Baum JI, Gray M, Binns A. Breakfasts higher in protein increase postprandial energy expenditure, increase fat oxidation, and reduce hunger in overweight children from 8 to 12 years of age [published online ahead of print August 12, 2015]. J Nutr. doi:10.3945/jn.115.214551.
This randomized crossover design study examined the differences in postprandial energy metabolism, fat oxidation, and reduced food intake at lunch following either a protein-based breakfast or a carbohydrate-based breakfast in normal weight and overweight children aged 8 to 12 years.
Data was analyzed from 16 normal weight children (BMI<85th percentile for age) and 13 overweight/obese children (BMI>85th percentile for age) who were randomly assigned to a group that either received a high-protein breakfast (344 kcal, 21% protein, 52% carbohydrates, and 27% fat) or a high-carbohydrate breakfast (327 kcal, 4% protein, 67% carbohydrates, 29% fat). During the following 4 hours, energy expenditure, substrate oxidation, appetite, and blood glucose were measured at 15 min, 30 min, 60 min, 120 min, and 240 min intervals. After 4 hours, participants were given access to a food buffet and amount of food consumption was measured.
Postprandial energy expenditure, fat and carbohydrate oxidation, appetite, and blood glucose levels following either a high-protein or high-carbohydrate breakfast were compared.
Overweight/obese children who received a high-protein breakfast experienced greater energy expenditure (P<0.0001) and fat oxidation than either of the normal weight groups. In both normal weight and overweight/obese children, fat oxidation was 16% greater (P<0.05) in the group that had a high-protein breakfast, and carbohydrate oxidation was 32% greater (P<0.01) at 4 hours. Blood glucose levels at 30 minutes were much greater (+10%; P<0.05) in the group who received the high-carbohydrate breakfast, but were higher at 240 min in the group who received the high-protein breakfast (93.7 + 1.1 vs. 88.1 + 1.3; P<0.01). All children who received the high-protein breakfast reported decreased hunger (-145; P< 0.01) and increased satiety (+32%; P< 0.05) compared to those who received the high-carbohydrate breakfast. At lunch, there was no difference between the normal weight and overweight/obese children in amount of food consumption.
While the importance of eating a high-protein breakfast has become fairly well- accepted among health care practitioners and their patients, this study highlights the implications this could have for children specifically. Not only does a high-protein breakfast appear to better stabilize blood sugar over time and increase fat and carbohydrate oxidation but, possibly more startling and exciting, overweight/obese children appear to have a greater energy expenditure following a high-protein breakfast than normal weight children who ate a high-protein or high-carbohydrate breakfast.
The National Health and Nutrition Examination Survey (NHANES) from the U.S. Department of Health and Human Services tells us that adolescent obesity prevalence has increased from 1999 to 2014, and that from 2011 to 2014 the prevalence of obesity in youth was 17%.1 A similar publication in 2014 reported that in 2011 to 2012, 16.9% of children 2 to 19 years of age were obese (measured at a BMI at or above the 95th percentile for sex-specific CDC growth charts).2 If we go a little deeper, we find that obesity prevalence increased proportionally with age group as well. Between 2009 and 2012, obesity prevalence was 10.3% in children age 2 to 5, 17.9% in children age 6 to 11, and 19.4% in adolescents age 12 to 19 for both boys and girls.3
Another study published in September 2015 compared normal-protein to high-protein breakfasts in overweight/obese adolescents who usually skipped breakfast. The study found that high-protein breakfasts correlated with improved weight management, voluntary reductions in food intake, and reductions in overall daily hunger.4 So we’re seeing from multiple studies that a high-protein breakfast does in fact reduce perceived hunger and responsive food consumption in adolescents, leading to better weight management.
Shifting from carbohydrate-laden cereals and Eggo waffles to more protein-dense options is only part of the challenge. The greater struggle practitioners may face is changing the reality that 20% to 30% of adolescents are skipping breakfast altogether.5 We have to face the realities that these young people are living in—time constraints and low income have become serious obstacles possibly at the root of this dilemma. Perhaps rather than just telling our patients to eat more protein, or to “find time” for breakfast, we can instead teach them how to make that possible through easy and affordable on-the-go meal prepping options. By finding a way to make breakfast accessible to this population again, through direct work with teens or indirectly through parent/school support, we may be able to affect major modifiable health factors before these “kids” come stumbling into our offices with even more complex health concerns during their 30s and 40s.
- Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;(219):1-8.
- Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814.
- Health, United States, 2014: With Special Features on Adults Aged 55-64. Hyattsville, MD: National Center for Health Statistics; 2015.
- Leidy HJ, Hoertel HA, Douglas SM, Higgins KA, Shafer RS. A high-protein breakfast prevents body fat gain, through reductions in daily intake and hunger, in "breakfast skipping" adolescents [published online ahead of print August 4, 2015]. Obesity, Silver Spring. 2015;23(9):1761-1764. doi:10.1002/oby.21185.
- The Case for Eating Breakfast. American Academy of Pediatrics Web site. Updated November 21, 2015.