Association of meal skipping with subjective health complaints in children and adolescents: the CASPIAN-V study

Interaction Between Early Meals (Big-Breakfast Diet), Clock Gene mRNA Expression, and Gut Microbiome to Regulate Weight Loss and Glucose Metabolism in Obesity and Type 2 Diabetes

The circadian clock gene system plays a pivotal role in coordinating the daily rhythms of most metabolic processes. It is synchronized with the light-dark cycle and the eating-fasting schedule. Notably, the interaction between meal timing and circadian clock genes (CGs) allows for optimizing metabolic processes at specific times of the day. Breakfast has a powerful resetting effect on the CG network. A misaligned meal pattern, such as skipping breakfast, can lead to a discordance between meal timing and the endogenous CGs, and is associated with obesity and T2D. Conversely, concentrating most calories and carbohydrates (CH) in the early hours of the day upregulates metabolic CG expression, thus promoting improved weight loss and glycemic control. Recently, it was revealed that microorganisms in the gastrointestinal tract, known as the gut microbiome (GM), and its derived metabolites display daily oscillation, and play a critical role in energy and glucose metabolism. The timing of meal intake coordinates the oscillation of GM and GM-derived metabolites, which in turn influences CG expression, playing a crucial role in the metabolic response to food intake. An imbalance in the gut microbiota (dysbiosis) can also reciprocally disrupt CG rhythms. Evidence suggests that misaligned meal timing may cause such disruptions and can lead to obesity and hyperglycemia. This manuscript focuses on the reciprocal interaction between meal timing, GM oscillation, and circadian CG rhythms. It will also review studies demonstrating how aligning meal timing with the circadian clock can reset and synchronize CG rhythms and GM oscillations. This synchronization can facilitate weight loss and improve glycemic control in obesity and those with T2D.

Overweight and Obesity Is Associated with Higher Risk of Perceived Stress and Poor Sleep Quality in Young Adults

Background and Objectives: Overweight and obesity are growing public health challenges, particularly concerning young adults. University life presents a unique set of stressors that may influence weight management alongside sleep quality. In this cross-sectional study, we aimed to investigate the association between overweight or obesity, stress, and sleep quality in a large sample of Greek university students. Materials and Methods: The study recruited 2116 active students from across various Greek universities. Participants completed questionnaires on sociodemographics, academic performance, and physical activity levels using the International Physical Activity Questionnaire (IPAQ). Stress and sleep quality were assessed using the Perceived Stress Scale (PSS) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Body weight and height were directly measured to calculate Body Mass Index (BMI). Results: Our analysis of 2116 Greek university students revealed significant associations between various factors and overweight/obesity. Compared to their rural counterparts, young adults in urban areas had an 88% higher prevalence of overweight/obesity (p = 0.0056). Regular smokers were twice as likely to be overweight or obese (p = 0.0012). Notably, those with low physical activity levels displayed a more than two-fold increased risk (p = 0.0008) compared to those with moderate or high activity levels. Similarly, students with moderate or high perceived stress levels had a more than two-fold prevalence of overweight/obesity compared to those with low stress (p = 0.0005). Inadequate sleep quality was also associated with an 86% higher risk of overweight/obesity (p = 0.0007). Interestingly, good academic performance showed a 57% greater prevalence of overweight/obesity compared to very good/excellent performance (p = 0.0103). Conclusions: Our findings reveal that perceived stress and poor sleep quality are significant risk factors for overweight and obesity in this young adult population.

The Relationship between the Frequency of Breakfast Consumption, Conversation with Parents, and Somatic Symptoms in Children: A Three-Wave Latent Growth Model

Breakfast consumption is essential for children to generate energy for the day. Parents play an important role in children's breakfast habits and spending time with parents during breakfast greatly influences children's emotional development. Therefore, this study investigated the relationship between the frequency of children's breakfast consumption, time spent in conversation with parents, and children's somatic symptoms. Data were obtained from the Korea Children and Youth Panel Survey 2018 and were initially collected from fourth-grade elementary school students and followed up for three years. SPSS 21.0 and AMOS 21.0 software were used for data analysis. Multivariate latent growth modeling was applied to analyze the effect of the breakfast consumption frequency on children's somatic symptoms and the mediating effect of parent-child conversation time on this relationship. Consequently, as children's frequency of breakfast consumption increased, their somatic symptoms decreased. Furthermore, parent-child conversation time mediated the relationship between these two variables. Therefore, students, parents, and teachers should be educated about the importance of having breakfast and communicating with parents for students' emotional health.

Obesity-Associated Anxiety Is Prevalent among College Students and Alleviated by Calorie Restriction

Anxiety is a common disorder among college students, especially those with obesity. Obesity contributes to metabolic disorders and disturbs the neural functions, further leading to anxiety. In this cross-sectional study, we aimed to determine the association between obesity and anxiety among college students and identified the potential factors for obesity-associated anxiety. We evaluated the intervention effects of calorie restriction on anxiety. Self-reported questionnaires were distributed to 1381 college students from January to March in 2021. Anxiety was measured by the State-Trait Anxiety Inventory (STAI). Participants were classified into anxiety and non-anxiety groups according to their STAI scores. Chi-squared test and logistic regression were used to analyze the potential factors. We found that 383 college students exhibited anxiety, accounting for 30.1% among all included college students, which was higher than the global average. The association between anxiety and obesity was observed among college students (p = 0.009), especially in males (p = 0.007). We identified that pre-obesity (p = 0.012), unhealthy calorie intake (p = 0.001), dieting (p = 0.003) and high academic year (p = 0.006) as the risk factors for anxiety and found that the long sleep duration was a protective factor for anxiety (p < 0.001). We found that more obese students showed an improvement of anxiety than the underweight students after calorie restriction (p < 0.001). Collectively, our findings suggest that obesity-associated anxiety is prevalent among the college students and could be alleviated by moderate calorie restriction. It is necessary for students to receive anxiety management in their college life. Additionally, the proper calorie restriction should be promoted to help students protect against obesity and obesity-associated anxiety.

Food and Mood: Daily Associations Between Missed Meals and Affect Among Early Adolescents

OBJECTIVE

Youth frequently miss meals and experience hunger, yet no studies have assessed how these experiences relate to changes in daily emotional states. This daily diary study examined associations of missing breakfast, missing lunch, and hunger with daily positive and negative affect among young adolescents.

METHODS

A community sample of 133 grade 5 and 6 students (50.4% boys, Mage = 10.77, 19.5% BIPOC) from two public schools completed baseline socio-demographic measures at the beginning of the study and daily measures at the end of the school day over 5 consecutive days. Measures included positive and negative affect, breakfast, lunch, and hunger. Multilevel regression models were constructed to test the associations.

RESULTS

Among participating youth, 27.8% missed breakfast at least once, 15.0% missed lunch at least once, and 26.3% felt hungry at least once. Missing breakfast was associated with increased negative affect (B = 0.36, p = .030) and missing lunch was related to both increased negative affect (B = 0.52, p = .019) and decreased positive affect (B = -0.80, p = .002). Hunger was not related to daily affect.

CONCLUSION

This study provides a unique view of youths' experiences of missing meals, hunger, and daily emotional states. The findings underscore the importance of youth being adequately nourished through school meal programs. Clinicians should screen for and address missing meals among their young patients.

Lifestyle Modifications to Help Prevent Headache at a Developmental Age

Headache is the world's seventh most significant cause of disability-adjusted-life in people aged between 10 and 14 years. Therapeutic management is based on pharmacological approaches and lifestyle recommendations. Many studies show associations between each migraine-promoting lifestyle, behavioral triggers, frequency, and intensity of headaches. Nevertheless, the overall aspects of this topic lack any definitive evidence. Educational programs advise that pediatric patients who suffer from migraines follow a correct lifestyle and that this is of the utmost importance in childhood, as it will improve quality of life and assist adult patients in avoiding headache chronicity, increasing general well-being. These data are important due to the scarcity of scientific evidence on drug therapy for prophylaxis during the developmental age. The "lifestyle recommendations" described in the literature include a perfect balance between regular sleep and meal, adequate hydration, limited consumption of caffeine, tobacco, and alcohol, regular physical activity to avoid being overweight as well as any other elements causing stress. The ketogenic diet is a possible new therapeutic strategy for the control of headache in adults, however, the possible role of dietary factors requires more specific studies among children and adolescents. Educational programs advise that the improvement of lifestyle as a central element in the management of pediatric headache will be of particular importance in the future to improve the quality of life of these patients and reduce the severity of cephalalgic episodes and increase their well-being in adulthood. The present review highlights how changes in different aspects of daily life may determine significant improvements in the management of headaches in people of developmental age.

Trend of nutrition research in endocrine disorders, gaps, and future plans: a collection of experiences of an endocrinology research institute

BACKGROUND

Nutrition plays a pivotal role in the prevention and treatment of endocrine disorders. The aim of this study was to provide a window in order to display the 25-year activities of Endocrinology & Metabolism Research Institute (EMRI), and the gaps and future plans in the field of nutrition and endocrine disorders.

METHODS

To collect papers affiliated to the EMRI in field of nutrition from the inception to December 1st 2019, the electronic databases including PubMed/Medline, Web of Science, and Scopus were searched. Publications in English and Persian languages were included. Scientific Landscapes (VOS viewer) software version 1.6.13 was used to provide bibliometric maps.

RESULTS

Of 4082 studies identified in the initial search, 319 relevant papers were included. They contributed systematic review and meta-analysis/review (n = 76), clinical trials (n = 58), cross-sectional (n = 171), case-control studies (n = 11), and animal studies (n = 3). Accordingly, most nutrition studies were dedicated to the level of evidence III (cross-sectional studies: 53.60%) followed by systematic review studies (23.82%) with the level of evidence I. There was also an increasing trend in the nutrition studies through years, with a peak in 2019.

CONCLUSION

An increasing trend in the publications related to nutrition science is observed at EMRI. However, nutrition research and publications can grow further through expanding collaborations with other fields related to endocrine. Given nutritional assessments in national projects and focusing on the identification of preventive nutritional strategies, considering the situations of our society can be helpful to make nutritional findings more practical.

Association of Vitamin D Concentrations with subjective health complaints in children and adolescents: the CASPIAN-V study

BACKGROUND

Vitamin D deficiency (VDD) is recognized as a global pandemic. Identification, any association between VDD and subjective health complaints (SHC), can be helpful to realize critical mechanisms and improve psychological and somatic symptoms. Given few studies published on this issue and the importance of its clarification, the main objective of this study was to examine the association between VDD and the SHC in children and adolescents.

METHODS

In this national cross-sectional study, 2596 Iranian children and adolescents aged 8-18 years were included. Data on SHC, anthropometric indices, physical activity, and serum levels of vitamin D were collected. Logistic regression models (crude, adjusted) were applied to examine the association between the VDD and the SHC. Statistical analysis was performed using STATA version 11. P-values< 0.05 were considered as statistically significant.

RESULTS

Serum levels of vitamin D in approximately 70% of Iranian children and adolescents were lower than 30 ng/mL. Among the SHC, irritability (40.9%) and feeling anxiety (33.7%) were the most prevalent ones. Multiple complaints in students with the VDD was 2.5 times greater than those with sufficient vitamin D concentrations (p <  0.001). Compared to the reference group, the strongest association was found between vitamin D status and difficulties in getting to sleep (OR: 2.5, 95%CI: 1.18, 3.53, p <  0.001).

CONCLUSION

VDD was observed in the considerable percentage of the study population. There were no significant differences between the two gender groups. In addition, there were significant associations between vitamin D status and most of the somatic and psychological symptoms, particularly for getting to sleep. It seems national interventional programs for vitamin D supplementation or food fortifications can be helpful.

Eating Habits of Children Born after Maternal Bariatric Surgery

Mothers who underwent bariatric surgery (BS) before pregnancy have worrisome eating habits, but little is known about the eating habits of their offspring. EFFECTOR is a cross-sectional, long-term follow-up study of 4-11-year-old children born from mothers that underwent bariatric surgery before pregnancy (n = 36), mothers with overweight/obesity (OW/OB) in a control group (n = 71), and mothers with a normal weight (NW) in a second control group (n = 35). Data on anthropometry and on eating habits obtained through a Food Frequency Questionnaire were collected prospectively. The children's body mass index (BMI) scores significantly correlated with maternal pre-pregnancy BMI. The prevalence of overweight and obesity was the highest in children of the BS group (38.9% vs. 15.5% for children of the OW/OB group and 5.7% for those of the NW group; p = 0.004). Meal-skipping behavior was comparable between the groups. There was no difference in fruit and vegetable consumption. The BS group consumed more low-calorie sweetened beverages compared to the NW group (p = 0.01) but less fruit juice compared to the NW and OW/OB groups (p = 0.01). Our results may indicate a sugar-avoiding behavior in children of the BS group, fitting dietary maternal habits in a strategy to prevent dumping syndrome. In conclusion, maternal pre-pregnancy bariatric surgery does not alter unhealthy eating behaviors and the risk of development of overweight during childhood in their children.

Association of fruit and vegetable intake with meal skipping in children and adolescents: the CASPIAN-V study

BACKGROUND

There are few studies on the association of main meal consumption with fruit and vegetable intake. This study aims to assess the relation between skipping main meals and fruit and vegetable intake in children and adolescents.

METHODS

This multi-centric cross-sectional study was conducted in 30 provinces of Iran. This study was conducted in the framework of the fifth survey of a national surveillance program entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease study (CASPIAN- V). 14,440 school students aged 7-18 years were assessed. Logistic regression analyses were used to evaluate the association between frequency of fruit and vegetable intake with skipping main meals.

RESULTS

Overall, 14,274 students completed the study (99% participation rate). Their mean (SD) age was 12.3 (3.2) (53% were aged 6-12), 50.6% of them were boys, and 71.3% lived in urban area. In multivariate logistic regression model, statistically significant associations were found between skipping main meals and low fruits and vegetables intake. Skipping breakfast was associated with vegetables intake [OR = 1.19(95% CI 1.02-1.38)] and fruits intake [OR = 5.33(95% CI 4.46-6.37)]. Skipping lunch was associated with vegetables intake [OR = 1.61(95% CI 1.29-1.96)] and fruit intake [OR = 9.11(95% CI 6.55-12.67)]. Skipping dinner was associated with vegetables intake [OR = 1.52 (95% CI 1.15-2.01)] and fruits intake [OR = 2.21(95% CI 1.64-2.97)].

CONCLUSIONS

In this study, low frequency of fruit and vegetable intake was associated with skipping main meals. The results highlight the importance of promoting regular meal consumption with increase in the intake of fruit and vegetables among children and adolescents.

LEVEL OF EVIDENCE

Level V.

Factors associated with sleep duration among pupils

BACKGROUND

Sleep shortage has been pervasive among pupils.

METHODS

Multiple regression analysis was used to analyze 2,722 questionnaires obtained from grade 5 to 12 pupils, to determine factors associated with sleep duration.

RESULTS

Significant regression formulae for sleep duration were obtained for all school types: adjusted R² / P value were 0.14/<0.001 for elementary school; 0.11/<0.001 for junior high school; 0.06/<0.001 for high school. Longer after-school activities (standardized regression coefficient/ P value were -0.22/<0.001 for elementary school; -0.10/<0.01 for junior high school; -0.18/<0.001 for high school) and more sleepiness (-0.09/<0.001 for elementary school; -0.07/<0.05 for junior high school; -0.07/<0.05 for high school) were significantly associated with reduced sleep duration for all school types. In both elementary and junior high schools, the higher grade (-0.53/<0.001 for elementary school; -0.10/<0.01 for junior high school), and longer weekday screen time (-0.15/<0.001 for elementary school; -0.19/<0.001 for junior high school) were also significantly associated with sleep loss. In elementary school, irregular dinner (-0.07/<0.05), breakfast skipping (-0.11/<0.001), longer weekend screen time (-0.09/<0.05) and better self-reported academic performance (0.07/<0.05) also revealed significant associations with sleep loss. In high school, reduction of sleep duration was also significantly associated with higher standardized body mass index (-0.08/<0.05).

CONCLUSIONS

Excessive after-school activity might be considered in association with pupils' sleep reduction.