent across
research studies. They conclude that “the lack of a standard
breakfast definition means that measurement of breakfast
consumption in research is subject to either individual study
participant interpretation of what constitutes breakfast or
differing definitions provided by researchers, which may
account for conflicting research results.”1 To address this
problem, they propose this basic definition of breakfast for
use in all breakfast research:
Breakfast is the first meal of the day that breaks the fast
after the longest period of sleep and is consumed within 2
to 3 hours of waking; it is comprised of food or beverage
Statement of Potential Conflict of Interest and Funding/Support: See page S7.
ª 2014 by the Academy of Nutrition and Dietetics.
from at least one food group, and may be consumed at
any location.1
The authors also propose criteria for a “quality” breakfast
that are suitable for consumer use. They reviewed current
research on breakfast, including consumption frequency and
energy and nutrient intake, consumer perceptions, and ideal
outcomes, and then used that information to develop a more
evidence-based definition of foods and beverages in a
nutritious breakfast pattern. In doing this, the authors
perform a real service for nutrition and dietetics practitioners
that will simplify our counseling tasks by describing the
pluses and minuses of each pattern in detail. It will come as
no surprise to registered dietitian nutritionists to learn that
there are many patterns for good breakfasts that contribute
reasonable amounts of calories while decreasing the content
of nutrients to limit, and contributing considerable amounts
of nutrients for which intakes need to be increased because
they are lacking in many American diets.
The authors also stress the importance of translating and
communicating breakfast guidance to consumers, industry,
and policymakers. They provide specific approaches for doing
so, including highlighting the tangible, personal benefits of
eating breakfast, and providing specific strategies for over-
coming barriers to daily breakfast eating. Also welcome is the
authors’ call “for more clinical research examining the impact
of breakfast consumed, using a standard definition, on
nutrient intakes, diet quality, and health biomarkers in lon-
gitudinal studies or using multiple days of assessment.”1 In
addition to these good suggestions, it would be helpful to
carry out rigorous randomized experimental studies in actual
classroom situations on the effects of breakfasts of various
types on cognition and attention in the classroom. Although
it is often assumed that breakfasts have positive effects, very
few high-quality studies exist on their presence.
A recent systematic review of existing evidence on the role
of energy and nutrients provided by breakfast on the accom-
plishment of school-related tasks and cognition concluded
that there was insufficient quantity and consistency among
existing studies to draw firm conclusions, and that the hy-
pothesis of better and more sustained performance with a
breakfast providing more than 20% daily energy intake still
needed substantiation.2 However, the review did find some
mixed evidence that a lower postprandial glycemic response
present with breakfast was beneficial to cognitive perfor-
mance, and this is worth pursuing. The ability of school
breakfast programs to encourage students to come to school
needs much more study in the United States. There is
conclusive evidence that this is true in developing countries,
but very little work has been done in highly industrialized
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RESEARCH
countries. There is good reason to suspect academic perfor-
mance will improve if school breakfasts attract students who
otherwise might not come to school on time or at all.3 Perhaps
it is also time to review the energy contributions of the Na-
tional School Breakfast Program—the current criterion is that
approximately 25% of a child’s energy needs are offered.
Considering the prevalence of obesity in children, should the
breakfast as served be less, with an option of getting freely
available seconds for children who ask for more?
The second article in the supplement, “Nutrient Intake, Diet
Quality, and Weight/Adiposity Parameters in Breakfast
Patterns Compared with No Breakfast in Adults: National
Health and Nutrition Examination Survey 2001-2008,” is new
research reviewing the literature that compares “nutrient
intake, diet quality, and weight/adiposity measures of con-
sumers assigned to different breakfast patterns with break-
fast skippers.”4 The National Health and Nutrition
Examination Survey (NHANES) data were used to categorize
the most prevalent breakfast patterns of US adults into 12
groups, and then the impact of those patterns on nutrient
intakes and diet quality was assessed.
The authors used cluster analysis to identify breakfast
consumption patterns based on the calorie intake from
certain foods. Of the 12 patterns identified, the most popular
was the Grain/100% Fruit Juice pattern consumed by nearly
25% of the sample. What is more surprising is that the second
most common pattern was skipping breakfast entirely, at
nearly 19%. There was no evidence that the skippers had
lower or higher energy intakes throughout the day than the
breakfast eaters. The contributions of calories to intakes
varied from about 4% to 26% of total energy intakes. When
the authors examined each pattern according to the energy
and nutrients consumed as well as the consumers’ weight
and adiposity, they discovered that, overall, breakfast had a
positive impact on nutrient intake and diet quality compared
with skipping breakfast, and that breakfast patterns including
nutrient-dense foods, such as fortified cereals, fruit, and low-
fat milk, might have an even greater impact on nutrient
intake, diet quality, and weight loss and maintenance. These
tantalizing observations from the NHANES population-based
cross sectional study need to be confirmed with more
definitive evidence from experimental studies on the asso-
ciations of breakfast with energy balance. Is it simply that
those who eat breakfast also have other characteristics and
lifestyles that may alter energy balance for the better and
favor weight maintenance, or is it that breakfast actually
changes energy balance for the better?
There is some new evidence from a randomized study of
English adults who were told to eat a large breakfast of about
700 kcal or no breakfast at all until noon, and who were then
monitored over a 6-week period. By the end of the study, no
metabolic adaptation to breakfast was apparent in resting
metabolic rates of the eaters vs those who had no breakfast.
Total daily intakes remained almost 500 kcal per day greater
than in the no breakfast after fasting group, suggesting
imperfect compensation. Over time, if there were little or no
compensation either by decreased energy intake at other
times of the day or increased physical activity, one might
expect very large breakfasts to increase overall energy in-
takes. Body mass and fatness were similar in the breakfast
and no breakfast groups at both baseline and at follow up.
Neither adipose tissue glucose uptake nor systemic indices of
S6 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
cardiovascular health differed at the end of the study,
although by the sixth week of the study, continuously
measured blood sugar levels were more variable during the
afternoon and evening among those who had been in the no
breakfast arm than in those in the breakfast group.5 However,
this was a small study, with only 33 subjects in all, and the
breakfasts served were very large by American standards. It
would be useful to repeat the study in the United States with
a “quality” breakfast similar to some of the lower-calorie
patterns identified in this supplement to the Journal, and to
carry out the intervention for a longer time.
Another recently published article focuses on whether
breakfast recommendations are helpful in weight loss, a
logical inference from some cross-sectional studies that
report that breakfast eaters have lower body weights than
breakfast skippers.6 The randomized clinical trial of 16 weeks
duration was among overweight and obese people with body
mass indices from 25 to 40 who were stratified according to
their pre-randomization breakfast eating habits. Weight
changes were observed over a 4-month period among the
experimental group, who were told to eat breakfast, and
another control group, who were told to skip breakfast.
Among the 283 participants who completed the study,
adherence to their assigned groups was good. However,
neither their initial breakfast-eating status nor the treatment
to which they were randomized had any effect on changes in
weight and, at the end of the study, there were no discern-
able differences in weight loss between the two groups.
The authors of the articles in this supplement are to be
commended for putting together this complex and confusing
literature. Taken together, they advance the understanding of
breakfast and its impact on health by establishing a consis-
tent definition of breakfast for use in research, identifying
existing breakfast consumption patterns, and proposing
optimal components and guidance for the composition of a
nutritious breakfast for both adults and children. With this
knowledge, nutrition and dietetics practitioners will be well-
equipped to educate consumers and policymakers alike on
the important benefits a nutritious breakfast can provide.
There is much evidence from the studies reviewed here and
others that eating breakfast can add to the quality of overall
nutrient intakes and some health indices.7 But it is the type of
breakfast that determines the size and direction of these ef-
fects. This is the message we need to remember ourselves
and impress upon consumers.
References
1. O’Neil CE, Byrd-Bredbenner C, Hayes D, Jana L, Klinger SE, Stephenson-
Martin S. The role of breakfast in health: Definition and criteria for a
quality breakfast. J Acad Nutr Diet. 2014;114(suppl 3):S8-S26.
2. Edefonti V, Rosato V, Parpinel M, et al. The effect of breakfast
composition and energy contribution on cognitive and academic
performance: A systematic review. Am J Clin Nutr. 2014;100(2):
626-656.
3. Levitsky DA. Next will be apple pie. Am J Clin Nutr. 2014;100(2):503-
504.
4. O’Neil CE, Nicklas TA, Fulgoni VL III. Nutrient intake, diet quality, and
weight/adiposity parameters in breakfast patterns compared with
no breakfast in adults: National Health and Nutrition Examination
Survey 2001-2008. J Acad Nutr Diet. 2014;114(suppl 3):S27-S43.
5. Betts JA, Richardson JD, Chowdhury EA, Homan GD, Tsintzas K,
Thompson D. The causal role of breakfast in energy balance and
health: A randomized controlled trial in lean adults. Am J Clin Nutr.
2014;100(2):539-547.
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6. Dharandhar EJ, Dawson J, Alcorn A, et al. The effectiveness of breakfast 7. Williams PG. The benefits of breakfast cereal consumption: A
recommendations on weight loss: A randomized controlled trial. Am J systematic review of the evidence base. Adv Nutr. 2014;5(5):
Clin Nutr. 2014;100(2):507-513. 636S-673S.

AUTHOR INFORMATION
J. Dwyer is professor of medicine, Tufts Medical School, and senior nutrition scientist, Jean Mayer USDA Human Nutrition Research Center on
Aging, Tufts University, Boston, MA.
Address correspondence to: Johanna Dwyer, DSc, RD, Frances Stern Nutrition Center, Box 783, Tufts Medical Center, 800 Washington St, Boston,
MA 02111. E-mail: DwyerJ1@od.nih.gov
STATEMENT OF POTENTIAL CONFLICT OF INTEREST
J. Dwyer owns stock in Kellogg’s, General Mills, and ConAgra Foods, and is a Public Trustee of ILSI North America.
FUNDING/SUPPORT
Publication of this article was supported by an unrestricted educational grant from the Kellogg Company. J. Dwyer received an honorarium from
the Academy of Nutrition and Dietetics for serving as guest editor of this supplement.
ACKNOWLEDGEMENTS
The assistance of Ryan Baechler is acknowledged with thanks.

December 2014 Suppl 3 Volume 114 Number 12 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS S7