A good-quality breakfast is associated with better mental health in adolescence. Public Health Nutr. 2009;12:249-258. [PMID: 19026092 DOI: 10.1017/s1368980008003935]

Is the frequency of breakfast consumption associated with life satisfaction in children and adolescents? A cross-sectional study with 154,151 participants from 42 countries

BACKGROUND

The promotion of daily breakfast consumption and the importance of making appropriate breakfast choices have been underscored as significant public health messages. The aim of this study was to examine the relationship between breakfast frequency and life satisfaction in large and representative samples of school-going children and adolescents aged 10-17 years from 42 different countries.

METHODS

This study used information from the 2017/2018 Health Behavior in School-aged Children study, comprising nationally representative samples of children and adolescents aged 10-17 years who were attending school. The total number of participants from the 42 countries included in the study was 155,451 (51.3% girls). The evaluation of breakfast consumption in this study involved a specific question: "How often do you typically have breakfast (more than a glass of milk or fruit juice)?". To measure life satisfaction, a subjective assessment scale was used in the form of a ladder, visually spanning from 0 to 10. On this scale, the topmost point (10) denotes the highest conceivable quality of life, whereas the bottom point (0) represents the worst imaginable quality of life.

RESULTS

After adjusting for several covariates, the lowest estimated marginal mean of life satisfaction was identified in those participants who skipped breakfast (mean [M] = 5.6, 95% confidence interval [CI] 5.5 to 5.8). Conversely, the highest estimated marginal mean of life satisfaction was observed in those who had breakfast every day (M = 6.5, 95% CI 6.3 to 6.6). Overall, a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents was identified (p-for-trend < 0.001). In addition, the highest estimated marginal mean of life satisfaction score was identified in those participants from Portugal who had breakfast every day (M = 7.7; 95% CI 6.9 to 8.5 points). Conversely, the lowest estimated marginal mean of life satisfaction was observed in those participants from Romania who no breakfast (M = 3.5; 95% CI 2.6 to 4.4 points).

CONCLUSIONS

There is a nearly linear relationship between higher frequency of breakfast and greater life satisfaction in children and adolescents. Considering the potential health advantages associated with breakfast during this critical age phase, these findings imply the necessity for additional global efforts to promote increased breakfast consumption among children and adolescents.

Breakfast quality and its sociodemographic and psychosocial correlates among Italian children, adolescents, and adults from the Italian Nutrition & HEalth Survey (INHES) study

BACKGROUND

Breakfast quality, together with regularity of breakfast, has been suggested to be associated with cardiometabolic health advantages. We aimed to evaluate the quality of breakfast and its socioeconomic and psychosocial correlates in a large sample of the Italian population.

METHODS

Cross-sectional analyses on 7,673 adult and 505 children/adolescent regular breakfast eaters from the Italian Nutrition & Health Survey (INHES; 2010-2013). Dietary data were collected through a single 24-h dietary recall. Breakfast quality was assessed through the Breakfast Quality Index (BQI) combining intake of ten food groups, energy, and nutrients of public health concern, and potentially ranging from 0 to 10. The association of sociodemographic and psychosocial factors with BQI were analyzed by multivariable-adjusted linear regression models.

RESULTS

The average BQI was 4.65 (SD ± 1.13) and 4.97 (SD ± 1.00) in adults and children/adolescents, respectively. Amongst adults, older age (β = 0.19; 95%CI 0.06 to 0.31 for > 65 vs. 20-40 years) and having a high educational level (β = 0.13; 0.03 to 0.23; for postsecondary vs. up to elementary) were independent predictors of better breakfast quality, while men reported lower BQI (β = -0.08; -0.14 to -0.02 vs. women). Perceived stress levels at home and work and financial stress were inversely associated with BQI. Children/adolescents living in Central and Southern Italian regions had lower BQI compared to residents in Northern Italy (β = -0.55; -0.91 to -0.19 and β = -0.24; -0.47 to -0.01, respectively).

CONCLUSIONS

In adults, breakfast quality was associated with age, sex, and educational level. Perceived stress levels were inversely associated with the quality of breakfast. In children/adolescents, a north-south gradient in breakfast quality was observed.

A mobile healthy lifestyle intervention to promote mental health in adolescence: a mixed-methods evaluation

BACKGROUND

A healthy lifestyle may improve mental health. It is yet not known whether and how a mobile intervention can be of help in achieving this in adolescents. This study investigated the effectiveness and perceived underlying mechanisms of the mobile health (mHealth) intervention #LIFEGOALS to promote healthy lifestyles and mental health. #LIFEGOALS is an evidence-based app with activity tracker, including self-regulation techniques, gamification elements, a support chatbot, and health narrative videos.

METHODS

A quasi-randomized controlled trial (N = 279) with 12-week intervention period and process evaluation interviews (n = 13) took place during the COVID-19 pandemic. Adolescents (12-15y) from the general population were allocated at school-level to the intervention (n = 184) or to a no-intervention group (n = 95). Health-related quality of life (HRQoL), psychological well-being, mood, self-perception, peer support, resilience, depressed feelings, sleep quality and breakfast frequency were assessed via a web-based survey; physical activity, sedentary time, and sleep routine via Axivity accelerometers. Multilevel generalized linear models were fitted to investigate intervention effects and moderation by pandemic-related measures. Interviews were coded using thematic analysis.

RESULTS

Non-usage attrition was high: 18% of the participants in the intervention group never used the app. An additional 30% stopped usage by the second week. Beneficial intervention effects were found for physical activity (χ21 = 4.36, P = .04), sedentary behavior (χ21 = 6.44, P = .01), sleep quality (χ21 = 6.11, P = .01), and mood (χ21 = 2.30, P = .02). However, effects on activity-related behavior were only present for adolescents having normal sports access, and effects on mood only for adolescents with full in-school education. HRQoL (χ22 = 14.72, P < .001), mood (χ21 = 6.03, P = .01), and peer support (χ21 = 13.69, P < .001) worsened in adolescents with pandemic-induced remote-education. Interviewees reported that the reward system, self-regulation guidance, and increased health awareness had contributed to their behavior change. They also pointed to the importance of social factors, quality of technology and autonomy for mHealth effectiveness.

CONCLUSIONS

#LIFEGOALS showed mixed results on health behaviors and mental health. The findings highlight the role of contextual factors for mHealth promotion in adolescence, and provide suggestions to optimize support by a chatbot and narrative episodes.

TRIAL REGISTRATION

ClinicalTrials.gov [NCT04719858], registered on 22/01/2021.

Association of breakfast, total diet quality, and mental health in adolescents: a cross-sectional study of HBSC in Greece

The emerging field of nutritional psychiatry offers proof that diet quality can be changed to reduce one's risk of developing mental illness. What you eat has a big impact on teenage mental health, and the quality and frequency of breakfast, as well as the different food groups, can affect adolescent mental health. In this study, regression models were employed to analyze four indicators (self-rated health, body satisfaction, life satisfaction, and eight symptoms) of mental health problems as well as demographic factors (gender, age, body mass index, affluence class, physical activity), with forest plots displaying the regression connections. This study, a descriptive cross-sectional survey of 3480 adolescents aged 11 to 15 years, chosen data from the 2018 Greek Health Behaviour in School-aged Children (HBSC) International Study for secondary analysis. The data revealed that high levels of four indicators of mental health (self-rated health, body satisfaction, life satisfaction, and eight symptoms) were significantly related to breakfast quality, total dietary patterns. Students reporting poor total food quality, for example, were more predictive of self-assessment when unhealthy (2.286 95% CI 1.851-2.824), and the largest connections with eating a "bad" breakfast were discovered when the eight symptoms of mental status were the worst (- 0.869 95% CI: - 1.300, - 0.439); physical activity may enhance the positive relationship of diet quality on mental health, while obesity weakens this positive relationship; and age patterns varied by gender, with girls and older individuals showing a higher risk of diet quality and mental health.   Conclusions: The findings revealed that each of the four indices of general mental health was correlated with teenage breakfast and overall diet quality. Physical activity and weight were shown to be moderating factors, and obesity had the biggest impact on psychological risk. Gender, age, and family economic inequality were potential explanations for the rise in psychological symptoms. Researchers are urged to focus more on nutritional psychiatry research and look into psychological perception disparities in the future. What is Known: • There is a potential correlation between adolescent dietary patterns or quality and mental health. • Factors such as age, gender, socio-economic status, body weight and physical activity all have an impact on diet and mental health outcomes. What is New: • There have been no studies of the ability to simultaneously predict breakfast quality and overall diet quality for broadly defined mental health complaints [positive (life satisfaction), neutral (body satisfaction, self-rated health) and negative (eight symptoms: depressed mood, irritability, nervousness, difficulty sleeping, dizziness, headache, stomachache and backache)]. • Differences in overall diet quality trends between demographic subgroups remain unclear.

The Correlation between Adolescent Daily Breakfast Consumption and Socio-Demographic: Trends in 23 European Countries Participating in the Health Behaviour in School-Aged Children Study (2002-2018)

Breakfast is often considered the most important meal of the day and can benefit adolescent health in several ways. The aims of the present study were (1) to identify adolescents' socio-demographic (sex, family affluence and family structure) determinants of daily breakfast consumption (DBC) and (2) to describe trends in DBC among adolescents across 23 countries. Cross-sectional surveys of nationally representative samples of adolescents (aged 11, 13, and 15 years) (n = 589,737) participating in the Health Behaviour in School-aged Children (HBSC) survey from 2002 to 2018 were used. Multilevel logistic regression analyses modeled DBC over time, adjusted for family affluence, family structure and year of survey. Four countries showed an increased trend in DBC (the Netherlands, Macedonia, Slovenia, and England). A significant decrease in DBC was observed in 15 countries (Belgium-Fr, France, Germany, Croatia, Portugal, Spain, Hungary, Poland, Russian Federation, Ukraine, Denmark, Finland, Latvia, Lithuania and Sweden). In 4 countries no significant change was observed (Czech Republic, Scotland, Ireland and Norway). In most of the countries (n = 19), DBC was higher among the adolescents from high-affluence homes. In all the countries analysed, the adolescents living in two-parent households report higher DBC use than those in single-parent households. More than half of the countries showed a decrease in DBC. There is a need to implement key interventions by developing different strategies (education, incorporating educational curriculum and counselling programmes) to increase DBC. Comparing DBC patterns across HBSC countries is important for understanding regional and global trends, monitoring strategies, and developing health promotion programmes.

Food Categories for Breakfast and Mental Health among Children in Japan: Results from the A-CHILD Study

There is limited evidence that what children eat for breakfast contributes to their mental health. This study aimed to examine the associations between food categories for breakfast and mental health among children in Japan. A proportion of participants aged 9-10 years in the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in Japan who consumed breakfast daily were included (n = 281). Foods eaten for breakfast were reported by the children each morning for 7 consecutive days, and defined according to the food categories in the Japanese Food Guide Spinning Top. Child mental health was assessed by caregivers using the Strength and Difficulties Questionnaire. The mean intake frequencies per week were six times for grain dishes, two times for milk products, and one time for fruits. Linear regression analysis revealed an inverse association between the frequent intake of grain dishes, whether rice or bread, and problem behaviors after adjustment for potential confounders. However, confectionaries, which mainly consisted of sweet breads or pastries, were not associated with problem behaviors. The intake of non-sweet grain dishes at breakfast may be effective for preventing behavioral problems in children.

Systematic Breakfast Consumption of Medium-Quantity and High-Quality Food Choices Is Associated with Better Vascular Health in Individuals with Cardiovascular Disease Risk Factors

BACKGROUND

Breakfast consumption has been associated with the improvement of many cardiovascular disease (CVD) risk factors, yet data regarding its association with subclinical vascular damage, which precedes the onset of CVD, are scarce. The aim of this study is to investigate this association in a large sample of adults with CVD risk factors.

METHODS

Anthropometric measurements, vascular biomarkers and dietary intake with two 24-h dietary recalls, focusing on breakfast frequency and its quantity and content, were assessed in 902 adults (45.2% males). Breakfast quality was assessed by identifying a posteriori breakfast dietary pattern (DP) by using principal component analysis (PCA).

RESULTS

Systematic breakfast consumption (SBC) was inversely associated with central systolic blood pressure (b: -3.28, 95% C.I.: -5.7 to -0.86), diastolic blood pressure (b: -1.85, 95% C.I.: -3.34 to -0.36), augmentation index (b: -3.17, 95% C.I.:-4.98 to 1.35) and left carotid intima media thickness (b: -0.03, 95% C.I.:-0.06 to -0.01) compared to breakfast skipping independently of age, sex, hypertension, diabetes, dyslipidemia, smoking, and BMI. SBC of 10-20% of daily total energy intake (dTEI) was inversely associated with Aix (b: -2.31, 95% C.I.:-4.05 to -0.57) compared to <10% dTEI after adjustment for the aforementioned confounders. DP1 (high coffee and sugar consumption, low consumption of low- and full-fat dairy products, fruits, and fresh juices) was positively associated with Aix (b: 1.19, 95% C.I.: 0.48 to 1.90).

CONCLUSION

SBC comprised of medium-energy density and high-nutrient content food items may be a simple daily habit associated with better vascular health.

Breakfast intake and associated factors and barriers among tertiary institution students in the Western Region, Ghana

BACKGROUND

Breakfast is considered the day's most important meal. Skipping breakfast consumption is detrimental to health and intellectual performance. University life has tight schedules and rigorous intellectual activities often very early in the morning. This study aimed at assessing breakfast intake and its associated factors among the students of Takoradi Technical University (TTU).

METHODS

This was a descriptive cross-sectional study. Data was collected from 347 students in TTU using pre-tested questionnaire. Data collected were analysed using STATA v17. It employed descriptive and inferential statistics such as logistic regression. P-value less than 0.05 was set as statistical significance at 95% confidence interval.

RESULTS

Regular breakfast was taken by 35.7% of the students. Higher odds of regular breakfast intake were found among respondents aged 25-29 years (AOR = 3.13, 95%CI = 1.57-6.24) and those who buy their breakfast (AOR = 5.13, 95%CI = 2.16-12.19). However, lower odds of regular breakfast consumption were found among respondents who were females (AOR = 0.40, 95%CI = 0.18-0.85). Barriers to regular breakfast intake included negative mood, insufficient funds, health condition, weight management, religious reasons such as fasting, limited time/unfavourable academic schedules, daily activities/workload, and cost of food on campus.

CONCLUSION

The study stressed on the need for external and personal factors such as sex, age, religion, limited time/unfavourable academic schedules among others that hinder habitual breakfast intake to be addressed adopting innovative approach such as peer education and campaigns. University management should implement favourable policies on academic schedules, canteens/cafeterias, less stringent regulation on cooking at halls of residence.

Skipping Breakfast and Eating Breakfast Away From Home Were Prospectively Associated With Emotional and Behavioral Problems in 115,217 Chinese Adolescents

BACKGROUND

Breakfast is deemed the most important meal of the day. We examined the prospective associations of breakfast habits with emotional/behavioral problems in adolescents and potential effect modification.

METHODS

115,217 Primary 6 students (United States Grade 6; mean age, 11.9; standard deviation [SD], 0.59 years) who attended the Student Health Service of Department of Health in Hong Kong in 2004/05, 2006/07, 2008/09 were followed till Secondary 6 (United States Grade 12). Emotional/behavioral problems were biennially examined using Youth Self-Report since Secondary 2 (United States Grade 8). Lifestyles were biennially examined using standardized questionnaires since Primary 6. Prospective associations of breakfast habit with emotional/behavioral problems and potential effect modification were examined using generalized estimating equations.

RESULTS

Compared with eating breakfast at home, eating breakfast away from home was significantly associated with total emotional/behavioral problems and seven syndromes, including withdrawal, somatic complaints, anxiety/depression, thought problems, attention problems, delinquent behaviors, and aggressive behaviors (adjusted odds ratios [AORs] 1.22-2.04), while skipping breakfast showed stronger associations with the above problems and social problems (AORs 1.34-2.29). Stronger associations were observed in younger students for total and attention problems (P < 0.03) and in those with lower weight status for delinquent behaviors (P = 0.005).

CONCLUSION

Eating breakfast away from home and especially skipping breakfast were prospectively associated with adolescent emotional/behavioral problems. The associations weakened with increasing age for total emotional/behavioral and attention problems, and weakened with higher weight status for delinquent behaviors, highlighting the vulnerability of younger and underweight children. If the associations are causal, increasing home breakfast may reduce adolescent emotional/behavioral problems and benefit psychosocial health.

The associations of dietary habits with health, well-being, and behavior in adolescents: A cluster analysis

INTRODUCTION

Dietary habits may be associated with adolescents' health and behavior. However, previous findings are inconsistent and often unadjusted for sociodemographic confounders. The aim of this study was to investigate (1) whether dietary habits (consumption of fruits, vegetables, sweets, soft drinks, breakfast, and family meals) cluster among adolescents and (2) how these clusters associate with a range of health, well-being, and behavior outcomes in a large population-based sample of adolescents.

METHODS

The study included adolescents (n = 7529; n = 3891 [51.7%] girls; mean [standard deviation] age = 14.9[2.1] years) from the 2018 Luxembourg Health Behaviour in School-aged Children study. We used cluster analysis to define clusters of dietary habits (consumption of fruits, vegetables, sweets, soft drinks, breakfast, and family meals) and logistic regression analyses to assess the cross-sectional associations of the clusters with health, well-being and behavior, adjusted for age, gender, family affluence, and migration background.

RESULTS

Cluster analysis yielded five clusters of dietary habits: (1) healthy, (2) family meal and breakfast skippers, (3) sugar consumption, (4) unbalanced diet, and (5) unhealthy. The healthy cluster was associated with better health and positive mental health and behavior, whereas the less healthy clusters were associated with worse health, mental health problems, and risk behavior.

CONCLUSION

Findings suggest that healthy dietary habits associate with positive health and behavior, whereas unhealthy dietary habits associate with health problems and risk behavior during adolescence. More research is needed to investigate the underlying mechanisms. Interventions should include dietary habits as a component of lifestyle modification to improve adolescents' health, well-being, and behavior.

Breakfast and psychosocial behavioural problems in young population: The role of status, place, and habits

The aim of this study was to examine whether breakfast status, place and habits are associated with psychosocial behavioural problems in a nationally representative sample of young people aged 4–14 years residing in Spain. This study analysed secondary data from the Spanish National Health Survey (2017), including 3,772 Spanish children and adolescents. Breakfast status, place, and habits were assessed by ad hoc questions answered by parents/guardians. The Strengths and Difficulties Questionnaire (SDQ) parents’ version form was applied to evaluate the psychosocial health of their children. Skipping breakfast and eating breakfast out of home were linked to greater odds of psychosocial behavioural problems (skipping breakfast: OR = 3.29; CI 95%, 1.47–7.35; breakfast out of home: OR = 2.06; CI 95%, 1.27–3.33) than eating breakfast at home. Similarly, not consuming coffee, milk, tea, chocolate, cocoa, yogurt, etc., for breakfast was related to greater odds of psychosocial behavioural problems (OR = 1.76; CI 95%, 1.21–2.55). This association was also found for those who did not eat bread, toast, cereals, pastries, etc., for breakfast (OR = 1.31; CI 95%, 1.01–1.73). Conversely, not consuming eggs, cheese, ham, etc., was associated with lower odds of psychosocial behavioural problems (OR = 0.56; CI 95%, 0.38–0.83). Our results show that eating breakfast (specifically at home) and breakfast habits related to the intake of certain food/beverages groups were associated with higher or lower odds of psychosocial behavioural problems.

Dietary patterns, breakfast consumption, meals with family and associations with common mental disorders in adolescents: a school-based cross-sectional study

BACKGROUND

Adolescence is a period of transition and vulnerabilities, in which mental illnesses can develop more easily. The objective of this work is to analyze the association of dietary patterns, breakfast consumption, and the practice of having meals accompanied by the family with the presence of Common Mental Disorders in Brazilian adolescents.

METHODS

This is a cross-sectional study which analyzed data from 71,553 Brazilian adolescents aged 12-17 years, from the Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA"). Principal Component Analysis was performed to identify dietary patterns, and Logistic Regression Models were performed to identify the associations between Common Mental Disorders, dietary patterns, and eating practices that are breakfast consumption and practice of having meals accompanied by family.

RESULTS

Two patterns were found, a Healthy Dietary Pattern and an Unhealthy Dietary Pattern. Adolescents classified in the second (OR: 0.79; 95% CI 0.70-0.89) or third (OR: 0.86; 95% CI 0.77-0.96) tercile of the Healthy Dietary Pattern had a lower chance of having Common Mental Disorders. Eating breakfast sometimes (OR: 0.71; 95% CI 0.61-0.83) or almost every day/every day (OR: 0.54; 95% CI 0.47-0.62), and the practice of having the main meals with the family sometimes (OR: 0.69; 95% CI 0.57-0.84) or almost every day/every day (OR: 0.50; 95% CI 0.44-0.58), decreased the chance for Common Mental Disorders.

CONCLUSION

This study observed that healthy dietary patterns are associated with better mental health in adolescents, thus should be encouraged and promoted.

A Differential Threshold of Breakfast, Caffeine and Food Groups May Be Impacting Mental Well-Being in Young Adults: The Mediation Effect of Exercise

Diet and exercise are known to influence mental health. However, the interaction between diet, dietary practices, and exercise and its impact on the mood of young adults (YA) is poorly understood. YA are inherently at risk for mental distress. They tend to consume a low-quality diet and are generally active. The purpose of the study was to assess these relationships through validating causal loop diagrams (CLD) that describe these connections by using a system dynamic (SD) modeling methodology. Adults 18-29 years were invited to complete the Food-Mood questionnaire. The anonymous questionnaire link was distributed to several institutional listservs and via several social media platforms targeting young adults. A multi-level analysis, including machine learning techniques, was used to assess these relationships. The key findings were then built into gender based CLD, which suggest that a differential repertoire may be needed to optimize diet quality, exercise, and mental well-being. Additionally, a potential net threshold for dietary factors and exercise may be needed to achieve mental well-being in young adults. Moreover, our findings suggest that exercise may boost the enhancing effect of food groups on mental well-being and may lessen the negative impact of dietary impediments of mental well-being.

Association of Quantity and Quality of Protein Intake with Depression and Anxiety Symptoms among Adolescent Boys and Girls (13-15 Years) Studying in Public Schools of Delhi

Data on prevalence of mental health disorders indicates that 4.5% and 3% of the Indian population is suffering from depression and anxiety respectively. Research suggest that a poor quality diet (lacking in macro and micronutrients) may lead to deficiencies that are associated with depression and anxiety disorders. The present research was designed to study the prevalence & association of depression & anxiety with protein intake among adolescent boys and girls (aged 13-15 y) studying in public schools of Delhi. 546 adolescents participated in this cross-sectional study (selected from public schools in Delhi). For the assessment of depression and anxiety symptoms and dietary micronutrient deficiencies Child Behavior Checklist (CBCL; administered to the parents) and 24 h recall and food frequency questionnaire (administered to the subjects) were used respectively. Adolescent Micronutrient Quality Index (AMQI) was further used to assess the protein quality of the diets. Prevalence of depression and anxiety were 33.5% and 27.47% respectively. Assessment of diets through AMQI revealed that low intake of protein rich foods like milk and legumes was significantly associated with higher mean scores of depression (p<0.001) and anxiety symptoms (p<0.001). In the multivariate analysis for depression and anxiety symptoms, it was observed that males who were not consuming milk for breakfast had higher odds of getting depressed (OR: 0.28; 95%CI: 0.10-0.77; p=0.0177) and anxious (OR: 0.28; 95%CI: 0.10-0.77; p=0.0177) and females had higher odds of getting depressed (OR: NE; 95%CI: NE; p≤0.0177). This study highlights the association of mental health with quality and quantity of protein consumed by adolescents. It will also serve as a strategic tool for mental health prevention and management policies designed for adolescents. It also adds to the growing body of research in the area of nutritional psychiatry.

Breakfast skipping alone and in interaction with inflammatory based quality of diet increases the risk of higher scores of psychological problems profile in a large sample of Iranian adults

The authors investigate the association of breakfast skipping and its interaction with a dietary inflammatory index (DII) with the severity of psychological disorders. A total of 2876 Iranian general adults were enrolled in this cross-sectional study. Psychological problems profile score was calculated using the regression method in the framework of factor analysis based on depression, anxiety and psychological distress. The higher scores indicate more severity of mental problem. The frequency of breakfast eating in a week was assessed. Dietary intakes were assessed using a food-frequency questionnaire and twenty-seven items were included in the calculation of DII. In the crude model, individuals who ate breakfast seldom had the highest odds for having worse psychological problems profile (OR 3⋅59; 95 % CI 2⋅52, 5⋅11). Adjustment for various confounders did not change the associations (OR 3⋅35; 95 % CI 2⋅11, 5⋅32). In the adjusted multinomial logistic regression model, participants with high DII (>median) who skipped breakfast had highest risk of being in the higher tertiles of psychological problems profile compared with those who had low DII (<median) and ate breakfast (OR 6⋅67; 95 % CI 3⋅45, 12⋅90). Similar results were observed in women and men regarding the impact of breakfast skipping alone and interaction with DII on scores of psychological problems profile. Breakfast skipping is associated with higher risk of psychological problems. Similar findings were obtained in the stratified analysis by sex. Our findings confirmed that the DII and breakfast skipping are associated with mental health, interactionally. Further longitudinal studies are needed to confirm the true link between breakfast skipping and psychological problems.

Breakfast consumption and mental health: a systematic review and meta-analysis of observational studies

OBJECTIVE

Several studies have been conducted on the relationship between breakfast consumption and mental health with conflicting results. Therefore, the present systematic review and meta-analysis was undertaken to summarize evidences on the association between skipping breakfast and mental health.

METHODS

We searched online databases for all related papers through the comprehensive international data bases of Institute of PubMed/ MEDLINE, ISI/WOS and Scopus up to December 2019, using relevant keywords. Overall, 14 studies were included in this systematic review and meta-analysis.

RESULTS

The total sample size of all selected studies was 399,550 individuals with age range of 6 to ≥65 years old. We found a significant positive association between skipping breakfast and Odds Ratio (OR) of depression (pooled OR: 1.39; 95% CI: 1.34-1.44), stress (pooled OR: 1.23; 95% CI: 1.04-1.43) and psychological distress (pooled OR: 1.55; 95% CI: 1.47-1.62). In contrast, there was no significant association between skipping breakfast and anxiety in all age cohort (pooled OR: 1.31; 95% CI: 0.97-1.65). However, subgroup analysis based on age stratification showed that there was a significant positive association between skipping breakfast and anxiety in adolescences (pooled OR: 1.51; 95% CI: 1.25-1.77).

CONCLUSION

In conclusion, skipping breakfast was positively associated with odds of depression, stress and psychological distress in all age groups and anxiety in adolescence, underlining impact of breakfast on mental health.

Meal regularity is associated with self-esteem among grade 5 children

BACKGROUND

Meal regularity is associated with many aspects of mental health. However, few studies have examined whether a relationship exists between meal regularity and self-esteem in children.

OBJECTIVES

The objective of this study was to determine whether an association exists between meal regularity and self-esteem in grade 5 children.

METHODS

Among 4009 grade 5 students (mean age = 11.0 years ± SEM = 0.006) from the 2011 Children's Lifestyle and School Performance Study (CLASS-II; Nova Scotia, Canada), cross-sectional meal regularity survey data (family supper, supper in front of the television, supper alone, skipping breakfast, and skipping lunch) were collected using the Harvard Youth/Adolescent Food Frequency Questionnaire and examined in relation to self-esteem. Multilevel mixed-effects logistic regression was used to determine the ORs and 95% CIs associated with low self-esteem. Analyses were stratified by sex and adjusted for sociodemographic and lifestyle covariates.

RESULTS

Compared to children who ate supper in front of the television or alone either never or less than once/week, children had greater odds of low self-esteem if 5 or more times/week they ate supper in front of the television (OR = 1.85; 95% CI, 1.40-2.43) or alone (OR = 4.23; 95% CI, 2.58-6.95). Compared to children who ate family supper 5 or more times/week, children who ate family supper never or less than once/week had greater odds of low self-esteem (OR: 1.97; 95% CI, 1.51-2.56). Skipping breakfast and skipping lunch were associated with greater odds of low self-esteem [OR = 2.92 (95% CI, 1.87-4.57) and OR = 4.82 (95% CI, 2.14-10.87) respectively].

CONCLUSIONS

In our study of grade 5 children, all 5 indicators of meal regularity tested are significantly and consistently associated with self-esteem.

An eating pattern characterised by skipped or delayed breakfast is associated with mood disorders among an Australian adult cohort

BACKGROUND

Meal timing may influence food choices, neurobiology and psychological states. Our exploratory study examined if time-of-day eating patterns were associated with mood disorders among adults.

METHODS

During 2004-2006 (age 26-36 years) and 2009-2011 (follow-up, age 31-41 years), N = 1304 participants reported 24-h food and beverage intake. Time-of-day eating patterns were derived by principal components analysis. At follow-up, the Composite International Diagnostic Interview measured lifetime mood disorder. Log binomial and adjacent categories log-link regression were used to examine bidirectional associations between eating patterns and mood disorder. Covariates included sex, age, marital status, social support, education, work schedule, body mass index and smoking.

RESULTS

Three patterns were derived at each time-point: Grazing (intake spread across the day), Traditional (highest intakes reflected breakfast, lunch and dinner), and Late (skipped/delayed breakfast with higher evening intakes). Compared to those in the lowest third of the respective pattern at baseline and follow-up, during the 5-year follow-up, those in the highest third of the Late pattern at both time-points had a higher prevalence of mood disorder [prevalence ratio (PR) = 2.04; 95% confidence interval (CI) 1.20-3.48], and those in the highest third of the Traditional pattern at both time-points had a lower prevalence of first onset mood disorder (PR = 0.31; 95% CI 0.11-0.87). Participants who experienced a mood disorder during follow-up had a 1.07 higher relative risk of being in a higher Late pattern score category at follow-up than those without mood disorder (95% CI 1.00-1.14).

CONCLUSIONS

Non-traditional eating patterns, particularly skipped or delayed breakfast, may be associated with mood disorders.

The Association between Parental Involvement Behavior and Self-Esteem among Adolescents Living in Poverty: Results from the K-CHILD Study

It is not yet known why some adolescents living in poverty show high self-esteem, while others do not. Parental involvement may be an important determinant to promote self-esteem among adolescents living in poverty. The aim of this study is to explore better parenting involvement behavior to promote self-esteem among adolescents living in poverty. Participants included fifth-, eighth-, and 11th-grade students living in Koichi prefecture, Japan. The participants were part of the Kochi Child Health Impact of Living Difficulty (K-CHILD) study, in 2016 (n = 10,784). Participants completed a questionnaire with questions about socioeconomic status and 14 parental involvement behaviors, including 9 specific kinds of parental interactions with their child (e.g., talking about school life), and 5 elements related to parental care for their child's physical health (e.g., access to health care). The numbers of parental involvement behaviors, parental interactions with their child, and parental care for their child's physical health were treated as continuous and quartile, to see the association. Overall, the study showed that the larger the number of parental involvement behaviors, the higher the self-esteem score of their off-spring (p < 0.01) among both adolescents living in poverty and not living in poverty, in which interaction between poverty and parental involvement behaviors was not significant. Both parental interaction with their child and parental care for their child's physical health were associated with higher self-esteem, in which parental interaction with their child had a larger effect than parental care for their child's physical health. To empower adolescents in poverty, caregivers need to provide both parental interaction with the child and parental care for the child's physical health.

Dietary habits and psychological disorders in a large sample of Iranian adults: a population-based study

BACKGROUND

Since an association has been found between diet and psychological problems, this study aimed to evaluate the relationship between dietary habits and psychological problems among Iranian adults.

METHODS

Data on dietary habits and psychological problems among 9965 adults were provided from the recruitment phase of Yazd Health Study, a population-based cohort research on Iranian adults. The association between dietary habits and psychological problems was assessed by multiple logistic regression analysis.

RESULTS

After the adjustment for confounders, fast food and fried food consumptions were associated with increased depressive [odds ratio (OR) = 1.61, 95% confidence interval (CI) 1.18-2.20] and stress symptoms (OR = 2.47, 95% CI 1.46-4.18), respectively. Eating breakfast had a protective role on stress features (OR = 0.60, 95% CI 0.39-0.92), while snack intake was related to higher odds of depressive (OR = 1.36, 95% CI 1.01-1.84), anxiety (OR = 1.99, 95% CI 1.55-2.56) and stress symptoms (OR = 1.73, 95% CI 1.23-2.54). There was also an inverse association between sweetened drink consumption and depressive (OR = 0.76, 95% CI 0.59-0.96), anxiety (OR = 0.76, 95% CI 0.62-0.93), and stress features (OR = 0.73, 95% CI 0.55-0.97; OR = 0.63, 95% CI 0.48-0.82).

CONCLUSIONS

Even though an inverse relationship was found between sweetened drinks intake and psychological problems, snack consumption was associated with higher chances of them. Eating breakfast had a protective effect on stress symptoms, while fast food and fried food intakes were related to increased depressive and stress features chances, respectively.

Skipping Breakfast and Its Association with Health Risk Behaviour and Mental Health Among University Students in 28 Countries

INTRODUCTION

The study aimed to investigate the associations between skipping breakfast and various health risk behaviours and mental health in university students in 28 countries.

METHODS

Using a cross-sectional study design, 21,972 university students with a median age of 20 years from 28 countries in Africa, the Americas and Asia, replied to self-reported measures of breakfast consumption, health compromising behaviours, mental health measures and protective factors.

RESULTS

In adjusted logistic regression analysis, infrequent and/or frequent breakfast skipping was associated with inadequate fruit and vegetable intake, frequent soft drink intake, not avoiding fat and cholesterol, current binge drinking, current tobacco use, gambling, not always wearing a seatbelt, inadequate physical activity, inadequate tooth brushing, not seeing a dentist in the past year and having been in a physical fight. In addition, infrequent and/or frequent breakfast skipping was associated with depression, lower happiness, posttraumatic stress disorder, loneliness, short sleep, long sleep, sleep problem, restless sleep, sleep problem due to traumatic event, and poor academic performance.

DISCUSSION

We found evidence that skipping breakfast was associated with 10 of 15 health risk behaviours, all of nine poor mental health indicators and poor academic performance.

Impact of consuming green and yellow vegetables on the depressive symptoms of junior and senior high school students in Japan

Adolescent depression is a significant public health concern. Although skipping breakfast is associated with depressive symptoms in adolescents, the effects of dietary patterns on their depressive symptoms remain unknown. Therefore, this study aims to determine whether dietary patterns are associated with depressive symptoms among junior and senior high school students in Japan. A total of 441 junior high school students and 417 senior high school students participated in this study. The Center for Epidemiologic Studies Depression scale (CES-D) was used to measure the participants' depressive symptoms. We surveyed the participants' breakfast consumption pattern, as well as their general dietary patterns (meat, fish, green and yellow vegetables, milk and dairy products, and fruits), using a self-report questionnaire. The results indicated that the senior high school students had a significantly higher CES-D score than the junior high school students. We found negative and significant partial correlations between regular consumption of breakfast and depressive symptoms, and between regular consumption of green and yellow vegetables and depressive symptoms in both junior and senior high school students, after controlling for age, sex, and sleep duration. Furthermore, a one-way analysis of covariance (ANCOVA) revealed that adolescents who consumed green and yellow vegetables every day (one or more times per day) had significantly lower depressive symptoms than those from the "Never/1-2 times a week" group. The findings of this study reveal that the regular consumption of green and yellow vegetables is associated with lower depressive symptoms in adolescents, that is, the consumption of green and yellow vegetables may be vital in the context of adolescents' mental health.

Skipping breakfast and non-high-density lipoprotein cholesterol level in school children: a preliminary analysis

OBJECTIVE

The objective of the study is to examine whether the increased levels of non-high-density lipoprotein cholesterol (non-HDL-c) are associated with skipping breakfast among school children.

STUDY DESIGN

A cross-sectional survey was conducted among 539 school children aged 8-12 years from the Niagara Region of Canada.

METHODS

Non-fasting finger blood was taken for total cholesterol (total-c) and HDL-c measurements. Non-HDL-c was calculated as the difference between total-c and HDL-c. The information of skipping breakfast in a week was obtained from a questionnaire, which was categorized into three groups, i.e., none, 1-3 times and 4 + times. Demographic information and other related variables were described by the three breakfast-skipping groups.

RESULTS

Approximately 44% of children (n = 182) reported skipping breakfast. There were significant differences between the three groups in the means of total-c, non-HDL-c, body mass index, waist circumference, proportions of overall health excellent, eating dinner with parent and skipping breakfast that affects learning (P < 0.05). The number of days of skipping breakfast was weakly correlated to the level of non-HDL-c (r = 0.145, P < 0.0001). Multiple regression results indicated that every one more time of skipping breakfast would increase approximately 0.05 mmol/L level of non-HDL-c (P < 0.01), on average, after adjusting for those aforementioned potential confounding variables. The adjusted mean levels of non-HDL-c were 2.77, 2.94 and 3.07 mmol/L for none, skipping 1-3 times and skipping 4 + times of breakfast, respectively; the mean differences between none and the other two groups were statistical significant (P < 0.05).

CONCLUSION

Non-HDL-c levels is positively associated with the number of skipping breakfast among school children, and further research is needed to confirm this relationship.

Risk factors associated with gastric cancer in Mexico: education, breakfast and chili

BACKGROUND AND AIM

the aim of the study was to use a validated questionnaire to identify factors associated with the development of gastric cancer (GC) in the Mexican population.

METHODS

the study included cases and controls that were paired by sex and ± 10 years of age at diagnosis. In relation to cases, 46 patients with a confirmed histopathological diagnosis of adenocarcinoma-type GC, as reported in the hospital records, were selected, and 46 blood bank donors from the same hospital were included as controls. The previously validated Questionnaire to Find Factors Associated with Gastric Cancer (QUFA-GC©) was used to collect data. Odds ratio (OR) and 95% confidence interval (IC) were estimated via univariate analysis (paired OR). Multivariate analysis was performed by logistic regression. A decision tree was constructed using the J48 algorithm.

RESULTS

an association was found by univariate analysis between GC risk and a lack of formal education, having smoked for ≥ 10 years, eating rapidly, consuming very hot food and drinks, a non-suitable breakfast within two hours of waking, pickled food and capsaicin. In contrast, a protective association against GC was found with taking recreational exercise and consuming fresh fruit and vegetables. No association was found between the development of GC and having an income that reflected poverty, using a refrigerator, perception of the omission of breakfast and time period of alcoholism. In the final multivariate analysis model, having no formal education (OR = 17.47, 95% CI = 5.17-76.69), consuming a non-suitable breakfast within two hours of waking (OR = 8.99, 95% CI = 2.85-35.50) and the consumption of capsaicin ˃ 29.9 mg capsaicin per day (OR = 3.77, 95% CI = 1.21-13.11) were factors associated with GC.

CONCLUSIONS

an association was found by multivariate analysis between the presence of GC and education, type of breakfast and the consumption of capsaicin. These variables are susceptible to intervention and can be identified via the QUFA-GC

Comparing adolescent and parent reports of externalizing problems: A longitudinal population-based study

Adolescent and parent reports of adolescent mental health problems often correlate poorly, and understanding this discrepancy has clinical importance. Yet contextual factors have only been inconsistently explained. At the 14- and 17-year follow-ups of the Western Australian Pregnancy Cohort (Raine) Study, 1,596 parent-child dyads completed the parent-reported Child Behaviour Checklist (CBCL) and the adolescent-rated Youth Self-Report (YSR). Maternal, family, adolescent, and parent factors were examined as potential predictors of discrepancies. When adolescent YSR scores were in the clinical range but parents' CBCL ratings were not, adolescents were more likely to report alcohol intoxication in the last 6 months, illicit drug use, low school motivation, and depression. When parents reported externalizing behaviour in the clinical range but adolescents did not, the characteristics associated with this were a younger maternal age, receiving social security benefit, stress related to parenting, depression, and poor family functioning. These new results will inform clinical management and research with adolescents who present with behavioural disorders. Statement of contribution What is already known on this subject? We know that adolescent and parent reports of adolescent mental health problems often correlate poorly, but little is known about which contextual factors lead to disagreement. Understanding the factors that influence agreement is clinically relevant for predicting and identifying externalizing behavioural disorders. This is a large-scale study with the ability to assess the impact of numerous psychosocial factors on instrument disagreement. What the present study adds We found that substance use, depression and low school motivation impacted on discrepancy in externalizing behaviour scores for 14-year-old male adolescents and their parents. Parental depression, stress, low family income, and family dysfunction also led to a higher likelihood of discrepancy in scores.

Eat or Skip Breakfast? The Important Role of Breakfast Quality for Health-Related Quality of Life, Stress and Depression in Spanish Adolescents

This study examined the associations between eating or skipping breakfast and the quality of breakfast eaten on health-related quality of life (HRQOL), perceived stress and depression in 527 Spanish adolescents. Results showed differences in stress and two domains of HRQOL; Moods and Emotions and Parent Relations and Home Life between adolescent breakfast skippers and eaters, those having breakfast showing higher levels of stress and poor HRQOL. When breakfast quality was analyzed in breakfast eaters, adolescents who ate a good quality breakfast showed better HRQOL and lower levels of stress and depression than those who ate a poor or very poor quality breakfast. Further, breakfast skippers showed better HRQOL and lower levels of stress and depression than breakfast eaters who ate a poor or very poor quality breakfast. These findings indicate the importance of eating a good quality breakfast, rather than just having or not having breakfast. The conclusions of the present study are especially relevant for clinicians and nutritional educators, given the significant impact of breakfast quality on health-related quality of life, stress and depression observed in the adolescents studied.

Which healthy lifestyle factors are associated with a lower risk of suicidal ideation among adolescents faced with cyberbullying?

Cyberbullying is associated with negative mental health outcomes including adolescent suicidal ideation. This requires effective and accessible preventive efforts. Healthy lifestyles are factors adolescents themselves can modify that may lower their risk of suicidal ideation. The aim of this study was to examine associations between physical activity, (outdoor) sport participation, a healthy diet, higher sleep duration and low levels of smoking and alcohol use, and suicidal ideation when faced with cyberbullying. A cross-sectional survey was administered in 2014-2015 to 1037 adolescents (12-18 years, M age = 15; 50% girls) in Flanders, Belgium. Logistic regression analyses were conducted to assess direct effects of cyberbullying involvement (victim, perpetrator, bystander) on suicidal ideation, and interaction effects between cyberbullying involvement, healthy lifestyles and suicidal ideation. Results showed that cyberbullying victimization, perpetration and bystanding were associated with higher suicidal ideation, but that the association with cyberbullying perpetration disappeared when corrected for other cyberbullying involvement forms. More physical activity, sleeping longer, more often taking a healthy diet and lower levels of smoking were associated with lower suicidal ideation. Some associations of healthy lifestyles with suicidal ideation disappeared at higher levels of cyberbullying involvement. Low alcohol consumption and (outdoor) sport participation were not associated with suicidal ideation, and sport participation was even associated with higher suicidal ideation at low levels of cyberbullying involvement. These findings suggest a novel approach to suicide prevention may be warranted, by strengthening healthy lifestyles as factors that adolescents themselves can modify to increase their resilience and reduce suicidal ideation.

Dietary patterns in relation with psychosomatic complaints profile: Results from SEPAHAN study among a large sample of general adults

Objective: Although dietary patterns have been evaluated in relation to psychological disorders, their associations with psychosomatic complaints are unclear. We investigated relations of dietary patterns with psychosomatic complaints profiles.Methods: In this cross-sectional study, a total of 3363 adults were included. Dietary intakes and psychosomatic complaints were assessed using self-administered Persian validated questionnaires. Dietary patterns and psychosomatic symptom profiles were identified using exploratory factor analysis.Results: Three dietary patterns and four psychosomatic complaints profiles were identified. Individuals in the top tertile of traditional diet had lower odds for gastrointestinal somatic complaints (odds ratio (OR)= 0.68, 95% confidence interval (CI): 0.50, 0.91). Individuals in the top tertile of healthy diet had lower odds for psychological (OR= 0.68, 95% CI: 0.51, 0.90), gastrointestinal (OR= 0.65, 95% CI: 0.49, 0.87), neuro-skeletal (OR= 0.66, 95% CI: 0.45, 0.96), and pharyngeal- respiratory somatic complaints (OR= 0.61, 95% CI: 0.47, 0.79). Individuals in the top tertile of Western diet had greater odds for psychological somatic complaints (OR= 1.50, 95% CI: 1.13, 2.00) than those in the first tertile.Discussion: The healthy dietary pattern is inversely related to the risk of psychosomatic complaints, whereas the Western diet might be associated with increased risk of psychosomatic complaints.

Parental involvement could mitigate the effects of physical activity and dietary habits on mental distress in Ghanaian youth

Introduction

Parental involvement in physical activity and dietary habits have been found to play a substantial role in the mental health of young people. However, there is little evidence about the associations between parental involvement, health behaviours and mental health among Ghanaian youth. This study sought to examine the role of parental involvement in the association between physical activity, dietary habits and mental health among Ghanaian youth.

Methods

Data were obtained from the 2012 Ghana Global School-based Student Health Survey (GSHS). The study population consisted of 1,984 school going youth in high schools with a median age of 15 years old, (53.7%) males. Bivariate and multivariate logistic regression statistical models using complex samples method were performed.

Results

The prevalence of mental distress was 18.1%, 16.6% and 23% for loneliness, feeling worried and suicidal ideation respectively. Younger students were more likely to feel lonely, worried and have suicidal ideation than older students. Students from low socio-economic backgrounds were significantly more likely to report loneliness, worry and suicidal ideation. After adjusting for socio-demographic characteristics, some physical activity and eating habits were associated with experiencing loneliness, worry and suicidal ideation but after introducing parental involvement, there was a decrease in the likelihood of some health behaviour factors in both physical activity and dietary habits to be associated with loneliness, worry and suicidal ideation.

Conclusion

Physical inactivity and poor dietary habits could have a negative effect on mental distress, however, parental involvement could mitigate the impact of these lifestyle habits on mental distress and should therefore be taken into consideration in efforts aimed at encouraging positive lifestyle habits for good mental health among Ghanaian youth.

A Low-Cost, Grab-and-Go Breakfast Intervention for Rural High School Students: Changes in School Breakfast Program Participation Among At-Risk Students in Minnesota

OBJECTIVE

Evaluate the impact of a grab-and-go component embedded within a larger intervention designed to promote School Breakfast Program (SBP) participation.

DESIGN

Secondary data analysis.

SETTING

Rural Minnesota high schools.

PARTICIPANTS

Eight schools were enrolled in the grab-and-go only intervention component. An at-risk sample of students (n = 364) who reported eating breakfast ≤3 d/wk at baseline was enrolled at these schools.

INTERVENTIONS

Grab-and-go style breakfast carts and policies were introduced to allow all students to eat outside the cafeteria.

MAIN OUTCOME MEASURES

Administrative records were used to determine percent SBP participation (proportion of non-absent days on which fully reimbursable meals were received) for each student and school-level averages.

ANALYSIS

Linear mixed models.

RESULTS

School-level increases in SBP participation from baseline to the school year of intervention implementation were observed for schools enrolled in the grab-and-go only component (13.0% to 22.6%). Student-level increases in SBP participation were observed among the at-risk sample (7.6% to 21.9%) and among subgroups defined by free- or reduced-price meal eligibility and ethnic or racial background. Participation in SBP increased among students eligible for free or reduced-price meals from 13.9% to 30.7% and among ineligible students from 4.3% to 17.2%.

CONCLUSIONS AND IMPLICATIONS

Increasing access to the SBP and social support for eating breakfast are effective promotion strategies.

The effects of breakfast on short-term cognitive function among Chinese white-collar workers: protocol for a three-phase crossover study

Background

As the first meal of the day, breakfast plays an important role in supplying energy and nutrients, which are critical to working and learning activities. A three-phase crossover study was designed to investigate the effects of breakfast on cognitive function among Chinese white-collar workers. The planned study protocol is presented.

Methods

A total of 264 participants aged 25–45 years will be recruited from Shenyang and Chongqing. Self-administered questionnaires will be used to collect information on age, gender, marital status, education level, occupation, smoking habits, drinking habits, and breakfast behaviours. The participants will be randomly assigned to 3 equal-sized groups (Groups A, B, and C) and will be provided with a nutrition-adequate breakfast, a nutrition-inadequate breakfast, or no breakfast, respectively. Each participant will receive the breakfast treatment on the basis of assignment to one of three sequences (ABC/BCA/CAB). Each participant will complete a battery of cognitive tests assessing short-term memory, attention, and working memory 120 minutes after breakfast. Mood will be measured through a self-administered questionnaire assessing the dimensions of positive and negative frames of mind. Additionally, fasting blood glucose and postprandial 2-hour blood glucose levels will be tested with a blood-glucose meter (Roche ACCU-CHEK®-Performa). All the participants will take all the tests in three successive weeks, and the order of presentation will be counter-balanced across groups.

Discussion

The present study will be the first investigation of the effect of breakfast food type and quality on cognitive function amongst white-collar workers in China. We predict that a nutrition-adequate breakfast, compared with a nutrition-inadequate breakfast and no breakfast, will significantly improve short-term cognitive function. The results of this study should provide scientific evidence of the effect of breakfast quality on cognitive function and provide scientific data to inform nutrition education strategies and promote a healthy lifestyle.

Trial registration

Chinese clinical trial registry (Primary registry in the WHO registry network) Registration number: ChiCTR-IPR-15007114. Date of registration: August 25, 2015.

Proposal for a breakfast quality index for brazilian population: Rationale and application in the Brazilian National Dietary Survey

Breakfast has been related to positive nutrition and health outcomes, but criteria for an optimal composition of this meal are not well established. The aim of this study was to propose a breakfast quality index (BQI) for the Brazilian population, and to describe the relationship between breakfast quality, socio-demographic factors, dietary intake at breakfast and for the total day. BQI was constructed based on individual dietary data of 22,279 breakfast consumers, aged 20+ years from the Brazilian National Dietary Survey, a population-based cross-sectional study. The BQI was comprised of food components (cereals, fruit/vegetables, dairy products), and nutrient criteria (energy, fiber, free sugar, saturated fat, calcium and sodium). Mean, percentage and 95% CIs were estimated for variables according to BQI categories. The mean BQI was 4.2, with 71% of individuals falling into medium BQI category and 6% in high category. Individuals in urban areas, in higher categories of income and education and women had higher BQI means. Consumers with high BQI had higher intake of fruits/vegetables and higher breakfast and total daily intake of energy, carbohydrates, fiber, total sugar, sodium, potassium, phosphorus, thiamin, riboflavin, niacin, folate and vitamins B6, A, C, and D, and lower trans fatty acids compared to those in low and medium BQI groups. Promoting a high-quality breakfast may contribute to a better nutrient intake and achievement of daily requirements.

Association of Breakfast Intake with Psychiatric Distress and Violent Behaviors in Iranian Children and Adolescents: The CASPIAN- IV Study

OBJECTIVE

To assess the relationship of breakfast intake with psychiatric distress and violent behaviors among Iranian children and adolescents.

METHODS

This national survey was conducted among 14,880 students, aged 6-18 y. They were selected by stratified multistage sampling method from urban and rural areas of 30 provinces of Iran. Breakfast intake, psychiatric distress, and violent behaviors were assessed by a questionnaire prepared based on the Global school-based student health survey of the World Health Organization. The data were analyzed by the STATA package.

RESULTS

The participation rate was 90.6 %. The percentage of psychiatric distress among breakfast skippers, semi-skippers and non-skippers was 13.4-50.4, 10.1-41.9, and 7.0-33.3 % respectively. The prevalence of psychiatric distress was significantly higher among breakfast skippers than semi-skippers and non-skippers (P value < 0.001). The frequency of psychiatric distress had a significant decreasing trend from breakfast skippers to non-skippers. The prevalence of violent behaviors was significantly higher among breakfast skippers than non-skippers. Students who skipped breakfast reported to be more victimized (29.2 % vs. 26.7 %, respectively, P = 0.04), bullied (21.0 % vs. 16.2 %, respectively, P < 0.001), and had more physical fight (42.6 % vs. 38.5 %, respectively, P = 0.0001) than their other counterparts.

CONCLUSIONS

Students who regularly consumed breakfast were less likely to experience mental health disorders and violent behavior. Adhering to a regular and balanced diet, besides the awareness of parents on the importance of breakfast eating, may be an appropriate approach for preventing mental health problems and violent behavior in children and adolescents.

The Cross-Sectional Association between Diet Quality and Depressive Symptomology amongst Fijian Adolescents

Objective

To examine the relationship between diet quality and depressive symptomology amongst a community-based sample of Fijian adolescents.

Methods

Participants included 7,237 adolescents (52.6% girls; mean age 15.6 years) at baseline (2005) and 2,948 (56% girls; mean age 17.4 years) at follow-up (2007/2008), from the Pacific Obesity Prevention in Communities Project. Intervention schools (n = 7) were selected from Nasinu, near Suva on the main Fijian island Viti Levu, and comparison schools (n = 11) were chosen from towns on the opposite, west side of the island. A dietary questionnaire was used to measure diet quality. Factor analysis clustered dietary variables into two unique and independent factors, referred to as healthy diet quality and unhealthy diet quality. Depressive symptomology was assessed via the emotional subscale of the Paediatric Quality of Life Inventory. Both measures were self-reported and self-administered. Multiple linear regression was used to test cross-sectional associations (at baseline and follow-up) between diet quality and depressive symptomology. Variables controlled for included gender, age, ethnicity, study condition, BMI-z scores, and physical activity.

Findings

Strong, positive dose-response associations between healthy diet and high emotional scores (lower depressive symptomology) were found in cross-sectional analyses at baseline and follow-up, among boys and girls. No association was found between emotional health and unhealthy diet.

Conclusions

This study suggests that cross-sectional relationships exist between a high quality diet during adolescence and less depressive symptoms, however more evidence is required to determine if these two variables are linked causally. Trial population health strategies that use dietary interventions as a mechanism for mental health promotion provide an opportunity to further test these associations. If this is indeed a true relationship, these forms of interventions have the potential to be inexpensive and have substantial reach, especially in Low and Middle Income Countries.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12608000345381

Good-quality diet in the early years may have a positive effect on academic achievement

AIM

The aim of this study was to investigate the associations between early diet and academic performance during childhood.

METHODS

Participants were from the Western Australian Pregnancy Cohort (Raine) Study (n = 2287). Frequency of consumption of food and beverages was collected at the one-, two- and three-year follow-ups, using a 24-hour food recall. Diet scores were developed from the number of eating occasions. The Western Australian Literacy and Numeracy Assessment (WALNA) data from grades five (age 10) and seven (age 12) were linked to the Raine study using The Western Australian Data Linkage System. The association between diet scores and WALNA scores was assessed using multivariate linear regression models.

RESULTS

A higher (i.e. better quality) diet score at one year of age was associated with significantly higher scores in mathematics, reading, writing and spelling at both grades five and seven. Associations were observed between a higher diet score at two years and academic scores for mathematics, writing and spelling at grade seven. Higher dairy consumption at ages one, two and three, and higher fruit consumption at age one were associated with higher academic scores at all ages.

CONCLUSION

Quality of early diet may be a predictor for later academic achievement.

Breakfast and Energy Drink Consumption in Secondary School Children: Breakfast Omission, in Isolation or in Combination with Frequent Energy Drink Use, is Associated with Stress, Anxiety, and Depression Cross-Sectionally, but not at 6-Month Follow-Up

A considerable amount of research suggests that breakfast omission and the frequent use of caffeinated energy drinks may be associated with undesirable effects, and particularly so in children and adolescents. The current paper presents cross-sectional and longitudinal data from the Cornish Academies Project to investigate the effects of consuming energy drinks and missing breakfast on stress, anxiety, and depression in a cohort of secondary school children from the South West of England. Questionnaires were administered at two time-points (spaced 6 months apart) to collect information relating to diet and lifestyle over the previous 6 months. Demographic and school data were acquired through the School Information Management System, and single-item measures of stress, anxiety, and depression were administered at the second time-point only. Associations between breakfast and energy drink consumption and stress, anxiety, and depression were investigated, and a multivariate approach was taken so that additional variance from diet, demography, and lifestyle could be controlled for statistically. Cross-sectional analyses showed that breakfast omission was consistently associated with negative outcomes, and that this was largely observed for both those who frequently consumed energy drinks and those who did not. However, cross-lag analyses showed that neither breakfast omission or energy drink consumption, alone or in combination, was predictive of stress, anxiety, or depression at 6-month follow-up. This suggests that associations between breakfast and mental health may be bi-directional rather than breakfast being the causal factor.

Associations of Child Temperament with Child Overweight and Breakfast Habits: A Population Study in Five-Year-Olds

This study examines the associations of child temperament with overweight/obesity and breakfast habits. Participants were 17,409 five-year-olds whose mothers partake in the Norwegian Mother and Child Cohort Study (MoBa), and completed a questionnaire at the child’s 5th birthday. Temperament was assessed as externalizing, internalizing and sociable temperament. Breakfast habits differentiated between “every day”, “4 to 6 times a week”, and “0 to 3 times a week”. The child’s weight status was determined by Body Mass Index-percentiles and categorized as normal weight versus overweight/obese. Children with externalizing temperament had higher odds of being overweight and higher odds of not eating breakfast daily. Children high in internalizing temperament had higher odds of not eating breakfast daily, but not of being overweight. Children with average scores of sociability were more prone to being overweight but had normal breakfast habits. All results were adjusted for key confounders. That five-year-olds high in externalizing temperament had a higher risk to be overweight adds important information to the literature. The association of externalizing temperament with child breakfast habits so early in life is intriguing, as parents mostly control eating patterns in children that young. Mechanisms mediating this association should be explored.

A Western dietary pattern is associated with poor academic performance in Australian adolescents

The aim of this study was to investigate cross-sectional associations between dietary patterns and academic performance among 14-year-old adolescents. Study participants were from the Western Australian Pregnancy Cohort (Raine) Study. A food frequency questionnaire was administered when the adolescents were 14 years old, and from the dietary data, a 'Healthy' and a 'Western' dietary pattern were identified by factor analysis. The Western Australian Literacy and Numeracy Assessment (WALNA) results from grade nine (age 14) were linked to the Raine Study data by The Western Australian Data Linkage Branch. Associations between the dietary patterns and the WALNA (mathematics, reading and writing scores) were assessed using multivariate linear regression models adjusting for family and socioeconomic characteristics. Complete data on dietary patterns, academic performance and covariates were available for individuals across the different analyses as follows: n = 779 for mathematics, n = 741 for reading and n = 470 for writing. Following adjustment, significant negative associations between the 'Western' dietary pattern and test scores for mathematics (β = -13.14; 95% CI: -24.57; -1.76); p = 0.024) and reading (β = -19.16; 95% CI: -29.85; -8.47; p ≤ 0.001) were observed. A similar trend was found with respect to writing (β = -17.28; 95% CI: -35.74; 1.18; p = 0.066). ANOVA showed significant trends in estimated means of academic scores across quartiles for both the Western and Healthy patterns. Higher scores for the 'Western' dietary pattern are associated with poorer academic performance in adolescence.

Associations between breakfast eating habits and health-promoting lifestyle, suboptimal health status in Southern China: a population based, cross sectional study

Background

Suboptimal health status (SHS) is the intermediate health state between health and disease, refers to medically undiagnosed or functional somatic syndromes, and has been a major global public health challenge. However, both the etiology and mechanisms associated with SHS are still unclear. Breakfast eating behavior is a dietary pattern marker and previous studies have presented evidence of associations between failure to consume breakfast and increased diseases. Accordingly, in view of the significance of breakfast eating behaviors with respect to health status, the associations between breakfast eating habits and healthy lifestyle, SHS require further elucidation.

Methods

A cross-sectional survey was conducted within a clustered sample of 24,159 individuals aged 12–80 years in 2012–13 within the population of Southern China. Breakfast eating habits were categorically defined by consumption frequency (‘scarcely, sometimes or always’). Health-promoting lifestyle was assessed via the health-promoting lifestyle profile (HPLP-II). SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0).

Results

Of the 24,159 participants, the prevalence rates for the ‘health’ , ‘SHS’ , and ‘disease’ were 18.8%, 46.0%, and 35.2%, respectively. Overall, 19.6% of participants reported ‘scarce’ breakfast eating habits, with frequent breakfast eaters scoring higher on both HPLP-II and SHMS V1.0. After demographic adjustment, regression analyses revealed a significant association between breakfast eating habits and healthy lifestyle (p <0.001). There were lower levels of breakfast consumption regularity amongst individuals with SHS than those with disease. Categorically ‘scarce’ breakfast eaters were approximately three times more likely to be assigned SHS (OR: 2.745, 95% CI: 2.468-3.053), while infrequent breakfast eaters (‘sometimes’) were just less than twice as likely to be assessed as being of SHS (OR: 1.731, 95% CI: 1.595-1.879).

Conclusions

Breakfast eating habits are significantly associated with a healthy lifestyle, and appear to be a useful predictor of a healthy lifestyle. Irregular breakfast eating habits are related to an increased risk of SHS; increased breakfast eating frequency may contribute to lowering the prevalence of SHS in Southern China.

Electronic supplementary material

The online version of this article (doi:10.1186/s12967-014-0348-1) contains supplementary material, which is available to authorized users.

The benefits of breakfast cereal consumption: a systematic review of the evidence base

There have been no comprehensive reviews of the relation of breakfast cereal consumption to nutrition and health. This systematic review of all articles on breakfast cereals to October 2013 in the Scopus and Medline databases identified 232 articles with outcomes related to nutrient intake, weight, diabetes, cardiovascular disease, hypertension, digestive health, dental and mental health, and cognition. Sufficient evidence was available to develop 21 summary evidence statements, ranked from A (can be trusted to guide practice) to D (weak and must be applied with caution). Breakfast cereal consumption is associated with diets higher in vitamins and minerals and lower in fat (grade B) but is not associated with increased intakes of total energy or sodium (grade C) or risk of dental caries (grade B). Most studies on the nutritional impact are cross-sectional, with very few intervention studies, so breakfast cereal consumption may be a marker of an overall healthy lifestyle. Oat-, barley-, or psyllium-based cereals can help lower cholesterol concentrations (grade A), and high-fiber, wheat-based cereals can improve bowel function (grade A). Regular breakfast cereal consumption is associated with a lower body mass index and less risk of being overweight or obese (grade B). Presweetened breakfast cereals do not increase the risk of overweight and obesity in children (grade C). Whole-grain or high-fiber breakfast cereals are associated with a lower risk of diabetes (grade B) and cardiovascular disease (grade C). There is emerging evidence of associations with feelings of greater well-being and a lower risk of hypertension (grade D), but more research is required.

Cross-sectional survey of daily junk food consumption, irregular eating, mental and physical health and parenting style of British secondary school children

BACKGROUND

Previous research has established that poor diets and eating patterns are associated with numerous adverse health outcomes. This study explored the relationships between two specific eating behaviours (daily junk food consumption and irregular eating) and self-reported physical and mental health of secondary school children, and their association with perceived parenting and child health.

METHODS

10 645 participants aged between 12 and 16 completed measures of junk food consumption, irregular eating, parental style, and mental and physical health through the use of an online survey implemented within 30 schools in a large British city.

RESULTS

2.9% of the sample reported never eating regularly and while 17.2% reported daily consumption of junk food. Young people who reported eating irregularly and consuming junk food daily were at a significantly greater risk of poorer mental (OR 5.41, 95% confidence interval 4.03-7.25 and 2.75, 95% confidence interval 1.99-3.78) and physical health (OR 4.56, 95% confidence interval 3.56-5.85 and 2.00, 95% confidence interval 1.63-2.47). Authoritative parenting was associated with healthier eating behaviours, and better mental and physical health in comparison to other parenting styles.

DISCUSSION

A worrying proportion of secondary school children report unhealthy eating behaviours, particularly daily consumption of junk food, which may be associated with poorer mental and physical health. Parenting style may influence dietary habits. Interventions to improve diet may be more beneficial if also they address parenting strategies and issues related to mental and physical health.

Eating patterns and mental health problems in early adolescence--a cross-sectional study of 12-13-year-old Norwegian schoolchildren

OBJECTIVE

To investigate the association between eating patterns and mental health problems in young Norwegian adolescents (12-13 years of age).

DESIGN

Cross-sectional study. Dietary information was reported by parents using a retrospective FFQ. Eating patterns were identified using principal component analysis. The Strengths and Difficulties Questionnaire was used to measure mental health problems. The association between eating patterns and mental health problems was examined using multiple logistic regression analysis.

SETTING

Primary schools, Telemark County, Norway.

SUBJECTS

Children (n 1095) aged 12-13 years and their parents.

RESULTS

Children with high scores on a 'varied Norwegian' eating pattern were less likely to have indications of any psychiatric disorders (adjusted OR = 0·5; 95 % CI 0·3, 1·0) and hyperactivity-inattention disorders (adjusted OR = 0·4; 95 % CI 0·2, 0·8) than children with low scores on this pattern. Children with high scores on a 'junk/convenient' eating pattern were more likely to have indications of hyperactivity-inattention disorders (adjusted OR = 3·4; 95 % CI 1·3, 8·6) than children with low scores on this pattern. Children with high scores on a 'snacking' eating pattern were more likely to have indications of conduct/oppositional disorders (adjusted OR = 3·8; 95 % CI 1·2, 11·5) than those with low scores on this eating pattern.

CONCLUSIONS

We identified a significant association between eating patterns and mental health problems in young adolescents, independently of physical activity, sedentary activity and background variables. A diverse diet rich in unrefined plant foods, fish and regular meals was associated with better mental health, while energy-dense, nutrient-poor diets and irregular meals were associated with poorer mental health.

The effects of breakfast on behavior and academic performance in children and adolescents

Breakfast consumption is associated with positive outcomes for diet quality, micronutrient intake, weight status and lifestyle factors. Breakfast has been suggested to positively affect learning in children in terms of behavior, cognitive, and school performance. However, these assertions are largely based on evidence which demonstrates acute effects of breakfast on cognitive performance. Less research which examines the effects of breakfast on the ecologically valid outcomes of academic performance or in-class behavior is available. The literature was searched for articles published between 1950–2013 indexed in Ovid MEDLINE, Pubmed, Web of Science, the Cochrane Library, EMBASE databases, and PsychINFO. Thirty-six articles examining the effects of breakfast on in-class behavior and academic performance in children and adolescents were included. The effects of breakfast in different populations were considered, including undernourished or well-nourished children and adolescents from differing socio-economic status (SES) backgrounds. The habitual and acute effects of breakfast and the effects of school breakfast programs (SBPs) were considered. The evidence indicated a mainly positive effect of breakfast on on-task behavior in the classroom. There was suggestive evidence that habitual breakfast (frequency and quality) and SBPs have a positive effect on children's academic performance with clearest effects on mathematic and arithmetic grades in undernourished children. Increased frequency of habitual breakfast was consistently positively associated with academic performance. Some evidence suggested that quality of habitual breakfast, in terms of providing a greater variety of food groups and adequate energy, was positively related to school performance. However, these associations can be attributed, in part, to confounders such as SES and to methodological weaknesses such as the subjective nature of the observations of behavior in class.