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Journal of the American College of Nutrition, Vol. 18, No. 2, 171-178 (1999)
Published by the American College of Nutrition

Breakfast Type, Daily Nutrient Intakes and Vitamin and Mineral Status of French Children, Adolescents and Adults

Paul Preziosi, MD1, Pilar Galan, MD, PhD1, Michèle Deheeger1, Nedra Yacoub1, Adam Drewnowski, PhD2 and Serge Hercberg, MD, PhD1

Institut Scientifique et Technique de la Nutrition et de l’Alimentation, Conservatoire National des Arts et Métiers, 2 rue Conté, F-75003 Paris, FRANCE (PP, PG, MD, NY, SH)
The University of Michigan, School of Public Health, 1420 Washington Heights, Ann Arbor, Michigan (AA)

Address reprint requests to: Serge Hercberg, MD, PhD, ISTNA/CNAM, 2 rue Conté, F-75003, Paris, FRANCE


   ABSTRACT
TOP
 FOOTNOTES
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 REFERENCES
 
Objective: to examine associations between the consumption of different types of breakfasts, dietary intakes, and selected indices of nutritional status.

Methods: dietary intakes were obtained using the dietary history method, and serum bioassays were used to assess vitamin and mineral status in a representative community-based sample of 1108 French children (ages 2 to 10 years), adolescents (ages 10 to 18 years), and adults (ages 18 to 65 years). Breakfasts were divided into three categories: low-energy (<15% of the energy RDA), medium-energy (15–25%) and high-energy (>25%).

Results: High-energy breakfasts were associated with the consumption of ready-to-eat (RTE) cereals. High-energy breakfasts and cereal consumption, both more common among children and adolescents than among adults, were also associated with a greater proportion of daily energy from carbohydrate and lower proportion of energy from fat. High-energy breakfasts and cereal consumption were further associated with higher intakes of vitamins and minerals as measured by percent RDAs. High-energy breakfasts and cereal consumption were associated with lower serum cholesterols and improved biochemical indices of nutritional status. Serum concentrations of vitamin B1 (in children and adolescents), vitamin B2 and beta-carotene (in adults) were significantly linked to the level of energy provided by breakfast.

Conclusion: The consumption of breakfast cereals appears to have a positive impact on nutritional status regardless of age.

Key words: breakfast, dietary intakes, recommended dietary allowances (RDAs), nutritional survey, ready-to-eat (RTE) cereals, serum biomarkers, vitamins, minerals, cholesterol


   INTRODUCTION
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
 RESULTS
 REFERENCES
 
The importance of breakfast in assuring adequate nutrient intakes has been documented in numerous studies both in the US and elsewhere [1–4]. Should breakfast be omitted, food consumption during the rest of the day may not provide sufficient nutrients to meet the recommended dietary allowances (RDAs) for vitamins and minerals [5,6].

Although a regular breakfast is an important part of healthy eating habits, there is no general agreement as to what foods ought to be consumed and in what amounts. Some investigators have proposed that an ideal breakfast should provide at least 25% of the recommended daily energy and 25% of the RDA for protein [7–9]. That recommendation was based on the Iowa breakfast study, which examined the impact of different types of breakfasts on a wide range of physiological parameters [10]. While the Iowa study has been subject to serious methodological criticisms [11], later studies confirmed that consuming an inadequate breakfast or no breakfast at all may have adverse effects on physical and mental performance and on overall health [12–15].

Whereas the association between breakfast consumption and adequate nutrient intakes has been addressed previously [16], fewer studies have examined the relationship between breakfast consumption and selected serum biomarkers of vitamin and mineral status or explored the consequences of skipping breakfast altogether. This study, based on a representative sample of French children, adolescents, and adults, explored the connection between breakfast consumption and selected biochemical assays of vitamin and mineral status. Further links were drawn between breakfast size and the consumption of ready-to-eat (RTE) cereals and total daily energy and macro- and micronutrient intakes.


   MATERIALS AND METHODS
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 REFERENCES
 
Population
The sample of residents of the Val-de-Marne district, located South-East of Paris (total population 1.1 million), was selected using two-step random sampling procedures. First, twelve out of 47 towns in the Val-de-Marne were randomly selected using proportional sampling procedures. Second, 75 households at each location were selected at random from telephone directories. Out of 900 households selected, 849 were successfully contacted and 527 agreed to participate in the study (response rate: 62%). This representative community-based sample numbered 1,108 individuals between the ages of two and 65 years.

Demographic characteristics of the sample have been described in previously published research [17]. The sample overrepresented clerical, sales and manual workers (48%) and underrepresented small business owners and agricultural workers (3%). The sample was of 86% French and 14% of immigrant origin.

Dietary Intake Data
Dietary intakes were estimated using the dietary history method [18]. Dietary interviews were conducted at home by trained dietitians. For each meal and for between-meal snacks, the amount and mean frequency of intake over a period of at least six months were recorded for each of 101 foods and beverages. The calculated mean intakes, expressed in grams per day, were representative of habitual diets and accounted for seasonal variations. Energy values and the macro- and micronutrient content of the diet were estimated using a computerized food composition table developed by ISTNA and based on previously published data [19,20].

Information concerning dietary patterns in the communities studied has been provided in other published studies also based on this data set [21–23]. But previous studies dealt only with adults and did not separate food intake meal by meal as is being done here. This is the first study that dealt with the issue of breakfast and included children.

Breakfast was defined as the first eating occasion involving a solid food or a beverage that occurred after waking. Persons who either omitted breakfast completely (at least five times a week) or consumed only a non-caloric beverage such as tea or coffee without sugar or milk were classified as breakfast skippers. Persons who consumed breakfast from three to five times per week on the average were defined as occasional eaters, while frequent breakfast eaters consumed breakfast six to seven times per week.

For purposes of data analysis, breakfast size was divided into three categories, based on the contribution of breakfast energy to the French Recommended Dietary Allowances (RDAs) for energy [24]. Low-energy breakfasts provided <15% of energy RDA; medium-energy breakfasts provided 15–25%, while high-energy breakfasts provided more than 25% of energy by age and gender [24].

Biochemical Assays
Venous blood for plasma biochemistry assays was drawn from fasting subjects between seven am and 10:30 am. Thiamin status was assessed by measuring erythrocyte transketolase (ETK) activity following activation by thiamine pyrophosphate [25]. Riboflavin status was assessed by measuring the activity of erythrocyte glutathione reductase (EGR) following stimulation with flavine adenine dinucleotide. Vitamin B6 status was measured through the activation of erythrocyte glutamate oxaloacetate transaminase (EGOT) with pyridoxal-5-phosphate (PLP coenzyme). Folate status was assessed by determination of erythrocyte folate concentration using a microbiological assay (Lactobacillus Casei) [26]. Vitamin C status was derived from serum ascorbic acid measures [27].

Vitamin A status was determined by measuring serum retinol and beta-carotene concentrations. Serum retinol was measured using HPLC and normal phase (silicagel) isocratic elution with n-hexane/isopropanol (970:30) and detection by UV at 330 nm [28]. Serum beta-carotene was measured by normal phase HPLC on silicagel and isocratic elution with n-hexane/dioxane (990:10) and detection in visible light at 436 nm [28]. Vitamin E status was determined by measuring serum alpha-tocopherol levels using normal phase HPLC on silicagel and elution with n-hexane/ethyl acetate (930:70) and fluorescence detection with excitation at 298 nm and emission at 328 nm [28].

Hemoglobin concentration was measured using a Coulter Counter Model 5560. Serum ferritin was assessed in duplicate using an enzyme-linked immunosorbent assay [29]. Serum zinc, selenium and copper were measured by flame atomic absorption spectrometry (Perkin-Elmer). Total cholesterol concentrations were measured using the COBAS BIO centrifugal analyzer [30].

Statistical Analyses
The data were analyzed using SPSS statistical package (version 3.0). The subjects’ dietary intakes and their vitamin and mineral statuses were examined as a function of diverse breakfast parameters using analyses of variance. Differences in dietary intakes and nutritional status between users and non-users of ready-to-eat (RTE) cereals were tested for significance using t-tests. The data were adjusted by age, and log transforms were employed in some cases to increase normality. Mean daily intakes of energy, protein, vitamins and minerals were compared to the French RDA values [24].


   RESULTS
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
REFERENCES
 
Subjects
The study sample included 235 children (ages 2 to 10 years) and adolescents (ages 10 to 18 years), including 133 boys and 102 girls. The 873 adult subjects (ages 18 to 65 years) included 382 men and 491 women, mean age 42 years. The adolescent group had mean body mass indices (BMI=kg/m2) of 19.3 for boys and 19.4 for girls. Adults had mean BMI values of 24.3 for men and 22.8 for women.

The Contribution of Breakfast to the RDAs
Analyses of breakfast consumption by gender and age group showed that 90% of all respondents ate breakfast, with 86% classified as frequent eaters and 4% as occasional eaters. Breakfast consumption was highest among children (100%) and lowest among adults (females 90%, males 82%). Breakfast was more likely to include a solid food plus a caloric beverage (90%) than a caloric beverage only (10%).

Energy and macronutrient intakes at breakfast are summarized in Table 1. Carbohydrates supplied between 57% and 62% of breakfast energy; proteins supplied between 11% and 13%, while fats supplied between 27% and 30%. On the average, breakfast contributed from 12% to 18% of the RDAs for energy. The contribution of breakfast to energy RDAs was higher among children (15 to 18%) than among adults (13 to 16%). Breakfast also contributed from 8% to 15% of the RDAs for protein. Again, the contribution of breakfast to protein RDAs was proportionately higher among children (12 to 14%) than among adults (9 to 12%).


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  		Table 1. Mean Energy and Macronutrient Intakes at Breakfast as a Function of Sex and Age. The Data Are Means and SDs

 
Breakfast contributed more than 50% of the RDA for vitamin B2 in children. For that age group, breakfast also contributed more than 20% of vitamin B1 and from 10 to 15% of vitamin A, vitamin B6 and vitamin C. The contribution of breakfast to minerals intake for children was in the order of 45% of RDAs for calcium and phosphorus, 33% of RDA for magnesium and between 10 and 15% for iron, zinc and copper. Although breakfast still contributed substantially to the RDAs for vitamins and minerals in adolescents, its contribution declined sharply among adults.

Breakfast Size and Nutrient Intakes
Subsequent analyses addressed associations between breakfast size and daily nutrient intakes. The three breakfast categories were defined as low-energy (<15% RDA), medium-energy (15–25% RDA) and high-energy (>25% RDA). Generally, breakfast size diminished with increasing age. Low-energy breakfasts were consumed by 57% of adults, but by only 40% of children and adolescents. In contrast, medium energy breakfasts were consumed by 49% of children and adolescents and by 34% of adults. High-energy breakfasts were consumed by 11% of children and adolescents and by 9% of adults. Similar patterns of consumption were observed for both men and women.

There are many nutritional advantages to a larger breakfast. As shown in Table 2, high-energy breakfasts were associated with total daily intakes (TDI) that were significantly higher in carbohydrates, but lower in fat and saturated fat. This effect was more pronounced among adults aged 18 to 65 years old than among young people under the age of 18 years. Table 2 also shows that the proportion of carbohydrate in the diet of adults rose from 41 to 46%, while the proportion of fat declined from 38 to 34% depending on breakfast size. High-energy breakfasts appear to be associated with better compliance with some of the key dietary guidelines.


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  		Table 2. Macronutrient Composition of the Daily Diet (% Daily Energy) and Selected Nutrient Intakes (in g/d) as a Function of Age and Breakfast Size

 
Breakfast type also had a measurable impact on meeting the RDAs for vitamins and minerals. Table 3 shows that RDAs for selected vitamins (B1 and B2) and minerals were higher among young people and adults consuming higher-energy breakfasts.


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  		Table 3. Mineral and Vitamin Intakes (as % RDAs) as a Function of Age and Breakfast Size. The Data Are Means and SDs

 
Impact of RTE Cereals on Nutrient Intakes
Ready-to-eat (RTE) cereal consumers and nonconsumers did not differ in any key demographic characteristic. Moreover there were no significant differences in smoking prevalence between consumers and nonconsumers. Consumption of RTE cereals was directly linked to breakfast size. Regular consumers of RTE cereals were more likely to consume medium or high-energy breakfasts. Cereal consumption also declined with age. As shown in Fig. 1, regular consumers of RTEC were more likely (80%) to consume medium and high-energy breakfasts providing more than 25% of the energy RDAs. In contrast, persons who did not consume RTE cereals were more likely (>50%) to consume breakfasts providing less than 15% of the energy RDAs.



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  		Fig. 1. Relationship between RTEC consumption and breakfast size.

 
Energy intakes and the macronutrient composition of the diet for RTE consumers and nonconsumers are summarized in Table 4. Regardless of age group, consumers of RTE cereals derived a greater proportion of daily energy from carbohydrate and a lesser proportion of energy from fat.


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  		Table 4. Macronutrient Composition of the Diet (Percent Daily Energy) and Alcohol Intakes (in g/d) as a Function of Age and Consumption of RTE Cereals

 
The impact of RTE cereal consumption on vitamin and mineral intakes was even more pronounced. Child and adolescent consumers of RTE cereals had higher dietary intakes of calcium, phosphorus, iron and vitamins B1 and B2 than did nonconsumers. Adult consumers had higher intakes of calcium and phosphorus, vitamins B1 and B2, vitamins A and C and folic acid than did nonconsumers. These data are summarized in Table 5.


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  		Table 5. Mineral and Vitamin Intakes (as % RDAs) as a Function of Age and RTE Consumption

 
Breakfast Type and Nutritional Status
Biological markers that serve as indices of nutritional status are summarized in Table 6. They are presented separately for children and adolescents (age<18 years) and for adults (age>=18 years), and have been grouped by breakfast size. It should be noted that the levels of most vitamins and minerals were measured directly, so that lower numbers correspond to lower concentrations or levels of activity. The water-soluble B vitamins (B1, B2 and B6) are the exception; their levels were measured indirectly through enzyme activation, in which case higher values denote lower vitamin B activity.


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  		Table 6. Serum Biochemistry Indices of Nutritional Status as a Function of Age and Breakfast Size. The Data Are Means and SDs

 
As can be seen in Table 6, vitamin B1 status in young people and vitamin B2 status and beta-carotene levels in adults were significantly higher in subjects consuming high-energy breakfasts. However, serum cholesterol levels were not significantly different among the three groups.

Similar analyses compared vitamin and mineral status of consumers of RTE cereals relative to nonconsumers. These data are summarized in Table 7. Among young people (age<18 years), consumers of RTE cereals had higher serum vitamin B2 and beta-carotene concentrations than did nonconsumers. Among adults, cereal consumers had higher levels of vitamin B1 and B2 status, higher serum levels of folate and beta-carotene and lower levels of total cholesterol. In addition, diets of cereal consumers were more nutrient dense even after adjustment for age.


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  		Table 7. Serum Biochemistry Indices of Nutritional Status as a Function of Age and RTE Cereal Consumption

 

   DISCUSSION
 
Whereas other studies have previously reported multiple associations between breakfast consumption and improved dietary intakes [6,9,31–38], the present study is among the first to report a relationship between breakfast parameters and selected biochemical assays of nutritional status. Serum vitamin B1 and B2 status as well as serum beta-carotene levels varied as a function of breakfast size and were influenced, moreover, by the consumption of ready-to-eat (RTE) cereals. In addition, persons who consumed low-energy breakfasts had the highest serum cholesterol levels; these results are consistent with prior reports on plasma cholesterol levels in breakfast skippers among both children [39] and adults [40].

The present study confirms earlier reports that most French people (90%) do consume breakfast on a regular basis. Previous observations that breakfast skipping was common in Western societies depended on the study and the population examined. A survey conducted in the US by Morgan et al. [31] showed that approximately 25% of American adults regularly skipped breakfast. A comparable study in Canada [3] reported that 29% of Canadians over the age of 15 years did not consume breakfast regularly. In contrast, a study conducted recently in Ireland [32] showed that 97% of the population, ages 8 to 80 years, reported eating breakfast, In general, adults were far more likely to omit breakfast than were children or adolescents, an observation replicated in the present study. French adults were also less likely to be consumers of RTE cereals than were children or adolescents.

Several studies suggest that the consumption of an inadequate breakfast may contribute to dietary inadequacies, if other meals fail to provide the necessary vitamins and minerals [6,9,33–38]. In our study, consumption of higher-energy breakfasts was associated with regular use of RTE cereals. Both high-energy breakfasts and RTE cereal use were associated with improved nutrition, as measured with reference to the RDAs and selected serum biomarkers. Persons consuming high-energy breakfasts (>25% of energy RDAs) derived more daily energy from carbohydrates and less energy from fat than did those who consumed low-energy breakfasts. Similarly, cereal consumers derived more daily energy from carbohydrate and less energy from fat than did nonconsumers. The present data are consistent with previous observations of Schlundt et al. [41]. However, other investigators have reported, to the contrary, that breakfast skippers also had lower daily intakes of fat, saturated fat and cholesterol [2,31,40].

Consumers of high-energy breakfasts and RTE cereal users had higher daily intakes of vitamins and minerals and were better able to meet the RDAs. These data are consistent with several previous survey studies of children, adolescents and adults, showing that RTE cereal consumption was associated with higher micronutrient intakes [2,31,42,43]. In other studies also, children who consumed RTE cereals derived less of their daily dietary intake from fat and had elevated intakes of vitamins and minerals [1,6,44].

The present data suggest that high-energy breakfasts as well as the consumption of RTE cereals contribute to the consumption of a balanced diet. The strong association between breakfast size and cereal consumption and vitamin and mineral intakes confirm previous studies suggesting that breakfast makes a major contribution to micronutrient consumption. In the present study, estimates of vitamin and mineral intakes were validated using selected serum biomarkers of nutritional status. These findings confirm that encouraging breakfast consumption should continue to be a priority area in the adoption of health-promoting dietary habits.


   FOOTNOTES
TOP
 FOOTNOTES
ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 REFERENCES
 
Supported in part by a research grant from Kellogg’s PA, France.

Received July 1, 1997. Accepted March 1, 1998.


   REFERENCES
TOP
 FOOTNOTES
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 REFERENCES
 

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