Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents

PROTOCOL: Breakfast consumption, anthropometry, and nutrition-related outcomes in adolescents from low- and middle-income countries: Protocol for a systematic review and meta-analysis

Objectives This is the protocol for a Campbell systematic review. The objectives are as follows: The aim of this systematic review is to examine the scientific evidence available from low- and middle-income countries on the association of breakfast consumption habits and anthropometry/adiposity- and nutrition-related outcomes in adolescents aged 10-19 years old.

No food for thought-How important is breakfast to the health, educational attainment and wellbeing of school-aged children and young people?

There have been reports from teachers of pupils in the United Kingdom arriving at school hungry. Poor nutritional intake during childhood can increase the risk of developing both short- and long-term health problems. Breakfast consumption has been associated with several outcomes including better diet quality and healthier weight status. Nevertheless, skipping breakfast is a frequent behaviour in young people, particularly adolescents, and those from lower socio-economic groups, who are less likely to meet dietary recommendations and nutritional targets. The aim of this narrative review is to explore the contribution of breakfast consumption at home or at school and the impact of breakfast skipping on nutrient intakes in school-aged children (aged 4-18 years), and their effect on weight and cardiometabolic health. We will also summarise evidence for a link with cognitive function and educational attainment. A broadly positive effect of breakfast intake on diet quality, weight status and school-related outcomes was found in the literature, although inconsistencies in findings and methodological limitations within the evidence base are notable. Further research is warranted to better understand impact of breakfast intake and school breakfast provision on longer-term learning, educational attainment and health outcomes. This also needs to consider the cost benefit, type of breakfast and any unintended consequences such as encouraging multiple breakfasts. Breakfast consumption could improve the nutritional intakes of the most vulnerable young people and may help to address inequalities in educational outcomes at least in the short term.

Skipping breakfast associated with socioeconomic and lifestyle factors in Brazilian adolescents

The aim is to estimate the prevalence and evaluate the association of socioeconomic and lifestyle factors with skipping breakfast among Brazilian adolescent students. A cross-sectional study carried out with adolescent ninth-graders from Brazilian public and private schools participating in the 2015 National School Health Survey. The prevalence of skipping breakfast (less than five days/week) and its respective 95% confidence intervals were estimated and stratified by gender according to demographic, socioeconomic, and lifestyle factors, self-perceived body image, and attitudes towards weight. A three-block hierarchical Poisson regression, considering the complex sample design. The prevalence of skipping breakfast was 35.6%, higher among girls than boys. In both genders, skipping breakfast was positively associated with the highest socioeconomic level, morning school shift, paid work, regular consumption of alcoholic beverages, living only with the mother, the father or neither, the irregular consumption of school food and meals with parents, considering oneself too fat/fat and trying to lose weight. In general, skipping breakfast was associated with socioeconomic factors and lifestyle behaviors harmful to health among adolescent students.

Breakfast skipping and cardiometabolic risk factors in adolescents: Systematic review

OBJECTIVE

To systematically review the results of the association between breakfast skipping and cardiometabolic risk factors in adolescents.

METHODS

The articles were searched in May 2020 from PubMed, Virtual Health Library, Scopus, Web of Science and Scientific Electronic Library Online (SciELO). The review included observational studies conducted with adolescents (10-19 years old), which estimated the association of breakfast skipping with at least one outcome (markers of body adiposity, blood pressure, serum lipid and glucose levels). Regarding the risk of bias, the articles were evaluated using the Research Triangle Institute (RTI) Item Bank on bias risk and accuracy of observational studies. The quality of the evidence was assessed by the Grade rating.

RESULTS

A total of 43 articles involving 192,262 participants met the inclusion criteria and were considered in this review. The prevalence of breakfast skipping ranged from 0.7% to 94% and 60.5% of studies were classified with low risk of bias. The significant association between breakfast skipping and cardiometabolic risk factors was found in twenty-nine cross-sectional articles (n = 106,031) and four longitudinal articles (n = 5,162) for excess adiposity, in three articles (n = 8,511) for high total cholesterol levels, low-density lipoprotein and triglycerides, and in three studies (n = 6,303) for high blood pressure levels. However, there was no significant association between breakfast skipping and glycemic profile. According to the Grade rating, all the associations had low quality of evidence.

CONCLUSION

The results of this review suggest that breakfast skipping is associated with cardiometabolic risk factors in adolescents aged 10 to 19 years. However, considering the low quality of the evidence, the present results should be interpreted carefully. In addition, our findings highlight the importance of standardizing the definition of breakfast skipping and that more prospective studies are needed to determine how skipping breakfast can affect cardiometabolic risk factors in the long time.

Level of Adherence to the Mediterranean Diet and Weight Status among Adolescent Female Gymnasts: A Cross-Sectional Study

Adolescent female gymnasts are a vulnerable population in terms of their diet, as their nutritional needs are higher due to their growth and high daily training demands. The Mediterranean diet (MD) is a well-known dietary pattern that is associated with a greater nutritional adequacy and a lower prevalence of overweight. The aim of this cross-sectional study was to evaluate the degree of adherence to the MD among adolescent female athletes who participated in all disciplines of gymnastics in Greece, as well as to explore the potential correlations between MD adherence, body weight, and body mass index (BMI). A total of 269 female gymnasts (between 11-18 years old) completed the Mediterranean Diet Quality Index (KIDMED) and reported their weight and height. Approximately 10% of the participants were underweight and a mere 5.6% were classified as overweight. A high adherence to the MD was reported by 34.9% of the sample and this was correlated with a healthier BMI. Moreover, specific eating habits, such as eating nuts 2-3 times per week and eating fast-food less than once-weekly, were also associated with BMI. Athletes, parents, and coaches of gymnastics should be informed and educated regarding balanced nutrition habits. Future studies could evaluate adherence to MD, as well as the factors that influence the eating behaviors of adolescent female and male athletes in various sports.

Skipping Breakfast for 6 Days Delayed the Circadian Rhythm of the Body Temperature without Altering Clock Gene Expression in Human Leukocytes

Breakfast is often described as “the most important meal of the day” and human studies have revealed that post-prandial responses are dependent on meal timing, but little is known of the effects of meal timing per se on human circadian rhythms. We evaluated the effects of skipping breakfast for 6 days on core body temperature, dim light melatonin onset, heart rate variability, and clock gene expression in 10 healthy young men, with a repeated-measures design. Subjects were provided an isocaloric diet three times daily (3M) or two times daily (2M, i.e., breakfast skipping condition) over 6 days. Compared with the 3M condition, the diurnal rhythm of the core body temperature in the 2M condition was delayed by 42.0 ± 16.2 min (p = 0.038). On the other hand, dim light melatonin onset, heart rate variability, and clock gene expression were not affected in the 2M condition. Skipping breakfast for 6 days caused a phase delay in the core body temperature in healthy young men, even though the sleep–wake cycle remained unchanged. Chronic effects of skipping breakfast on circadian rhythms remain to be studied.

Waist circumference, waist-to-hip ratio, and waist-to-height ratio reference percentiles for abdominal obesity among Macedonian adolescents

Introduction

Background: the goal of this study was to define waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHRt) smoothed reference percentiles for assessing abdominal obesity in Macedonian adolescents aged 11 to 18 years in order to investigate possible obesity cut-offs of WHR and WHtR, and to compare WC percentiles with those of other adolescents. Methods: the research was conducted on a sample of 2,490 adolescents of the Republic of Macedonia aged 11 to 18 years: 1,288 males and 1,202 females. Weight, height, body mass index (BMI), WC, hip circumference (HC), WHR and WHtR were measured and percentiles were calculated using Cole's Lambda, Mu and Sigma (LMS) method. The relation between WHR, WHtR and general obesity, as defined by the International Obesity Task Force, was investigated with a receiver operating characteristic (ROC) analysis. Results: the boys had statistically significant higher values in all anthropometric measures except in HC, where statistically significant gender differences were not found. BMI, WC, and HC showed an increasing trend with age. The WHtR variable is a better indicator for assessing general obesity in both boys and girls (AUC, 95 % CI: 0.905-0.928) than WHR, which showed lower AUC values (95 % CI: 0.697-0.734) in predicting IOTF obesity; the WHtR cut-off of 0.5 had a sensitivity of 74 % and a specificity of 92 % for both genders and all age groups. Conclusions: the obtained reference percentile curves can be used temporarily for early detection of abdominal obesity among Macedonian adolescents aged 11 to 18 years; a WHtR of 0.5 may also be used as an obesity threshold in these age groups.

Prevalence and associated factors of skipping breakfast among university students from 28 countries: a cross-sectional study

Background Skipping breakfast can negatively affect one's health. Objective The study aimed to assess the prevalence and correlates of skipping breakfast among university students in 28 countries. Methods Using a cross-sectional study design, 21,958 university students with a median age of 20 years from 28 mainly low - and middle-income countries, replied to self-reported measures of breakfast consumption, health risk behaviours, mental health measures and protective factors. Results Indicates that 48.0% of students skipped breakfast (never, rarely or sometimes had breakfast). In adjusted multinomial logistic regression, living away from home, perceived overweight, inadequate fruit and vegetable intake, physical inactivity, short sleep, long sleep, depression and in a physical fight were associated with infrequent and/or frequent skipping breakfast. Conclusion Almost two in five students skipped breakfast, and several factors were identified that can be targeted in intervention programmes.

Association Between Serum Lipid Levels in Greek Children with Dyslipidemia and Mediterranean Diet Adherence, Dietary Habits, Lifestyle and Family Socioeconomic Factors

Background: Childhood dyslipidemia is an important risk factor for developing cardiovascular disease in adulthood. Our study aimed to investigate a possible correlation between nutritional, lifestyle, behavioral and socioeconomic factors and serum lipid levels in children with dyslipidemia. Methods: In this retrospective, observational study, in 31 children with dyslipidemia, aged 3–14 years, dietary habits, physical activity, hours watching television or playing video games, family’s socioeconomic status, weight of children and parents, and duration of breastfeeding were recorded. The children’s adherence to the Mediterranean diet was also evaluated by KidMed index. Statistical analysis was performed using SPSS.22. Results: Children with increased physical activity had lower triglyceride levels, compared to those with lower physical activity (p = 0.001). Children who consumed only one meal per day, had increased levels of total cholesterol (p = 0.01), LDL-cholesterol (p = 0.01), ApoB (p = 0.001) and lipoprotein (a) (p = 0.018), compared to those who consumed more than 3 meals per day (p < 0.05). Children who were breastfed less than 6 months had significantly increased LDL-C levels (p = 0.022), compared to children who were breastfed more than 6 months. All other parameters investigated did not differ significantly. Conclusions: This study showed association between lipid profile of children with dyslipidemia and specific nutritional and socioeconomic factors, such as increased physical activity, increased meals consumption during the day, and exclusive breastfeeding for more than 6 months. Nevertheless, further research is needed, in order to confirm these findings.

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.

[Association of regular consumption of breakfast and health-related behavior among adolescents]

The objective of this study was to estimate the frequency of regular breakfast consumption (five or more times a week) among adolescents, and to investigate the association with demographic variables, school and job shift, health-related behaviors, eating habits and food consumption. A cross-sectional study was conducted in 30 state schools in Curitiba, State of Paraná, with the participation of 1,232 adolescents. The prevalence of regular breakfast consumption was 58,6% (95% CI 53,9, 63.2). After adjusted analysis, higher regular breakfast consumption was observed among adolescents who: attended the evening and intermediate/full shifts; performed supervised physical activity; reported sleeping more than eight hours/night; reported having lunch and dinner with the family every day; and took 4 or more meals per day. The weekly frequency of breakfast was associated with higher consumption of milk and dairy products and the lower consumption of instant noodles and soft drinks. It is noteworthy that the habit of eating breakfast was associated with healthy eating practices and habits, reinforcing its values as a marker of other health-related behaviors. Partaking of breakfast should be encouraged among adolescents.

Screening of Egyptian obese children and adolescents for insertion/deletion (I/D) polymorphism in angiotensin-converting enzyme gene

Background

/aims: The role of angiotensin-converting enzyme (ACE) gene polymorphism in the development of obesity and hypertension in children has not been widely studied. We aimed to screen Egyptian obese children and adolescents for insertion/deletion (I/D) polymorphism in the ACE gene.

Methods

One hundred forty-two children and adolescents were included (70 with simple obesity and 72 controls). Blood pressure was measured, and anthropometric parameters were assessed in all included children and adolescents. Fasting lipid profile, fasting glucose, and insulin were measured. DNA extraction and ACE I/D polymorphism genotyping were also performed.

Results

Obese children had a higher frequency of DD genotype (30% in obese versus 11.1% in controls, P = .01) and D alleles (61.8% in obese versus 48.6% in controls, P = .01). Obese children with hypertension and prehypertension had higher frequency of DD genotype than II genotype and higher D alleles than I alleles. DD genotype and D allele were independently associated with hypertension (OR: 9.86 and 11.57, respectively, P < .001), while dyslipidemia and insulin resistance were not associated with the ACE I/D gene polymorphism.

Conclusion

DD genotype and D-allele of the ACE gene polymorphism were associated with obesity and with hypertension and pre-hypertension in Egyptian children.

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.

Delayed first active-phase meal, a breakfast-skipping model, led to increased body weight and shifted the circadian oscillation of the hepatic clock and lipid metabolism-related genes in rats fed a high-fat diet

The circadian clock is closely related to human health, such as metabolic syndrome and cardiovascular disease. Our previous study revealed that irregular feeding induced abnormal lipid metabolism with disruption of the hepatic circadian clock. We hypothesized that breakfast skipping induces lipid abnormalities, such as adiposity, by altering the hepatic circadian oscillation of clock and lipid metabolism-related genes. Here, we established a delayed first active-phase meal (DFAM) protocol as a breakfast-skipping model. Briefly, rats were fed a high-fat diet during zeitgeber time (ZT) 12-24 in a control group and ZT 16-4 in the DFAM group. The DFAM group showed increased body weight gain and perirenal adipose tissue weight without a change in total food intake. The circadian oscillations of hepatic clock and de novo fatty acid synthesis genes were delayed by 2-4 h because of DFAM. The peaks of serum insulin, a synchronizer for the liver clock, bile acids, and non-esterified fatty acid (NEFA) were delayed by 4-6 h because of DFAM. Moreover, DFAM delayed the surge in body temperature by 4 h and may have contributed to the increase in body weight gain and adipose tissue weight because of decreased energy expenditure. These data indicated a potential molecular mechanism by which breakfast skipping induces abnormal lipid metabolism, which is related to the altered circadian oscillation of hepatic gene expression. The results also suggested that the delayed peaks of serum NEFA, bile acids, and insulin entrain the circadian rhythm of hepatic clock and lipid metabolism-related genes.

Associations between perceived friends' support of healthy eating and meal skipping in adolescence

OBJECTIVE

Meal skipping is a relatively common behaviour during adolescence. As peer influence increases during adolescence, friendship groups may play a role in determining eating patterns such as meal skipping. The current study examined cross-sectional and longitudinal associations between perceived friends' support of healthy eating and breakfast and lunch skipping among adolescents.

DESIGN

Survey of intrapersonal, social and environmental factors that may influence eating patterns at baseline (2004/05) and follow-up (2006/07).

SETTING

Thirty-seven secondary schools in Victoria, Australia.

SUBJECTS

Sample of 1785 students aged 12-15 years at baseline.

RESULTS

Adolescents who reported that their friends sometimes or often ate healthy foods with them were less likely (adjusted OR; 95 % CI) to skip breakfast (sometimes: 0·71; 0·57, 0·90; often: 0·54; 0·38, 0·76) or lunch (sometimes: 0·61; 0·41, 0·89; often: 0·59; 0·37, 0·94) at baseline than those who reported their friends never or rarely displayed this behaviour. Although this variable was associated with lunch skipping at follow-up, there was no evidence of an association with breakfast skipping at follow-up. There was no evidence of an association between perceived encouragement of healthy eating, and an inconsistent relationship between perceived discouragement of junk food consumption, and meal skipping.

CONCLUSIONS

Friends eating healthy foods together may serve to reduce meal skipping during early adolescence, possibly due to the influence of directly observable behaviour and shared beliefs held by those in the same friendship group. Verbal encouragement or discouragement from friends may be less impactful an influence on meal skipping (than directly observable behaviours) in adolescents.

Breakfast Consumption Frequency and Its Relationships to Overall Diet Quality, Using Healthy Eating Index 2010, and Body Mass Index among Adolescents in a Low-Income Urban Setting

The aim of this study was to describe the relationship of breakfast frequency to diet quality and BMI among low-income, predominantly African American adolescents aged 9-15 (n = 239). Mean frequency of breakfast consumption was 5.0 ± 0.15 times per week. A significant, positive relationship was seen between HEI scores and frequency of breakfast consumption (p = .01). Dairy (p = .02) and whole grains (p < .01) HEI component scores were significantly related to breakfast frequency. No relationship was seen between breakfast frequency and BMI. Research with more rigorous designs should be conducted to assess the potential effects of breakfast consumption on diet quality in this population.

Breakfast Consumption and Its Associations with Health-Related Behaviors among School-Aged Adolescents: A Cross-Sectional Study in Zhejiang Province, China

Evidence indicates that breakfast consumption is associated with a cluster of health-related behaviors, yet studies in mainland China are scarce. This study is conducted to describe the frequency of breakfast consumption among Chinese adolescents and examine its associations with other dietary, physical activity, sedentary, sleep, cigarette-smoking, and alcohol-drinking behaviors. Breakfast consumption and other health-related behaviors data was collected via a self-administered questionnaire in a cross-sectional study in Zhejiang Province, China. A total of 19,542 school-aged adolescents were recruited in this survey. The associations between breakfast consumption and other health-related behaviors were examined using logistic regression models. A significantly higher prevalence of daily breakfast consumption was found among students who were younger (p for trend <0.001), from urban schools (p < 0.001), and academic high schools (p < 0.001). More frequent vegetable and milk consumption, greater physical activity, and longer sleep duration were positively associated with daily breakfast consumption, while soft drinks and fast food consumption, computer use, cigarette-smoking and alcohol-drinking behaviors were inversely associated. The prevalence of irregular breakfast consumption was relatively high among Chinese adolescents in Zhejiang Province. Daily breakfast consumption was associated with a constellation of health-related behaviors.

Nutritional Status Associated to Skipping Breakfast in Brazilian Health Service Patients

Recent studies show that skipping breakfast is associated with an increased risk of obesity, diabetes and cardiovascular diseases. In this context, this study evaluated 400 patients from the Brazilian health service who had their nutritional status defined based on the body mass index and were classified as physically active or insufficient active. The energy intake and macronutrients was also assessed by a 24-hour dietary recall where the association of overweight/obesity with the investigated variables was evaluated using chi-square, Student's t test and multivariate analysis (p < 0.05). The main results showed that more than half of the studied population have the habit of omitting breakfast (55.8%), and among those, 81.2% were overweight/obese (p < 0.0001). Almost three-fourths of these individuals consumed no more than 4 meals a day (73.0%), and regarding this meal frequency/day, 78.8% of the individuals who reported having 4 meals or less a day were overweight/obese compared with 57.8% who reported as having 5-6 meals/day (p < 0.0001). The individuals who reported to omit breakfast had a higher chance of being overweight compared with those who had this habit (OR 2.20; 95% CI 1.40-3.60) and the chance of the physically insufficient active individuals to be overweight/obese was 2.9 times higher when compared to the active individuals (p < 0.0001). Our findings suggest that regular breakfast consumption may decrease overweight and obesity risk.

Influence of proximities to food establishments on body mass index among children in China

BACKGROUND AND OBJECTIVES

Over the past two decades, food environment has changed, and the obesity and overweight rates have increased dramatically in China. Previous studies have suggested an association between food environment and obesity, while most studies were based on the data from developed countries, and few were conducted in developing countries.

METHODS AND STUDY DESIGN

The current study evaluated the influence of food establishments (distance to and types of grocery store, free market, restaurant, and food stall) on body mass index (BMI) in 348 children aged 6-17 years, surveyed in the 2009 and 2011 China Health and Nutrition Survey in nine provinces. Food establishments were assessed using geographic information system (GIS) data. Weight and height of children were directly measured.

RESULTS

Our longitudinal analysis suggested boys in the 2nd quartile of the proximity to the nearest grocery store had higher BMI (by 1.6 kg/m2, 95% CI, 0.07 to 3.24) as compared to those in the 1st quartile, while girls in higher quartiles had lower BMI (-1.78 kg/m2, 95% CI: -3.38 to - 0.18, 2nd quartile; -1.62 kg/m2, 95%: -3.22 to -0.01, 3rd quartile) as compared to those in the 1st quartile. Boys and girls in the 2nd quartile of the proximity to the nearest Chinese restaurant had lower BMI (-1.69 kg/m2, 95% CI: - 3.27 to -0.12; -1.76 kg/m2, 95% CI: -3.26, -0.27, respectively) as compared to those in the 1st quartile.

CONCLUSIONS

Food environment may affect children's BMI in China, while the association is inconsistent with previous studies. Further research is needed.

A Historical Review of Changes in Nutrition Standards of USDA Child Meal Programs Relative to Research Findings on the Nutritional Adequacy of Program Meals and the Diet and Nutritional Health of Participants: Implications for Future Research and the Summer Food Service Program

Background: The USDA child meal programs (CMPs) (National School Lunch Program (NSLP), School Breakfast Program (SBP), and Summer Food Service Program (SFSP) were established in 1946 (NSLP) and 1975 (SBP and SFSP) to improve the diet and nutritional health of US children. There is concern that participation in these programs may in fact be a contributor to the current childhood obesity epidemic. Objective: The purpose of this study was to determine if the CMPs are meeting their intended goal by reviewing the historical changes to nutrition standards of the CMPs in correspondence with the literature that examines the nutritional adequacy of meals served as part of these programs, as well as the dietary intakes and nutritional status of participants. Methods: Public Law and the Federal Register were reviewed and websites and online databases were systematically searched. Results: NSLP and SBP first underwent updates to the nutrition standards in 1994 and subsequently 2010, whereas SFSP last underwent modifications in 2000. The majority of data, all collected prior to 2010, demonstrate that meals served as part of the NSLP and SBP are not meeting nutrition standards. In addition, the dietary intakes of NSLP and SBP participants are high in calories, fat, saturated fat, and sodium, and low in fiber. Studies examining the weight status and other nutrition-related health outcomes of NSLP and SBP participants have produced mixed results. In contrast, no studies published in the peer-reviewed literature have been conducted examining the nutritional adequacy of SFSP meals or the dietary intakes or nutritional health of SFSP participants. There are public reports available on the nutritionally adequacy of SFSP meals, however, they are severely outdated (1988 and 2003). Due to this dearth of information, a case study on a sample SFSP menu from summer 2015 was conducted; results showed that the meals are high in carbohydrate and protein content and insufficient in vegetable servings. Conclusions: There is critical need for policy change that would enable updates to the SFSP nutrition standards to match those of the NSLP and SBP. In addition, strategies are needed to facilitate development of CMP menus that meet current nutrition standards. Finally, rigorously designed studies are needed to understand the direct impact of CMP participation on child diet and health, particularly the SFSP for which there is limited published data.

Waist circumference, waist-to-hip ratio and waist-to-height ratio reference percentiles for abdominal obesity among Greek adolescents

BACKGROUND

Indices predictive of adolescent central obesity include waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). Such reference data are lacking for Greek adolescents. The aim of this study was to develop age- and gender-specific WC, WHR and WHtR smoothed reference percentiles for abdominal obesity among Greek adolescents aged 12-17 years, to investigate possible obesity cut-offs of WHR and WHtR and to compare WC percentiles to other adolescent populations.

METHODS

A representative sample of 1610 high school adolescents (42.2% boys, 57.8% girls; mean age ± sd 14.4 ± 1.72 years) participated in this cross-sectional study in Attica, Greece, in 2013. Weight, height, body mass index (BMI), WC, hip circumference (HC), WHR and WHtR were measured and percentiles were calculated using the LMS method. The relation between WHR, WHtR and general obesity, as defined by the International Obesity Task Force, was investigated with receiver operating characteristic (ROC) analysis. The discriminating power of WHR and WHtR was expressed as area under the curve (AUC). Greek adolescents' WC measurements at the 50th and 90th percentile were compared with their counterparts' smoothed percentiles from Norway, Turkey, Poland, South India, Germany and Kuwait.

RESULTS

Boys had significantly higher mean in all measures than girls, except for BMI where there was no statistical difference in terms of gender. BMI, WC and HC showed an increasing trend with age. WC leveled off in both genders at the age of 17 years. WHR and WHtR showed a continuous decrease with advancing age. WHtR was a better predictor for general obesity in both boys and girls (AUC 95% CI 0.945-0.992) than the WHR (AUC 95% CI 0.758-0.870); the WHtR cut-off of 0.5 had sensitivity 91% and specificity 95% for both genders and all age groups combined. International comparisons showed that Greek adolescents had relatively high levels of abdominal obesity in early-middle adolescence but this did not persist at the age of 17 years.

CONCLUSIONS

These reference percentile curves could be used provisionally for early detection of abdominal obesity in Greek adolescents aged 12-17 years; WHtR of 0.5 could also be used as a threshold for obesity in this age group.

Body composition and eating behaviours in relation to dieting involvement in a sample of urban Greek adolescents from the TEENAGE (TEENs of Attica: Genes & Environment) study

OBJECTIVE

To document the prevalence of dieting and to compare body composition markers, dietary intakes and eating behaviours across dieting categories.

DESIGN

Prospective, cross-sectional study.

SETTING

Twenty-four randomly selected secondary public schools located in Attica, Greece.

SUBJECTS

Anthropometric, medical and dietary information was obtained from 857 (54·9 % females) adolescents (mean age 13·4 (sd 0·9) years). Meal patterns, eating behaviours and eating style score, reflecting conditions around eating, were assessed. Adolescents were asked about their dieting involvement and were categorised as 'never dieters', 'current dieters' or 'past dieters'.

RESULTS

Overall, 20·1 % of the adolescents were currently dieting and 15·2 % reported past dieting. Mean BMI and body fat percentage of never dieters were significantly lower than those of both groups of dieters (P < 0·001). Breakfast skipping (χ 2 = 10·92, P = 0·004) and eating large quantities of food (χ 2 = 7·18, P = 0·028) differed significantly across dieting groups in females. Significant differences in dinner skipping were observed in both males (χ 2 = 10·55, P = 0·005) and females (χ 2 = 20·91, P < 0·001). Female past dieters had significantly higher eating style scores than never dieters (P = 0·010) and current dieters (P = 0·042), indicating less well-structured feeding practices and food intake for reasons other than hunger.

CONCLUSIONS

The present study showed a high prevalence of dieting among adolescents. Current dieters and past dieters had higher BMI and body fat percentage than never dieters. Eating behaviours differed significantly depending on dieting involvement, especially in females; while an apparently healthier, ordered eating style adopted by dieters during the dieting period seemed not to be maintained in the long term.

Effect of skipping breakfast on subsequent energy intake

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

Ready-to-eat cereal consumption and the School Breakfast Program: relationship to nutrient intake and weight

BACKGROUND

Children in the United States exhibit high rates of nutrient inadequacy and overweight/obesity; other international studies report similar associations. The School Breakfast Program (SBP) may help alleviate these conditions for youth in the United States. This research examined the association of ready-to-eat (RTE) breakfast cereal consumption with students' (SBP participants and nonparticipants) dietary nutrient intake and weight status.

METHODS

Data were from the third School Nutrition Dietary Assessment Study (SNDA-III), conducted in 2004-2005. Analyses included all 2298 SNDA-III participants (ages 5-18 years), who completed a dietary recall and whose parents completed an interview. Students were categorized as skipping versus eating breakfast; students eating breakfast were categorized by SBP participation (SBP participant vs nonparticipant) and breakfast type (with vs without RTE cereal). Analyses estimated the association of these categorizations with total daily nutrient intake and weight-related measures, after adjusting for covariates.

RESULTS

RTE cereal breakfast consumers (regardless of SBP participation) had greater intake of vitamin A, iron, and whole grain, compared with noncereal breakfast eaters. Breakfast consumers (regardless of SBP participation and type) had greater intake of vitamins A and C, calcium, iron, dietary fiber, and whole grain, relative to breakfast skippers.

CONCLUSIONS

The SBP increases opportunity for improved nutrient intake and healthier body weight through breakfast consumption, especially whole grain RTE cereals, as recommended by the Dietary Guidelines 2010.

Selected eating behaviours and excess body weight: a systematic review

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