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

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l42 (Published 30 January 2019) Cite this as: BMJ 2019;364:l42
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Visual summary available

A GOfER diagram (Graphical Overview for Evidence Reviews) showing a visual summary of the included trials from this review.

Opinion

Breakfast—the most important meal of the day?

  1. Katherine Sievert, research officer1,
  2. Sultana Monira Hussain, research fellow1,
  3. Matthew J Page, research fellow2,
  4. Yuanyuan Wang, senior research fellow1,
  5. Harrison J Hughes, junior doctor1,
  6. Mary Malek, medical student1,
  7. Flavia M Cicuttini, head of musculoskeletal unit1
  1. 1Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
  2. 2Research Methodology Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  1. Correspondence to: F M Cicuttini flavia.cicuttini{at}monash.edu
  • Accepted 29 November 2018

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Clinical Trials Registry Platform search portal were also searched in October 2018 to identify any registered yet unpublished or ongoing trials.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.

Footnotes

  • Contributors: KS and SMH share joint first authorship. FMC and CL were involved in designing the study. KS and SMH were involved in searching the database. KS and CL screened citations for inclusion. KS, MJP, and MM were involved in risk of bias analysis. KS, YW, and HJH were involved in extracting data and interpretation. MJP analysed the data. KS, FC, MJP and SMH drafted the manuscript. FMC is study guarantor. All authors reviewed the final manuscript and agreed to be accountable for all aspects of the work and approved the final manuscript for submission. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: This study did not receive any specific funding. SMH is supported by an early career fellowship from the National Health and Medical Research Council (NHMRC; No 1142198); YW is the recipient of NHMRC career development fellowships (clinical level 1, No 1065464); MJP is a recipient of an NHMRC early career fellowship (No 1088535).

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: The data and statistical analysis code for this paper are available on the Open Science Framework: https://osf.io/sqgn9/.

  • FMC affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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