The Effects of Breakfast on Neuropsychological Functioning
Condition: Neuropsychology
Study type: Interventional

Summary: 
      This study is designed to examine healthy children who skip breakfast and the effects of
      fasting on their neuropsychological functioning and the potential benefits that a Balanced
      Breakfast may have on their learning abilities. It is expected that this study will provide
      new knowledge on how prolonged periods of 8 or more hours without food affect neurocognitive
      processes and thus learning how specific meals following this period of fasting, which most
      children experience, change those processes, potentially for the better.

      The hypotheses for this study are:

        1. Children who consume breakfast will demonstrate significantly higher levels of
           attention, greater concentration, and diminished impulsivity compared to children who do
           not consume breakfast.

        2. Children who consume breakfast will demonstrate a significantly quicker reaction time
           and increased accuracy in correctly identifying target stimuli from an array compared to
           children who do not consume breakfast.

        3. Children who consume breakfast will demonstrate increased freedom from distractibility
           and enhanced short-term memory compared to children who do not consume breakfast.

        4. Children who consume breakfast will demonstrate increased cognitive processing speed
           compared to children who do not consume breakfast.

        5. Children who consume breakfast will have improved verbal learning compared to children
           who do not consume breakfast.

        6. Children who consume breakfast will have improved visual memory compared to children who
           do not consume breakfast.
    

Detailed description: 
      Hunger can be considered a chronic health condition. Among children, the lack of available
      food to meet usual physical needs on a regular basis leads to poor cognitive and behavioral
      performance and is associated with adverse physical and mental health outcomes. All of these
      findings are well documented among poor children living in families with sufficient food and
      are exacerbated even more among those in families living under conditions of food
      insufficiency. There has been a significant effort over the past 2 decades to document the
      effects of mechanisms of how hunger affects learning, cognitive performance, and behavior and
      how a meal, such as breakfast can mitigate those effects.

      The longest period during a 24-hour day when children go without food is the period from the
      beginning of sleep at night to the first meal of the following day. Therefore, the morning
      seems an ideal time to examine those biological factors that result from hunger or fasting
      and how they affect basic processes that underpin learning and behavior. Underprivileged but
      otherwise healthy children seem most affected by hunger. Thus, studies are needed to compare
      children from families of different economic income strata to understand better how a
      breakfast meal might affect those learning and behavioral processes, and whether the
      breakfast meal truly has a positive effect on basic learning and behavior.

      The goal of this study is to evaluate the effects on short-term neuropsychological
      functioning of: a) consumption of breakfast versus no breakfast (2 different breakfast meals
      will be employed); and b) consumption of breakfast by groups of children from low income
      families vs children from families with average/middle incomes, who are 8-10 years of age.
      The primary outcome will be neuropsychological functioning in specific areas of cognition, as
      measured by standardized tests. A secondary outcome will be glucose homeostasis, measured by
      blood ketones and blood glucose and insulin.

      A total of 154 children will be recruited with an anticipated 20% drop out rate. The final
      sample will consist of 64 children in each socioeconomic group (total n=128) who will stay
      overnight three separate nights and participate in each breakfast condition. The sample will
      consist of low and middle income African- and Hispanic-Americans and Caucasian male and
      female children between the ages of 8-10. The sample size will consist of an equal number of
      boys and girls and will have an equal representation of children from the socioeconomic
      conditions (i.e. low and middle income) and ethnicities (African and Hispanic Americans and
      Caucasians) identified.

      The design consists of two independent groups based on SES with a crossover,
      repeated-measures (within subject and across subject design, under three breakfast
      conditions. The outcome measures (dependent variables) will include a battery of
      neuropsychological measures. All participating subjects are admitted to the Children's
      Nutrition Research Center (CNRC) Metabolic Research unit (MRU) three times for overnight
      stays with intervals of at least 2 weeks apart across 3 months.
    

Intervention name(s): Nutella Breakfast; Waffle Breakfast
Intervention type(s): Other; Other
Intervention description(s): Breakfast composed of bread and Nutella, milk and apple slices; Breakfast composed of waffles and syrup, milk, and apple slices
Intervention model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Neuropsychology; Breakfast eating patters; Glucose; Child Psychology