Received wisdom is that breakfast is the most important meal of the day, an observation that most clinical studies support. However, there are doubters. Recently, the New York Times¹ ran an opinion piece by a professor of pediatrics at Indiana University School of Medicine that stated bluntly in its title, “Sorry, There’s Nothing Magical About Breakfast.” Unluckily for this professor, new research just published in the Journal of the American College of Nutrition (2016) yet again supports breakfast as being important for academic performance.² It also reports the significant finding that whereas greater consumption of whole grains at breakfast is a positive factor (because of the lower glycemic index/more sustained energy qualities of these foods), greater consumption of fruit juices (not whole fruit) exerts a negative impact on academic performance. In other words, basic sound nutrition plays a role in school performance.

Breakfast Supports Academic Achievement in Schoolchildren
In the current study, the authors sought to address a number of objections raised to the body of literature supporting the health benefits of breakfast. Critics have suggested that confounding variables, meaning issues such as total energy intake, parental education, and socioeconomic status, are largely responsible for the benefits of breakfast eating found in school children in past studies. The authors did not address the validity of such objections. Instead, they constructed a model population of students matched for gender, ethnicity, race, free/reduced-cost meals, parents’ education and household income. It began from baseline data from the Physical Activity and Academic Achievement Across the Curriculum (A+PAAC) study already available.

The investigation aimed to evaluate whether student breakfast consumers performed better on a standardized test (Wechsler Individual Achievement Test, WIAT-11I 1241) than did non-breakfast consumers and, among breakfast consumers, whether breakfast content influenced test scores. Three areas were of interest on the standardized test: spelling, reading comprehension and fluency, and mathematics. Physical data on differences in body composition (anthropometric data) and cardiovascular fitness also were assessed.

Immediately before taking the WIAT-111 test, participants completed a breakfast recall of all food and drink that they had consumed that morning. A total of 698 participants completed the breakfast recall; 617 participants were classified as breakfast consumers and 81 were classified as non-breakfast consumers. This allowed the determination that breakfast consumers did significantly better than non-consumers on all three portions of the test.

The percentage of calories from carbohydrates was positively correlated with the standard score for spelling, but other aspects of the macronutrient distribution of the diet were not significantly associated with any scores. In contrast, servings of fruit juice were not related to the spelling score, but were negatively correlated with reading comprehension and fluency and with mathematics performance. More servings of whole grains were significantly positively related to higher scores in reading comprehension and fluency, but not to spelling scores. In conclusion, the authors write, “[t]he present results suggest that … consumption of breakfast, high in whole grains and low in added sugars, may be beneficial for academic performance in elementary school students.”

Better Nutrition Extends Beyond Carbs, Fat and Protein
This 2016 Journal of the American College of Nutrition article examines the role of macronutrients consumption at breakfast in academic performance and supports the findings of a substantial volume of research literature to the effect that breakfasts based on substantial protein and/or substantial whole grain consumption are superior to skipping breakfast or eating breakfasts including high glycemic foods, such as sweet rolls and juice. But what about multi-vitamin and mineral supplements (MVM)?

The first question to ask about supplements is whether their use generally is safe. The answer to this question is that reasonably dosed supplements can help fill nutrient shortfalls without concern for long-term safety. A paper by Prof Hans Biesalski and Jana Tinz from the Institute of Biological Chemistry and Nutrition at the University of Hohenheim (Germany) concluded, “MVM are safe at physiological doses (100% DRI) in the short and the long term, whereas adverse effects may occur if single vitamins at high doses are consumed." "An MVM can help to improve the nutrient supply and overcome problems of inadequacy without concern for its long-term safety."³

The next question is, do vitamins and other dietary measures work? A number of studies indicate that the answer most certainly is "yes." Take, for instance, the scourge of modern American education, children with attention-deficit/ hyperactivity disorder (ADHD). ADHD poses a challenge beyond simply improving academic performance in the average student. In a report published just last year, the conclusion is that the "study demonstrates the clinical benefit, feasibility, and safety of broad-spectrum micronutrients in the treatment of childhood ADHD."⁴ More generally, taking a multi-vitamin supplement daily can improve cognitive performance in both children and adults. One trial found significant improvement in the areas of cognition and mood in healthy children with just 12 weeks supplementation and another trial turned in similar results in adults.^5,6

Other measures that can be adopted at the same time as adding micronutrients to the diet also may provide benefits. A Norwegian study of teenage males demonstrated that there is a positive association between the number of times fish are eaten per week at age 15 and cognitive performance measured three years later in both poorly and highly educated subjects. Frequent fish intake at age 15 was associated with significantly better cognitive performance three years later.⁷

Small Changes, Big Results
The take-away from these and many other studies is that relatively small and inexpensive changes in dietary habits can yield important results in children and adolescents. Various aspects of intelligence, emotional control and behavior in elementary school students and in teenagers respond positively to simple changes in diet and the use of vitamin and mineral supplements. These are easy tests for parents to try at home: put away the sugared cereals, substitute whole fruit for fruit juices, break out the eggs and whole grain breakfasts, and provide a serving of multi-vitamin/mineral insurance every morning.

Endnotes

1. The New York Times, May 23, 2016.
2. Ptomey LT, Steger FL, Schubert MM, Lee J, Willis EA, Sullivan DK, Szabo-Reed AN, Washburn RA, Donnelly JE. Breakfast Intake and Composition Is Associated with Superior Academic Achievement in Elementary Schoolchildren. J Am Coll Nutr. 2016 May—Jun;35(4):326—33.
3. Biesalski HK, Tinz J. Multivitamin/mineral supplements: rationale and safety—XA systematic review. Nutrition. Published online ahead of print, doi: 10.1016/j.nut.2016.02.013.
4. Gordon HA, Rucklidge JJ, Blampied NM, Johnstone JM. Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study. J Child Adolesc Psychopharmacol. 2015 Dec;25(10):783—98.
5. Haskell CF, Scholey AB, Jackson PA, Elliott JM, Defeyter MA, Greer J, Robertson BC, Buchanan T, Tiplady B, Kennedy DO. Cognitive and mood effects in healthy children during 12 weeks¡¦ supplementation with multi-vitamin/minerals. Br J Nutr. 2008 Nov;100(5):1086—96.
6. Haskell CF, Robertson B, Jones E, Forster J, Jones R, Wilde A, Maggini S, Kennedy DO. Effects of a multi-vitamin/ mineral supplement on cognitive function and fatigue during extended multi-tasking. Hum Psychopharmacol. 2010 Aug;25(6):448—61.
7. Aberg MA, Aberg N, Brisman J, Sundberg R, Winkvist A, Toren K. Fish intake of Swedish male adolescents is a predictor of cognitive performance. Acta Paediatr. 2009 Mar;98(3):555—60.