Factors associated with non-frequent breakfast consumption in adolescents (EVA-JF Study) / Fatores associados ao consumo não frequente de café da manhã em adolescentes (Estudo EVA-JF)

ABSTRACT Objective To estimate the association of infrequent breakfast consumption with socioeconomic, behavioral, and individual factors in a sample of Brazilian adolescents from public schools. Methods Cross-sectional study with adolescents aged from 14 to 19 from public schools in Juiz de Fora, state of Minas Gerais. The frequency of consumption of breakfast, snacks, soft drinks, industrialized drinks, the usual food consumption, body mass index, body fat percentage, and waist circumference were evaluated. Other socioeconomic, behavioral, and individual data were obtained through questionnaires. Logistic regression analysis and hierarchical selection of variables were used to verify the associated factors. Results The sample consisted of 805 adolescents; 53.4% reported infrequent breakfast consumption. Through hierarchical logistic regression analysis, it was evidenced that the house occupancy status (OR: 0.618; 95%CI: 0.4410.865; p=0.005) was the distal factor associated with infrequent breakfast consumption; the intermediate factors were the consumption of industrialized beverages (OR: 0.658; 95%CI: 0.486-0.890; p=0.007) and percentage of energy from processed foods (OR: 0.935; 95%CI: 0.907-0.964; p<0.001); and the proximal factors were the male gender (OR: 0.696; 95%CI: 0.520-0.932; p=0.0015) and being nonwhite (OR: 1.529; 95%CI: 1.131-2.069; p=0.006). Conclusion Male adolescents who lived in owned houses, with occasional consumption of industrialized beverages and a higher percentage of energy derived from processed foods, had lower chances of infrequent breakfast consumption, while non-white adolescents had higher chances.

RESUMO Objetivo Estimar as associações do consumo não frequente de café da manhã com fatores socioeconômicos, comportamentais e individuais em uma amostra de adolescentes de escolas públicas. Métodos Estudo transversal realizado com adolescentes de 14 a 19 anos matriculados em escolas públicas de Juiz de Fora (MG). Foram avaliadas a frequência de consumo de café da manhã, lanches, refrigerantes e bebidas industrializadas, consumo alimentar usual, IMC, percentual de gordura corporal e perímetro da cintura. Demais dados socioeconômicos, comportamentais e individuais foram obtidos através de questionários. A análise de regressão logística e seleção hierárquica das variáveis foram usadas para verificar fatores associados. Resultados A amostra foi composta por 805 adolescentes e 53,4% deles relataram consumo não frequente de café da manhã. Através da análise de regressão logística hierarquizada, evidenciou-se que a ocupação em domicílio próprio (OR: 0,618; IC95%: 0,441-0,865; p=0,005) foi o fator distal associado ao consumo não frequente de café da manhã, além dos fatores intermediários "consumo não frequente de bebidas industrializadas" (OR: 0,658; IC95%: 0,486-0,890; p=0,007) e "percentual de energia proveniente de alimentos processados" (OR: 0,935; IC95%: 0,907-0,964; p<0,001) e dos fatores proximais "sexo masculino" (OR: 0,696; IC95%: 0,520-0,932; p=0,0015) e "cor da pele não branca" (OR: 1,529; IC95%: 1,131-2,069; p=0,006). Conclusão Adolescentes que residiam em domicílios próprios, com consumo não frequente de bebidas industrializadas, com maior percentual de energia proveniente de alimentos processados e do sexo masculino apresentaram menores chances de consumo não frequente de café da manhã, enquanto, adolescentes com cor da pele não branca apresentaram maiores chances.

Association between breakfast consumption frequency and the risk of irritable bowel syndrome among Chinese female college students: A cross-sectional study.

ABSTRACT: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects specific groups of people. The relationship between breakfast consumption frequency and the risk of IBS is unclear. This study aimed to investigate the association between breakfast consumption frequency and the risk of IBS among Chinese female college students.In this cross-sectional study (n = 706) conducted in October 2018, the frequency of breakfast consumption was categorized as 0 to 3 times/week, 4 to 6 times/week, or daily. IBS was diagnosed according to the Rome III criteria and was based on the presence of abdominal pain or discomfort for at least 3 months during the previous 6 months, with at least 2 or more of the following conditions: changes in frequency or form of stool and/or decrease in pain after defecation. We adjusted for confounding factors, including age, only child (yes or no), parents' educational levels (senior high school or below, college, or postgraduate), parents' marital status (married, widowed, or divorced), smoking status (smoker or nonsmoker), drinking status (drinker or nondrinker), body mass index, and depressive symptoms. A multiple logistic regression analysis was performed to determine the relationship between breakfast frequency and the risk of IBS.Among 706 participants, 23.7% were the only child in their family, and the proportion of parents divorced or widowed was 18.5%. The proportion of fathers and mothers with high school education or above was 93.3% and 96.3%, respectively. The prevalence of IBS among the participants was 17.3% (122/706). Multivariate logistic regressions analysis showed that breakfast consumption frequency is negatively associated with the risk of IBS after adjusting for confounding factors. The odds ratios (95% confidence intervals) for IBS in the breakfast frequency category of 0 to 3 times/week, 4 to 6 times/week, and daily were 1.00 (reference), 0.96 (0.58, 1.60), and 0.45 (0.26, 0.78), respectively (P = .002).Our data revealed that regular breakfast consumption is associated with a lower risk of IBS among Chinese college students. Future cohort and/or interventional studies should be conducted to further explore the association between breakfast consumption frequency and IBS.

Why do we eat cereal but not lamb chops at breakfast? Investigating Americans' beliefs about breakfast foods.

Healthy breakfast consumption has a multitude of positive benefits. However, typical American breakfasts are notoriously unhealthy. We hypothesize that the resistance to include nutritious foods at breakfast is due in part to misconceptions about what "breakfast" should be. Consistent with this proposal, results from three studies (N = 1097) suggest that American adults perceive typical breakfast foods as particularly well suited for breakfast and believe that more nutritious alternatives consumed at lunch or dinner are less appropriate for breakfast. As a result, people are unwilling to add more nutritious alternatives to their breakfast repertoire. To counter this rigidity, we devised an intervention passage emphasizing that (1) many foods became breakfast staples because of intensive marketing campaigns, and that (2) people in other cultures readily include lunch or dinner foods on their breakfast plate. This approach effectively revised people's beliefs about breakfast foods, and improved their motivation to adopt a healthier breakfast diet. Our findings demonstrate the power of a conceptually rich framework in undermining mistaken beliefs and boosting healthy eating behaviors.

Breakfast consumption and depressive mood: A focus on socioeconomic status.

Skipping breakfast can be potentially harmful because breakfast consumption is considered one of the important health-related behaviors that benefit physical and mental health. As the rate of depression has increased recently, we investigated the association between the frequency of eating breakfast and depression in adults. We obtained the data from the 2013 Korean Community Health Survey; a total of 207,710 survey participants aged 20 years or over were studied. Participants were categorized into three groups by the frequency of breakfast consumption as follows: "seldom," "sometimes," and "always." We performed a multiple logistic regression to investigate the association between breakfast consumption and depressive mood. Subgroup analyses were conducted by stratifying socioeconomic variables controlling for variables known to be associated with depressive symptoms. Participants who had breakfast seldom or sometimes had higher depressive symptoms than those who always ate breakfast ("seldom": OR = 1.43, 95% CI 1.36-1.52; "sometimes": OR = 1.32, 95% CI 1.23-1.40). Subgroup analyses showed that this association was more marked in those who were 80 years or older, those who had low household income, or those with elementary school education level or less. The result of this study suggests that lack of breakfast consumption is associated with depression among adults with different socioeconomic factors.

Moral Fiber: Breakfast as a Symbol of 'a Good Start' in an Australian Obesity Intervention.

What are the symbolic meanings of breakfast in the context of one of Australia's largest childhood obesity intervention programs? Utilizing a range of theoretical insights into the morality of food and eating and the anthropology of food, we trace how breakfast is packaged and promoted to families in an Australian community as a 'healthy start' to the day. Through ethnographic and historic investigation, we argue that eating breakfast and certain types of breakfast foods are symbolic of a classed, healthy lifestyle pattern, embodying parental knowledge and bodily regulation to routinely structure daily life. In communities where poverty and unemployment are harsh realities, well-intentioned programs that encourage people to eat a healthy breakfast are encoded with an assemblage of moral values-of knowledge, foods, families, and times and spaces-that are often difficult to reconcile with the wider sociocultural context in which many people live.

Inflammatory and metabolic responses to dietary intervention differ among individuals at distinct cardiometabolic risk levels.

OBJECTIVE: The aim of this study was to investigate the effects of two interventions in breakfast with different fatty acid content on metabolic and inflammatory biomarkers in individuals at different cardiovascular risk levels. METHODS: This crossover clinical trial included 80 overweight participants who were grouped according to the presence of metabolic syndrome (MetS). The participants received two isocaloric breakfast interventions for 4 wk, with a 2-wk washout. The "Brazilian" breakfast was enriched with saturated fat, whereas the "modified" meal was enriched with unsaturated fatty acids and fibers. Repeated-measures analysis of variance was used to compare dietary data, and Student's t or Wilcoxon tests were used to compare clinical and inflammatory variables. A χ2 test was employed to compare frequencies. RESULTS: Frequencies of MetS increased after the Brazilian breakfast and decreased after the modified meal. Significant reduction in mean values of WC and diastolic blood pressure (DBP) and elevation in high-density lipoprotein cholesterol were detected at the end of the modified intervention. Participants with or without the MetS exhibited contrasting responses to the modified breakfast: respectively, significant changes in DBP levels (-3.7 ± 6.9 versus -0.5 ± 6.9 mm Hg; P < 0.05), plasma glucose (-3 ± 7.3 versus 3 ± 7.4 mg/dL; P < 0.05), and apolipoprotein-B (-0.1 ± 0.6 versus 0.2 ± 0.3 mg/mL; P < 0.05), interferon-γ (-0.6 ± 1.2 versus 0.1 ± 1.3 pg/mL; P < 0.05), and tumor necrosis factor-α concentrations (0.4 ± 3.6 versus -0.8 ± 2.8 pg/mL; P < 0.05) were observed. CONCLUSIONS: Dietary intervention of small magnitude, for a short period, was able to improve traditional risk factors for cardiovascular disease and inflammatory markers, as well as the frequency of MetS. Responses to dietary interventions of individuals at different levels of cardiovascular risk should be examined through different biomarkers.

Late-night overeating is associated with smaller breakfast, breakfast skipping, and obesity in children: The Healthy Growth Study.

OBJECTIVE: Excessive energy intake during evening hours is associated with several health problems. The aim of this study was to investigate for the first time the possible association of late-night overeating with breakfast habits and obesity in a large sample of Greek children ages 9 to 13 y. METHODS: In all, 2655 schoolchildren (9-13 y) participated in the Healthy Growth Study, a cross-sectional epidemiologic study conducted in 77 primary schools in four large regions in Greece. The present study presents results on 1912 children having full data regarding anthropometric, dietary, physical activity, and physical examination indices. RESULTS: High-energy intake at dinner and evening snack was associated with higher likelihood of skipping breakfast (odds ratio, 1.85; 95% confidence interval 1.42-2.39) and with lower caloric intake at breakfast (ß = 0.14; P < 0.001). Children at the lowest quartile of physical activity levels were found to have a positive association between the calories consumed at dinner and their body mass index (ß = 0.11; P = 0.019). This association was inverse for children at the highest quartile of physical activity levels (ß = -0.10; P = 0.033). CONCLUSIONS: Late-night overeating is associated with skipping and/or consuming a smaller breakfast. In children with low levels of physical activity, it is associated with increased body mass index. Future relevant studies are essential to further explore and confirm the findings of the present study.

Impact of Breakfast Skipping and Breakfast Choice on the Nutrient Intake and Body Mass Index of Australian Children.

Recent data on breakfast consumption among Australian children are limited. This study examined the impact of breakfast skipping and breakfast type (cereal or non-cereal) on nutrient intakes, likelihood of meeting nutrient targets and anthropometric measures. A secondary analysis of two 24-h recall data from the 2007 Australian National Children's Nutrition and Physical Activity Survey was conducted (2-16 years; n = 4487) to identify (a) breakfast skippers and (b) breakfast consumers, with breakfast consumers further sub-divided into (i) non-cereal and (ii) cereal consumers. Only 4% skipped breakfast and 59% of skippers were 14-16 years. Breakfast consumers had significantly higher intakes of calcium and folate, and significantly lower intakes of total fat than breakfast skippers. Cereal consumers were more likely to meet targets and consume significantly higher fibre, calcium, iron, had significantly higher intakes of folate, total sugars and carbohydrate, and significantly lower intakes of total fat and sodium than non-cereal consumers. The prevalence of overweight was lower among breakfast consumers compared to skippers, and among cereal consumers compared to-cereal consumers (p < 0.001), while no significant differences were observed for mean body mass index (BMI), BMI z-score, waist circumference and physical activity level across the categories. Breakfast and particularly breakfast cereal consumption contributes important nutrients to children's diets.

Breakfast Macronutrient Composition Influences Thermic Effect of Feeding and Fat Oxidation in Young Women Who Habitually Skip Breakfast.

The purpose of this study was to determine if breakfast macronutrient composition improved thermic effect of feeding (TEF) and appetite after a one-week adaptation in young women who habitually skip breakfast. A randomized, controlled study was conducted in females (24.1 ± 2 years), who skip breakfast (≥5 times/week). Participants were placed into one of three groups for eight days (n = 8 per group): breakfast skipping (SKP; no breakfast), carbohydrate (CHO; 351 kcal; 59 g CHO, 10 g PRO, 8 g fat) or protein (PRO; 350 kcal; 39 g CHO, 30 g PRO, 8 g fat). On days 1 (D1) and 8 (D8), TEF, substrate oxidation, appetite and blood glucose were measured. PRO had higher (p < 0.05) TEF compared to SKP and CHO on D1 and D8, with PRO having 29% higher TEF than CHO on D8. On D1, PRO had 30.6% higher fat oxidation than CHO and on D8, PRO had 40.6% higher fat oxidation than CHO. SKP had higher (p < 0.05) fat oxidation on D1 and D8 compared to PRO and CHO. There was an interaction (p < 0.0001) of time and breakfast on appetite response. In addition, CHO had a significant increase (p < 0.05) in PP hunger response on D8 vs. D1. CHO and PRO had similar PP (postprandial) glucose responses on D1 and D8. Consumption of PRO breakfast for 8 days increased TEF compared to CHO and SKP, while consumption of CHO for one week increased PP hunger response.

Family sociodemographic characteristics as correlates of children's breakfast habits and weight status in eight European countries. The ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.

OBJECTIVE: The purpose of the present study was to investigate the associations of family sociodemographic characteristics with children's weight status and whether these potential associations are mediated by children's breakfast habits. DESIGN: A school-based survey among 10-12-year-old children was conducted in eight European countries. Children's weight and height were measured and breakfast habits and family sociodemographic characteristics were self-reported by 5444 children and their parents. International Obesity Task Force cut-off points were used to categorize children as overweight/obese or normal weight. Mediation analyses were used to test the potential mediating effect of children's breakfast consumption on the associations between family sociodemographic characteristics and children's overweight/obesity. SETTING: Schools in eight European countries participating in the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project. SUBJECTS: Children aged 10-12 years and their parents (n 5444). RESULTS: Children's reported daily breakfast consumption varied from 56 % in Slovenia to 92 % in Spain on weekdays and from 79 % in Greece to 93 % in Norway on weekends. Children of native parents, with both parents employed and with at least one parent having more than 14 years of education were more likely to consume breakfast daily and less likely to be overweight/obese. Finally, mediation analyses revealed that the association of parental nationality and parental educational status with children's overweight/obesity was partially mediated by children's daily breakfast consumption. CONCLUSIONS: The study shows that the lower likelihood of being overweight/obese among 10-12-year-old children of native background and higher parental educational status was partially mediated by children's daily breakfast consumption.

Regular breakfast consumption and type 2 diabetes risk markers in 9- to 10-year-old children in the child heart and health study in England (CHASE): a cross-sectional analysis.

BACKGROUND: Regular breakfast consumption may protect against type 2 diabetes risk in adults but little is known about its influence on type 2 diabetes risk markers in children. We investigated the associations between breakfast consumption (frequency and content) and risk markers for type 2 diabetes (particularly insulin resistance and glycaemia) and cardiovascular disease in children. METHODS AND FINDINGS: We conducted a cross-sectional study of 4,116 UK primary school children aged 9-10 years. Participants provided information on breakfast frequency, had measurements of body composition, and gave fasting blood samples for measurements of blood lipids, insulin, glucose, and glycated haemoglobin (HbA1c). A subgroup of 2,004 children also completed a 24-hour dietary recall. Among 4,116 children studied, 3,056 (74%) ate breakfast daily, 450 (11%) most days, 372 (9%) some days, and 238 (6%) not usually. Graded associations between breakfast frequency and risk markers were observed; children who reported not usually having breakfast had higher fasting insulin (percent difference 26.4%, 95% CI 16.6%-37.0%), insulin resistance (percent difference 26.7%, 95% CI 17.0%-37.2%), HbA1c (percent difference 1.2%, 95% CI 0.4%-2.0%), glucose (percent difference 1.0%, 95% CI 0.0%-2.0%), and urate (percent difference 6%, 95% CI 3%-10%) than those who reported having breakfast daily; these differences were little affected by adjustment for adiposity, socioeconomic status, and physical activity levels. When the higher levels of triglyceride, systolic blood pressure, and C-reactive protein for those who usually did not eat breakfast relative to those who ate breakfast daily were adjusted for adiposity, the differences were no longer significant. Children eating a high fibre cereal breakfast had lower insulin resistance than those eating other breakfast types (p for heterogeneity <0.01). Differences in nutrient intakes between breakfast frequency groups did not account for the differences in type 2 diabetes markers. CONCLUSIONS: Children who ate breakfast daily, particularly a high fibre cereal breakfast, had a more favourable type 2 diabetes risk profile. Trials are needed to quantify the protective effect of breakfast on emerging type 2 diabetes risk. Please see later in the article for the Editors' Summary.

Breakfast consumption is positively associated with nutrient adequacy in Canadian children and adolescents.

Although breakfast is associated with more favourable nutrient intake profiles in children, limited data exist on the impact of breakfast on nutrient adequacy and the potential risk of excessive intakes. Accordingly, we assessed differences in nutrient intake and adequacy among breakfast non-consumers, consumers of breakfasts with ready-to-eat cereal (RTEC) and consumers of other types of breakfasts. We used cross-sectional data from 12,281 children and adolescents aged 4-18 years who took part in the nationally representative Canadian Community Health Survey, 2004. Mean nutrient intakes (obtained using a multiple-pass 24 h recall method) were compared among the breakfast groups using covariate-adjusted regression analysis. Usual nutrient intake distributions, generated using the National Cancer Institute method, were used to determine the prevalence of nutrient inadequacy or the potential risk of excessive intakes from food sources alone and from the combination of food plus supplements. Of these Canadian children, 10% were breakfast non-consumers, 33% were consumers of RTEC breakfasts and 57% were consumers of other types of breakfasts. Non-consumption of breakfast increased with age (4-8 years: 2%; 9-13 years: 9%; 14-18 years: 18%). Breakfast consumers had higher covariate-adjusted intakes of energy, many nutrients and fibre, and lower fat intakes. The prevalence of nutrient inadequacy for vitamin D, Ca, Fe and Mg (from food alone or from the combination of food plus supplements) was highest in breakfast non-consumers, intermediate in consumers of other types of breakfasts and lowest in consumers of RTEC breakfast. For vitamin A, P and Zn, breakfast non-consumers had a higher prevalence of nutrient inadequacy than both breakfast groups. The potential risk of excessive nutrient intakes was low in all groups. Efforts to encourage and maintain breakfast consumption in children and adolescents are warranted.

Association between fruits and vegetables intake and frequency of breakfast and snacks consumption: a cross-sectional study.

BACKGROUND: There are very few studies on the frequency of breakfast and snack consumption and its relation to fruit and vegetable intake. This study aims to fill that gap by exploring the relation between irregular breakfast habits and snack consumption and fruit and vegetable intake in Tuscan adolescents. Separate analyses were conducted with an emphasis on the potentially modifying factors of sex and age. METHODS: Data was obtained from the 2010 Tuscan sample of the Health Behaviour in School-aged Children (HBSC) study. The HBSC study is a cross-sectional survey of 11-, 13- and 15-year-old students (n = 3291), selected from a random sample of schools. Multivariate logistic regression was used for analyzing the food-frequency questionnaire. RESULTS: A significant relation was found between low fruit and vegetable intake and irregular breakfast habits. Similarly, low fruit intake was associated with irregular snack consumption, whereas vegetable intake did not prove to be directly related to irregular snack consumption. Different patterns emerged when gender and age were considered as modifying factors in the analyses. A statistically significant relation emerged only among female students for irregular breakfast habits and fruit and vegetable intake. Generally, older female participants with irregular breakfast habits demonstrated a higher risk of low fruit and vegetable intake. Age pattern varied between genders, and between fruit and vegetable consumption. CONCLUSIONS: Results suggest that for those adolescents who have an irregular consumption of breakfast and snacks, fruit intake occurs with a lower frequency. Lower vegetable consumption was associated with irregular breakfast consumption. Gender and age were shown to be moderators and this indicated the importance of analyzing fruit and vegetable intake and meal types separately. This study also confirmed that health-promotion campaigns that aim to promote regular meal consumption and consumption of fruits and vegetables need to take into account gender and age differences in designing promotional strategies. Future research should identify evidence-based interventions to facilitate the achievement of the Italian guidelines for a healthy diet for fruit, vegetables and meals intake.

Effects of different proportion of carbohydrate in breakfast on postprandial glucose excursion in normal glucose tolerance and impaired glucose regulation subjects.

BACKGROUND: The variability of postprandial plasma glucose is an independent risk factor for diabetes. The type and amount of carbohydrate may be important determinants of glycemic control. The aim of the study was to compare the effects of different proportions of carbohydrate in breakfast on postprandial blood glucose fluctuations in impaired glucose regulation (IGR) and normal glucose tolerance (NGT) subjects. SUBJECTS AND METHODS: This is a cross-sectional study of two groups including 55 subjects with IGR and 78 individuals with NGT. Their recorded breakfast was sorted into low-carbohydrate (LC) (carbohydrate <45%), medium-carbohydrate (MC) (carbohydrate 45-65%), and high-carbohydrate (HC) (carbohydrate >65%) meals according to the proportion of carbohydrate. Glucose concentrations were continuously measured with a continuous glucose monitoring system, and parameters such as the incremental area under the curve (iAUC) of glucose and postprandial glucose excursion (PPGE) were calculated to evaluate postprandial glucose fluctuations. RESULTS: The postprandial fluctuations of glucose increased gradually with increased proportions of carbohydrate in breakfast in both IGR and NGT subjects. For the MC and HC meals, iAUC, PPGE, postprandial glucose spike (PGS), and mean blood glucose were significantly greater than those in the NGT group (P<0.05), respectively. The median time to PGS and the time period in which glucose concentrations decreased to baseline after the MC and HC meals in the IGR group were significantly longer than those in the NGT group (P<0.01), respectively. Compared with the NGT subjects for the HC meal, the IGR subjects consuming the MC meal had greater PGS, range of glucose concentrations, SD, and PPGE (P<0.05). CONCLUSIONS: The proportion of carbohydrate in breakfast contributes to glucose excursions in the NGT and IGR subjects. In the IGR subjects, a HC meal should be avoided and a LC meal should be recommended to prevent development of diabetes.

Energy, saturated fat and fibre intakes among Dutch children and adolescents at breakfast and implications for educational messages.

The aim of this study was to assess energy, saturated fat and fibre intakes at breakfast among Dutch youngsters aged 10-19 years and the extent to which they meet nutritional value recommendations and the educational messages on food group intake by the Netherlands Nutrition Centre (NNC). A cross-sectional design was used and data were collected through an online questionnaire among 2380 students attending 71 Dutch schools for primary and secondary education. Energy intake at breakfast was, on average, 15.8% of daily recommended energy intake; mean saturated fat intake was 7.5 en% and mean fibre intake 1.0 g per 100 kcal. Of the participants, 67.2% met the saturated fat intake recommendation and 35.3% the fibre intake recommendation. In addition, 25.5% were assessed to have an adequate energy intake based on daily recommended, but not individually measured, age- and gender-specific energy intake. Most participants consumed products from the grains food group, in combination with products from one or two other food groups. Consumption from two or more food groups resulted in less favourable intake. Our study found generally inadequate fibre intake at breakfast as well as an indication of inadequate energy intake at breakfast among Dutch youngsters. The educational message of the NNC to consume at least (wholemeal) bread or another fibre-rich product (cereals) at breakfast seems realistic in terms of compliance and favourable in terms of the resulting nutritional value. The educational message to preferably eat from each of the five main food groups should be reconsidered.