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Clinician Article

Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials.



  • Sievert K
  • Hussain SM
  • Page MJ
  • Wang Y
  • Hughes HJ
  • Malek M, et al.
BMJ. 2019 Jan 30;364:l42. doi: 10.1136/bmj.l42. (Review)
PMID: 30700403
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Public Health
    Relevance - 6/7
    Newsworthiness - 5/7
  • Endocrine
    Relevance - 5/7
    Newsworthiness - 6/7

Abstract

OBJECTIVE: To examine the effect of regular breakfast consumption on weight change and energy intake in people living in high income countries.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: PubMed, Ovid Medline, and CINAHL were searched for randomised controlled trials published between January 1990 and January 2018 investigating the effect of breakfast on weight or energy intake. ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform search portal were also searched in October 2018 to identify any registered yet unpublished or ongoing trials.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials from high income countries in adults comparing breakfast consumption with no breakfast consumption that included a measure of body weight or energy intake. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Random effects meta-analyses of the effect of breakfast consumption on weight and daily energy intake were performed.

RESULTS: Of 13 included trials, seven examined the effect of eating breakfast on weight change, and 10 examined the effect on energy intake. Meta-analysis of the results found a small difference in weight favouring participants who skipped breakfast (mean difference 0.44 kg, 95% confidence interval 0.07 to 0.82), but there was some inconsistency across trial results (I2=43%). Participants assigned to breakfast had a higher total daily energy intake than those assigned to skip breakfast (mean difference 259.79 kcal/day, 78.87 to 440.71; 1 kcal=4.18 kJ), despite substantial inconsistency across trial results (I2=80%). All of the included trials were at high or unclear risk of bias in at least one domain and had only short term follow-ups (mean period seven weeks for weight, two weeks for energy intake). As the quality of the included studies was mostly low, the findings should be interpreted with caution.

CONCLUSION: This study suggests that the addition of breakfast might not be a good strategy for weight loss, regardless of established breakfast habit. Caution is needed when recommending breakfast for weight loss in adults, as it could have the opposite effect. Further randomised controlled trials of high quality are needed to examine the role of breakfast eating in the approach to weight management.

STUDY REGISTRATION: PROSPERO registration number CRD42017057687.


Clinical Comments

Endocrine

This meta-analysis and systematic review of weight loss trials suggests that participants did better with not having breakfast. This study is not overly significant; not one I would go out of my way to read.

Endocrine

This study highlights the poor quality of studies related to the impact of breakfast on weight regulation and the need for additional high quality randomizes controlled trials that do not exist to date.

Family Medicine (FM)/General Practice (GP)

This study really calls into question the idea that eating breakfast helps patients lose weight. (As Will Rogers said, "It isn't what we don't know that gets us in trouble. It's what we know that ain't so.") The study's major problem is that it cannot address other possible beneficial effects of breakfast. So, in terms of overall health, it offers little value.

General Internal Medicine-Primary Care(US)

I am not sure this paper will help us give guidance. It is tricky to sort out a clean intervention here.

General Internal Medicine-Primary Care(US)

Useful systematic review and meta-analysis, largely to assess the evidence base for the commonly held belief that eating breakfast can help with efforts to lose weight. As is often the case, it turns out the evidence does not support the belief or the recommendation. This may not be the last word on the value of breakfast (authors point out that energy expenditure in morning might be greater in breakfast eaters). Ultimately, the value of breakfast may depend more on what people eat, rather than on whether or not they eat.

General Internal Medicine-Primary Care(US)

Another item from childhood found to be untrue. We don't have to eat breakfast (and we can swim after eating and we don't have to drink 8 glasses of water each day). The science around human nutrition is surprisingly thin.

Public Health

The systematic review was done in a reasonable manner, but the underlying data quality is not strong. This is probably of interest to those who are obesity researchers, but I don't think the findings are robust enough for direct application to practice.

Public Health

Well-presented meta-analysis of small studies that are generally at high risk for bias. However, I would expect that bias from non-blinding, for example, to favor the intervention given the prevailing belief that breakfast improves health. In any case, this confirms that we should focus on things other than encouraging breakfast.

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