A nutritious breakfast

A growing body of research has revealed the important role of breakfast in ensuring adequate nutrient intake in both children and adults. Breakfast consumption has been associated with several health benefits, including cognitive and academic performance. Unfortunately, according to breakfast consumption data in developing countries, many people skip this important meal, making them miss the many benefits associated with it. Notably, breakfast skippers may not be able to make up for missed nutrients at other meals eaten during the day. This may be one of the contributing factors to relatively high under nutrition rates in developing countries, including Kenya.

The South African National Health and Nutrition Examination Survey 2013 reports that in South Africa one out of five children do not eat breakfast in the morning and 51% do not take lunch to school. While there are no such figures for Kenya, it is assumed that the situation is similar or even worse as there are no dietary guidelines recommending or promoting breakfast in Africa.

According to MENUCHECK (2014) (a habits and attitudes study on commonly eaten dishes in Kenya), the most common foods eaten for breakfast in Kenya are bread/bread toast with or without spread & tea, boiled porridge & tea and fried egg (once a week). These breakfasts are usually not nutritious because food groups like fruits, vegetables and fats are missing. Consequently, the Kenyan breakfasts will not sufficiently deliver important nutrients, such as fibre, vitamin A, C and folic acid, which increase the risk of malnutrition.

The Magnitude of Malnutrition
In fact, micronutrient deficiencies are widely prevalent in African countries. Twenty six percent of the children suffering from vitamin A deficiency (VAD) live in Africa, with the largest proportion in sub-Saharan Africa(6). According to the Kenya Ministry of Health(7), the prevalence of severe VAD is 14% and moderate VAD is 61% among children under 5. Other major micronutrient deficiencies in Africa include iodine deficiency disorder, iron deficiency anaemia and zinc deficiency, with high rates among young children. Approximately 25% of children are iodine deficient(8). Studies in Kenya show that 56% school age children are anaemic and especially girls. In some regions this is as high as 89.5% due to food insecurity and poverty(9,10,11). Half of the children under five years are zinc deficient(12,13,8).

Micronutrient deficiencies may have adverse effects on children’s growth and development. However, also inadequate intake of energy and protein will impair physical growth, leading to thinness and stunting. The global prevalence of stunting - when a child is too short for his age - has decreased over the past decades, however, still 161 million children under the age of five years are stunted(14). The vast majority is living in Sub-Saharan Africa and South Asia, where 38% of the children under five years old are stunted(15). According to the Kenya Demographic and Health Survey(16) 25% of the children under five are stunted in Kenya. Underweight - when a child’s weight is too small for their age - is at a national average of 11%.

Next to undernutrition, the prevalence of overweight is also increasing in developing countries(17), including Kenya. However, this problem has not been addressed adequately by nutrition surveys in Kenya. Overweight in Children has not significantly change from 6% in 1993, 2003 (6%), 2008-09 (5%) and 2014 (4%)(16). The study indicates that in adult women there is an increasing trend of overweight and obese women at 25% in 2008-09 and 33% in 2014. These trends have been associated with a rise in non-communicable diseases such as diabetes, hypertension, heart disease and cancer(16).

Good nutrition, an adequate well-balanced diet combined with regular physical activity, is the foundation of good health. Malnutrition can impair our daily health and wellbeing and reduce our ability to lead an enjoyable and active life. Moreover, both under and over nutrition may substantially impact long term health status and life expectancy.
How Can Breakfast Help in Providing Good Nutrition?

Breakfast means ‘break the fast’, as the previous meal is typically 8–10 hours before waking up in the morning. Breakfast is important in re-fuelling the body with energy and nutrients, kick-starting the day. Many dietary guidelines recommend to consume a nutrient dense breakfast daily(18,19). In addition, it is generally recommended by several dietary guidelines that 15 to 25 percent of the recommended daily requirement for nutrient (vitamins and minerals) and energy should come from breakfast.

The consumption of breakfast is associated with healthier daily nutrient intake in all age groups, especially in children and adolescents as an individual is more likely to consume the recommended daily nutrients unlike when breakfast is skipped(20,21,22). For example, a study reported that children who skipped breakfast did not meet two thirds of the recommended daily allowances (RDA; 40-60%) compared with those who consumed breakfast at school (<5-30%) or at home (<5-58%). Cross-sectional data has shown that children and adolescents who consume breakfast, such as, enriched grains and bread, eggs, milk etc. have better macro and micro-nutrient intakes, that is, they are more likely to meet the recommended intake(23,24). Several studies have reported that breakfast consumers had higher intakes of vitamins A, E, C, B-6, and B-12; folate; iron; calcium; phosphorus; magnesium; potassium; and dietary fibre(25,20,26). Cross-sectional data in children shows that the lower micronutrient intake due to breakfast skipping may not be compensated by other meals during the day(20,27). Several observational studies in children and adolescents have suggested that consuming unhealthy snacks instead of breakfast or consuming an unhealthy breakfast may be a contributing factor to unhealthy nutrient profile such as higher intakes of saturated fats, trans fats and sugars(20,26,28).

A Nutritious Breakfast for Healthy Growth and Development of Children

Daily nutritious breakfast consumption may contribute to longer-term healthy growth and development of children. Consequently this may have a positive impact on overall school performance of children in the long term.

Few studies from developing countries have looked into the role of breakfast and physical growth of children. Three studies, one intervention study from Jamaica (29) and two observational studies from China (30,31) reported that breakfast consumption is positively associated with linear growth of children. These studies suggest a positive relation between breakfast and growth but the data is too limited to draw a firm conclusion. However, it can be assumed that the intake of nutritious breakfast (vs. skipping) can help to increase energy intake and nutrient intake. This increase in energy and nutrient intake may positively influence growth especially in undernourished children.

A Nutritious Breakfast Helps Children to Do Better at School: Cognition & School Performance

Children may be vulnerable to the nutritional effects of breakfast on brain activity and associated cognitive outcomes as they have a higher brain glucose metabolism compared with adults (32). The higher metabolic turnover of children, their rapid growth rates and the importance of their cognitive function for academic achievement underlie the need for optimal nutrition including breakfast intake. Most studies on breakfast consumption suggest breakfast to be positively associated with learning in children in terms of behavior, cognitive, and school performance(1). It is generally assumed that the beneficial effects of eating breakfast on cognitive performance are expected to be short term and specific to the morning on which breakfast is eaten and to selective cognitive functions. However, several studies have shown the benefit of habitual or regular breakfast (increased frequency >5 days/week) consumption on academic performance(2,3). At the same time, some evidence suggests that breakfast quality (and not just frequency), in terms of providing a greater variety of food groups (3-4) and adequate energy (>20-25%E of the estimated energy needs), was positively related to school performance(33).

A study by Cardiff University found a significant link between eating breakfast and performing above average on teacher assessment scores. The children who ate a healthy morning meal such as cereal, bread, dairy or fruit were up to twice as likely to achieve better than average grades compared to those who had none and compared to those who snacked on junk foods(34).

What Makes a Good Breakfast?

Breakfast is an important meal of the day. It is generally recommended by several dietary guidelines that 15 to 25 % of recommended daily requirement for nutrients (vitamins and minerals) and energy should come from breakfast. In addition, the amount and type of fats as well as sugar and sodium should be in line with recommendations from the World Health Organization(35). Food based dietary guidelines are developed to help people choose an adequate diet. These guidelines are based on existing consumption of locally available foods and aims to address nutrition-related public health problems. Like for total diets, it is recommended to combine a variety of foods from the different food groups of the food-based dietary guidelines into breakfast.

Breakfast should be commonly based on starchy foods (for example brown bread or whole grain porridge), which should be combined with a hot beverage such as tea with milk, or a portion of milk or other source of protein. Furthermore, it is important to also add a variety of fruits or some vegetables, because these are rich sources of different vitamins and minerals including vitamin C and A, folic acid, potassium, and fibre. In addition, to help get more good fats, it is recommended to add some spread with Omega 3 and 6 fats and fatsoluble vitamins such as margarine.

Therefore, a good breakfast will deliver required nutrients to start the day such as carbohydrates, good fats (Omega 3 and 6), proteins, water soluble and fat-soluble vitamins, and minerals. The food choices for breakfast will depend on what is locally available and accessible. Examples of a good breakfast for Kenyan children could contain local staple foods like sweet potatoes, boiled cassava, boiled arrow root, whole grain chapatti, legumes and nuts, whole grain porridge with some margarine, a fried or boiled egg, whole meal bread spread with margarine, milk (cow, camel, goat, soya) yoghurt, a cup of tea with milk and seasonal fruits.

Good Fats are an Essential Part of a Nutritious Breakfast

It is generally recommended to eat some fat or oil with breakfast, and this fat should be of the right quality. WHO recommends that 6-11% of the daily energy intake should be delivered by polyunsaturated fats (PUFA), which helps prevent chronic diseases. PUFA are mainly the essential fats linoleic acid (LA – omega 6) and alphalinolenic acid (ALA – omega 3), for. Five to eight percent has to come from LA, and 1-2% from ALA(36).

Essential fats cannot be produced by the human body, hence they need to be part of the diet and are needed for vital functions. They are used by the body to synthesise bioactive metabolites (eicosanoids, prostaglandins) via conversion to very long chain fatty acids, and are building blocks for cells and tissues. In children, essential fats are needed for optimal growth and development(37). In addition, polyunsaturated fats can have a beneficial effect on the heart when eaten in moderation and when use to replace saturated fat and trans fat(37). Polyunsaturated fats can help reduce bad (LDL) cholesterol levels the blood which can lower the risk o heart disease and strokes(38,39).

Children across the globe do not get enough of the essential fats; mainly Omega 3 intake is very low(40). A recent study in Indonesia showed that 40% of the children had saturated fat intake exceeding recommendations, while 84% of the children had ALA intakes below recommendations(42). There are no intake data available for children in Kenya.

Vegetable oils that are rich in polyunsaturated fats provide essential fats. Margarine is made with vegetable oils and so provides omega 3 and 6. In addition, it delivers the fat-soluble vitamins A, D and E. Adding margarine to breakfast will provide energy and vitamins, will add taste, and will help children to get the essential fats they need.

Improving Breakfast Behaviour

The Blue Band social program aims to improve the health and well-being and education of children in Kenya by promoting a nutritious breakfast every day.

Starting the day with a nutritious breakfast will help children to get the nutrients they need, and therefore we need to make breakfast a habit for all.

The role of advocacy, social mobilisation and communication cannot be underestimated. Evidence has shown clearly that advocacy and empowerment of individuals, communities and all other relevant stakeholders can bring tangible and sustainable changes in the improvement of the country nutrition profile. Mass media campaigns through television, radio and print media have stepped up efforts to bring positive behavior change in the society. Moreover, appropriate communications through health c facilities and community outreach services have also been used to foster better community nutrition outcomes. The food industry can contribute b developing affordable and accessible nutrient dense products. Blue Ban margarine, for example is a product which provides the essential Omega 6 fats, and a variety of water and fat soluble vitamins. These products can to make a nutritious breakfast available and attractive for every child.

Conclusion

There is need to change breakfast intake behaviour of children as this will help them in their growth and development, acting as a strategy for improved nutrition and health. Achieving behaviour change on good breakfast consumption is a huge task and requires concerted efforts by all nutrition stakeholders. A call to action for every stakeholder would mean active participation in a movement that advocates relentlessly for good breakfast behaviours, which are implemented at household level and reinforced in the school system. In order to ensure that all children in Kenya have a good breakfast at home every day, a Good Breakfast Alliance would be ideal to bring together various nutrition stakeholders from different sectors such as agriculture, health, education, UN agencies, development partners and Non Governmental organizations. This alliance will join efforts to promote behaviour change for good breakfast. The behaviour change will increase the number of children who take breakfast at home every day.

References
Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD: Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 2005;105:743-760.

Kleinman RE, Hall S, Green H, Korzec-Ramirez D, Patton K, Pagano ME, Murphy JM: Diet, breakfast, and academic performance in children.Ann Nutr Metab 2002,46 Suppl 1:24-30.

Murphy JM, Pagano ME, Nachmani J, Sperling P, Kane S, Kleinman RE (1998). The Relationship of School Breakfast to Psychosocial and Academic Functioning: Cross-sectional and Longitudinal Observations in an Inner-city School Sample. Arch Pediatr Adolesc Med. 1998;152:899-907.

Shisana O, Labadarios D, Rehle T et al & SANHANES-1 team: South African National Health and Nutrition Examination Survey (SANHANES-1) 2013. Cape town: HSRC Press

Kaushal N & Nashrath N: MENUCHECK 2014; TNS Global, Singapore

McLaren DS & Kraemer K (eds): Manual on Vitamin A Deficiency Disorders (VADD). World Review of Nutrition and Dietetics 2012;103:1-192

Republic of Kenya,Division of Nutrition, MoPHS : Kenya Nutrition Bulletin Vol 4/10, July – September 2010http:// mdg.ei.columbia.edu/east/sitefiles/file/Kenya Nutrition Bulletin 3rd Quarter 2010.pdf

Ministry of Public Health Services [Kenya] & Save the Children UK (SCUK): Report on Nutrition Situation in Kenya. Latest draft, May 2011.

Kenya National Bureau of Statistics (KNBS) and ICF Macro.( 2010). Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro.

UNICEF. (2009). State of the World’s Children

Division of Nutrition: Maternal Infant and Young Child Nutrition-National Operational Guidelines for Health Workers 2013. Nairobi: Ministry of Health, Kenya.

Republic of Kenya,Division of Nutrition, MoPHS: Kenya Nutrition Bulletin Vol 4/10, July – September 2010http:// mdg.ei.columbia.edu/east/sitefiles/file/Kenya Nutrition Bulletin 3rd Quarter 2010.pdf

Mwaniki, D.L., Omwega, A.M., Muniu, E.M., Mutunga, J.N., Akelola, R., Shako, B.R., Gotink, M.H. and Pertet, A.M.: Anaemia and Status of Iron, Vitamin A and Zinc in Kenya. 2002 Ministry of Health, Nairobi.

Repositioning nutrition as central to development: a strategy for large-scale action. Washington DC: The World Bank; 2006 http://siteresources.worldbank. org/NUTRITION/Resources/281846-1131636806329/ NutritionStrategy.pdf, accessed 21 October 2014)

Unicef 2014: The State of the World’s Children

Kenya National Bureau of Statistics (KNBS) and ICF Macro.: Kenya Demographic and Health Survey 2014. Calverton, Maryland: KNBS and ICF Macro

International Food Policy Research Institute: Global Nutrition Report 2015: Actions and Accountability to Advance Nutrition and Sustainable Development. Washington, DC.

Dutch Nutrition Guidelines: Richlijnen Voedselkeuze 2011:2014

USDA Dietary Guidelines for Americans 2010:2010

Nicklas TA, O’Neil CE, Berenson GS: Nutrient contribution of breakfast, secular trends, and the role of ready-to-eat cereals: a review of data from the Bogalusa Heart Study. Am J Clin Nutr 1998;67:757S-763S.

Ruxton CH, O’Sullivan KR, Kirk TR, Belton NR, Holmes MA (1996): The contribution of breakfast to the diets of a sample of 136 primary-schoolchildren in Edinburgh. Br J Nutr 1996;75:419-431.

Barr SI, DiFrancesco L, Fulgoni VL, III (2013): Consumption of breakfast and the type of breakfast consumed are positively associated with nutrient intakes and adequacy of Canadian adults. J Nutr 2013;143:86-92.

Skinner JD, Salvetti NN, Ezell JM, Penfield MP, Costello CA (1985): Appalachian adolescents’ eating patterns and nutrient intakes. J Am Diet Assoc 1985;85:1093-1099.

Nicklas TA, Myers L, Reger C, Beech B, Berenson GS: Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts. J Am Diet Assoc 1998;98:1432-1438.

Nicklas TA, Bao W, Webber LS, Berenson GS (1993): Breakfast consumption affects adequacy of total daily intake in children. J Am Diet Assoc 1993;93:886-891.

Nicklas TA, Reger C, Myers L, O’Neil C: Breakfast consumption with and without vitamin-mineral supplement use favorably impacts daily nutrient intake of ninth-grade students. J Adolesc Health 2000;27:314-321.

Morgan KJ, Zabik ME, Stampley GL(1986): Breakfast consumption pattern of U.S. children and adolescents.; 1986, pp 635-646.

Deshmukh-Taskar PR, Nicklas TA, O’Neil CE, Keast DR, Radcliffe JD, Cho S (2010).: The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: the National Health and Nutrition Examination Survey 1999- 2006. J Am Diet Assoc 2010;110:869-878.

Powell,C.A.,Walker,S.P.,Chang, S.M.,and GranthamMcGregor, S. M.(1998).Nutrition and education: a randomized trial of the effects of breakfast in rural primary schoolchildren. Am.J.Clin.Nutr. 68, 873–879

Zhang ZL, Luo M, Wang Z, Luo J, Shi Y.(2013). Relationship between dietary behaviors and growthdevelopment of 1-7 years old children from seven provinces in Chinese rural areas]. Wei Sheng Yan Jiu. 2013 May;42(3):375-80

Fu LG1, Ma J, Wang HJ, Hu PJ, Song Y, Liu JS, Zhang ZL, Shang XR, Yang YD: [Influence of diet behaviors on height among children and adolescents in China: a multiple level analysis]. Beijing Da Xue Xue Bao. 2013 Jun 18;45(3):370-5.

Sokoloff (1976): Circulation and energy metabolism. in GJ Siegel RBe, (ed): Basic Neurochemistry. Boston, Little Brown., 1976, pp 388-413.

O’Sullivan TA, Robinson M, Kendall GE, Miller M, Jacoby P, Silburn SR, Oddy WH.: A good-quality breakfast is associated with better mental health in adolescence Public Health Nutr. 12(2): 249-58. Epub 2008 Nov 25.

Steffan Messeger: healthy breakfasts help pupils do well . Nov. 2015 http/www.bbc.co.uk/news/ uk=wales-34834837

WHO2003:Report of a joint WHO/FAO Expert Consultation. Diet Nutrition and Prevention of chronic diseases. Geneva:World Health Organization; 2003. Report No.:916.

WHO. 2008b:. Strengthening action to improve Feeding of Infants and Young Children 6-23 months of age in nutrition and child health programmes: Report of proceedings, Geneva

Gurr MI.: Role of fats in food and nutrition. 2nd ed. Elsevier applied sciences; 1992.

National Cholesterol Education Program (NCEP):highlights of the report of the Expert Panel on Blood Cholesterol Levels in children and Adolescents. Pediatrics 1992 Mar; 89(3):495-501.

Simell O, Niinikoski H, Ronnemaa T, Lapinleimu H, Routi T, Lagstrom H, et al.: Special Turku Coronary Risk Factor Intervention Project for babies (STRIP). Am J Clin Nutr 2000 Nov;72(5 Suppl):1316S-31S

Harika RK, Cosgrove MC, Osendarp SJ, Verhoef P, Zock PL.: Fatty acid intakes of children and adolescents are not in line with the dietary intake recommendations for future cardiovascular health: a system review of dietary intake data from thirty countries. Br J Nutr 2011 Aug; (3):307-16.

Neufingerl N, Ratna D, Otten-Hofman A, Reisi N, Garczarek U, Ahmad S, Zock PL, Eilander A.: Intake of essential fatty acids in Indonesian children: secondary analysis of data from a nationally representative survey. British Journal of Nutrition, 2016.

Neufingerl N, Ratna D, Otten-Hofman A, Reisi N, Garczarek U, Ahmad S, Zock PL, Eilander A. Intake of essential fatty acids in Indonesian children: secondary analysis of data from a nationally representative survey. British Journal of Nutrition, 2016.

Blue Band Produits

Blue Band Recettes

Mentions Legales

A Nutritious Breakfast

to enhance the health and well-being of children in Kenya

Blue Band Produits

Blue Band Recettes

Mentions Legales