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Title:   Author  item
                                            WIDAMAN, ADRIANNE - University Of Californiaitem
                                            WITBRACHT, MEGAN - University Of Californiaitem
                                            FORESTER, SHAVAWN - University Of Californiaitem
                                            Laugero, Kevinitem
                                            Keim, Nancy
  Submitted to: Journal of the Academy of Nutrition and Dietetics
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 12/30/2014
                                    Publication  Date: 5/6/2016
                                    Citation: Widaman, A.M., Witbracht, M.G., Forester, S.M., Laugero, K.D., Keim, N.L. 2016. Chronic stress is associated with indicators of diet quality in habitual breakfast skippers. Journal of the Academy of Nutrition and Dietetics. 116(11):1776-1784. doi: 10.1016/j.jand.2016.03.016.Interpretive Summary: A significant portion of young adults in the U.S. do not regularly eat breakfast, which is unfortunate because some  studies show that eating breakfast improves the overall quality of the diet. However, little is known about factors that might contribute to diet quality when breakfast is eaten regularly or when it is omitted. We conducted a study to measure diet quality of women with established breakfast habits to determine if stress or decision-making ability contributed to diet quality. Even though breakfast eaters and breakfast skippers ate similar amount of calories during the day, the quality of their diets differed. The breakfast eaters had diets that were more in line with the current Dietary Guidelines for Americans. The diets of breakfast eaters contained more dietary fiber, calcium, vitamin D, and potassium. These nutrients are of concern because they are not consumed at optimal levels in the diet. Breakfast skippers consumed more added sugar and saturated fat in the evening, which may contribute to risk of chronic disease because evening eating has been linked to undesirable metabolic consequences. In breakfast skippers, higher stress was associated with consumption of more empty calories and higher intake of added sugars, but stress was not associated with these diet components in breakfast eaters. These findings suggest that the effects of stress appear to be buffered in breakfast eaters and provide evidence to support the idea that breakfast should be promoted as a behavior that has positive health benefits.
                                Technical Abstract: Background. Previous studies suggest that eating breakfast is associated with better diet quality, but reasons underlying this relationship are not clear.
Objective. Our objective was to assess diet quality of women with established breakfast habits and determine if stress or cognitive function contributed to diet quality.
Design. A cross-sectional study with individuals who met strict criteria for either regularly eating breakfast or regularly skipping breakfast. 
Participants/setting. Seventy-five women participated (breakfast eaters (BE) n=40; breakfast skippers (BS) n=35.
Main outcome measures. Diet assessment was based on three 24-hour recalls conducted by a trained dietitian. The Healthy Eating Index-2010 was the primary measure of diet quality. Stress was measured with the Wheaton Chronic Stress Inventory, and executive function was evaluated by the Iowa Gambling Task.
Statistical analyses performed. Diet characteristics of BE and BS were compared using one-way ANOVA, with body mass index as covariate. Correlational analysis was performed using Pearson’s test. 
Results. Despite no observed differences in daily energy, carbohydrate, fat, or protein intake between BS and BE, the diet quality of BE was better overall with higher HEI-2010 scores (p<0.002), whole grains (p<0.001), whole fruits (p<0.002), and higher intake of dietary fiber (p<0.001), calcium (p<0.003), potassium (p<0.02) and folate (p<0.002). Breakfast eaters also consumed less added sugar (p<0.03) and saturated fat (p<0.02) in the evening. Reported stress influenced certain characteristics of the diet in BS including the avoidance of empty calories (r= -0.452; p<0.01), intake of added sugars (all day intake: r= 0.497; p<0.005; evening intake: r=0.501; p<0.005), and evening intake of fat (r=0.371; p<0.04). Similar relationships were not observed in BE. Overall diet quality was correlated with executive function skill in BS (r=0.392; p<0.03) but not in breakfast eaters.  
Conclusions. Habitual breakfast eating was associated with higher diet quality. Both stress and executive function influenced certain aspects of the diet in breakfast skippers, whereas breakfast eaters appeared to be more immune to the negative effects of stress.  The consumption of more added sugar, and saturated fat in the evening by breakfast skippers may be of concern, since evening eating may have undesirable long-term cardiometabolic consequences.


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