Breakfast is often referred to as the most important meal of the day and in recent years has been implicated in weight control, cardio-metabolic risk factors and cognitive performance although, at present, the literature remains inconclusive as to the precise health benefits of breakfast. There are extensive reports of breakfast’s contributions to daily food and nutrient intakes, as well as many studies that have compared daily food and nutrient intakes by breakfast consumers and skippers. However, significant variation exists in the definitions of breakfast and breakfast skippers, and in methods used to relate breakfast nutrient intakes to overall diet quality. The present review describes a novel and harmonised approach to the study of the nutritional impact of breakfast through The International Breakfast research Initiative involving national dietary survey data from Canada, Denmark, France, Spain, the UK and the USA. It is anticipated that the analysis of such data along harmonised lines, will allow the project to achieve its primary goal of exploring approaches to defining optimal breakfast food and nutrient intakes. Such data will be of value to public health nutrition policy-makers and food manufacturers and will also allow consistent messaging to help consumers to optimize food choices at breakfast.

Background/objectives It is not known whether dietary changes able to simultaneously achieve nutritional adequacy and reduce diet-related greenhouse gas emissions (GHGE) are similar across Europe when cultural and gender specificities are taken into account. Subjects/methods Starting from each mean observed diet in five European countries (France, UK, Italy, Finland, and Sweden) and for each gender, nutritionally adequate diets departing the least from observed diet were designed with linear programming by applying stepwise 10% GHGE reductions. Other models directly minimized GHGE. Results For most countries and whatever the gender, achieving nutritional adequacy implied between-food-group subtitutions (i.e., replacing items from the sugar/fat/alcohol food-group with items from the fruit and vegetables and starchy food-groups), but increased GHGE. Once nutritional adequacy was met, to decrease GHGE, the optimization process further induced within-food-groups substitutions that were reinforced by stepwise GHGE reductions. Diet modeling results showed the need for changes in consumption of animal-based products but those changes differed according to country and gender, particularly for fish, poultry, and non-liquid milk dairy. Depending on country and gender, maximal GHGE reductions achievable ranged from 62% to 78% but they induced large departures from observed diets (at least 2.8 kg/day of total absolute weight change) by modifying the quantity of at least 99% of food items. Conclusions Setting nutritional goals with no consideration for the environment may increase GHGE. However, diet sustainability can be improved by substituting food items from the sugar/fat/alcohol food group with fruit, vegetables, and starches, and country-specific changes in consumption of animal-based products. Standardized surveys and individual diet modeling are promising tools for further exploring ways to achieve sustainable diets in Europe.

The contribution of breakfast to diet quality (DQ) can inform future dietary guidelines. This study examined breakfast nutrition in relation to overall DQ, using dietary data from the first reported day of the National Health and Examination Survey (NHANES) 2011–2014 (n = 14,488). Relative DQ was assessed using the Nutrient Rich Foods Index (NRF9.3) and the USDA Healthy Eating Index 2015 (HEI 2015). The sample was stratified by NRF9.3 tertiles and by age and socioeconomic groups. Four out of 5 NHANES participants had breakfast on the day of the interview. Breakfast provided 19–22% of dietary energy depending on age. Breakfast intakes of complex carbohydrates and total sugars were proportionately higher and intakes of protein and fats were lower relative to breakfast energy intakes. Breakfast provided more that 20% of daily intakes of B vitamins, vitamins A and D, folate, calcium, iron, potassium and magnesium. Eating breakfast was associated with higher NRF9.3 DQ scores. Breakfasts associated with the top tertile of NRF9.3 scores had less added sugars and fats than those associated with the bottom tertile. Such breakfasts had more fruit and juices, more whole grain products, more milk and yogurt and less meat and eggs. Breakfast patterns and food choices that favored fruit, whole grains and dairy were associated with healthiest diets.

The International Breakfast Research Initiative (IBRI) set out to derive nutritional recommendations for a balanced breakfast using a standardized analysis of national nutrition surveys from Canada, Denmark, France, Spain, UK and the US. In all countries, the frequency of breakfast consumption by age was high and U-shaped with children and older adults having a higher frequency of breakfast consumption. Breakfast contributed 16% to 21% of daily energy intake. In all countries, breakfast was a carbohydrate- and nutrient-rich meal, providing more carbohydrates (including sugars), thiamin, riboflavin, folate, calcium, potassium, and magnesium, and less vitamin A, fats and sodium relative to its contribution to daily energy intakes. Breakfast consumers were stratified by tertiles of the Nutrient Rich Foods (NRF) index, used as a measure of diet quality. Breakfast intakes associated with the top tertile of NRF, along with the Codex Alimentarius international food standards and World Health Organization (WHO) diet guidelines, were used to derive the proposed nutrient recommendations. The goal was to preserve the nutrient density of existing breakfasts, while addressing concerns regarding added sugars, saturated fats, dietary fiber, and vitamin D. This initiative is unique in seeking to derive nutrient recommendations for a specific meal using the observed nutritional profile of such meal.

The UK government has announced a tax on sugar-sweetened beverages. The aim of this study was to assess consumption patterns for plain drinking water relative to sugary beverages among UK children. Dietary intake data for 845 children aged 4–13 years came from the nationally representative cross-sectional National Diet and Nutrition Survey, 2008–2011. Beverage categories were drinking water (tap or bottled), milk, 100% fruit juices, soda, fruit drinks, tea, coffee, sports drinks, flavored waters, and liquid supplements. Consumption patterns were examined by age group, gender, household incomes, time and location of consumption, region and seasonality. Total water consumption from drinking water, beverages, and foods, and the water-to-calorie ratios (L/kcal) were compared to the EFSA (European Food Safety Authority) adequate intake standards. Total water intake (1338 ml/d) came from plain water (19%), beverages (48%), and food moisture (33%). Plain drinking water provided 258 g/d (241 g/d for children aged 4–8 years; 274 g/d for 9–13 years), mostly (83.8%) from tap. Water and beverages supplied 901 g /d of water. Tap water consumption increased with income and was highest in the South of England. The consumption of bottled water, soda, tea and coffee increased with age, whereas milk consumption declined. About 88.7% of children did not meet EFSA adequate intake standards. The daily water shortfall ranged from 322 ml/d to 659 ml/d. Water-to-calorie ratio was 0.845 L/1000 kcal short of desirable levels of 1.0–1.5 L/1000 kcal. Total water intake were at 74.8% of EFSA reference values. Drinking water consumption among children in the UK was well below US and French estimates.

Shifting towards a more plant-based diet, as promoted in Western countries, will reduce the animal protein contribution to total proteins. Such a reduction may not only impair protein adequacy, but also the adequacy in other nutrients. We determined, for different adult subpopulations, the minimum total protein level and the minimum animal protein contribution to total proteins that are compatible with the fulfillment of all non-protein nutrient-based recommendations. Mean nutritional content and mean diet cost for 5 French subpopulations were estimated using a French cross-sectional representative survey: Women < 50 years (A), Women 50–64 years (B), Women ≥ 65 years (C), Men < 65 years (D), Men ≥ 65 years (E). For each subpopulation, linear programming optimization was used to assess the minimum protein level (Model Set#1) and the minimum animal protein contribution to total proteins (Model Set#2) that are compatible with the fulfilment of all nutrient-based recommendations (except proteins for which levels were analyzed as output). Total diet cost was not allowed to increase. Eating habits were considered in Model Set#2 only. The minimum amount of protein that was theoretically compatible with the fulfilment of nutrient-based recommendations (Model Set#1) was below the minimum recommended protein intake for all subpopulations except A. In Model Set#2, for women and men over 65 years (C and E), decreasing animal protein contribution to total proteins below 55% and 60% respectively led to protein levels below recommend levels. For the other subpopulations (A, B, and D), the lowest animal protein contribution to total proteins compatible with a nutritionally adequate diet (including protein adequacy) was 55%, 50% and 45%, respectively. This study provides factual information about the animal protein contribution to total proteins compatible with meeting all nutrient-based recommendations at no additional cost and shows that it varies between 45% and 60% depending on the group of adults considered.