title: The effect of breakfast composition and energy contribution on cognitive and academic performance: a systematic review.
abstract: BACKGROUND
  Most studies that assess the effects of breakfast on subsequent mental abilities compared performance in subjects who had or had not consumed this meal. However, characteristics of breakfast itself may induce metabolic and hormonal alterations of the gastrointestinal tract and potentially modify cognitive performance. Moreover, as far as the evidence on the positive effects of having breakfast is becoming more robust, interest may shift to the specific characteristics of an adequate breakfast.
  
  
  OBJECTIVE
  The objective was to summarize existing evidence on the role of nutrient composition or energy intake at breakfast on the accomplishment of school-related tasks and cognition.
  
  
  METHODS
  We conducted a systematic review of the literature through the PubMed database.
  
  
  RESULTS
  From the literature search, we identified 102 articles, 15 of which met the inclusion criteria. Of these, 3 studies provided information on the relation between cognitive and academic performance and energy intake at breakfast, 11 provided the same information for the macronutrient composition of breakfast, and 1 investigated both the aspects. Eleven studies considered breakfast meals differing in glycemic index/load. Selected studies were generally carried out in well-nourished children and adults of both sexes from general education. They were mostly experimental studies of short duration and had a limited number of subjects. Cognitive and academic performance was investigated by looking at multiple domains, including memory, attention, reasoning, learning, and verbal and math abilities, with a variety of test batteries scheduled at different time points in the morning. Breakfast options differed in terms of included foods and place and time of administration.
  
  
  CONCLUSIONS
  There is insufficient quantity and consistency among studies to draw firm conclusions. However, whereas the hypothesis of a better and more sustained performance with a breakfast providing >20% daily energy intake still needs substantiation, there does appear to be emerging, but still equivocal, evidence that a lower postprandial glycemic response is beneficial to cognitive performance.
authors.affiliation: From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA).
authors.forename: Valeria
authors.initials: V
authors.lastname: Edefonti
authors.affiliation: From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA).
authors.forename: Valentina
authors.initials: V
authors.lastname: Rosato
authors.affiliation: From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA).
authors.forename: Maria
authors.initials: M
authors.lastname: Parpinel
authors.affiliation: From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA).
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nebbia
authors.affiliation: From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA).
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fiorica
authors.affiliation: From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA).
authors.forename: Emilio
authors.initials: E
authors.lastname: Fossali
authors.affiliation: From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA).
authors.forename: Monica
authors.initials: M
authors.lastname: Ferraroni
authors.affiliation: From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA).
authors.forename: Adriano
authors.initials: A
authors.lastname: Decarli
authors.affiliation: From the Section of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy (VE, VR, MF, and AD); the Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, Università degli Studi di Udine, Udine, Italy (MP); the Pediatric Clinic (GN and LF) and the Pediatric Emergency Unit (EF), IRCCS Ospedale Maggiore Policlinico, Milan, Italy; the Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy (AD); and the Pediatric Clinic, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy (CA).
authors.forename: Carlo
authors.initials: C
authors.lastname: Agostoni
mesh_terms: D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D000328:Adult; D062408:Breakfast; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003071:Cognition; D004522:Educational Status; D002149:Energy Intake; D019317:Evidence-Based Medicine; D006293:Health Promotion; D006801:Humans; D007858:Learning; D008568:Memory; D018673:Nutrition Policy; D013647:Task Performance and Analysis