Breakfast eating and overweight in a pre-school population: is there a link?

The effect of breakfast on childhood obesity: a systematic review and meta-analysis

Objective

Previous cohort trials have shown that skipping breakfast increases the risk of obesity or overweight in children. However, this finding remains controversial. Through a meta-analysis, this study systematically evaluated the effect of skipping breakfast on the prevalence of obesity or overweight in children.

Methods

We performed a literature search for studies published until March 19, 2023. using the Cochrane, PubMed, and Embase databases. Based on the inclusion and exclusion criteria, observational studies on the relationship between skipping breakfast and overweight/obesity in children and adolescents were analyzed. Three investigators independently screened the relevant literature, extracted the data, and assessed the risk of bias. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). A random-effects model was used. The odds ratio (OR) with its 95% confidence interval (CI) was used to indicate the effect size.

Results

A total of 40 retrospective studies with 323,244 children ranging in age from 2 to 20 years were included in this study. The results of this meta-analysis showed that children and adolescents who skipped breakfast had a significantly higher prevalence of obesity or overweight than those who ate breakfast (OR, 1.59; 95% CI, 1.33-1.90; P < 0.001). Skipping breakfast was positively associated with overweight in children and adolescents (OR, 1.37; 95% CI, 1.23-1.54; P < 0.001). Similarly, skipping breakfast was positively associated with obesity in children and adolescents (OR, 1.51; 95% CI, 1.30-1.76; P < 0.001). The effect was also different by sex, with girls being the most affected (OR, 1.47; 95% CI, 1.23-1.76; P < 0.001). There was also a correlation between skipping breakfast and abdominal obesity in children (OR, 0.65; 95% CI, 0.55-0.77; P < 0.001).

Conclusion

This meta-analysis suggested that skipping breakfast is associated with an increased risk of overweight/obesity in children and adolescents. The findings provide support for a possible protective role of breakfast against excessive weight gain in children and adolescents. However, more rigorous study designs with validated and standardized measures of relevant variables are needed.

Social inequalities in meal skipping patterns among children and adolescents: The CASPIAN-V study

BACKGROUND & AIM

The appropriate meal consumption affects the children's and adolescents' health. Few studies have shown an association between the socioeconomic inequality and the eating behavior among children and adolescents. Therefore, the aim of this study was to assess the socioeconomic inequality in meal skipping patterns among children and adolescents.

MATERIALS & METHODS

The data were accessible through the fifth round of a school-based program in Iran in 2015. In this cross-sectional nationwide study, 14,286 students aged 7-18 years were selected via the multistage cluster sampling from 30 provinces of Iran. The Global School-based Health Survey validated questionnaire was used to assess the socioeconomic variables and meal consumption patterns among children and adolescents. Socioeconomic status (SES) was computed using principle component analysis method. Multivariate logistic regression analysis was used to assess the socioeconomic inequality in meal skipping patterns.

RESULTS

The frequency of breakfast, lunch, and dinner skipping were 13.8% (95% CI: 13.3-14.5), 6.8% (95% CI: 6.4-7.2), and 7.5% (95% CI: 7.1-7.9), respectively. In multivariate model, living in a two-parent family compared to living in a single-parent family decreased the odds of breakfast skipping (OR: 0.53, 95% CI: 0.42-0.67)). Low SES level was associated with higher odds of skipping breakfast (OR: 1.79, 95% CI: 1.50-2.14) and dinner (OR: 1.80, 95% CI: 1.42-2.28). Moreover, maternal illiteracy and unemployment were associated with skipping breakfast, lunch, and dinner (all p values < 0.05).

CONCLUSION

Some demographic and socioeconomic characteristics, such as maternal illiteracy and unemployment, low SES level, and living in a single-parent family were suggested as the main predictors of meal skipping patterns in children and adolescents.

Trend and Causes of Overweight and Obesity among Pre-School Children in Kuwait

Identifying life risk factors of obesity early will help inform policymakers to design evidence-based interventions. The following study aims to assess the trend of overweight and obesity over four years among pre-school Kuwait children, and to examine their association with breakfast skipping (BF), sugary and sweetened beverage (SSB) consumption, and screen time. Children aged 2-5 years (n = 5304) were selected from 2016 to 2019 national surveys. Overweight and obesity were defined according to the World Health Organization references. The children's mothers were asked about the BF of their children the day of the survey, their frequency of SSB consumption, and their weekly screen time use. Logistic regression was used to identify the risk factors associated with overweight/obesity. No significant decline (p values ≥ 0.12) was found for both overweight and obesity. Contrastingly, BF skipping, SSB consumption, and screen time declined (p < 0.0001). The BF skippers were found to have a 31% lower risk of being overweight. Daily TV watching, for 2-3 h, increases the odds of obesity by 5.6-fold. Our findings are encouraging regarding the decline in risky behaviours over time. However, more effort should be made both at the micro- and macro-level for a sustainable reduction in overweight and obesity.

Effects of a Rice-Based Diet in Korean Adolescents Who Habitually Skip Breakfast: A Randomized, Parallel Group Clinical Trial

During adolescence, healthy eating habits are important, and regular meal intake has an especially positive effect on future health. However, the rate of skipping breakfast has gradually increased. Therefore, this study was conducted to evaluate the positive effects of a rice-based breakfast in Korean adolescents who usually skip breakfast. In this open parallel-group, randomized controlled trial, 105 middle and high school students aged 12-18 years who habitually skipped breakfast were recruited. They were randomly divided into three groups: the rice meal group (RMG, n = 35), wheat meal group (WMG, n = 35), and general meal group (GMG, n = 35). The RMG and WMG received a rice-based breakfast and wheat-based breakfast, respectively, for 12 weeks. After a 12-week intervention, the body fat mass (p < 0.05) and body mass index (p < 0.05) in the RMG were significantly lower than those in the other two groups, and the stress score was also significantly lower in the RMG (p < 0.05). Moreover, after the intervention, in the RMG only, compared to baseline levels, the relative theta (RT) wave activity significantly decreased in eight electrode sites, and the relative alpha (RA) wave activity increased significantly. Eating a rice-based breakfast has positive effects on body fat accumulation and cognitive function in Korean adolescents. Furthermore, a rice-based breakfast plan that is preferred by adolescents should be developed to assist them in developing healthy eating habits.

Use of Machine Learning to Determine the Information Value of a BMI Screening Program

INTRODUCTION

Childhood obesity continues to be a significant public health issue in the U.S. and is associated with short- and long-term adverse health outcomes. A number of states have implemented school-based BMI screening programs. However, these programs have been criticized for not being effective in improving students' BMI or reducing childhood obesity. One potential benefit, however, of screening programs is the identification of younger children at risk of obesity as they age.

METHODS

This study used a unique panel data set from the BMI screening program for public school children in the state of Arkansas collected from 2003 to 2004 through the 2018-2019 academic years and analyzed in 2020. Machine learning algorithms were applied to understand the informational value of BMI screening. Specifically, this study evaluated the importance of BMI information during kindergarten to the accurate prediction of childhood obesity by the 4th grade.

RESULTS

Kindergarten BMI z-score is the most important predictor of obesity by the 4th grade and is much more important to prediction than sociodemographic and socioeconomic variables that would otherwise be available to policymakers in the absence of the screening program. Including the kindergarten BMI z-score of students in the model meaningfully increases the accuracy of the prediction.

CONCLUSIONS

Data from the Arkansas BMI screening program greatly improve the ability to identify children at greatest risk of future obesity to the extent that better prediction can be translated into more effective policy and better health outcomes. This is a heretofore unexamined benefit of school-based BMI screening.

Anthropometric, Familial- and Lifestyle-Related Characteristics of School Children Skipping Breakfast in Jeddah, Saudi Arabia

Breakfast is a vital meal that provides children with important nutrients and energy. This study examined the anthropometric, familial- and lifestyle-related characteristics of school children skipping breakfast. A total of 1149 children (boys: 45.5%), 6 to 12 years old (mean and SD: 9.3 ± 1.7 years), were randomly selected from elementary schools in Jeddah. Weight and height were measured. Breakfast eating frequency, socio-demographics, and lifestyle behaviors were assessed using a specifically designed self-report questionnaire reported by the parents. Nearly 80% of the children skipped daily breakfast at home with no significant age or gender differences. The most common reasons for skipping breakfast at home included not feeling hungry and waking up late for school. Fried egg sandwiches and breakfast cereals were most frequently consumed for breakfast. Strong parental support for breakfast as the main daily meal was significantly associated with daily breakfast intake. Logistic regression analyses, adjusted for age, gender, and socio-demographics, revealed that paternal education (aOR = 1.212, 95% CI = 1.020–1.440, p = 0.029), maternal education (aOR = 1.212, 95% CI = 1.003–1.464, p=0.046), insufficient sleep (aOR = 0.735, 95% CI = 0.567–0.951, p = 0.019), and BMI <25 kg/m² (aOR = 1.333, 95% CI = 1.015–1.752, p = 0.039) were significantly associated with breakfast intake. The findings have implications for children’s health and school performance. Concerted effort is required to promote breakfast consumption among Saudi children.

Breakfast consumption among Saudi primary-school children relative to sex and socio-demographic factors

Background

Breakfast is an important meal that provides essential nutrients and energy. However, few comprehensive studies have reported breakfast habits and related behaviors among Saudi children. This study investigated breakfast consumption patterns and the associations of socio-demographic variables with daily breakfast intake among Saudi children.

Methods

A multistage stratified cluster random sampling technique was used to select 1051 elementary school boys and girls in Riyadh. Body weight and height were measured and body mass index (BMI) was computed. The breakfast eating habits and behaviors were assessed using a specifically designed self-reported questionnaire that was completed by the children’s parents.

Results

More than 79% of children skipped daily breakfast, with no significant sex difference. Children in private schools consumed breakfast more frequently than those attending public schools. Multivariate analyses showed that boys in private schools had a significantly higher intake of breakfast than that in boys in public schools, yet, boys in public schools had significantly higher BMI than boys in private schools. Using logistic regression while adjusting for confounders showed insignificant effect for parent education. Among breakfast eaters, spread cheese sandwiches were consumed most frequently, followed by fried egg sandwiches and breakfast cereals. Full-fat milk, tea with milk, water, and fruit juice were the most consumed drinks. Girls consumed significantly more fresh fruits during breakfast than did boys. Mothers prepared breakfast at home most of the time (84.5%). Parents appeared mostly satisfied with the breakfast consumed by their child at home and placed high importance on breakfast compared to lunch or dinner.

Conclusions

The proportion of school children who ate daily breakfast at home was low, which may have implications for children’s school performance. Effort is needed to promote daily breakfast consumption among Saudi school children and to introduce appropriate interventions aimed at promoting daily breakfast consumption among Saudi children.

Pre-school nutrition-related behaviours at home and early childhood education services: findings from the Growing Up in New Zealand longitudinal study

OBJECTIVE

Pre-school nutrition-related behaviours influence diet and development of lifelong eating habits. We examined the prevalence and congruence of recommended nutrition-related behaviours (RNB) in home and early childhood education (ECE) services, exploring differences by child and ECE characteristics.

DESIGN

Telephone interviews with mothers. Online survey of ECE managers/head teachers.

SETTING

New Zealand.

SUBJECTS

Children (n 1181) aged 45 months in the Growing Up in New Zealand longitudinal study.

RESULTS

A mean 5·3 of 8 RNB were followed at home, with statistical differences by gender and ethnic group, but not socio-economic position. ECE services followed a mean 4·8 of 8 RNB, with differences by type of service and health-promotion programme participation. No congruence between adherence at home and in ECE services was found; half of children with high adherence at home attended a service with low adherence. A greater proportion of children in deprived communities attended a service with high adherence, compared with children living in the least deprived communities (20 and 12 %, respectively).

CONCLUSIONS

Children, across all socio-economic positions, may not experience RNB at home. ECE settings provide an opportunity to improve or support behaviours learned at home. Targeting of health-promotion programmes in high-deprivation areas has resulted in higher adherence to RNB at these ECE services. The lack of congruence between home and ECE behaviours suggests health-promotion messages may not be effectively communicated to parents/family. Greater support is required across the ECE sector to adhere to RNB and promote wider change that can reach into homes.

Parent-related mechanisms underlying the social gradient of childhood overweight and obesity: a systematic review

BACKGROUND

Low socio-economic status (SES) is a significant risk factor for childhood overweight and obesity (COWOB) in high-income countries. Parents to young children buffer and accentuate social and cultural influences, and are central to the development of this disease. An understanding of the parent-related mechanisms that underlie the SES-COWOB relationship is needed to improve the efficacy of prevention and intervention efforts.

OBJECTIVE

A systematic review of relevant literature was conducted to investigate the mechanisms by which levels of SES (low, middle and high) are associated to COWOB, by exploring mediation and interaction effects.

METHOD

Six electronic databases were searched yielding 5155 initial records, once duplicates were removed. Studies were included if they investigated COWOB, SES, parent-related factors and the multivariate relationship between these factors. Thirty studies were included. Factors found to be mediating the SES-COWOB relationship or interacting with SES to influence COWOB were categorized according to an ecological systems framework, at child, parent, household and social system level factors.

RESULTS

High parent body mass index, ethnicity, child-care attendance, high TV time (mother and child), breastfeeding (early weaning), food intake behaviours and birthweight potentially mediate the relationship between SES and COWOB. Different risk factors for COWOB in different SES groups were found. For low SES families, parental obesity and maternal depressive symptoms were strong risk factors for COWOB, whereas long maternal working hours and a permissive parenting style were risk factors for higher SES families. None of the studies investigated parental psychological attributes such as attitudes, beliefs, self-esteem and so on as potential mechanisms/risk factors.

CONCLUSIONS

Families from different SES groups have different risk and protective factors for COWOB. Prevention and intervention efforts may have improved efficacy if they are tailored to address specific risk factors within SES.

Impact of Breakfast Skipping and Breakfast Choice on the Nutrient Intake and Body Mass Index of Australian Children

Recent data on breakfast consumption among Australian children are limited. This study examined the impact of breakfast skipping and breakfast type (cereal or non-cereal) on nutrient intakes, likelihood of meeting nutrient targets and anthropometric measures. A secondary analysis of two 24-h recall data from the 2007 Australian National Children’s Nutrition and Physical Activity Survey was conducted (2–16 years; n = 4487) to identify (a) breakfast skippers and (b) breakfast consumers, with breakfast consumers further sub-divided into (i) non-cereal and (ii) cereal consumers. Only 4% skipped breakfast and 59% of skippers were 14–16 years. Breakfast consumers had significantly higher intakes of calcium and folate, and significantly lower intakes of total fat than breakfast skippers. Cereal consumers were more likely to meet targets and consume significantly higher fibre, calcium, iron, had significantly higher intakes of folate, total sugars and carbohydrate, and significantly lower intakes of total fat and sodium than non-cereal consumers. The prevalence of overweight was lower among breakfast consumers compared to skippers, and among cereal consumers compared to-cereal consumers (p < 0.001), while no significant differences were observed for mean body mass index (BMI), BMI z-score, waist circumference and physical activity level across the categories. Breakfast and particularly breakfast cereal consumption contributes important nutrients to children’s diets.

Father Involvement in Feeding Interactions with Their Young Children

OBJECTIVE

To examine the associations of father-child feeding and physical interactions with dietary practices and weight status in children.

METHODS

A nationally representative sample of children, mothers, and fathers who participated in the Early Childhood Longitudinal Study Birth cohort study (N = 2441) was used to explore the relationship of father-child feeding and physical activity interactions with child dietary practices and weight status. Logistic multivariable regression analyses were adjusted for child, father, mother, and socio-demographic characteristics.

RESULTS

Approximately 40% of fathers reported having a great deal of influence on their preschool child's nutrition and about 50% reported daily involvement in preparing food for their child and assisting their child with eating. Children had over 2 times the odds of consuming fast food at least once a week if fathers reported eating out with their child a few times a week compared to fathers who reported rarely or never eating out with their child (OR, 2.89; 95% CI, 1.94-4.29), adjusting for all covariates. Whether fathers reported eating out with their children was also significantly associated with children's sweetened beverage intake.

CONCLUSIONS

Potentially modifiable behaviors that support healthy dietary practices in children may be supported by targeting fathers.

Meal-Skipping Behaviors and Body Fat in 6-Year-Old Children

OBJECTIVE

To assess the prospective associations of breakfast, lunch, and dinner skipping at age 4 years with body fat (ie, percent fat mass, body mass index [BMI], and weight status) at age 6 years.

STUDY DESIGN

Data were analyzed from 5913 children participating in the Generation R Study, a population-based prospective cohort study in Rotterdam, The Netherlands. Meal-skipping behaviors were assessed through parent-report questionnaires. Children's weight and height were objectively measured and converted to BMI SDSs. Weight status (ie, overweight or normal weight) was defined according to age- and sex-specific cutoff points. At age 6 years, percent fat mass was assessed by dual-energy X-ray absorptiometry. Linear and logistic regression analyses were performed, adjusting for covariates and BMI at age 4 years.

RESULTS

Breakfast skipping at age 4 years was associated with a higher percent fat mass at age 6 years (β = 1.38; 95% CI, 0.36-2.40). No associations were found with BMI or weight status. Furthermore, no associations were found between lunch and dinner skipping at age 4 years and body fat at age 6 years.

CONCLUSION

Breakfast skipping at age 4 years is associated with a higher percent fat mass at age 6 years. Further prospective studies, including intervention studies, are warranted to extend the evidence base on the directionality and causality of this association.

Skipping breakfast in early childhood and its associations with maternal and child BMI: a study of 2-5-year-old Australian children

BACKGROUND/OBJECTIVES

Evidence supporting the association between skipping breakfast and children's body mass index (BMI) has been widely reported, and some consideration has been given to children aged 2-5 years. However, no evidence has considered an association between children skipping breakfast and mother's BMI. This study therefore investigated associations between skipping breakfast, child's BMI and mother's BMI in a large cohort of Australian children.

SUBJECTS/METHODS

Data were drawn from wave 2 (2-3 years, n=4601) and wave 3 (4-5 years, n=4381) of the Longitudinal Study of Australian Children. The primary outcome was skipping breakfast. Child's and mother's BMI was assessed by trained professionals.

RESULTS

Girls at 4-5 years were significantly more likely to skip breakfast compared with boys (56.9% versus 43.1%; P=0.031). In cross-sectional data analysis, obese boys at 2-3 years (odds ratio (OR) 2.38; P=0.039) and at 4-5 years (OR 2.32; P=0.046), and also obese girls at 4-5 years (OR 2.26; P=0.018), were more likely to skip breakfast. Skipping breakfast was positively associated with boys at 2-3 years (OR 2.04; P=0.042) whose mothers were overweight and with girls at 4-5 years (OR 2.60; P=0.001) whose mothers were obese. In longitudinal cross-lagged analysis, boys at 2-3 years whose mothers were obese were more likely to skip breakfast 2 years later at age 4-5 years (OR 2.36; P=0.045).

CONCLUSIONS

Skipping breakfast was associated with higher BMI in children and mothers. Future interventions should target obese mothers to promote breakfast intake among children. The interventions may involve changes to dietary and lifestyle habits and provision of education on the benefits of breakfast intake.

School Breakfast Receipt and Obesity among American Fifth- and Eighth-Graders

BACKGROUND

School breakfast consumption can improve children's nutrition, but the implications of breakfast at school for children's weight remains unclear.

OBJECTIVE

The aim of this study was to determine whether receiving breakfast at school is related to changes in children's weight between the fifth and eighth grades, and whether the relationship between school breakfasts and obesity varies for children of different socioeconomic backgrounds.

DESIGN

This was a longitudinal study of children observed in the fifth and eighth grades.

PARTICIPANTS

Data are from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99, a nationally representative prospective cohort of children in the United States. The analytic sample consisted of 6,495 children interviewed in the fifth and eighth grades.

MAIN OUTCOME MEASURE

Standard thresholds from the Centers for Disease Control and Prevention were used to classify children as not obese or obese based on direct-measured height and weight.

STATISTICAL ANALYSES PERFORMED

Difference-in-difference propensity score matching and fixed-effect logistic regression models were used to estimate the relationship between receipt of school breakfast and change in obesity between the fifth and eighth grades, adjusting for child, household, and school characteristics.

RESULTS

School breakfast receipt was not associated with a change in obesity status between the fifth and eighth grades for children overall (odds ratio=1.31; P=0.129). In the propensity score model, receiving school breakfasts more than doubled the odds of becoming obese (odds ratio=2.31; P=0.0108) for children from families below the federal poverty line compared with children of similar socioeconomic backgrounds who did not regularly receive school breakfasts.

CONCLUSIONS

School breakfast receipt was not independently related to obesity for most children. Receiving school breakfasts in the fifth grade may be associated with weight gain between the fifth and eighth grades for children from families below the federal poverty line compared with children of similar socioeconomic status who did not receive breakfasts.

Students' Consumption of Beverages and Snacks at School and Away from School: A Case Study in the North East of Italy

In North-East Italy (the Veneto region), several public school nutrition policies have been developed to reduce the consumption of high-caloric snacks and beverages. However, little is known about whether the policies actually influence students’ dietary behaviors. In order to address this point, a multi-center cross-sectional survey of 691 Italian students was conducted. Students completed the Beverage and Snack Questionnaire, which assesses the consumption of beverages and snacks at school and out of school. Three-level Poisson Models with random intercept with students (level 1 units) nested into classroom (level 2 units), and nested into schools (level 3 units), were used to examine the influence of the school setting vs. the out of school environment (independent variable) on students’ consumption of sweet beverages, snacks, milk-based beverages, low-carbohydrate drinks, fruit, and vegetables (dependent variable) (p ≤ 0.05). The results showed a significantly higher consumption of sweet beverages, snacks, milk-based beverages, low-carbohydrate drinks, fruit, and vegetables out-of-the school, suggesting a school-protective association Thus, the policies aimed to limit or deny access to unhealthy foods in the school environment may play an important role in promoting more healthful dietary patterns for school children. Additional studies should be conducted to compare students’ dietary behaviors between schools with nutrition policies to those without nutrition policies.

Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990-2013

Background

Childhood obesity is a major problem in rich countries due to its high prevalence and its harmful health consequences. An exploratory analysis conducted in the PubMed database highlighted that the number of papers published on the relationship between socioeconomic position (SEP) and childhood-adolescent weight status had risen substantially with respect to an earlier review which had covered the period 1990–2005.

Methods

To describe the findings on the relationship between SEP and childhood-adolescent weight status in papers published in rich countries from 1990 through 2013, studies were identified in the following databases: PubMed; Web of Knowledge (WOK); PsycINFO; Global Health; and Embase. We included observational studies from the 27 richest OECD countries, which covered study populations aged 0 to 21 years, and used parental education, income and/or occupation as family SEP indicators. A total of 158 papers met the inclusion criteria and reported 134 bivariable and 90 multivariable analyses.

Results

Examination of the results yielded by the bivariable analyses showed that 60.4 % of studies found an inverse relationship, 18.7 % of studies did not found relationship, and 20.9 % of studies found a relationship that varied depending on another variable, such as age, sex or ethnic group; the corresponding percentages in the multivariable analyses were 51.1, 20.0 and 27.8 %, respectively. Furthermore, 1.1 % found a positive relationship.

Conclusion

The relationship between SEP and childhood-adolescent weight status in rich countries is predominantly inverse and the positive relationship almost has disappeared. The SEP indicator that yields the highest proportion of inverse relationships is parents’ education. The proportion of inverse relationships is higher when the weight status is reported by parents instead using objective measurements.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0443-3) contains supplementary material, which is available to authorized users.

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

Background

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

Methods

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

Results

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

Conclusion

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

Association between breakfast intake with anthropometric measurements, blood pressure and food consumption behaviors among Iranian children and adolescents: the CASPIAN-IV study

OBJECTIVE

The aim of this study is to assess the association between breakfast intake with anthropometric measurements and blood pressure among Iranian children and adolescents. The second goal is to investigate the correction of breakfast consumption with other food consumption behaviors.

RESEARCH METHODS & PROCEDURES

In this national survey, 13,486 children and adolescents, aged 6-18 years, were selected by multistage, cluster sampling method from rural and urban areas of 31 provinces of Iran (2011-2012). Physical measurements included height, weight, waist circumference, and blood pressure. Food habits were assessed by self-reported questionnaire. Breakfast frequency was defined as skippers (eating breakfast 0-2 days/week), semi-skippers (eating breakfast 3-4 days/week) and non-skippers (eating breakfast 5-7 days/week). The data were analyzed by the STATA package.

RESULTS

Of the participants, 18.9%, 13.2% and 67.9%, were breakfast skippers, semi-skippers and non-skippers respectively. The prevalence of overweight and obesity among breakfast skippers were higher than non-skippers counterparts (P-value < 0.001). The percentage rates of abdominal obesity among breakfast skippers and non-skippers group were 22.6% (CI 95%: 21-24.3) and 17.9% (CI 95%: 17-18.6), respectively. Blood pressure did not significantly differ between non-skippers students and breakfast skippers (P-value = 0.1). Non-skipping adolescents ate more fresh fruits, dried fruits, vegetables and drank milk more frequently compared with breakfast skipper; while the skippers showed a higher intake of salty snack, soft drinks, packed fruit juice and fast foods (all P-value < 0.001).

CONCLUSION

Regular breakfast consumption is significantly associated with lower body fatness and healthier dietary habits but that further study, using controlled intervention trials, is required to test whether this represents a causal relationship.

Is breakfast skipping associated with physical activity among U.S. adolescents? A cross-sectional study of adolescents aged 12-19 years, National Health and Nutrition Examination Survey (NHANES)

OBJECTIVE

To examine the association between breakfast skipping and physical activity among US adolescents aged 12-19 years.

DESIGN

A cross-sectional study of nationally representative 2007-2008 National Health and Nutrition Examination Survey (NHANES) data.

SETTING

Breakfast skipping was assessed by two 24 h dietary recalls. Physical activity was self-reported by participants and classified based on meeting national recommendations for physical activity for the appropriate age group. Multiple logistic regression analysis was used to model the association between breakfast skipping and physical activity while controlling for confounders.

SUBJECTS

A total of 936 adolescents aged 12-19 years in the USA.

RESULTS

After adjusting for family income, there was no association between breakfast skipping and meeting physical activity guidelines for age among adolescents aged 12-19 years (OR = 0.95, 95% CI 0.56, 1.32).

CONCLUSIONS

Findings from the study differ from previous research findings on breakfast skipping and physical activity. Therefore, further research that uses large, nationally representative US samples and national recommended guidelines for physical activity is needed.

Parental characteristics have a larger effect on children's health behaviour than their body weight

OBJECTIVE

Parents take an important role in a child's development, but there is currently limited information on parental correlates with children's health behaviour. The purpose of this study, therefore, was to examine whether parental characteristics, such as body weight, TV consumption and sport participation, affect children's body weight and health behaviour.

METHODS

To examine the effects of parental characteristics on children's body weight and health behaviour, baseline data of 1,118 elementary school children (7.6 ± 0.4 years) participating in a school-based intervention in southwest Germany was used. Children's height and weight were measured and parent as well as child behaviour was assessed via questionnaire.

RESULTS

BMI percentiles of children were positively associated with parental BMI (r = 0.2, p <0.01). Further, high parental TV time increased the odds for high TV time in children (OR mother= 2.2, OR father = 2.3) and parental club sport participation increased the odds for club sport participation in children (OR mother = 1.9, OR father = 1.7). The relationship between parental and child behaviour was stronger than the relationship between parental BMI and BMI percentiles of the child.

CONCLUSION

These results suggest that parental behaviour and role modeling provide an important contribution to childrens' health behaviour, especially at younger ages.

The effect of breakfast cereal consumption on adolescents' cognitive performance and mood

The aim of the current study was to investigate the effect of breakfast consumption on cognitive performance and mood in adolescents, and any interaction that breakfast consumption might have with cognitive load. The rationale for this approach was that the beneficial effects of any intervention with regard to cognitive function may be more readily apparent when more demands are placed on the system. Furthermore, as skipping breakfast is particularly prevalent within this age group, thus, we focused on adolescents who habitually skip breakfast. Cognitive load was modulated by varying the level of difficulty of a series of cognitive tasks tapping memory, attention, and executive functions. Mood measured with Bond–Lader scales (1974) as well as measures of thirst, hunger, and satiety were recorded at each test session both at baseline and after the completion of each test battery. Forty adolescents (mean age = 14:2) participated in this within-subjects design study. According to treatment, all participants were tested before and after the intake of a low Glycaemic index breakfast (i.e., a 35 g portion of AllBran and 125 ml semi-skimmed milk) and before and after no breakfast consumption. Assessment time had two levels: 8.00 am (baseline) and 10.45 am. The orders of cognitive load tasks were counterbalanced. Overall it appeared that following breakfast participants felt more alert, satiated, and content. Following breakfast consumption, there was evidence for improved cognitive performance across the school morning compared to breakfast omission in some tasks (e.g., Hard Word Recall, Serial 3's and Serial 7's). However, whilst participants performance on the hard version of each cognitive task was significantly poorer compared to the corresponding easy version, there was limited evidence to support the hypothesis that the effect of breakfast was greater in the more demanding versions of the tasks.

Parental education associations with children's body composition: mediation effects of energy balance-related behaviors within the ENERGY-project

Background

It is well known that the prevalence of overweight and obesity is considerably higher among youth from lower socio-economic families, but there is little information about the role of some energy balance-related behaviors in the association between socio-economic status and childhood overweight and obesity. The objective of this paper was to assess the possible mediation role of energy balance-related behaviors in the association between parental education and children’s body composition.

Methods

Data were obtained from the cross sectional study of the “EuropeaN Energy balance Research to prevent excessive weight Gain among Youth” (ENERGY) project. 2121 boys and 2516 girls aged 10 to 12 from Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain were included in the analyses. Data were obtained via questionnaires assessing obesity related dietary, physical activity and sedentary behaviors and basic anthropometric objectively measured indicators (weight, height, waist circumference). The possible mediating effect of sugared drinks intake, breakfast consumption, active transportation to school, sports participation, TV viewing, computer use and sleep duration in the association between parental education and children’s body composition was explored via MacKinnon’s product-of-coefficients test in single and multiple mediation models. Two different body composition indicators were included in the models, namely Body Mass Index and waist circumference.

Results

The association between parental education and children’s body composition was partially mediated by breakfast consumption, sports participation, TV viewing and computer use. Additionally, a suppression effect was found for sugared drinks intake. No mediation effect was found for active transportation and sleep duration. The significant mediators explained a higher proportion of the association between parental education and waist circumference compared to the association between parental education and BMI.

Conclusions

Tailored overweight and obesity prevention strategies in low SES preadolescent populations should incorporate specific messages focusing on the importance of encouraging daily breakfast consumption, increasing sports participation and decreasing TV viewing and computer use. However, longitudinal research to support these findings is needed.

The prevalence of obesity and the level of adherence to the Korean Dietary Action Guides in Korean preschool children

The objective of this study was to investigate the associations between the prevalence of overweight and obesity and the degree of adherence to the Korean Dietary Action Guides for Children (KDAGC). In a cross-sectional study based on a child care center-based survey in Seoul, Korea, we collected parental-reported questionnaires (n = 2,038) on children's weight and height, frequency of fruit and vegetable consumption, and the quality of dietary and activity behaviors based on the 2009 KDAGC Adherence Index (KDAGCAI) which was developed as a composite measure of adherence to the KDAGC. Overweight and obesity were determined according to age- and sex-specific BMI percentile from the 2007 Korean national growth chart. Associations were assessed with generalized linear models and polytomous logistic regression models. Approximately 17.6% of Korean preschool children were classified as overweight or obese. Obese preschoolers had lower adherence to the KDAGCAI compared to those with lean/normal weight. Preschoolers with a high quality of dietary and activity behaviors had a 51% decreased odds ratio (OR) of being obese (highest vs. lowest tertile of KDAGCAI-score, 95% CI 0.31, 0.78; P = 0.001); the associations were more pronounced among those who were older (P = 0.048) and lived in lower income households (P = 0.014). A greater frequency of vegetable consumption, but not fruit, was associated with a borderline significant reduction in the prevalence of obesity. Our findings support the association between obesity prevention and high compliance with the Korean national dietary and activity guideline among preschool children.

Adolescents' diets do not comply with 2007 Canada's food guide recommendations

This study evaluated the eating behaviours of students in grade six and, three years later when they were in grade nine, relative to the recommendations of Canada's 2007 Food Guide. Students completed a self-administered questionnaire on eating behaviours in 2002 (n=647) and again in 2005 (n=520) as part of Better Beginnings, Better Futures, a primary prevention initiative among economically disadvantaged communities. McNemar analysis and X(2) analysis were used to assess differences in compliance with the recommendations of the Food Guide. Differences in the mean number of servings of the four food groups and the Other Foods group were examined using independent sample t-tests and paired t tests. In grade six, 5% of males and 7% of females met the minimum number of recommended servings for all four food groups. By grade nine this had dropped to 0.4% and 2% respectively. Among males who completed the questionnaire in both grade six and grade nine there was a decline in the mean number of daily servings for all four food groups. For females a similar trend was observed. The likelihood of adolescents meeting all Food Guide recommendations decreased from grade six to grade nine.

Behavioral risk factors for overweight in early childhood; the 'Be active, eat right' study

Background

The lifestyle-related behaviors having breakfast, drinking sweet beverages, playing outside and watching TV have been indicated to have an association with childhood overweight, but research among young children (below 6 years old) is limited. The aim of the present study was to assess the associations between these four behaviors and overweight among young children.

Methods

This cross-sectional study used baseline data on 5-year-old children (n = 7505) collected for the study ‘Be active, eat right’. Age and sex-specific cut-off points for body mass index of the International Obesity Task Force were used to assess overweight/obesity. Multivariable logistic regression analyses were applied.

Results

For children whom had breakfast <7 days/week and watched TV >2 hours/day, the odds ratio (OR) for having overweight (obesity included) was, respectively, 1.49 (95% confidence interval (CI): 1.13-1.95), and 1.25 (95% CI: 1.03-1.51). There was a positive association between the number of risk behaviors present and the risk for having overweight. For children with 3 or all of the risk behaviors having breakfast <7 days/week, drinking sweet beverages >2 glasses/day, playing outside <1 h/day, watching TV >2 hs/day, the OR for overweight was 1.73 (95% CI: 1.11-2.71) (all models adjusted for children’s sex and sociodemographic characteristics).

Conclusion

Given the positive association between the number of behavioral risk factors and overweight, further studies are needed to evaluate the effectiveness of behavioral counseling of parents of toddlers in preventing childhood overweight. In the meantime we recommend physicians to target all four behaviors for counseling during well-child visits.

SECULAR TRENDS IN BODY COMPOSITION AND FREQUENCY OF OVERWEIGHT AND OBESITY IN BOYS AGED 3–18 FROM KRAKOW, POLAND, WITHIN THE LAST 30 YEARS (FROM 1983 TO 2010)

The aim of this study was to examine the changes in body composition (fatness and muscle and bone mass) and BMI in three cohorts of boys living in Krakow, Poland, over the last 30 years, and to assess how overweight and obesity frequencies have developed over the period. The anthropological survey was conducted in 2010, and comprised 1863 boys from Krakow aged 3–18 years. The analysis compared the latest measurements of selected skinfold thicknesses, BMI, total body muscle mass and bone mass with the results of surveys from 1983 (N=1934) and 2000 (N=2323). The frequency of overweight and obesity was assessed for the last survey series, and their trends determined for the years 1983–2000 and 2000–2010. The analysis of fat tissue distribution showed that the boys from the 2010 cohort, as compared with those examined in 2000, had a higher trunk adiposity, as manifested by greater thickness of subscapular and suprailiac skinfold thicknesses, and boasted a larger muscle mass and lower bone mass. The survey results also showed that, from 1983 to 2000, the percentage of overweight boys increased slightly (from 11.69% to 12.48%), whereas the frequency of obesity did not change. Over the last decade, the percentage of overweight people has increased to 15.94%, and the frequency of obesity has doubled, equalling 4.94% in 2010. The last decade has seen a minor trend in boys towards increased trunk adiposity, muscle mass, BMI and prevalence of overweight and obesity, and a slight decrease in bone mass.

Breakfast consumption and meal frequency interaction with childhood obesity

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Selected eating behaviours and excess body weight: a systematic review

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

Factors associated with childhood obesity in Spain. The OBICE study: a case–control study based on sentinel networks

Objective

To estimate the association strength of dietary behaviour and sedentary habits in relation to childhood obesity in Spain.

Design

A matched case–control study was carried out using data collected by sentinel network paediatricians in general practices.

Setting

Five Spanish autonomous communities.

Subjects

Cases were 437 children (2–14 years old) with BMI >95th percentile according to Spanish reference tables. Controls were 751 children (2–14 years old; two paired per case) with BMI <84th percentile. Data were collected in two phases: individual (questionnaires filled in by sentinel paediatricians) and family (self-administered questionnaires filled in a family environment). Crude OR and adjusted OR (ORc and adj OR) for the given variables were calculated using a simple and multiple conditional logistic regression analysis.

Results

The factors with the greatest effect on obesity were family history of obesity: both parents (adj OR = 11·2), mother but not father (adj OR = 9·1), father but not mother (adj OR = 6·1), siblings (adj OR = 2·7); and eating between meals (adj OR = 2·5) and consumption of sweets and soft drinks >2 times/week (adj OR = 2·0). The highest protection effect was found for five meals per day (adj OR = 0·5), the regular consumption of breakfast (adj OR = 0·5) and for eating fruit for dessert (adj OR = 0·6). Factors related to sedentary habits did not appear as noteworthy.

Conclusions

We have determined the association between certain dietary behaviour and family history with childhood obesity in several Spanish regions.

Changes in meal pattern among Norwegian children from 2001 to 2008

OBJECTIVE

The present study aimed to analyse changes in meal pattern among Norwegian children from 2001 to 2008 in general; to analyse associations between meal pattern and gender, parental educational level and number of parents in the household; and to analyse the association between intake of unhealthy snacks, meal pattern and the mentioned variables.

DESIGN

Within the Fruits and Vegetables Make the Marks (FVMM) project, two cross-sectional studies were conducted, one in 2001 and one in 2008, where participants from the same schools filled in a questionnaire on meals eaten the previous day.

SUBJECTS

Participants were 6th and 7th grade pupils, n 1488 in 2001 and n 1339 in 2008.

SETTING

Twenty-seven elementary schools in two Norwegian counties.

RESULTS

There were no significant changes in children's meal pattern from 2001 to 2008. For both years more than 90 % of the participants reported that they had breakfast yesterday, while 95 % had lunch, 94 % had dinner and 82 % had supper. More girls than boys reported that they had lunch yesterday (96 % v. 94 %, P = 0·03). More children with higher v. lower educated parents reported that they had breakfast yesterday (93 % v. 88 %, P < 0·001). More children living with two parents v. one parent had breakfast (93 % v. 88 %, P = 0·001) and lunch yesterday (97 % v. 93 %, P < 0·001).

CONCLUSIONS

There were no changes in meal pattern from 2001 to 2008 among Norwegian children. Characteristics associated with skipping meals were living in a one-parent family and having lower educated parents.

Eating habits of preschool children with high migrant status in Switzerland according to a new food frequency questionnaire

Assessment of eating habits in young children from multicultural backgrounds has seldom been conducted. Our objectives were to study the reproducibility and the results of a food frequency questionnaire (FFQ) developed to assess changes in eating habits of preschool children with a high migrant population, in the context of a multidisciplinary multilevel lifestyle intervention. Three kindergarten classes (53% from migrant backgrounds) in French-speaking Switzerland were randomly selected and included 16 girls and 28 boys (mean age +/- SD, 5.4 +/- 0.7 years). The FFQ was filled out twice within a 4-week interval by the parents. Spearman rank correlations between the first and the second FFQ for the 39 items of the food questions were as follows: low (r < 0.50) for 8 (7 P < .05 and 1 nonsignificant), moderate (0.50 <or= r < 0.70) for 22 (all P < .01), and high (r >or= 0.70) for 9 (all P < .01). In addition, 28 of 39 intraclass correlation coefficients were high (>0.50, all P < .01). Eighty-six percent of the children ate breakfast at home daily, but only 67% had lunch at home. The percentages of children eating at least once a week in front of the TV were as follows: 50% for breakfast, 33% for lunch, 38% for dinner, and 48% for snacks. Forty percent of children asked their parents to buy food previously seen in advertisements and ate fast food between once a week and once a month. Children generally consumed foods with a high-energy content. The FFQ yielded good test-retest reproducibility for most items of the food questions and gave relevant findings about the eating habits of preschool children in areas with a high migrant population.

Meal patterns and childhood obesity

PURPOSE OF REVIEW

To summarize the literature concerning the relationship between meal patterns and childhood obesity. Literature searches of MEDLINE and the Cochrane Library were performed in October 2009 for studies published in the last 18-24 months.

RECENT FINDINGS

Available data indicate that not only meal composition but also some components that form a specific meal pattern can promote childhood obesity. Reducing meal and snack frequency, especially breakfast skipping, seem to be such components. On the contrary, limiting consumption of sugar-sweetened beverages and snack foods (defined as high-fat, energy-dense foods) may be associated with a reduction in the risk of obesity.

SUMMARY

There is still much to be learned about specific aspects of the association between meal patterns and obesity. Although current knowledge does not allow one to draw any definitive conclusions, it provides a solid basis for further research.

Systematic review demonstrating that breakfast consumption influences body weight outcomes in children and adolescents in Europe

Skipping breakfast is common among children and adolescents. However, there is uncertainty regarding whether breakfast consumption contributes to or protects against overweight or obesity. We aimed to review the evidence on the effects of breakfast consumption on body weight outcomes in children and adolescents in Europe. The Cochrane Library, MEDLINE, and EMBASE were searched in January 2009. We identified 16 studies. All were cross-sectional or cohort trials involving more than 59,000 children/adolescents from Europe. Thirteen studies (n = 57,481) consistently showed that breakfast has a protective effect against becoming overweight or obese. One trial (n = 886) showed that this effect was significant only for boys. The effect of eating breakfast on the body mass index (BMI) was analyzed in 4 studies (n = 2897). All of these studies showed an increase in BMI in breakfast skippers. In one study (n = 1245), this effect was significant only for boys. The results of this analysis suggest that eating breakfast is associated with a reduced risk of becoming overweight or obese and a reduction in the BMI in children and adolescents in Europe. However, almost all of the data in this review were gathered from observational studies, thus, causality should not be assumed based on these findings.

Reproducibility and validity of a diet quality index for children assessed using a FFQ

The diet quality index (DQI) for preschool children is a new index developed to reflect compliance with four main food-based dietary guidelines for preschool children in Flanders. The present study investigates: (1) the validity of this index by comparing DQI scores for preschool children with nutrient intakes, both of which were derived from 3 d estimated diet records; (2) the reproducibility of the DQI for preschoolers based on a parentally reported forty-seven-item FFQ DQI, which was repeated after 5 weeks; (3) the relative validity of the FFQ DQI with 3 d record DQI scores as reference. The study sample included 510 and 58 preschoolers (2.5-6.5 years) for validity and reproducibility analyses, respectively. Increasing 3 d record DQI scores were associated with decreasing consumption of added sugars, and increasing intakes of fibre, water, Ca and many micronutrients. Mean FFQ DQI test-retest scores were not significantly different: 72 (sd 11) v. 71 (sd 10) (P = 0.218) out of a maximum of 100. Mean 3 d record DQI score (66 (sd 10)) was significantly lower than mean FFQ DQI (71 (sd 10); P < 0.001). The reproducibility correlation was 0.88. Pearsons correlation (adjusted for within-person variability) between FFQ and 3 d record DQI scores was 0.82. Cross-classification analysis of the FFQ and 3 d record DQI classified 60 % of the subjects in the same category and 3 % in extreme tertiles. Cross-classification of repeated administrations classified 62 % of the subjects in the same category and 3 % in extreme categories. The FFQ-based DQI approach compared well with the 3 d record approach, and it can be used to determine diet quality among preschoolers.

Breakfast and the diets of Australian children and adolescents: an analysis of data from the 1995 National Nutrition Survey

The aim of this study was to describe the nutrients provided to Australian children and adolescents by the breakfast meal and compare the food and nutrient intakes and health of regular breakfast eaters (those who ate breakfast 5 days or more a week) and skippers (who are breakfast rarely or never). The Australian Bureau of Statistics was commissioned to undertake additional analysis of data collected in the 1995 Australian National Nutrition Survey. The survey included 24-h recalls, physical measurements and a food-habits questionnaire collected during the period February 1995-March 1996, with a nationally representative sample of 3,007 Australians aged between 2 and 18 years. The median nutrient intakes at breakfast and the proportion of the daily total contributed by breakfast were calculated. Differences between regular breakfast eaters and breakfast skippers in terms of nutrient intake, body mass index and health status were compared using student t-tests. The findings show the typical breakfast consumed by young Australians was low in fat, high in carbohydrate and a good source of thiamin, riboflavin, niacin, calcium and magnesium. Those who did not eat breakfast cereal were much more likely to have inadequate nutrient intakes, especially of thiamin, riboflavin, calcium, magnesium and iron. There was no difference between the fat intake and the body mass index of regular breakfast eaters compared with breakfast skippers. Regular breakfast consumption is associated with better diets for children and adolescents.

Parent-reported eating and leisure-time activity selection patterns related to energy balance in preschool- and school-aged children

OBJECTIVE

Compare parent-reported preschool- and school-aged children's eating and leisure-time activity patterns that are proposed to influence energy balance.

DESIGN

Cross-sectional investigation of children, 2 to 12 years, attending a well visit.

SETTING

Pediatric private practice/ambulatory pediatric clinic.

PARTICIPANTS

One hundred seventy-four children: 49% preschool-aged, 54% female, 28% Hispanic, and 34% overweight or at risk for overweight.

VARIABLES MEASURED

Parent-reported eating/leisure-time behaviors. Height/weight from medical records.

ANALYSIS

Analyses of covariance/chi-square tests; significance at P

RESULTS

By parents' report, preschool-aged children consumed more servings/day of low-fat dairy (2.1 +/- 1.6 vs 1.7 +/- 1.5; P < .01), fewer servings/day of sweetened drinks (1.4 +/- 1.9 vs 2.2 +/- 2.6; P < .01) and watched fewer hours/day of weekend TV (2.3 +/- 1. 3 vs 2.7 +/- 1.3; P < .05) than school-aged children. Fewer preschool-aged children consumed salty (14.0% vs 26.1%; P < .05) and sweet (16.3% vs. 29.5%; P < .05) snack food daily, and a greater percentage regularly consumed dinner with a parent (93.0% vs 80.7%; P < .05), as assessed by parent report.

CONCLUSIONS AND IMPLICATIONS

Parent-reported children's eating/leisure-time patterns that may influence energy balance were less healthful in the school-aged children. However, most children did not meet recommendations, irrespective of age or weight. Interventions for meeting recommendations should start with families with preschool-aged children. Future research should focus on identifying factors that might be contributing to increased reporting of problematic food and leisure-time activity patterns in school-aged children.

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Key Words

• children
• preschool
• diet
• leisure-time
• obesity

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MESH Headings

• Age Distribution
• Ambulatory Care Facilities
• Analysis of Variance
• Child
• Child, Preschool
• Cross-Sectional Studies
• Energy Intake/physiology
• Energy Metabolism/physiology
• Feeding Behavior/ethnology
• Feeding Behavior/physiology
• Feeding Behavior/psychology
• Female
• Humans
• Leisure Activities/psychology
• Male
• Overweight/etiology
• Parents
• Pediatrics
• Surveys and Questionnaires

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Grants

• R21 DK074919-01 NIDDK NIH HHS
• R21 DK074919-02 NIDDK NIH HHS
• R21 DK074919-03 NIDDK NIH HHS
• R21 DK074919 NIDDK NIH HHS
• DK074919 NIDDK NIH HHS

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Affiliation(s)

Hollie A Raynor Department of Nutrition, University of Tennessee, Knoxville, Tennessee 37996, USA.
Elissa Jelalian
Patrick M Vivier
Chantelle N Hart
Rena R Wing

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

Objectives

To examine the association between skipping breakfast, daily energy, macronutrients and food intakes, and BMI in pre-school children.

Design

A cross-sectional study using information on children’s food consumption and measured height and weight. Energy and macronutrient intakes of the children were derived from parent/day-care attendant’s responses to 24 h recall interviews and eating behaviour questionnaires.

Setting

Data obtained from a representative sample (n2103) of children born in Quebec (Canada) in 1998.

Subjects

One thousand five hundred and forty-nine children, with a mean age of 49 (sd3·12) months.

Results

Ten per cent of children ate breakfast on fewer than 7 days per week. This behaviour was associated with a lower diet quality and concentrated energy intakes through higher protein intakes at lunch and the consumption of snacks higher in energy and carbohydrate in the afternoon and evening; yet total daily energy intakes were not significantly different from those of pre-school children who ate breakfast every day. Breakfast skippers’ mean BMI increased as intake of energy, carbohydrates or servings of grain products increased; however, this was not the case for breakfast eaters. When Cole’s cut-off for overweight/obesity was used, overweight/obesity in breakfast skippers was related to the dinner-time consumption of approximately 3000 kJ (700 kcal) or more for energy intake, approximately 100 g or more of carbohydrates, or approximately 3 servings or more of grain products.

Conclusions

Eating breakfast every day is associated with having a healthy body weight, likely due to a more even distribution of energy intake across meals throughout the day.

Benefits of Breakfast for Children and Adolescents: Update and Recommendations for Practitioners

A number of studies report health benefits for children and adolescents who consume breakfast. Breakfast skipping is fairly common in children and adolescents and increases as children age. Breakfast can enhance children's diets by positively contributing to daily nutrient intake, augmenting intake of key nutrients such as fiber and calcium, and provides an opportunity to help meet the recommendations of the Dietary Guidelines for Americans. Breakfast also is associated with more healthful food choices. Cross-sectional studies support that eating breakfast more often may help children and adolescents maintain a healthful weight. However, the results from longitudinal studies are inconclusive and suggest that more research is needed to clarify this relationship, including understanding the mediating effects of initial weight status, dieting behavior, and physical activity levels. Breakfast consumption may provide some benefit toward cognitive function and academic achievement, but more research is needed. Breakfast is one facet of a healthy lifestyle that may help contribute to the short- and long-term health and well-being of children and adolescents. Health practitioners can promote healthy breakfast consumption in children and adolescents by addressing barriers to eating breakfast and focusing on individuals who may be more likely to skip breakfast on a regular basis.

Breakfast cereal is associated with a lower prevalence of obesity among 10-12-year-old children: the PANACEA study

BACKGROUND AND AIM

Eating behaviours and obesity status among children have already been evaluated in several studies, with conflicting results. The aim of this study is to assess the correlation of breakfast cereal with childhood obesity.

METHODS AND RESULTS

A representative sample of 700 children (323 male) selected from 18 schools located in Athens greater area were enrolled. Children and their parents completed questionnaires that evaluated dietary habits and physical activity. We also retrieved information about the type of breakfast most frequently consumed. Height and weight of the children was measured and body mass index (BMI) was calculated. Simple and multiple logistic regression methods were used in order to determine the relationship between cereal intake for breakfast and obesity. Some boys (8.6%) and girls (9.0%) were obese, whereas 33.9% of boys and 22.1% of girls were overweight. For boys, the adjusted odds ratio for breakfast cereal intake for being overweight or obese was 0.54 (95% confidence interval (CI): 0.45-1.29), while for girls it was 0.41 (95% CI: 0.21-0.79). Moreover, the odds ratio of overweight/obesity for boys who ate daily breakfast was 0.51 (95% CI: 0.25-1.05), and for girls was 0.27 (95% CI: 0.12-0.64), adjusted for physical activity and other potential confounders.

CONCLUSION

These data provide evidence that breakfast cereal as a most frequent choice, and daily consumption of breakfast, are inversely associated with the prevalence of overweight or obesity in 10-12-year-old children.

Breakfast skipping and body mass index among adolescents in Greece: whether an association exists depends on how breakfast skipping is defined

Many studies have found an association between breakfast skipping and either body mass index (BMI; calculated as kg/m(2)) or overweight/obesity among adolescents, but several studies have found no association. This cross-sectional study investigated the hypothesis that this discrepancy is partly due to three differences in methodology. First, some studies have examined BMI, but other studies have examined overweight/obesity. Second, some studies have controlled for potential confounders, but other studies have not. Third, different studies have used different definitions of breakfast skipping. This study examined both the relationship between breakfast skipping and BMI and the relationship between breakfast skipping and overweight/obesity, compared unadjusted results with results adjusted for potential confounders, and compared results for 24 definitions of breakfast skipping. The sample consisted of 811 students at high schools in Piraeus, Greece, who completed a questionnaire and had their height and weight measured. The results supported this hypothesis. First, fewer breakfast-skipping variables were associated with BMI than with overweight/obesity. Second, fewer associations were found when controlling than when not controlling for potential confounders. Third, fewer associations were found for variables corresponding to some definitions of breakfast skipping than for variables corresponding to other definitions.

Effects of lifestyle habits and eating meals together with the family on the prevalence of obesity among school children in Tokushima, Japan: a cross-sectional questionnaire-based survey

Obesity in children has become a major global public health concern. The prevention of obesity must start from early childhood in order to establish sound lifestyle habits and promote healthy adulthood. In this study, we evaluated factors associated with the prevention of obesity and the development of healthy lifestyle habits in children. A cross-sectional, questionnaire-based survey was performed in elementary and junior high school students in Tokushima Prefecture, Japan, during the summer of 2004. The questionnaire consisted of 30 items such as physique, sleep, eating habits, diet, exercise, free time, and attending after-school lessons. Our study revealed that eating meals as a family every day is associated with a lower rate of obesity as well as getting good lifestyle habits such as eating balanced meals and getting enough sleep. Of the 3,291 students who responded to the questionnaire, 2,688 (81.7%) reported that they eat meals with their family every day. The percentage of students who eat meals with their family every day decreased with increasing school grade, with the lowest percent in the junior high school students. However, the results regarding female junior high school students revealed a marked association between eating meals with the family every day and good lifestyle habits. We recommend that parents and school teaching staff encourage the establishment of sound, healthy lifestyle habits in children from early childhood as an effective measure for the prevention of obesity.