Breakfast skipping is associated with differences in meal patterns, macronutrient intakes and overweight among pre-school children

Nutrient Intake, Diet Quality, and Weight Measures in Breakfast Patterns Consumed by Children Compared with Breakfast Skippers: NHANES 2001-2008

Most studies showing that children consuming breakfast have better nutrient intakes, diet quality, and lower weight than breakfast skippers have the incorrect premise that breakfast meals are homogeneous. The purpose of this study was to classify breakfast meals into patterns and determine the association of the breakfast patterns with daily and breakfast nutrient intakes, diet quality, and weight. Data from children (2-18 years of age; N = 14,200) participating in the National Health and Nutrition Examination Survey 2001-2008 were used. Intake was determined from one day 24-hour dietary recalls. Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005). Body mass index (BMI) z-scores were determined. Twelve patterns (including No Breakfast [∼19% of population]), explaining 63% of the variance in energy from breakfast, were examined. Covariate adjusted general linear models were used to compare outcome variables of consumers of different patterns with breakfast skippers. The p value was Bonferroni corrected (< 0.05/12 = < 0.0042). Consumers of the Eggs/Grain/Meat, Poultry, Fish (MPF)/ Fruit Juice (FJ) and MPF/ Grain/FJ patterns showed higher daily intakes of saturated fats, solid fats, and sodium and lower daily intakes of added sugars than breakfast skippers. Consumers of most breakfast patterns showed higher daily intakes of some nutrients of public health concern (dietary fiber, vitamin D, calcium, and potassium); however, those consuming the Grain or MPF/Grain/FJ pattern did not. Consumers of the Grain/Lower Fat Milk (LFM)/Sweets/FJ, Presweetened (PS) Ready-to-eat Cereal (RTEC)/ LFM, RTEC/LFM, Cooked Cereal/Milk/FJ, and Whole Fruit patterns had higher total HEI-2005 scores than breakfast skippers; those consuming the MPF/ Grain/FJ pattern had lower diet quality than breakfast skippers. Consumption of the Grain/ LFM/Sweets/FJ, PSRTEC/whole milk, Soft Drinks/ FJ/Grain/Potatoes, RTEC/whole milk, and Cooked Cereal/ Milk/ FJ patterns was associated with lower BMI z-scores than seen in breakfast skippers. There are dietary and weight advantages of consuming breakfast, especially breakfasts that include grains, cereals, LFM, and fruit/ FJ, in contrast to the potential adverse effects of skipping breakfast.

Social Inequalities in Young Children's Meal Skipping Behaviors: The Generation R Study

Background

Regular meal consumption is considered an important aspect of a healthy diet. While ample evidence shows social inequalities in breakfast skipping among adolescents, little is known about social inequalities in breakfast skipping and skipping of other meals among young school-aged children. Such information is crucial in targeting interventions aimed to promote a healthy diet in children.

Methods

We examined data from 4704 ethnically diverse children participating in the Generation R Study, a population-based prospective cohort study in Rotterdam, the Netherlands. Information on family socioeconomic position (SEP), ethnic background, and meal skipping behaviors was assessed by parent-reported questionnaire when the child was 6 years old. Multiple logistic regression analyses were performed to assess the associations of family SEP (educational level, household income, employment status, family composition) and ethnic background with meal skipping behaviors, using high SEP children and native Dutch children as reference groups.

Results

Meal skipping prevalence ranged from 3% (dinner) to 11% (lunch). The prevalence of meal skipping was higher among low SEP children and ethnic minority children. Maternal educational level was independently associated with breakfast skipping ([low maternal educational level] OR: 2.21; 95% CI: 1.24,3.94). Paternal educational level was independently associated with lunch skipping ([low paternal educational level] OR: 1.53; 95% CI: 1.06,2.20) and dinner skipping ([mid-high paternal educational level] OR: 0.39; 95% CI: 0.20,0.76). Household income was independently associated with breakfast skipping ([low income] OR: 2.43, 95% CI: 1.40,4.22) and dinner skipping ([low income] OR: 2.44; 95% CI: 1.22,4.91). In general, ethnic minority children were more likely to skip breakfast, lunch, and dinner compared with native Dutch children. Adjustment for family SEP attenuated the associations of ethnic minority background with meal skipping behaviors considerably.

Conclusion

Low SEP children and ethnic minority children are at an increased risk of breakfast, lunch, and dinner skipping compared with high SEP children and native Dutch children, respectively. Given these inequalities, interventions aimed to promote regular meal consumption, breakfast consumption in particular, should target children from low socioeconomic groups and ethnic minority children. More qualitative research to investigate the pathways underlying social inequalities in children’s meal skipping behaviors is warranted.

Breakfast intake is associated with nutritional status, Mediterranean diet adherence, serum iron and fasting glucose: the CYFamilies study

OBJECTIVE

To assess the association of breakfast intake with Mediterranean diet adherence, physical activity levels, obesity, selected cardiovascular risk markers and Fe status.

DESIGN

Cross-sectional study. BMI, body fat percentage and waist circumference were assessed. Physical activity was assessed using a pedometer and diet quality was evaluated by applying the KIDMED index. Blood tests to assess blood lipids, high-sensitivity C-reactive protein, fasting glucose, serum Fe and ferritin, as well as Hb, were performed.

SETTING

Primary-school children of the Troodos mountainous area in Cyprus.

SUBJECTS

Eighty-three Cypriot children (mean age 9·2 (sd 1·7) years).

RESULTS

Compared with breakfast skippers, regular breakfast eaters were 40 % more likely to have a KIDMED score higher by one point on average (OR=1·41; 95 % CI 1·08, 1·84) after accounting for obesity levels and other confounders. Breakfast skippers, on the other hand, were by about 14 % more likely to have a body fat percentage value higher by one unit, as well as higher values for both BMI and waist circumference. The relationship was significantly strengthened when combining body fat percentage and waist circumference into a composite variable (OR=0·20; 95 % CI 0·06, 0·69). Fasting glucose was inversely correlated to breakfast intake in descriptive analyses, whereas serum Fe was positively correlated to breakfast intake after considering age, gender and diet quality. The latter relationship disappeared, however, after considering physical activity levels.

CONCLUSIONS

Cypriot children who take breakfast regularly exhibit a higher adherence to the Mediterranean diet and have higher serum Fe concentrations and lower BMI, waist circumference, body fat percentage and fasting glucose levels, compared with children who skip breakfast. Public health professionals, educators and parents should prioritize on actions that will motivate children to regularly eat breakfast.

Dietary Habits and Cardiometabolic Health in Obese Children

BACKGROUND

Prevalence rates of cardiometabolic risk factors vary largely among overweight children. This study investigated the relationships between dietary habits and cardiometabolic health among obese children living in a city of Northern Italy.

METHODS

Dietary habits were collected in 448 obese subjects aged 6-18 years, attending an obesity outpatient center in Milan. Anthropometry, blood pressure (BP), lipids, fasting and post-load glucose, and insulin were measured. Physical activity was assessed in adolescents using a questionnaire.

RESULTS

Frequency of glucose intolerance, hypertension and dyslipidemia was 0.7%, 13% and 27.2%, respectively. Plausible reporters consumed more animal protein and sodium and less legumes than recommended in nutritional recommendations and adequate amounts of fiber mainly derived from whole grains. Subjects skipping breakfast had unhealthy diets and greater body fatness. After adjustment for confounders, waist/height and fasting glucose were associated with sodium intake (r =0.149 and r = 0.142, respectively; p < 0.05), 2-hour glucose with fiber (r = -0.172; p < 0.01), and BP with vegetable protein intake (systolic r = -0.120 (p < 0.05); diastolic r = -0.267 (p < 0.01)). Hypertensive children consumed less vegetable protein than normotensive children.

CONCLUSIONS

The cardiometabolic health of obese children improves with vegetable protein and whole grain intake, whereas dysglycemia and adiposity increase with sodium intake.

Breakfast intake among adults with type 2 diabetes: influence on daily energy intake

OBJECTIVE

To assess the association between breakfast energy and total daily energy intake among individuals with type 2 diabetes.

DESIGN

Cross-sectional study. Daily energy intake was computed from a 24 h dietary recall. Multiple regression models were used to estimate the association between daily energy intake (dependent variable) and quartiles of energy intake at breakfast (independent variable), expressed in either absolute or relative (percentage of total daily energy intake) terms. Orthogonal polynomial contrasts were used to test for linear and quadratic trends. Models were controlled for sex, age, race/ethnicity, BMI, physical activity and smoking. In addition, we used separate multiple regression models to test the effect of quartiles of absolute and relative breakfast energy on energy intake at lunch, dinner and snacks.

SETTING

The 1999-2004 National Health and Nutrition Examination Survey (NHANES).

SUBJECTS

Participants aged ≥30 years with self-reported history of diabetes (n 1146).

RESULTS

Daily energy intake increased as absolute breakfast energy intake increased (linear trend, P<0·0001; quadratic trend, P=0·02), but decreased as relative breakfast energy intake increased (linear trend, P<0·0001). In addition, while higher quartiles of absolute breakfast intake had no associations with energy intake at subsequent meals, higher quartiles of relative breakfast intake were associated with lower energy intake during all subsequent meals and snacks (P<0·05).

CONCLUSIONS

Consuming a breakfast that provided less energy or comprised a greater proportion of daily energy intake was associated with lower total daily energy intake in adults with type 2 diabetes.

Unhealthy and healthy food consumption inside and outside of the school by pre-school and elementary school Mexican children in Tijuana, Mexico

Food from lunch packs (LP) or food available inside and outside of school can play an important role in the development of obesity. The purpose of this study was to evaluate the LP of elementary school (ES) and preschool children (PS) in Tijuana, and the foods available to them inside and outside of school. Eight public schools participated in the study. A random sample of all the groups from a school district was conducted. A questionnaire was administered to children in first through sixth grade (ES) and to the parents of PS. LP and food available inside and outside of the school were classified as healthy, unhealthy, and adequate according to the guidelines set forth by the Secretariat of Health. A total of 2,716 questionnaires were administered and the content of 648 LP was assessed. It was observed that 99% of PS had LP prepared at home, a higher percentage than ES. None of the LP of the ES was classified as healthy, and 1% was classified as adequate. Among PS, 21% of the LP were classified as healthy and 6% as adequate. More than half of the children recognized the brand name of foods high in fat, salt, and added sugar available inside and outside of school grounds. Most of the LP of ES and PS and the foods available inside and outside of school were unhealthy and inadequate. A strategy to prevent the availability of unhealthy and inadequate food in LP and foods available inside and outside schools is recommended.

Programme coordinators' perceptions of strengths, weaknesses, opportunities and threats associated with school nutrition programmes

OBJECTIVE

As part of a larger evaluation of school nutrition programmes (SNP), the present study examined programme coordinators' perceptions of strengths, weaknesses, opportunities and threats (SWOT) regarding their SNP and public health professionals' support.

DESIGN

Qualitative interviews were conducted with twenty-two of eighty-one programme coordinators who had completed a programme evaluation survey. Interviews followed a SWOT framework to evaluate programmes and assessed coordinators' perceptions regarding current and future partnerships with public health professionals.

SETTING

The study was conducted in a large, urban region within Ontario.

SUBJECTS

The twenty-two coordinators who participated represented a cross-section of elementary, secondary, Public and Catholic schools.

RESULTS

SNP varied enormously in foods/services offered, how they offered them and perceived needs. Major strengths included universality, the ability to reach needy students and the provision of social opportunities. Major weaknesses included challenges in forming funding partnerships, lack of volunteers, scheduling and timing issues, and coordinator workload. Common threats to effective SNP delivery included lack of sustainable funding, complexity in tracking programme use and food distribution, unreliable help from school staff, and conflicts with school administration. Opportunities for increased public health professionals' assistance included menu planning, nutrition education, expansion of programme food offerings, and help identifying community partners and sustainable funding.

CONCLUSIONS

The present research identified opportunities for improving SNP and strategies for building on strengths. Since programmes were so diverse, tailored strategies are needed. Public health professionals can play a major role through supporting menu planning, food safety training, access to healthy foods, curriculum planning and by building community partnerships.

Meal pattern among Norwegian primary-school children and longitudinal associations between meal skipping and weight status

Objective

To investigate meal pattern longitudinally and explore whether meal skipping was associated with overweight among Norwegian children and adolescents.

Design

Longitudinal study. Children's meal frequencies were reported by their parents using a retrospective FFQ. Weight and height were measured by public health nurses. Descriptive data comparing 4th and 7th grade were analysed by paired-sample t tests for continuous variables and χ2 tests for categorical variables. Odds ratio estimates, including confidence intervals, with BMI category (normal/overweight) as the dependent variable, were determined through logistic regression analyses.

Setting

Primary schools, Telemark County, Norway.

Subjects

A cohort of 428 Norwegian boys and girls; 4th graders in 2007, 7th graders in 2010.

Results

The number of children eating four main meals per day (regular meal frequency) decreased from 4th grade (47 %) to 7th grade (38 %; P = 0·001). Those who ate regular meals in 4th grade but not in 7th grade had higher odds (OR = 3·1; 95 % CI 1·1, 9·0) of being overweight in 7th grade after adjusting for gender, maternal education and physical activity, but the odds ratio was not statistically significant after adjusting for overweight in 4th grade (OR = 2·8; 95 % CI 0·7, 11·6).

Conclusions

The present study showed significant increases in overall meal skipping among children between 4th and 7th grade. The results indicate an association between overweight and meal skipping, but additional prospective and longitudinal analyses and intervention trials are warranted to confirm this relationship.

Breakfast consumption and physical activity in adolescents: daily associations and hourly patterns

BACKGROUND

The association between breakfast consumption and physical activity (PA) is inconclusive.

OBJECTIVE

We aimed to investigate daily associations and hourly patterns of PA and breakfast consumption in British adolescents.

DESIGN

Daily PA [accelerometry-derived moderate and vigorous physical activity (MVPA)] and breakfast consumption (diet diary) were measured simultaneously over 4 d in 860 adolescents (boys: 43.4%; mean ± SD age: 14.5 ± 0.5 y). Associations between MVPA and breakfast consumption were assessed by using a multilevel mixed-effects logistic regression separately by sex and for weekends and weekdays. Hourly patterns of MVPA by breakfast consumption status were displayed graphically, and differences were tested by using ANOVA. Multilevel linear regression was used to investigate differences in log MVPA on days when 570 inconsistent breakfast consumers ate or skipped breakfast.

RESULTS

On weekends, boys and girls with higher MVPA were more likely to eat breakfast [OR (95% CI): boys, 1.78 (1.30, 2.45) (P < 0.001); girls, 2.30 (1.66, 3.08) (P < 0.001)] when adjusted for socioeconomic status, percentage of body fat, and total energy intake. Peak hourly MVPA differed for breakfast consumers compared with nonconsumers on weekends (P < 0.001). Inconsistent breakfast consumers did more MVPA on days when they ate breakfast [exponentiated β coefficients (95% CIs): 1.2 (1.0, 1.5) on weekdays and 1.4 (1.1, 1.8) on weekends for boys and 1.6 (1.3, 2.1) on weekends for girls; all P < 0.03].

CONCLUSIONS

Eating breakfast was associated with higher MVPA on weekends. The time of peak MVPA differed between breakfast consumers and nonconsumers on weekends. Breakfast consumption at weekends is worth additional investigation to potentially inform PA promotion in adolescents.

Genetic and environmental influences on eating behaviors in 2.5- and 9-year-old children: a longitudinal twin study

BACKGROUND

Eating behaviors during childhood are related both to children's diet quality and to their weight status. A better understanding of the determinants of eating behavior during childhood is essential for carrying out effective dietary interventions.

METHODS

We assessed the contribution of genetic and environmental factors to variations in selected eating behaviors in early and late childhood. Information on eating behaviors came from questionnaires administered to parents of children participating in the Quebec Newborn Twin Study when the twins were 2.5 and 9 years old (n = 692 children). Dichotomous variables were derived and analyzed using structural equation modeling, as part of a classic twin study design. We performed univariate and bivariate longitudinal analyses to quantify sources of variation and covariation across ages, for several eating behavior traits.

RESULTS

We found moderate to strong heritability for traits related to appetite such as eating too much, not eating enough and eating too fast. Univariate analysis estimates varied from 0.71 (95% CI: 0.49, 0.87) to 0.89 (0.75, 0.96) in younger children and from 0.44 (0.18, 0.66) to 0.56 (0.28, 0.78) in older children. Bivariate longitudinal analyses indicated modest to moderate genetic correlations across ages (r(A) varying from 0.34 to 0.58). Common genetic influences explained 17% to 43% of the phenotypic correlation between 2.5 and 9 years for these appetite-related behaviors. In 9-year-old children, food acceptance traits, such as refusing to eat and being fussy about food, had high heritability estimates, 0.84 (0.63, 0.94) and 0.85 (0.59, 0.96) respectively, while in younger children, the shared environment (i.e., common to both twins) contributed most to phenotypic variance. Variances in meal-pattern-related behaviors were mostly explained by shared environmental influences.

CONCLUSIONS

Genetic predispositions explain a large part of the variations in traits related to appetite during childhood, though our results suggest that as children get older, appetite-related behaviors become more sensitive to environmental influences outside the home. Still, for several traits environmental influences shared by twins appear to have the largest relative importance. This finding supports the notion that familial context has considerable potential to influence the development of healthy eating habits throughout childhood.

Relationship between eating behaviors and physical activity among primary and secondary school students: results of a cross-sectional study

BACKGROUND

With a view toward developing concerted efforts in fostering healthy eating habits and a physically active lifestyle among young people, a study was carried out to explore associations between eating behavior and physical activity (PA).

METHODS

In the school district, questionnaires were completed at home by parents of primary school children (N = 8612) and by secondary school youth (N = 5250) during a break in the schedule. The rates of response were 79% and 83%, respectively. Inferential and descriptive analyses were performed.

RESULTS

The results indicate significant differences between the eating behaviors of young people who engage in 60 minutes of daily PA and those who are sedentary. The physically active children were generally more likely to eat fruit, vegetables, and whole-grain products and to have breakfast (p < .05 among high-school students). The lack of self-confidence (55%) and not enjoying PA (46%) stood out as the greatest obstacles facing adolescents trying to lose weight.

CONCLUSION

There should be particular actions targeting students in the last half of primary school aimed at developing individual accountability and autonomy with respect to healthy eating and PA. These actions should also consider sex differences and those who have more sedentary lifestyles.

Eating breakfast more frequently is cross-sectionally associated with greater physical activity and lower levels of adiposity in overweight Latina and African American girls

BACKGROUND

Eating breakfast is believed to promote a healthy body weight. Yet, few studies have examined the contribution of energy balance-related behavioral factors to this relation in minority youth.

OBJECTIVE

We assessed the associations between breakfast consumption and dietary intake, physical activity (PA), and adiposity before and after accounting for energy intake and PA in minority girls.

DESIGN

Cross-sectional data were obtained on body mass index (BMI), percentage body fat (measured by BodPod), dietary intake (measured with 3-d dietary records), and PA (measured with 7-d accelerometry) from 87 Latina and African American girls 8-17 y of age (75% Latina, 80% overweight). Dietary records were used to categorize girls as more frequent breakfast eaters (MF; 2 or 3 of 3 d; n = 57) or less frequent breakfast eaters (LF; 0 or 1 of 3 d; n = 30). Chi-square tests, ANCOVA, and multiple regression analyses were conducted. Mediation was assessed with a Sobel test.

RESULTS

Compared with the MF group, the LF group spent 30% less time (12.6 min/d) in moderate-to-vigorous-intensity PA (MVPA; P = 0.004) and had a higher percentage body fat (P = 0.029). MVPA accounted for 25% (95% CI: -8.8%, 58.1%; P = 0.139) of the relation between breakfast consumption and percentage body fat. We were unable to show that energy intake or MVPA was a significant mediator of the relation between breakfast consumption and adiposity in this sample.

CONCLUSIONS

Evidence suggests that among predominantly overweight minority girls, MVPA, but not energy intake, was associated with both breakfast consumption and adiposity; however, a lack of power reduced our ability to detect a significant mediation effect. Other unobserved variables likely contribute to this relation.

Effect of skipping breakfast on subsequent energy intake

The objective was to examine the effect of consuming breakfast on subsequent energy intake. Participants who habitually ate breakfast and those who skipped breakfast were recruited for two studies. Using a randomized crossover design, the first study examined the effect of having participants consume either (a) no breakfast, (b) a high carbohydrate breakfast (335 kcals), or (c) a high fiber breakfast (360 kcals) on three occasions and measured ad libitum intake at lunch. The second study again used a randomized crossover design but with a larger, normal carbohydrate breakfast consumed ad libtum. Intake averaged 624 kcals and subsequent food intake was measured throughout the day. Participants ate only foods served from the Cornell Human Metabolic Research Unit where all foods were weighed before and after consumption. In the first study, neither eating breakfast nor the kind of breakfast consumed had an effect on the amount consumed at lunch despite a reduction in hunger ratings. In the second study, intake at lunch as well as hunger ratings were significantly increased after skipping breakfast (by 144 kcal), leaving a net caloric deficit of 408 kcal by the end of the day. These data are consistent with published literature demonstrating that skipping a meal does not result in accurate energy compensation at subsequent meals and suggests that skipping breakfast may be an effective means to reduce daily energy intake in some adults.

Regular breakfast consumption is associated with increased IQ in kindergarten children

BACKGROUND

Studies have documented a positive relationship between regular breakfast consumption and cognitive outcomes in youth. However, most of these studies have emphasized specific measures of cognition rather than cognitive performance as a broad construct (e.g., IQ test scores) and have been limited to Western samples of school-age children and adolescents. This study aims to extend the literature on breakfast consumption and cognition by examining these constructs in a sample of Chinese kindergarten-age children.

METHODS

This cross-sectional study consisted of a sample of 1269 children (697 boys and 572 girls) aged 6 years from the Chinese city of Jintan. Cognition was assessed with the Chinese version of the Wechsler preschool and primary scale of intelligence-revised. Breakfast habits were assessed through parental questionnaire. Analyses of variance and linear regression models were used to analyze the association between breakfast habits and IQ. Socioeconomic and parental psychosocial variables related to intelligence were controlled for.

RESULTS

Findings showed that children who regularly have breakfast on a near-daily basis had significantly higher full scale, verbal, and performance IQ test scores (all p<0.001) compared to children who "sometimes" have breakfast. This relationship persisted for VIQ (verbal IQ) and FIQ (full IQ) even after adjusting for gender, current living location, parental education, parental occupation, and primary child caregiver.

CONCLUSION

Findings may reflect nutritional as well as social benefits of regular breakfast consumption on cognition, and regular breakfast consumption should be encouraged among young children.

Infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity in Malaysian school-aged adolescents

Unhealthy dietary pattern increases the risk of obesity and metabolic disorders in growing children and adolescents. However, the way the habitual pattern of breakfast consumption influences body composition and risk of obesity in adolescents is not well defined. Thus, the aim of the present study was to assess any associations between breakfast consumption practices and body composition profiles in 236 apparently healthy adolescents aged 12 to 19 years. A self-administered questionnaire on dietary behaviour and lifestyle practices and a dietary food frequency questionnaire were used. Body composition and adiposity indices were determined using standard anthropometric measurement protocols and dual energy χ-ray absorptiometry (DXA). Mean age of the participants was 15.3±1.9 years. The majority of participants (71.2%) fell in the normal body mass index (BMI) ranges. Breakfast consumption patterns showed that only half of the participants (50%) were consuming breakfast daily. Gender-specific multivariate analyses (ANCOVA) showed that in both boys and girls, those eating breakfast at least 5 times a week had significantly lower body weight, body mass index (BMI), BMI z-scores, waist circumference, body fat mass and percent body fat (%BF) compared to infrequent breakfast eaters, after adjustment for age, household income, pubertal status, eating-out and snacking practices, daily energy intakes, and daily physical activity levels. The present findings indicate that infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity. Therefore, daily breakfast consumption with healthy food choices should be encouraged in growing children and adolescents to prevent adiposity during these critical years of growth.

Lunch habits of German children and adolescents: composition and dietary quality

BACKGROUND/AIMS

Data from the ongoing, open-cohort Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were used to describe warm family lunch meals and the association of the lunch composition with total diet quality.

METHODS

2,095 three-day weighed dietary records, collected between 2004 and 2009, from a 4- to 18-year-old DONALD study subgroup were used.

RESULTS

Warm lunch (eating occasions between 11.30 a.m. and 2.29 p.m. including at least one course that is typically consumed warm) was eaten on 68.8% of all record days. Meat lunch (>50%) was predominant, followed by vegetarian (25%), fish (13%) and sweet lunch meals (3%). The prevalence of desserts at lunch was high and beverages were drunk at 80% of lunch meals. A meat lunch was associated with a higher protein (+1.4% energy intake, %E) and fat intake (+1.7%E) than a sweet lunch; also densities of vitamin A, folate and iron were higher. A dessert at lunch decreased protein intake slightly (-0.2%E), but increased carbohydrate (+0.7%E) and added sugar intake (+1.4%E) as well as density of calcium (+18 mg/MJ).

CONCLUSION

Our study proves the impact of lunch on daily dietary quality and yields valuable insights on the development of food and meal-based dietary guidelines.

The development and evaluation of the Australian child and adolescent recommended food score: a cross-sectional study

Background

Diet quality tools have been developed to assess the adequacy of dietary patterns for predicting future morbidity and mortality. This study describes the development and evaluation of a brief food-based diet quality index for use with children at the individual or population level. The Australian Child and Adolescent Recommended Food Score (ACARFS) was developed to reflect adherence to the Dietary Guidelines for Children and Adolescents in Australia and modelled on the approach of the US Recommended Food Score.

Methods

The ACARFS has eight sub-scales and is scored from zero to 73. The diet quality score was evaluated by assessing correlation (Spearman’s correlations) and agreement (weighted κ statistics) between ACARFS scores and nutrient intakes, derived from a food frequency questionnaire in 691 children (mean age 11.0, SD 1.1) in New South Wales, Australia. Nutrient intakes for ACARFS quartiles were compared with the relevant Australian nutrient reference values.

Results

ACARFS showed slight to substantial agreement (κ 0.13-0.64) with nutrient intakes, with statistically significant moderate to strong positive correlations with all vitamins, minerals and energy intake (r = 0.42-0.70). ACARFS was not related to BMI.Participants who scored less than the median ACARFS were more likely to have sub-optimal intakes of fibre, folic acid and calcium.

Conclusion

ACARFS demonstrated sufficient accuracy for use in future studies evaluating diet quality. Future research on its utility in targeting improvements in the nutritional quality of usual eating habits of children and adolescents is warranted.

Nutrition knowledge and other determinants of food intake and lifestyle habits in children and young adolescents living in a rural area of Sicily, South Italy

OBJECTIVE

The study aimed to test the reliability of a nutrition questionnaire and to assess potential associations between nutrition knowledge, food consumption and lifestyle behaviours, controlling for sociodemographic factors.

DESIGN

Cross-sectional survey.

SETTING

Comprehensive school in the municipality of Butera, a rural area of Sicily, South Italy.

SUBJECTS

The survey was conducted between March and May 2010 on 445 students (4-16 years).

RESULTS

All constructs of the questionnaire had statistically significant Cronbach's a and Pearson's correlation coefficients, showing good internal consistency and temporal stability. After controlling for covariates, nutrition knowledge was positively associated with pasta/rice, fish, vegetable and fruit intakes, and negatively with sweets, snacks, fried foods and sugary drinks consumption. Moreover, students whose parents were in the highest educational and occupational categories reported eating significantly more fruits and vegetables and less meat, sweets, snacks, fried foods and sugary drinks. Students with higher nutrition knowledge scores were less likely to have two or more snacks daily and to spend more than 3 h in sedentary activities daily (OR=0.89, 95% CI 0.83, 0.97 and OR=0.92, 95% CI 0.86, 0.99, respectively). High parental education was associated with less frequent snacking and more frequent weekly physical activity, compared with lower categories, whereas high parental occupational category was associated with daily breakfast.

CONCLUSIONS

Improving nutrition knowledge in children and young adolescents may translate into educating them in good dietary habits. Moreover, nutrition intervention programmes should also involve parents to improve dietary quality and nutritional habits of the entire family.

Proposal for a Breakfast Quality Index (BQI) for children and adolescents

OBJECTIVE

To propose and apply an instrument to assess the breakfast quality of children and adolescents in the Mediterranean area.

DESIGN

Randomized, cross-sectional survey of breakfast consumption using a validated semi-quantitative FFQ administered at school by trained dietitians between Tuesday and Friday. A Breakfast Quality Index (BQI) score was developed, assigning a positive value to the consumption of cereals, fruit, vegetables, dairy products, MUFA, Ca and compliance with energy recommendations, and to the absence of SFA and trans-rich fats. Data were analysed by Student's t test and ANOVA.

SETTING

Schools in Granada and Balearic Islands (Spain).

SUBJECTS

All schoolchildren (n 4332) aged 8-17 years at randomly selected and representative schools between 2006 and 2008, stratified by age and sex.

RESULTS

Breakfast was not consumed by 6·5 % of participants. BQI score was highest for children aged 7-9 years and decreased with age (P = 0·001). Females scored higher in all age groups. The lowest score was in males aged 14-17 years and the highest in females aged 7-9 years (P = 0·006).

CONCLUSIONS

The proposed BQI appears useful to estimate the breakfast quality of schoolchildren and to form a basis for nutrition education.

Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study

Objective

To examine the association between breakfast consumption and CVD risk factors in European adolescents.

Design

Cross-sectional. Breakfast consumption was assessed by the statement ‘I often skip breakfast’ and categorized into ‘consumer’, ‘occasional consumer’ and ‘skipper’. Blood pressure, weight, height, waist circumference, skinfold thickness, total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), TAG, insulin and glucose were measured and BMI, TC:HDL-C, LDL-C:HDL-C and homeostasis model assessment–insulin resistance index (HOMA-IR) were calculated.

Setting

The European Union-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

Subjects

European adolescents, aged 12·50–17·49 years, from ten cities within the HELENA study (n2929,n925 with blood sample, 53 % females).

Results

In males, significant differences across breakfast consumption category (‘consumer’, ‘occasional consumer’ and ‘skipper’) were seen for age, BMI, skinfold thickness, waist circumference, cardiorespiratory fitness, systolic and diastolic blood pressures, TC:HDL-C, LDL-C:HDL-C, glucose, insulin, HOMA-IR and LDL-C; in females, for cardiorespiratory fitness, skinfold thickness, BMI, insulin and HOMA-IR. In overweight/obese males significant differences were also seen for TC and LDL-C, whereas no differences were observed in non-overweight males or in females regardless of weight status.

Conclusions

Our findings among European adolescents confirm previous data indicating that adolescents who regularly consume breakfast have lower body fat content. The results also show that regular breakfast consumption is associated with higher cardiorespiratory fitness in adolescents, and with a healthier cardiovascular profile, especially in males. Eating breakfast regularly may also negate somewhat the effect of excess adiposity on TC and LDL-C, especially in male adolescents.

Irregular breakfast consumption in adolescence and the family environment: underlying causes by family structure

Data from the 2002, 2006 and 2010 Scottish Health Behaviour in School-aged Children (HBSC) surveys were analysed using logistic multilevel regression for outcome variable irregular breakfast consumption (IBC). IBC prevalence in Scotland was higher among young people from reconstituted and single parent families, and particularly single father families. Family characteristics, found previously to be associated with breakfast consumption, such as number of siblings, perceived parenting, parental involvement and family affluence, differed by family structure. Family structure inequalities in IBC existed, also after adjustment for year and child's sex, age, grade and ethnicity. Across all family structures, IBC was more prevalent at the older age groups, among those who had difficult communication with their parents, and where household routines were infrequent. Greater number of siblings and lower family affluence were associated with higher odds of IBC in single mother and both parent families, while having a second home was associated with higher odds in reconstituted households. Fair parenting and being close to at least one parent was associated with reduced odds of IBC in single mother households, while being close to all parents was in single father households. In single mother homes, having a working mother was also positively associated with IBC. Family structure differences should be considered when addressing irregular breakfast consumption in adolescence.

Family structure and breakfast consumption of 11-15 year old boys and girls in Scotland, 1994-2010: a repeated cross-sectional study

Background

The benefits of breakfast during childhood and adolescence have been reported previously though few studies have considered family structure inequalities in breakfast consumption. The proportion of young people living in non-traditional family types has increased in recent years, strengthening the need to describe and monitor the impact of the changing family unit on adolescent breakfast consumption. This study aimed to describe changes in daily breakfast consumption among adolescents in Scotland between 1994 and 2010, while also considering family structure inequalities, and the degree to which these have changed over time.

Methods

Data from the 1994, 1998, 2002, 2006 and 2010 Scottish Health Behaviour in School-aged Children (HBSC) surveys were analysed using logistic multilevel regression models for binary outcome variable daily breakfast consumption.

Results

Daily breakfast consumption among adolescents increased between 1994 and 2010, although there were differences by age and sex. In fact those aged over 14.5 years saw decreases in breakfast consumption, and girls saw significantly larger increases than boys. Daily breakfast consumption was more prevalent among adolescents from 'both parent' families, with lowest prevalence among those from single parent families. Trends in daily breakfast consumption between 1994 and 2010 also varied by family structure. While prevalence of daily breakfast consumption increased among those living with 'both parents', the largest proportion of the population, prevalence decreased over time among adolescents of single parent families, and particularly among those living with their father.

Conclusions

Family structure inequalities in daily breakfast consumption increased between 1994 and 2010, while breakfast consumption across the population as a whole increased. As the proportion of young people living in an alternative family structure continues to grow it is important to understand why these inequalities have increased and how these may be overcome. Possible reasons for family structure inequalities and their increase in recent years are discussed.

Breakfast consumption and meal frequency interaction with childhood obesity

OBJECTIVES

Increased meal frequency and daily breakfast consumption have been inversely associated with childhood obesity. The purpose of the study was to examine the possible interaction effect between meal frequency and breakfast consumption on childhood obesity.

METHODS

Seven hundred children (323 boys) aged 10-12 years were enrolled in this cross-sectional study. Several lifestyle, dietary and physical activity characteristics were recorded with food frequency and physical activity questionnaires. Body height and weight were measured and body mass index was calculated in order to classify children as overweight or obese (International Obesity Task Force classification). Multiple logistic regression analysis was used in order to evaluate the interaction between daily breakfast intake and more than three meals per day consumption with overweight or obesity.

RESULTS

Of the children, 27.6% and 9.0% were overweight and obese, respectively. Moreover, 60.2% consumed three or more meals per day and 62.7% consumed breakfast in a regular daily basis. Children who consumed more than three meals per day and also consumed breakfast daily, were two times less likely to be overweight or obese (adjusted odds ratio: 0.49, 95% confidence interval: 0.27-0.88).

CONCLUSION

A combined higher meal frequency and daily breakfast consumption dietary pattern may prevent overweight and obesity in children.

Selected eating behaviours and excess body weight: a systematic review

The relationship between obesity and the intake of macronutrients and specific foods is uncertain. Thus, there is growing interest in some eating behaviours because they may reflect the joint effect of several foods and nutrients and, thus, increase the likelihood of finding a link to obesity. This study examined the association between selected eating behaviours and excess weight in the general population throughout a systematic review of publications written in English, Spanish or Portuguese identified in a PubMed search up to 31 December 2010. We included 153 articles, 73 of which have been published since 2008. Only 30 studies had a prospective design; of these, 15 adjusted for sociodemographic variables, physical activity and energy or food intake. Moreover, definitions of eating behaviours varied substantially across studies. We found only small or inconsistent evidence of a relationship between excess weight and skipping breakfast, daily eating frequency, snacking, irregular meals, eating away from home, consumption of fast food, takeaway food intake, consumption of large food portions, eating until full and eating quickly. In conclusion, this review highlights the difficulty in measuring human behaviour, and suggests that a more systematic approach is needed for capturing the effects of eating behaviours on body weight.

Increased breakfast frequency and nutritional quality among schoolchildren after a national breakfast promotion campaign in Australia between 2000 and 2006

This national study examined student breakfast consumption and nutritional quality of breakfast in 2000 and 2006 by gender, school grade, school socioeconomic status (SES) and weight status after the implementation of a national breakfast promotion campaign. Participants were 4237 schoolchildren in grades 2-12 from 32 schools in 2000 and 5645 schoolchildren from the same schools in 2006. Height and weight were measured. Missing breakfast decreased from 2000 to 2006 in primary school females (9.6-6.0%) and males (9.4-6.0%) and in secondary school females (27.7-18.7%) and males (19.9-12.1%). Breakfast skipping was greater and nutritional quality was poorer in students from low SES schools in both study years but significant improvement was seen from 2000 to 2006 among all SES groups. Overweight/obese participants were more likely than normal weight students to miss breakfast in 2000 (20.7% versus 16.0%) and in 2006 (14.3% versus 10.4%) but significant improvement was observed over the 6-year study period. Findings suggest that the consistent, significant and far-reaching improvements in breakfast consumption observed in this study were attributed to the breakfast promotion program conducted in each school community and disseminated nationally via a mass media campaign.

Breakfast and the achievement gap among urban minority youth

OBJECTIVES

To outline the prevalence and disparities of breakfast consumption among school-aged urban minority youth, causal pathways through which skipping breakfast adversely affects academic achievement, and proven or promising approaches for schools to increase breakfast consumption.

METHODS

Literature review.

RESULTS

On any given day a substantial proportion of American youth do not eat breakfast. On an average day, less than half (∼46%) of children participating in free or reduced-price lunch also participated in the School Breakfast Program for which they were also eligible. In a large study of 9-year-olds, 77% of White girls and 57% of Black girls consumed breakfast on all 3 days assessed; by age 19, the respective rates were 32% and 22%. Neuroscience research has identified the processes by which dietary behavior influences neuronal activity and synaptic plasticity, both of which influence cognitive functions. Participation in School Breakfast Programs has also been associated with reduced absenteeism. Universal School Breakfast Programs and allowing youth to eat breakfast in the classroom (vs cafeteria) are approaches that have been shown to increase participation.

CONCLUSIONS

Skipping breakfast is highly and disproportionately prevalent among school-aged urban minority youth, has a negative impact on academic achievement by adversely affecting cognition and absenteeism, and effective practices are available for schools to address this problem. Despite wide availability, the majority of American youth do not participate in School Breakfast Programs. High-quality universal breakfast programs that allow students to eat breakfast in the classroom are especially needed for youth who are not likely to get good nutrition the rest of the day.

Does consuming breakfast influence activity levels? An experiment into the effect of breakfast consumption on eating habits and energy expenditure

OBJECTIVE

To experimentally compare the effects of eating or skipping breakfast on energy expenditure, activity levels and dietary habits.

DESIGN

A randomised cross-over trial, lasting 2 weeks. Participants were provided breakfast during one week and were required to fast until mid-day during the other week.

SETTING

University campus.

SUBJECTS

Forty-nine participants (twenty-six female and twenty-three male participants) were recruited. Food intake was monitored using food diaries, and energy expenditure was assessed using pedometers and heart rate monitors. Morningness-eveningness, physical activity and health were assessed using validated questionnaires.

RESULTS

Across all participants, daily energy expenditure did not differ between the two experimental conditions. Total energy intake over 24 h did not vary with condition (male participants: 8134 (sd 447) kJ/d and 7514 (sd 368) kJ/d; female participants: 7778 (sd 410) kJ/d and 7531 (sd 535) kJ/d, for the breakfast and no-breakfast conditions, respectively). However, when comparing habitual breakfast eaters with those with irregular or breakfast-skipping habits, it was found that male non-habitual breakfast eaters consumed significantly (P = 0·029) more energy during the breakfast condition. Furthermore, female participants who were habitual breakfast eaters were found to eat significantly (P = 0·005) more and later in the day under the no-breakfast condition.

CONCLUSIONS

Although the suggestion that breakfast is a behavioural marker for appropriate dietary and physical activity patterns is not refuted by the present findings, our data suggest that the effect of breakfast may vary as a function of gender and morning eating habits, and thus there may be other mechanisms that link BMI and breakfast consumption behaviour.

Prevalence and correlates of self-induced vomiting as weight-control strategy among adolescents in Taiwan

AIMS

This study was designed to assess the prevalence and correlates of self-induced vomiting to control body weight among adolescents in Taiwan.

BACKGROUND

Over the past decades, the rate of obesity among children in Taiwan has nearly tripled. Educational authorities have devoted considerable effort to prevent the increase in childhood obesity.

DESIGN

An observational exploratory design to investigate the problem of using unhealthy weight-reduction strategy.

METHODS

This study consists of a cross-sectional study aimed at collecting national representative data. We chose 120 representative schools using a three-stage stratified systematic sampling design with probability proportionate to the size of the population in Taiwan. Participants consisted of 8673 girls and 7043 boys, aged 10-18 old.

RESULTS

Of the participants, 13% reported using self-induced vomiting, the prevalence being highest in participants aged 10-12 (15·9%) and lowest in participants aged 16-18 (7·5%). Several factors were significantly and positively associated with the use of self-induced vomiting as a weight-loss strategy, specifically subjects who (1) watched television, used computer, surfed the Internet or played video games for greater than or equal to two hours/day, (2) consumed fried food every day and (3) ate night-time snacks every day (odds ratio = 1·55, 2·10 and 1·51, respectively; p < 0·05). Eating breakfast every day and sleeping for more than eight hours a day were both protective factors against the use of self-induced vomiting to control body weight (odds ratio = 0·43 and 0·86, respectively; p < 0·05).

CONCLUSIONS

Self-induced vomiting was prevalent among adolescents who had tried to lose weight; sedentary lifestyle, shorter sleep length and unhealthy eating habits may contribute significantly to this behaviour among these adolescents.

RELEVANCE TO CLINICAL PRACTICE

School nurses who are helping adolescents lose weight should also pay attention to the possibility they are using self-induced vomiting as a weight-control strategy.

Meal pattern and BMI in 9–11-year-old children in Finland

Objective

In many studies it has been shown that breakfast is associated with normal weight in children and adolescents. Other meals, family meals and a regular meal pattern have been less studied. Therefore, the aim of the present study was to examine whether a regular meal pattern, or breakfast, lunch or dinner as separate regular meals, is associated with the BMI of children.

Design

A cross-sectional study conducted within the Helsinki region during 2006. Study participants were measured and weighed by research staff. Children filled in a study questionnaire on their health behaviour, including the frequency of consuming meals. A regular meal was defined as one usually eaten on every school day. A regular meal pattern was defined as one consisting of a usual consumption of breakfast, school lunch and dinner on every school day. Covariance analysis was used as the statistical analysis method.

Setting

Capital region, Finland, 2006.

Subjects

A total of 604 schoolchildren (312 girls) aged 9–11 years.

Results

Irregular breakfast and an irregular meal pattern were associated with higher BMI. Regularity of school lunch, dinner or family dinner was not associated with BMI.

Conclusions

A regular breakfast and meal pattern was associated with lower BMI in children, although breakfast was the only single meal associated with BMI. We conclude that, although the association between breakfast and weight status in children is fairly consistent, the role of other meals is less convincing.

National School Lunch Program participation and sex differences in body mass index trajectories of children from low-income families

OBJECTIVES

To investigate participation patterns in the National School Lunch Program (NSLP) among low-income children from kindergarten to fifth grade and to examine the ways in which participation influences sex differences in the trajectories of body mass index (BMI) through the eighth grade.

DESIGN

Longitudinal, secondary data analysis.

SETTING

Sample of low-income US children who entered kindergarten in 1998.

PARTICIPANTS

Girls (n = 574) and boys (n = 566) from low-income families who participated in the Early Childhood Longitudinal Study, Kindergarten Cohort.

MAIN EXPOSURE

Participation in the NSLP.

MAIN OUTCOME MEASURES

Temporary and persistent patterns of NSLP participation, and age-specific and sex-specific BMI raw scores calculated at 5 data points.

RESULTS

Among the low-income children who attended schools that participated in the NSLP, both the children who persistently participated in the program and those who temporarily participated in the program displayed similar socioeconomically disadvantaged factors. Nonlinear mixed models indicated a larger rate of change in BMI (ie, an increase) among low-income, participating girls than among low-income, nonparticipating girls; however, mean BMIs did not significantly differ between low-income girls who participated and those who did not participate. No significant differences were observed among low-income boys.

CONCLUSIONS

Results suggest that participation in the NSLP is associated with rapid weight gain for low-income girls but not for low-income boys.

The impact of eating habits on anthropometric characteristics in French primary school children

BACKGROUND

Obesity is increasing worldwide, reaching alarming proportions. Eating habits have changed over time and nowadays children and adolescents' environment favours the adoption of unhealthy eating behaviours leading to metabolic impairment.

OBJECTIVE

To explore the impact of eating risk factors and their cumulative effect on anthropometric characteristics in French primary school children.

METHODS

A total of 278 healthy French children (7.50 ± 0.67 years old) and their legal representatives agreed to take part in this study. Parents were asked to fill in an eating habits clinical questionnaire with questions about skipping breakfast, snacking between meals, eating in front of the TV and sugar-sweetened beverage consumption. On the basis of the answers, children were classified into four categories as a function of the number of eating risk factors they presented. Body mass index (BMI), the sum of four skinfolds (Σ4 skinfolds: tricipital, bicipital, sub-scapular and supra-iliac) and waist circumference (WC) were measured. BMI was transformed into z-BMI for each child.

RESULTS

ANOVA and unpaired t-test provided significantly higher z-BMI, Σ4 skinfolds and WC in children who were used to skipping breakfast, snacking, watching TV while eating and consuming sugar-sweetened beverages. The more children accumulated eating risk factors, the higher were their z-BMI, Σ4 skinfolds and WC (MANOVA: P < 0.001).

CONCLUSIONS

Eating habits appear to be associated with anthropometric characteristics in French primary school children. Anthropometric values (z-BMI, Σ4 skinfolds and WC) increased with the number of eating risk factors they presented.

Breakfast trends in children and adolescents: frequency and quality

Objective

Although breakfast is important for obesity prevention and dietary quality, breakfast skipping is a common behaviour. Knowledge of changes in breakfast habits may provide potential behaviour targets for intervention programmes. The present study describes the actual data on trends in breakfast habits and composition.

Design

A total of 7800 3 d dietary records of 1081 participants aged 2–18 years collected between 1986 and 2007 in the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study were analysed using mixed linear models.

Results

Breakfast was eaten at 78 % of all record days; regular breakfast (breakfast was eaten on all three recorded weekdays) was eaten in 75 % of records. During the study period, the number of records with regular breakfast decreased significantly in 6–12- and 13–18-year-olds (P= 0·0084 and 0·0350, respectively). Of all breakfast meals, 62 % were bread meals and 21 % were ready-to-eat cereal (RTEC) meals. RTEC meals nearly doubled from the youngest to the oldest age group (P< 0·0001). During the study period, the percentage of bread meals decreased, whereas the percentage of RTEC meals increased (P< 0·0001). A higher percentage of RTEC meals than the bread meals was in accordance with the food-based guidelines (36 %v. 20 %,P< 0·0001), i.e. a breakfast including grain, dairy and fruit/vegetables.

Conclusions

In the DONALD Study sample, a negative age and time trend in breakfast consumption was verified. Interventions regarding breakfast habits should be aimed at adolescents and should focus on fruit/vegetables.

Energy intake and snack choice by the meal patterns of employed people

The aim of this study was to provide descriptive information on meal and snack patterns and to investigate snacks in relation to energy intake and food choice according to the meal patterns of employed people in Korea. 683 employed people (292 males, 391 females) were interviewed to collect one day dietary data by using 24-h dietary recall. A recorded day was divided into 3 meal and 3 snack periods by the respondent's criteria and the time of consumption. To analyze the eating pattern participants were divided as the more frequent snack eaters (MFSE) and the less frequent snack eaters (LFSE). They were also categorized into 6 groups according to the frequency of all eating occasions. The common meal pattern in nearly half of the subjects (47.6%) was composed of three meals plus one or two snacks per day. A trend of an increasing the number of snacks in between main meals emerges, although the conventional meal pattern is still retained in most employed Korean adults. Women, aged 30-39, and urban residents, had a higher number of being MFSE than LFSE. Increasing eating occasions was associated with higher energy, protein, and carbohydrate intakes, with the exception of fat intakes. 16.8% of the total daily energy intake came from snack consumption, while the 3 main meals contributed 83.2%. Energy and macronutrient intakes from snacks in the MFSE were significantly higher than the LFSE. Instant coffee was the most popular snack in the morning and afternoon, whereas heavy snacks and alcohol were more frequently consumed by both of the meal skipper groups (</=2M+2,3S and </=2M+0,1S) in the evening. In conclusion, meal pattern is changing to reflect an increase of more snacks between the three main meals. Meal and snack patterns may be markers for the energy and macronutrient intakes of employed people in Korea.

The contribution of dietary factors to dental caries and disparities in caries

Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars, is significantly associated with increased dental caries risk. Malnutrition (undernutrition or overnutrition) in children is often a consequence of inappropriate infant and childhood feeding practices and dietary behaviors associated with limited access to fresh, nutrient dense foods, substituting instead high-energy, low-cost, nutrient-poor sugary and fatty foods. Lack of availability of quality food stores in rural and poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation, including changes in traditional ethnic eating behaviors, can further deter healthful eating and increase risk for early childhood caries and obesity. America is witnessing substantial increases in children and ethnic minorities living in poverty, widening the gap in oral health disparities noted in Oral Health in America: A Report of the Surgeon General. Dental and other care providers can educate and counsel pregnant women, parents, and families to promote healthy eating behaviors and should advocate for governmental policies and programs that decrease parental financial and educational barriers to achieving healthy diets. For families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy foods, particularly in urban and rural neighborhoods, to effect positive changes in children's diets and advance the oral components of general health.

Television viewing, computer game play and book reading during meals are predictors of meal skipping in a cross-sectional sample of 12-, 14- and 16-year-olds

Objective

To examine whether television viewing, computer game playing or book reading during meals predicts meal skipping with the aim of watching television, playing computer games or reading books (media meal skipping).

Design

A cross-sectional study was conducted using a standardized self-administered questionnaire. Analyses were controlled for age, gender and BMI.

Setting

Data were obtained from a random sample of adolescents in Flanders, Belgium.

Subjects

Seven hundred and ten participants aged 12, 14 and 16 years.

Results

Of the participants, 11·8 % skipped meals to watch television, 10·5 % skipped meals to play computer games and 8·2 % skipped meals to read books. Compared with those who did not use these media during meals, the risk of skipping meals in order to watch television was significantly higher for those children who watched television during meals (2·9 times higher in those who watched television during at least one meal a day). The risk of skipping meals for computer game playing was 9·5 times higher in those who played computer games weekly or more while eating, and the risk of meal skipping in order to read books was 22·9 times higher in those who read books during meals less than weekly. The more meals the respondents ate with the entire family, the less likely they were to skip meals to watch television.

Conclusions

The use of media during meals predicts meal skipping for using that same medium. Family meals appear to be inversely related to meal skipping for television viewing.

Eating late in the evening is associated with childhood obesity in some age groups but not in all children: the relationship between time of consumption and body weight status in U.S. children

Background

Some studies in adults indicate a positive correlation between eating later in the day and overall energy intake as well as body weight status. Thus, the time of food intake may be a risk factor in childhood obesity. This study was designed to describe the proportion of energy consumed in the time from 4 pm to midnight measured in two-hour increments and to determine a potential association between the time of proportion of energy consumed and body weight status.

Methods

Dietary, anthropometric, and socio-demographic data of 2–18 year olds (N = 11,072) of the National Health and Nutrition Examination Survey (NHANES) 1999–2004 was examined to describe the proportion of total energy consumed within two-hour time periods between 4 pm and midnight. To examine the potential association between eating later in the day and body weight status, generalized estimating equations (GEE) models were used to quantify the effect of time trends (proportion of total energy consumed in each 2-hour time period from 4 pm to 11.59 pm) on body weight status. Analysis was conducted in the total sample and in subgroups stratified by sex, ethnic group (Non-Hispanic white, Non-Hispanic black, Mexican American, Other Hispanic, and Other Race including multi-racial) and age group (2–5, 6–11, and 12–18 year olds). Complex sample survey analysis were used to assess differences at a significance level of p-value < 0.05.

Results

Proportion of energy consumed varied by sex, ethnic group, and age groups between 4 pm and 11.59 pm. Compared to healthy weight children, overweight school-age children consumed significantly higher while overweight adolescents consumed significantly lower proportions of total daily energy with each advancing two-hour time increment.

Conclusion

The association between the circadian rhythm of eating and body weight status needs to be investigated further to examine the effect of time of consumption on the risk of childhood obesity. Especially longitudinal studies in diverse child populations would help elucidate the importance of time of eating on obesity.

A good-quality breakfast is associated with better mental health in adolescence

OBJECTIVE

Breakfast consumption has been associated with better mental health in adulthood, but the relationship between breakfast and mental health in adolescence is less well known. The aims of the present study were to evaluate breakfast quality in a cohort of adolescents and to investigate associations with mental health.

DESIGN

Cross-sectional population-based study. Breakfast quality was assessed by intake of core food groups at breakfast, as determined from 3 d food diaries. Mental health was assessed using the Child Behaviour Checklist (CBCL), with higher scores representing poorer behaviour.

SETTING

The Western Australian Pregnancy Cohort (Raine) Study, Perth, Western Australia.

SUBJECTS

Eight hundred and thirty-six males and females aged between 13 and 15 years.

RESULTS

Mean mental health score as assessed by the CBCL was 45.24 (sd 11.29). A high-quality breakfast consisting of at least three food groups was consumed by 11 % of adolescents, while 7 % of adolescents did not consume any items from core food groups on average over the 3 d period. The two most common core food groups consumed at breakfast in this population were dairy products followed by breads and cereals. For every additional food group eaten at breakfast, the associated total mental health score decreased by 1.66 (95 % CI -2.74, -0.59) after adjustment for potential confounding factors, representing an improvement in mental health score.

CONCLUSION

These findings support the concept that breakfast quality is an important component in the complex interaction between lifestyle factors and mental health in early adolescence.