Bath Breakfast Project (BBP) - Examining the role of extended daily fasting in human energy balance and associated health outcomes: Study protocol for a randomised controlled trial [ISRCTN31521726]

Abstract

BackgroundCurrent guidance regarding the role of daily breakfast in human health is largely grounded in cross-sectional observations. However, the causal nature of these relationships has not been fully explored and what limited information is emerging from controlled laboratory-based experiments appears inconsistent with much existing data. Further progress in our understanding therefore requires a direct examination of how daily breakfast impacts human health under free-living conditions.Methods/DesignThe Bath Breakfast Project (BBP) is a randomised controlled trial comparing the effects of daily breakfast consumption relative to extended fasting on energy balance and human health. Approximately 70 men and women will undergo extensive laboratory-based assessments of their acute metabolic responses under fasted and post-prandial conditions, to include: resting metabolic rate, substrate oxidation, dietary-induced thermogenesis and systemic concentrations of key metabolites/hormones. Physiological and psychological indices of appetite will also be monitored both over the first few hours of the day (i.e. whether fed or fasted) and also following a standardised test lunch used to assess voluntary energy intake under controlled conditions. Baseline measurements of participants' anthropometric characteristics (e.g. DEXA) will be recorded prior to intervention, along with an oral glucose tolerance test and acquisition of adipose tissue samples to determine expression of key genes and estimates of tissue-specific insulin action. Participants will then be randomly assigned either to a group prescribed an energy intake of ≥3000 kJ before 1100 each day or a group to extend their overnight fast by abstaining from ingestion of energy-providing nutrients until 1200 each day, with all laboratory-based measurements followed-up 6 weeks later. Free-living assessments of energy intake (via direct weighed food diaries) and energy expenditure (via combined heart-rate/accelerometry) will be made during the first and last week of intervention, with continuous glucose monitors worn both to document chronic glycaemic responses to the intervention and to verify compliance.Trial registrationCurrent Controlled Trials ISRCTN31521726.

Exercise counteracts the effects of short‐term overfeeding and reduced physical activity independent of energy imbalance in healthy young men

“…Anthropometric measurements were made in triplicate using a metallic tape measure (Lufkin, TX, USA) before lean and fat mass were determined using dual‐energy X‐ray absorptiometry (DEXA; Discovery, Hologic, Bedford, UK). Resting metabolic rate (RMR) was determined via indirect calorimetry based on four 5 min expired gas collections accepted as stable within 100 kcal day −1 (Compher et al 2006; Betts et al 2011); the lowest of these was accepted as RMR. Following application of a topical local anaesthetic, a cannula was inserted into an antecubital vein and a baseline blood sample collected.…”

The effect of breakfast on appetite regulation, energy balance and exercise performance

“…This was investigated as part of the Bath Breakfast Project (35) . In these studies, the glycaemic, orexigenic and anorexigenic hormonal responses 3 h after breakfast consumption/omission and 3 h after an ad libitum lunch were determined in both lean (26) and obese (27) subjects.…”

Is breakfast the most important meal of the day?

“…Our recent investigations did not impose any dietary limitations on the participants in 264 either group other than maintaining the morning fast until noon or consuming ≥700 kcal by 1100 265 h, with at least half of this consumed within two hours of waking (9) . In lean individuals we found 266 evidence for limited dietary compensation, with the breakfast group consuming 539 kcal/d (95%…”

“…This instrument is particularly sensitive to the 366 low-to-moderate intensity, spontaneous lifestyle activities that we hypothesized might be most 367 responsive to breakfast (9,62) . groups apparent for the morning period and for light intensity activities (14) .…”

“…(11) . completers-only analysis) (9) . In this sense, our examination of body mass changes as an indication 152 of net energy (im)balance better reflects an efficacy trial and nicely complements the results of a 153 concurrent effectiveness trial which reported no significant difference in weight-loss over weeks with a recommendation to eat or skip breakfast (i.e.…”