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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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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?

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

Dear Kate Nyhan from Yale University,

We thank you for your comments regarding the search and possible omissions from our results. You have rightfully pointed out that a limitation of systematic reviews is that some relevant studies may be missed. We have acknowledged this in the manuscript and have noted this in our limitations section, indicating that we may have missed studies that did not mention energy intake or weight loss in the abstract. For this review we examined n=1868 titles and abstracts. The challenges of performing systematic reviews have recently been examined by Bramer et al.

Regarding the specific issue of the study by Nas (2017) that Kate mentioned, we did not include this study because the title of the paper and the abstract indicate that the aim was to focus on the effect of breakfast skipping and dinner skipping on regulation of energy balance and metabolic risk. There was no mention in either the title or abstract of energy intake or weight measures.

On examination of the full text of this paper, it was a study of 17 participants and in Table 2 they report that of the 15 who skipped breakfast, they had less energy intake (controls: mean 2283 sd 487 vs breakfast skippers: mean 2248 sd 486 (kcal/day), supporting the conclusions of our study. Importantly that study concluded that compared with consuming 3 meals/day, meal skipping increased energy expenditure.

Thank you,

Kate Sievert, Sultana Monira Hussain and Flavia Cicuttini on behalf of the study team.

References:
Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6(1):245
Nas, A., et al. (2017). "Impact of breakfast skipping compared with dinner skipping on regulation of energy balance and metabolic risk." Am J Clin Nutr 105(6): 1351-1361.

Competing interests: No competing interests

06 February 2019
Katherine E Sievert
Research officer
Sultana Monira Hussein, Flavia M Cicuttini
Monash University
School of Public Health and Preventative Medicine