Energy and macronutrient intakes at breakfast and cognitive declines in community-dwelling older adults: a 9-year follow-up cohort study

Am J Clin Nutr. 2021 May 8;113(5):1093-1103. doi: 10.1093/ajcn/nqaa403.


Background: It is unclear whether breakfast consumption and breakfast composition are independently associated with changes in cognition over a long-term period in older adults.

Objectives: We aimed to examine the associations between energy and macronutrient intakes at breakfast and cognitive declines.

Methods: We included 2935 participants aged 55-93 y at baseline from the China Health and Nutrition Survey in our analysis. Cognition was assessed in 1997, 2000, 2004, 2006, and 2015. Dietary intake was assessed using weighing methods in combination with 24-h food records.

Results: Breakfast contributed to 25.9% of total energy intake of the day and percentages of breakfast energy intake from protein, fat, and carbohydrates were 12.8%, 11.5%, and 75.7%, respectively. During a median follow-up of 9 y, the β values for changes in global cognitive z-scores for Quintile 5 of protein and fat intakes at breakfast, with Quintile 1 as the reference, were 0.13 (95% CI: 0.01-0.25) and 0.17 (95% CI: 0.04-0.30), respectively. Substitution of 5% energy from carbohydrates with equivalent energy from protein (β, 0.06; 95% CI: 0.01-0.11) or fat (β, 0.05; 95% CI: 0.02-0.08) at breakfast was positively associated with the change in the global cognitive z-score. Energy intake at breakfast was not significantly associated with the global cognitive z-score. Similar results were found for the verbal memory z-score. The positive association of breakfast fat intake and the inverse association of breakfast carbohydrate intake with cognitive declines were stronger in urban residents.

Conclusions: Higher intakes of protein and fat and lower intake of carbohydrates at breakfast were associated with a lower rate of cognitive decline in older adults. Substitution of carbohydrates with protein or fat intake at breakfast may help to delay or prevent cognitive declines.

Keywords: breakfast; cognitive decline; dietary carbohydrates; dietary fat; dietary protein; energy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aging*
  • Breakfast*
  • Cognitive Dysfunction*
  • Cohort Studies
  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Proteins
  • Female
  • Humans
  • Independent Living*
  • Male
  • Middle Aged
  • Nutritional Status
  • Nutritive Value


  • Dietary Carbohydrates
  • Dietary Fats
  • Dietary Proteins