Abstract
BackgroundCurrent guidance regarding the role of daily breakfast in human health is largely grounded in cross-sectional observations. However, the causal nature of these relationships has not been fully explored and what limited information is emerging from controlled laboratory-based experiments appears inconsistent with much existing data. Further progress in our understanding therefore requires a direct examination of how daily breakfast impacts human health under free-living conditions.Methods/DesignThe Bath Breakfast Project (BBP) is a randomised controlled trial comparing the effects of daily breakfast consumption relative to extended fasting on energy balance and human health. Approximately 70 men and women will undergo extensive laboratory-based assessments of their acute metabolic responses under fasted and post-prandial conditions, to include: resting metabolic rate, substrate oxidation, dietary-induced thermogenesis and systemic concentrations of key metabolites/hormones. Physiological and psychological indices of appetite will also be monitored both over the first few hours of the day (i.e. whether fed or fasted) and also following a standardised test lunch used to assess voluntary energy intake under controlled conditions. Baseline measurements of participants' anthropometric characteristics (e.g. DEXA) will be recorded prior to intervention, along with an oral glucose tolerance test and acquisition of adipose tissue samples to determine expression of key genes and estimates of tissue-specific insulin action. Participants will then be randomly assigned either to a group prescribed an energy intake of ≥3000 kJ before 1100 each day or a group to extend their overnight fast by abstaining from ingestion of energy-providing nutrients until 1200 each day, with all laboratory-based measurements followed-up 6 weeks later. Free-living assessments of energy intake (via direct weighed food diaries) and energy expenditure (via combined heart-rate/accelerometry) will be made during the first and last week of intervention, with continuous glucose monitors worn both to document chronic glycaemic responses to the intervention and to verify compliance.Trial registrationCurrent Controlled Trials ISRCTN31521726.
Highlights
Current guidance regarding the role of daily breakfast in human health is largely grounded in crosssectional observations
* Correspondence: Kostas.Tsintzas@nottingham.ac.uk 3School of Biomedical Sciences, Queen’s Medical Centre, Nottingham, NG7 2UH, UK Full list of author information is available at the end of the article. It is over four decades since Pavel Fábry and colleagues published their studies showing positive correlations between infrequent daily meal patterns and overweight, hypercholesterolaemia, impaired glucose tolerance and ischaemic heart disease [1]
Summerbell et al (1995) reanalysed the data from 3 existing studies across a range of age groups and found that the commonly reported associations between frequent daily meal patterns/high energy intake at breakfast and overweight do not persist once corrected for ‘unreasonably low’ energy intakes [23]. These corrected results fall into agreement with the one other existing cross-sectional study which found no relationship between daily meal frequency and percent body fatness as determined by hydrostatic weighing, in which dietary records were managed on an individual basis via telephone [24]
Summary
Current guidance regarding the role of daily breakfast in human health is largely grounded in crosssectional observations. Summerbell et al (1995) reanalysed the data from 3 existing studies across a range of age groups and found that the commonly reported associations between frequent daily meal patterns/high energy intake at breakfast and overweight do not persist once corrected for ‘unreasonably low’ energy intakes [23]. These corrected results fall into agreement with the one other existing cross-sectional study which found no relationship between daily meal frequency and percent body fatness as determined by hydrostatic weighing, in which dietary records were managed on an individual basis via telephone [24]. Issues regarding the accurate measurement of changes in energy intake may even question the validity of these findings
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