20 and 25% of the recommended dietary allowance
of energy and other nutrients. In western countries,
the widespread fortification of breakfast products
(e.g., cereals) with vitamins and minerals means that
eating an adequate breakfast usually increases the
chances of meeting daily micronutrient requirements.
Many school-aged children miss breakfast or have
inadequate breakfast. Children from poor or disor-
ganized families are at high risk of missing breakfast,
as are children of working mothers. In developing
countries, children may have to walk long distances
to school as well as do household or farming work
before going to school and thus use a considerable
amount of energy before arriving at school. Therefore
eating breakfast is likely to be particularly important.
0002 Studies from several western countries show that
skipping breakfast is common among adolescent
girls. For example, 30% of 14–15-year-old girls in a
Swedish study skipped breakfast. This trend has been
blamed on efforts by young girls to fit ‘desirable’
body images portrayed by the media. Although the
obvious goal for skipping breakfast is to limit calorie
intake, paradoxically, skipping breakfast may actu-
ally increase overall daily calorie intake by increasing
the likelihood of eating more at lunch, or relieving
hunger with higher-fat snacks.
0003 An important question is, does missing breakfast
affect children’s ability to achieve in school? Several
studies have shown that children who usually miss
breakfast have poorer cognition and school achieve-
ment than children who eat breakfast. However,
missing breakfast is often associated with poverty
and disorganized families, which may independently
affect children’s function. Therefore the best evidence
of the effect of eating breakfast comes from experi-
mental studies in which children are given breakfast
or asked to miss it. We will first review evidence for
breakfast affecting children’s cognition, including
attention, memory, and problem-solving.
Breakfast and Cognitive Performance
0004 The short-term effects of having or missing breakfast
have been examined in several studies conducted in
schools. In these, children who had breakfast were
compared with those who did not have breakfast on
tests of cognitive performance. The results were in-
consistent. A possible explanation is that the studies
had no control over the children’s prior diet and
activity and there were no baseline measures before
treatment to compare with after-treatment measures.
The most rigorous experiments have been done in a
laboratory setting, where the effect of missing or
receiving breakfast was examined in the same
children in a crossover design. Children were given
cognitive tests on the mornings when they received
breakfast and when they did not, and their perform-
ance was compared. The studies achieved tight con-
trol over the children’s prior diet and activity by
admitting them overnight to the laboratory before
the experiments. The rigor of the studies was im-
proved by random assignment of children to receive
breakfast or placebo on the first occasion. Two such
studies in the USA found that the children’s perform-
ance on cognitive tests improved when they received
breakfast. In two other studies in Jamaica and Peru,
undernourished children’s cognition deteriorated
when they missed breakfast whereas well-nourished
children were not affected.
0005It appears that the quality of breakfast is also
important. One study from Sweden using a crossover
design found that children who received adequate
breakfast (e.g., cereal, yogurt, sandwiches, and milk)
performed better in tests of creativity and addition as
well as physical exercise compared with those who
ate inadequate breakfast (e.g., sweet rolls and sweet
drink).
0006In a Jamaican study conducted in schools, children
were given breakfast at school regardless of whether
they had it at home. The study had a crossover design
and all children were tested after 1–2 weeks of receiv-
ing breakfast and after not receiving breakfast. In
spite of loss of control over previous diet and activity
the findings were similar to the previous Jamaican
study. The undernourished children showed benefits
in their performance on cognitive tests on the morn-
ings when they received breakfast.
0007In summary, the evidence from the best-controlled
studies indicates that missing breakfast or having
an inadequate breakfast affects children’s cognitive
performance especially if they are already under-
nourished.
How Can Breakfast Affect Cognitive
Performance?
0008The cognitive effects of breakfast are likely to be
mediated by several factors. The relief of hunger
may play a role. Children who miss breakfast may
suffer short-term hunger during midmorning school
work. Hungry children may be easily distracted and
undermotivated and thus not attend to learning tasks.
Eating breakfast can relieve these adverse effects of
hunger on children, thereby improving the children’s
ability to learn.
0009Second, the nutritional components of breakfast
may have direct metabolic benefits on cognition. In
particular, glucose or its precursors is thought to be
important. Several studies in elderly subjects, young
adults, and children have found that glucose drinks
662 BREAKFAST AND PERFORMANCE