By Caitlin Dow, PhD

Breakfast is often considered the “most important meal of the day,” and if you are looking to lose weight, you mustn’t skip breakfast… or so the story goes. This idea is widely believed in popular culture as well as by many nutrition scientists and government bodies and is repeated so often that many in the field consider it health dogma. Indeed, the Dietary Guidelines for Americans even recommend breakfast consumption as an important tool for weight loss. But what does the science say?

Observational studies indicate that breakfast consumption is linked to lower weight. Data from the National Weight Control Registry demonstrated that 78% of the nearly 3,000 subjects included in the analysis (adults who had lost at least 13 kg and kept the weight off for a year or more) reported eating breakfast everyday and only 4% reported never eating breakfast [1]. Further, a recent meta-analysis of observational studies that have evaluated the relation between weight and breakfast consumption found that skipping breakfast was associated with a 55% increased odds of having overweight or obesity [2]. These findings are likely the reason many tout breakfast consumption as an important weight loss modality, despite these studies not actually testing that outcome.

Observational studies can only describe associations, but are not appropriate to determine causation. Thus, randomized controlled trials (RCTs) have sought to test whether breakfast consumption directly impacts weight. In one of the first RCTs to evaluate the role of breakfast in weight loss, Schlundt et al. [3]studied women with obesity who were self-reported breakfast eaters or skippers.Within each group, women were randomized to eat or skip breakfast in addition to following a 1200 kcal/day diet for 12 weeks. All groups lost at least 6 kg, but interestingly, those who were randomized to switch their breakfast condition (e.g. ate breakfast at baseline, then started skipping) lost more weight than those who maintained their breakfast habit. These results suggest that changing an eating behavior in addition to following a reduced calorie diet may accelerate weight loss. However, the results from a study by Dhurandhar et al. did not corroborate those findings. Adults with overweight and obesity were randomized to one of three conditions in which all groups received a USDA pamphlet on healthy eating practices: the control group received no other information, one group received additional instructions to consume breakfast, and the third group was instructed to not eat breakfast [4]. After 16 weeks, there was no observed effect of treatment assignment on weight loss.Contrary to the results from the Schlundt study, baseline breakfast eating habit was not related to weight change, though this study didn’t evaluate breakfast consumption in conjunction with a reduced calorie diet.Finally, in a recently published 4-week study, adults with overweight and obesity were randomized to three different breakfast conditions: water (control), frosted flakes, or oatmeal [5].Interestingly, skipping breakfast resulted in an average weight loss of 1.2 kg, while those randomized to either breakfast condition demonstrated no significant weight change.However, total cholesterol also increased in the control group, suggesting that skipping breakfast may result in slight weight loss, but have detrimental effects on cardiometabolic health.

Thus, the results from the few RCTs completed in adults with overweight and obesity, to date, do not support the notion that breakfast consumption should be part of a weight loss regimen. Importantly, though, the results are also not compelling to suggest that eating breakfast hinders weight loss. This field is still young and many questions remain unanswered. I look forward to more RCTs evaluating breakfast consumption (and potentially, breakfast quality) on various facets of weight and metabolic health.

References

1.Wyatt, H.R., et al., Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obes Res, 2002. 10(2): p. 78-82.

2.Brown, A.W., M.M. Bohan Brown, and D.B. Allison, Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence. Am J Clin Nutr, 2013. 98(5): p. 1298-308.

3.Schlundt, D.G., et al., The role of breakfast in the treatment of obesity: a randomized clinical trial. Am J Clin Nutr, 1992. 55(3): p. 645-51.

4.Dhurandhar, E.J., et al., The effectiveness of breakfast recommendations on weight loss: a randomized controlled trial. Am J Clin Nutr, 2014. 100(2): p. 507-13.

5.Geliebter, A., et al., Skipping breakfast leads to weight loss but also elevated cholesterol compared with consuming daily breakfasts of oat porridge or frosted cornflakes in overweight individuals: a randomised controlled trial. J Nutr Sci, 2014. 3: p. e56.

By: Emma Partridge, MS Candidate

Green tea contains a high concentration of polyphenols, most of which are flavanols. Flavanols are commonly known as catechins, the most active catechin being epigallocatechin-3-gallate (EGCG).1 Within the world of nutrition, green tea is consistently touted as a beverage with a plethora of health benefits. These benefits are far-reaching and specific roles of green tea have been identified to improve symptoms or reverse disease damage amongst people with autoimmune disease, heart disease, cancer, liver disorders, smoking complications, chronic inflammation, and more. The roles of green tea often overlap and while green tea consumption is important for those with various diseases, the consumption of green tea by healthy individuals may be integral in the prevention of many of the following diseases.

Chronic Inflammatory Disease
EGCG may be most important flavanol when it comes to inflammation control.2 EGCG has been shown to suppress the production of cytokines, pro-inflammatory mediators. Suppressing cytokines decreases long-term inflammation and has been shown to improve inflammation-related symptoms in arthritis models.3,4

Autoimmune Disease
In addition to helping to control the chronic inflammation associated with most autoimmune diseases, EGCG has been shown to suppress auto-reactive T cell proliferation. Auto-reactive T cells act against the body, resulting in various forms of autoimmune diseases. EGCG may also help to regulate T-helper cell balance, which may decrease the pathogenesis of arthritic diseases, especially rheumatoid arthritis.3

Type 2 Diabetes Risk
Type 2 Diabetes is sweeping America, and food production practices, availability, and affordability are making it harder for people to access healthy options. The ease of accessing and affording unhealthy foods is increasing the risk of diabetes among populations. Green tea, as well as coffee, has been associated with lowering the risk of type 2 diabetes, though the mechanism is unknown and the data inconsistent. However, in a study of 40,000+ people followed for 10 years, researchers found that daily consumption of at least three cups of coffee or tea may lower type 2 diabetes risk.5

Heart Disease & Stroke Risk
In an article published by the American Heart Association, researchers found that people who drank two to three cups of green tea per day had a 14% lower risk of stoke.6 The research on green tea and stroke risk comes on the wake of multiple studies finding links between green tea and heart health. Multiple studies found green tea consumption to lower risk of death from heart attacks by 26% and lower risk of coronary artery disease by 28%.7

Cancer & Tumor Growth
Cancer is a leading cause of death in the United States, behind heart disease. Green tea has already been shown to be beneficial in preventing the leading cause of death; now studies have now shown that the EGCG may affect transformed cells by inhibiting the growth of certain cell lines, inducing apoptosis, and altering gene expression to prevent transformed cells from becoming cancerous.8

Smoking
The polyphenols in green tea have shown to work against carcinogens, while the antioxidant effects may reverse endothelial dysfunction in healthy smokers.8 The reversal of endothelial dysfunction in smokers is important because it plays a role in the pathogenesis of atherosclerosis and cardiovascular disease.9

Liver Disease
Green tea’s aforementioned anti-carcinogenic affect may play a role in preventing liver disease. Active polyphenols detoxify reactive oxygen species, preventing oxygen free radicals from destroying hepatocytes and causing oxidative DNA damage. Multiple studies have shown that, most likely via this method, green tea intake can attenuate liver disease or liver cancer.10

Weight Loss & Weight Maintenance
Green tea’s affect on weight loss may be attributed to two components: EGCG and caffeine. Caffeine alone does play some role in increasing energy expenditure, but when combined with EGCG, the mixture stimulates energy expenditure and fat oxidation to a greater degree. This may trigger weight loss, and additional evidence reveals that continual green tea consumption can further help to maintain weight.11

In determining whether or not green tea is for you, the answer is likely yes. While there are risks by way of overconsumption, a few glasses a day has been shown to be beneficial for the all-around healthy person in preventing disease and for the person suffering from various diseases or ailments.

1.Ehrlich SD. Green Tea. 2011; http://umm.edu/health/medical/altmed/herb/green-tea.
2.Hamer M. The beneficial effects of tea on immune function and inflammation: a review of evidence from in vitro, animal, and human research. Nutrition Research. 2007;27(7):373-379.
3.Wu DY, Wang JP, Pae M, Meydani SN. Green tea EGCG, T cells, and T cell-mediated autoimmune diseases. Molecular Aspects of Medicine. 2012;33(1):107-118.
4.Kim HR, Rajaiah R, Wu QL, et al. Green Tea Protects Rats against Autoimmune Arthritis by Modulating Disease-Related Immune Events. Journal of Nutrition. 2008;138(11):2111-2116.
5.van Dieren S, Uiterwaal C, van der Schouw YT, et al. Coffee and tea consumption and risk of type 2 diabetes. Diabetologia. 2009;52(12):2561-2569.
6.Green tea, coffee may help lower stroke risk. 2013; http://newsroom.heart.org/news/green-tea-coffee-may-help-lower-stroke-risk.
7.Green tea may lower heart disease risk. Harvard Heart Letter 2012; http://www.health.harvard.edu/heart-health/green-tea-may-lower-heart-disease-risk.
8.Chen ZP, Schell JB, Ho CT, Chen KY. Green tea epigallocatechin gallate shows a pronounced growth inhibitory effect on cancerous cells but not on their normal counterparts. Cancer Letters. 1998;129(2):173-179.
9.Nagaya N, Yamamoto H, Uematsu M, et al. Green tea reverses endothelial dysfunction in healthy smokers. Heart. 2004;90(12):1485-1486.
10.Jin X, Zheng R-h, Li Y-m. Green tea consumption and liver disease: a systematic review. Liver International. 2008;28(7):990-996.
11.Hursel R, Viechtbauer W, Westerterp-Plantenga MS. The effects of green tea on weight loss and weight maintenance: a meta-analysis. International Journal of Obesity. 2009;33(9):956-961.

By Amber Furrer, MS

The term “food security” at a basic level was defined by the World Food Summit of 1996 as “when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life” (FAO 1996). This is obviously a key element in success and well-being of any people, though its realization will look a little bit different in America, where we do still have food insecure, compared to other parts of the world.

There are many facets to the problem: poor infrastructure and organization, poverty, limited education, social injustice and gender inequality, conflict, and lack of natural resources. Solutions also cannot generally be broadly applied because each country experiences these issues differently. Despite the successes of the Green Revolution in agriculture and food research implementation and nutrition interventions since the 1960’s, around 850 million people (or about 15% of the world’s population) remain malnourished. For children specifically, this jumps to 20%. The enormity of the problem can leave a person wondering what possible difference one person or one organization could make.

On May 8, I traveled to Uganda on 3-week assignment with a United States-based NGO whose mission is to serve the vulnerable in developing countries with development and relief efforts. Uganda, like the surrounding countries, is given a “low human development” score in the 2014 Human Development Report by the United Nations. In 2006, 38% of Ugandan children experienced chronic malnutrition, or stunting. Vitamin A and iron deficiency remain critical problems in population health, especially for mother and children (FAO 2010)

The broad focus of my assignment was nutrition education and recipe development for a small-holder farmer cooperative. In general, farmers are an important target for nutrition education because they are able to impact the local food supply and most farmers are women of reproductive age.
Preparing for my trip, I wasn’t sure what kind of impact I would have. A semi-tropical climate allows Ugandans to grow and consume a variety of foods, and on paper I thought their diet seemed pretty adequate. But of course things on paper are always a bit different than what you find in reality.

I spent two days with each group of farmers, the first day communicating (through a translator) the basic, important concepts of nutrition and the second explaining and demonstrating foods and preparation methods that could improve the diet quality of people in their district. I shared the kind of information that we take for granted: the role of carbohydrates, protein, fat, vitamins, and minerals in our bodies and the importance of consuming a balanced diet including a variety of foods in addition to other simple but important tidbits like “don’t feed tea and coffee to your children.” When it came to recipe demonstrations, I explained things that most people in the US could look up on a computer whenever they wanted, but for these women and men was not accessible.

Along the way, I began to recognize that consumption patterns, while related to economic factors, often have more to do with cultural practices and preferences and societal barriers. A visitor to Uganda immediately notices the huge amount of carbohydrate sources consumed at every meal. There are several, including Irish potatoes, (white) sweet potatoes, cassava, green banana, rice, corn and millet-based pastes, and wheat-based chapatti. Ugandans also grow a variety of beans, ground and tree nuts, vegetables, and fruits, so it is not that nutritious foods are totally absent, but are consumed in skewed proportions.

Fruit is considered child’s food, and vegetables (including beans) are consumed in very small amounts. Meat, dairy, and eggs are not widely affordable, and insects and fish have an undesirable “poor food” stigma attached. Influences and perceptions of a Western diet have made white bread and other packaged foods sought-after commodities, rather than the native whole grain millet, avocadoes, mangos, and other naturally nutritious foods that Americans are ironically trending towards.

In lacking a strong education system and broad computer access, Ugandan people live in an information desert. Despite the agricultural potential for variety, many dishes are made and consumed the same way day after day with the same ingredients because knowledge on nutrition and food preparation is lacking. There are countries with enough conflict and natural resource struggles that educating on the benefits of vegetable and dairy/animal protein consumption might be a moot point, but in Uganda these things are more achievable. Timing seems critical: these farmers were at a point where they requested this training, and that makes the potential impact far greater.

Easily-modified agricultural factors can have broad influence on the diet. For example, simple introduction of orange-fleshed, rather than white-fleshed, sweet potatoes can vastly improve vitamin A intake. Increasing use of fertilizers or crop rotation practices can ensure that minerals which foods like peanuts should theoretically contain are actually present.
Gender-related issues can also impact diet quality. Women are responsible for feeding themselves and their children, but the money, even money they earned, is not always in their hands. Men may have a nice meal at a restaurant while women eat cassava and potatoes at home. In addition, the common practice of multiple wives and the perception of children as a status symbol often make families quite large.

Overall, while economic, agricultural, and societal factors do play a role in food security, in countries such as Uganda I think nutrition education has strong potential to directly provide needed knowledge and indirectly change practices and prejudices that impede diet quality. My personal experience fully supports UNICEF recommendations for future nutrition education programs, including starting young, investing in women and girls, and collaborating across ministries to support integrated approaches to improving the diet (Unicef 2014). These integrated approaches address other strong nutrition influencers such as food safety and hygiene and health and disease, in addition to agricultural production.

FAO. 1996. “Declaration on World Food Security.” World Food Summit, Rome: FAO.
FAO. 2010. “Uganda.” United Nations. http://www.fao.org/ag/AGN/nutrition/uga_en.stm
Unicef. 2014. “Multi-Sectoral Approaches to Nutrition: The Case for Investment by Educational Programmes.” http://www.unicef.org/eapro/Brief_Education_Nutrition.pdf

By Emily Roberts

For nutrition professionals, deciphering the Nutrition Facts labels on food packages may be second nature. However, for the general public it is often difficult to understand and interpret this information. The FDA took this into consideration when proposing new requirements for Nutrition Facts labels in 2014 (1). Two main changes were proposed: new information on labels as well as design changes and new serving and package size requirements (2). The appearance of the label will be quite different if they are accepted.

This is of course to be the biggest change since 1993. The only alteration in the past 20 years has been the requirement of the amount of trans fat to the label in 2006 (1). This month the FDA proposed two more changes to the label. The one getting the most attention is the percent daily value of added sugars.

The most notable changes issued in March 2014 were (1):
• increased font size of calories
• changing of serving size requirements
• placement and update of percent daily value
• including added sugars
• removing calories from fat
• including the gram amount of micronutrients
• including vitamin d and potassium
• making vitamin C and vitamin A voluntary

As of this July 2015, two new changes were proposed (1):
• require the percent daily value of added sugars
• change the footnote to help consumers understand daily values

What are considered added sugars?
Simply stated added sugars are not naturally occurring and are added to the product. ChooseMyPlate says they are sugars that are added when processed or prepared. USDA lists some common sources of added sugars seen on ingredient lists including corn syrup, honey, fructose and lactose. However, for many manufactures this can be quite difficult to quantify because fructose and lactose are naturally occurring in fruits and milk. Yet, when they are added during processing they are now considered an “added sugar”. The current requirements from the FDA states in The Code of Federal Regulations Title 21 (101.60 c) that manufactures can use the claim “No added sugars” if “no sugar or sugar-containing ingredient is added during processing” (3).

Why does the FDA want percent daily value of added sugars?
Currently, there is no percent daily value of sugars because the FDA recommends that consumers limit their sugar intake to as low as possible. Things changed this month when the FDA argued that the percent daily value helps consumers understand how much is too much added sugars. Added sugars provide no nutrient value, increase caloric intake and replace nutrient dense foods. Susan Mayne, director of the FDA’s Center for Food Safety and Applied Nutrition, argued this change will help consumers reduce their intake of added sugars (4).

How much is too much of added sugars?
FDA recommends that daily intake of added sugars should not exceed 10% of total calories (1). If you are eating a 2,000 calorie diet you can easily exceed this 10% mark by consuming one 20 fl oz Minute Maid Lemonade.

How are food manufacturers reacting?
Food companies argue that including added sugars and a percent daily value could be misleading because the body utilizes added sugars the same as natural sugars and question the amount and quality of scientific evidence the FDA used to support their new proposal. Manufacturers claim that nutrition information seldom alters consumer’s food intake, so these changes would be more costly than they would be beneficial (5).

When can the public see these new changes?
The two new proposed changes will go through a comment period before they are accepted.

References
1. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm#supplemental
2. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm387533.htm
3. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm064911.htm
4. http://www.npr.org/sections/thesalt/2015/07/24/425908798/no-more-hidden-sugar-fda-proposes-new-label-rule
5. http://www.wsj.com/articles/fda-proposes-listing-added-sugar-on-food-labels-1437774370
6. http://www.natlawreview.com/article/calorie-count-delay-fda-extends-compliance-date-menu-labeling-rules
7. http://www.choosemyplate.gov/weight-management-calories/calories/added-sugars.html
8. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm
9. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.9
10. http://www.minutemaid.com/content/minutemaid/en/home/products/lemonade/lem