THE CAUSAL ROLE OF BREAKFAST IN

ENERGY BALANCE AND HEALTH: A

RANDOMIZED CONTROLLED TRIAL IN OBESE
ADULTS
E N H A D A C H O W D H U RY , J U D I T H D R I C H A R D S O N , G E O F F R E Y D H O L M A N , KO S TA S T S I N T Z A S ,
DY L A N T H O M P S O N , A N D JA M E S A B E TT S

Cally Byrne
CVRR Rotation
Jeff Luckring MS, RD, LD

BACKGROUND
Breakfast is the most
important meal of the
day!
Current evidence
Cross-sectional associations
Prospective studies
Different breakfast types vs.
presence/absence of breakfast

OBJECTIVE
To compare the effects of daily breakfast
consumption relative to extended
morning fasting on energy balance and
human health.

DESIGN
Randomized Controlled Trial
Free-living conditions
6-week period: breakfast vs.
fasting
Assessed energy balance and
health

PARTICIPANTS
Obese cohort from Bath Breakfast Project
n=23
Inclusion criteria:
21-60,
Record of regular menstrual cycle/contraceptive use
No anticipated changes in diet and/or physical activity habits during the study
period
Weight stable (2% over 6 mos.)
Non-shift workers
Not pregnant or breastfeeding
Free from any other condition or behavior deemed to pose undue personal risk or
introduce bias into the experiment

INTERVENTION
6-week intervention
Assigned group
Breakfast Group: >700 kcals before 11:00 AM daily, w/ at least half consumed within 2
hours of waking
Fasting Group: Abstained from ingesting energy-providing nutrients until 12:00 PM
each day

INTERVENTION
Week 1: Baseline/Monitored
Intervention
Laboratory assessments, anthropometrics,
key metabolites/hormones
Monitored by Actiheart and Continuous
Glucose Monitor

Weeks 2-4: Free-living Intervention

Wore Actiheart device
Food diaries

Week 6: Follow-up/Monitored
Intervention
Laboratory assessments, anthropometrics,
key metabolites/hormones
Monitored by Actiheart and Continuous

MAIN OUTCOME MEASURES

Primary Outcome
Measure: Components of
energy balance
Secondary Outcome
Measures:
Regulatory/mechanistic data,
markers of CV health, markers
of metabolic control at
baseline and follow-up

STATISTICAL ANALYSES
SPSS version 22
Paired or independent ttests
Mixed-model ANOVA
P < 0.05

RESULTS

Breakfast Group Physical Activity

Thermogenesis
> Fasting Group Physical Activity
Thermogenesis before 12:00pm
(P=0.03)

No significant
difference in Diet
Induced
Thermogenesis
(P=0.3)
No significant
difference in
RMR (P=0.8)

KEY FINDINGS
1. No difference in reported total energy intake,
indicating compensatory effect
2. Breakfast Group: Greater physical activity
thermogenesis before 12:00PM
3. Breakfast Group: Decreased insulinemic response
to OGTT
4. No evidence that omitting breakfast impacts body
weight

CONCLUSIONS
Compensation Effect of Obese
Individuals > Compensation Effect of
Lean Individuals
Morning fasting lower physical
activity expenditure
Breakfast Weight loss
Breakfast insulin sensitivity
glycemic control

IMPLICATIONS FOR CLINICAL

PRACTICE
Differentiate between
effect of breakfast on
weight vs. other aspects of
health (Ex. Glycemic
control, mental
performance)
Need for larger studies
that focus on impact of
breakfast on weight

REFERENCES
Chowdhury EA, Richardson JD, Holman GD. The causal role of
breakfast in energy balance and health: a randomized controlled
trial in obese adults. Am J Clin Ntrn. 2016;103:747-756.