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.

Longitudinal relationships between changes in body composition and changes in selected metabolic risk factors (abdominal obesity and blood pressure) among South African adolescents

BACKGROUND

Incidence of childhood high blood pressure (BP) is increasing worldwide. This study examined the longitudinal relationship between changes in body composition (i.e. body mass index (BMI), waist circumference (WC) and percentage body fat) and selected metabolic risk factors (abdominal obesity and BP) among adolescents from the Tlokwe municipality in the North West Province of South Africa.

METHOD

One hundred and eight-six adolescents (81 boys and 105 girls) aged 14 to 16 years participated in the study. Body composition was measured following the International Society of the Advancement of Kinanthropometry standard procedures. BMI, abdominal obesity using WC measurement, and resting BP were determined. Analysis of variance (ANOVA) for repeated measures was calculated to determine changes in anthropometric measures and body composition as well as changes in BP. Additionally, Univariate analysis of variance with repeated measures and participants as a random sample was applied. Diastolic BP (DBP) and systolic BP (SBP) were used as dependent variables and sex, age, BMI, WC, and waist-to-height ratio as independent variables.

RESULTS

Significant changes were found for stature, BMI, body mass, WC, SBP, and DBP. BMI for the total group was significant and positively related to abdominal obesity in 2012 (r = 0.55; p < 0.01) and in 2013 (r = 0.77; p < 0.01) and to SBP (r = 0.26; p < 0.05) in 2012 and (r = 0.17; p = 0.43) in 2013. BMI among the boys was significantly and positively related to abdominal obesity in 2012 (r = 0.83; p < 0.01) and 2013 (r = 0.91; p < 0.01). For the girls, BMI was significantly and positively related to abdominal obesity (r = 0.49; p < 0.01) and to SBP (r = 0.32; p = 0.05) in 2012. Boys with a higher WC in 2012 had significantly increased DBP (p < 0.05). Boys measured in 2012 with greater WC and BMI show a significant increase in SBP.

CONCLUSIONS

BMI was positively related to BP and abdominal obesity over time. Relatively high BMI and abdominal obesity significantly increased the likelihood of elevated BP over time, especially in boys. BMI was a predictor of abdominal obesity in boys, while in girls, BMI was a predictor of both abdominal obesity and SBP. In view of the future health implications of both abdominal obesity and elevated BP, urgent strategic interventions programs aimed at increasing physical activity and advocating for well-balanced dietary practices as well as importance of keeping normal blood pressure among South African adolescents are needed.

Prevalence and associates of obesity and overweight among school-age children in a rural community of Thailand

Purpose

Information about overweight and obesity among students in rural areas of Thailand is limited. Therefore, we aimed to determine overweight and obesity prevalences and associated factors among school-aged children in a rural community of Thailand.

Methods

We selected 9 public schools through cluster sampling in 2 provinces located in central Thailand in 2016. Anthropometric measurements were measured using standard techniques, classified as overweight (>1 standard deviation [SD]) and obese (>2 SD) with respect to their age and sex using 2007 World Health Organization reference charts. Standardized questionnaires on risk factors were sent to parents to be completed together with their child.

Results

Among 1,749 students, 8.98% had overweight and 7.26% had obesity. Mean age (range) was 11.5 years (5–18 years). Independent factors associated with overweight and obesity included primary school student (reference as secondary school) (adjusted odds ratio [aOR], 2.25; 95% confidence interval [CI], 1.24–4.08; P=0.07), mother’s body mass index (aOR, 1.07; 95% CI, 1.02–1.12; P=0.001), self-employed father (aOR, 1.99; 95% CI, 1.12–3.55; P=0.018), number of siblings (aOR, 0.61; 95% CI, 0.47–0.81; P=0.001), having sibling(s) with obesity (aOR, 1.82; 95% CI, 1.20–2.77; P=0.005), more than one (aOR, 7.16; 95% CI, 2.40–21.32; P<0.001), consuming 2–3 ladles of rice/meal (aOR, 2.14; 95% CI, 1.38–3.32; P=0.001), consuming >3 ladles of rice/meal (aOR, 2.69; 95% CI, 1.11–6.46; P= 0.27), watching <2 hours of television/day (aOR, 2.18; 95% CI, 1.19–4.01; P=0.012), and watching >2 hours of television/day (aOR, 2.60; 95% CI, 1.36–4.96; P=0.004).

Conclusion

Many sociodemographic, dietary, and behavioral factors were related to overweight and obesity among school-aged children not only in urban but also rural communities of Thailand.

[Evaluation, correction and impact of non-response in studies of childhood obesity]

OBJECTIVE

To evaluate and correct the impact of non-response in the prevalence of underweight, overweight and obesity in children aged 6 to 15 years old using silhouette scales.

METHOD

Cross-sectional study carried out in 2013 among 8,145 Galician schoolchildren aged 6-15 years old. The students who agreed to participate were weighed and measured and, based on body mass index, the prevalence of underweight, overweight and obesity was estimated. Teachers rated all students using silhouette scales. The valuations were used to estimate the prevalence corrected by non-response. Using the Bayes theorem, participation rates were estimated according to weight status.

RESULTS

The participation rate was 92.3% in the 6 -to 11-year-old group, and 90% in the 12- to 15-year old age group. In both groups, the prevalence of underweight and overweight were similar between participants and non-participants. However, obesity was higher among non-participants, especially at 12 to 15 years of age (6.3% vs. 12.2% ; p < 0.05). The prevalence did not change when corrected by the teacher's valuation. The participation rate of obese students was lower than the overall rate (82% vs. 90% at 12 to 15 years old; p < 0.05).

CONCLUSIONS

The presence of participation bias, which was greater at 12-15 years old, was confirmed. However, the impact of the bias on prevalence was negligible due to the high participation rate. In obesity studies with objective measures, it is essential to quantify non-participation, as well as to assess its impact and correct it.

Why are primary school children overweight and obese? A cross sectional study undertaken in Kinondoni district, Dar-es-salaam

Background

The world is experiencing an alarming increase in prevalence of childhood obesity. Despite this trend little is known about determinants of childhood obesity in Tanzania. A cross sectional study determined the prevalence and factors associated with overweight and obesity in 1722 children aged 7–14 years (10.9 ± 1.74) attending primary schools in Dar es Salaam.

Methods

Six public and four private schools were systemically selected from a total of 227 primary schools. Anthropometric measurements (weight and height) were collected using a standard protocol and Body Mass Index (BMI) was calculated. Interviews collected demographic characteristics and lifestyle factors. Multiple logistic regression test was used to assess the influence of independent variables on overweight and obesity while controlling for confounding factors. The level of significance was set at α = 5 %.

Results

Of 1, 722 children 10.2 % were overweight and 4.5 % were obese. Overweight and obesity was higher in boys (14.9 %) than girls (14.5 %), higher in children attending private schools (27.7 %) than public schools (5.9 %). Children who walked to and from school were less likely to be overweight or obese than those who used vehicles (AOR = 0.5; 95%CI: 0.3–0.6; p < 0.001). Those who used private cars or school buses were more likely to be overweight or obese than those who used public transport (AOR = 2.9; 95%CI: 0.2–0.7; p < 0.05). Computer/video game use were associated with increased risk of overweight and obesity (AOR = 1.6; 95%CI: 1.1–2.3; p = 0.03). Lunch provided by schools was associated with increased risk of overweight or obese (AOR = 6.4, 95 % CI = 4.2–9.6, p < 0.001).

Conclusions

The findings of this study identified a number of behavioural and dietary factors that are related to overweight and obesity. Parents and teachers should encourage children to be physically active by limiting screen time and promoting active transport to and from school to promote health and reduce obesity. Ministry of education needs to formulate/enforce policies that encourage physical activities for school children and regulate quality of foods provided to children at schools.

Dietary Carbohydrate and Nocturnal Sleep Duration in Relation to Children's BMI: Findings from the IDEFICS Study in Eight European Countries

Previous research has found an association between being overweight and short sleep duration. We hypothesized that this association could be modified by a high carbohydrate (HC) diet and that the timing and type (starch or sugar) of intake may be an important factor in this context. Participants in the prospective, eight-country European study IDEFICS were recruited from September 2007 to June 2008, when they were aged two to nine years. Data on lifestyle, dietary intake and anthropometry were collected on two occasions. This study included 5944 children at baseline and 4301 at two-year follow-up. For each meal occasion (morning, midday, and evening), starch in grams and sugar in grams were divided by total energy intake (EI), and quartiles calculated. HC-starch and HC-sugar intake categories were defined as the highest quartile for each meal occasion. In a mutually adjusted linear regression model, short sleep duration as well as HC-starch in the morning were positively associated with body mass index (BMI) z-scores at baseline. HC-starch at midday was positively associated with body mass index (BMI) z-scores in children with short sleep duration, and negatively associated with BMI z-scores in those with normal sleep. After adjustment for baseline BMI z-scores, associations between total HC from starch or sugar and high BMI z-scores at two-year follow-up did not persist. Our observations offer a perspective on optimal timing for macronutrient consumption, which is known to be influenced by circadian rhythms. Reduced carbohydrate intake, especially during morning and midday meals, and following nocturnal sleep duration recommendations are two modifiable factors that may protect children from being overweight in the future.

Risk Factors Associated with Overweight among Adolescents in Serbia

INTRODUCTION

The pandemic of obesity in adolescents is one of the challenges of public health.

AIM

The aim of this study was to examine the association of overweight with demographic, socioeconomic and lifestyle factors among Serbian adolescents.

METHOD

A cross-sectional study of 2139 adolescents aged 10 to 19 years was carried out. Data used in this study were from the 2006 Health Survey. In accordance with the international sex- and age-specific Body Mass Index cut-off points, all participants were classified as being normal weight or overweight, including obese. The association between the risk factors and overweight were examined using a multivariate logistic regression model.

RESULTS

The study showed that 28.9% of boys and 17.0% of girls were overweight, while 14.5% of boys and 8.1% of girls were obese. Boys were more likely to be overweight/obese, compared with girls. Being younger (p< 0.01 for 14 to 15 years) and (p< 0.01, for 16 to 19 years), engaging in physical activities that last less than 7 hours a week, in such a manner that they breathe quickly and become sweaty, (p< 0.01) and skipping breakfast (p< 0.05) were risk factors significantly associated with overweight among adolescents. No significant association was found with wealth index.

CONCLUSION

These findings should be an integral part of further preventive interventions, especially oriented towards younger adolescents, who are physically inactive, have a habit of skipping breakfast and are boys.

Prevalence of overweight and obesity in adolescents: a systematic review

Objective. To review the extant literature on the prevalence of overweight and obesity in adolescents (10-19 years old) of both sexes. Design. The search was carried out using Medline and Scopus considering articles published from the establishment of the databanks until June 7, 2012. Data on the prevalence of children being overweight and obese from the International Obesity Task Force (IOTF) website was also reviewed. Only original articles and one National Health Report were considered. Forty studies met the inclusion criteria. Results. Twenty-five of these studies were nationally representative, and ten countries were represented only by regional data. Conclusions. The prevalence of overweight and obesity among adolescents worldwide is high, and obesity is higher among boys. The IOTF criterion is the most frequently used method to classify adolescents as overweighed or obese in public health research.

[Health-related quality of life and factors associated with overweight and obesity in the pediatric population of Catalonia, Spain]

The aim of this work is to describe the health-related quality of life (HRQOL), and to analyze the associated factors to overweight/obesity in a representative sample of the Catalan population 0-14 years old. Proxyrespondents answered the child's questionnaire of the Encuesta de Salud de Cataluna (ESCA) 2006 (n = 2.200). Variables analyzed were weight and height, the KIDSCREEN-10 HRQOL questionnaire, and also scales on risky behaviors, physical activity, frequency of fast food consumption, and number of hours of television viewing. Logistic regression models were adjusted. In 31% of children HRQOL was excellent/very good. Risky behaviors and restriction of activity were the associated factors to the best and the worst HRQOL. Maternal level of education and some habits and behaviors were associated to overweight/obesity. The ESCA contributes with useful information to monitor and to assess interventions addressed to the children population.

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

OBJECTIVE

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

DESIGN

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

SETTING

Schools in Granada and Balearic Islands (Spain).

SUBJECTS

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

RESULTS

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

CONCLUSIONS

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

Modifiable risk factors for overweight and obesity in children and adolescents from São Paulo, Brazil

Background

Brazil is currently experiencing a nutrition transition: the displacement of traditional diets with foods high in saturated fat, sodium, and cholesterol and an increase in sedentary lifestyles. Despite these trends, our understanding of child obesity in Brazil is limited. Thus, the aims of this study were (1) to investigate the current prevalence of overweight and obesity in a large sample of children and adolescents living in São Paulo, Brazil, and (2) to identify the lifestyle behaviors associated with an increased risk of obesity in young Brazilians.

Methods

A total of 3,397 children and adolescents (1,596 male) aged 7-18 years were randomly selected from 22 schools in São Paulo, Brazil. Participants were classified as normal weight, overweight, or obese based on international age- and sex-specific body mass index thresholds. Selected sociodemographic, physical activity, and nutrition behaviors were assessed via questionnaire.

Results

Overall, 19.4% of boys and 16.1% of girls were overweight while 8.9% and 4.3% were obese. Two-way analysis of variance revealed that the prevalence of overweight and obesity was significantly higher in boys and in younger children when compared to girls and older children, respectively (P < 0.05 for both). Logistic regression analysis revealed that overweight was associated with more computer usage, parental encouragement to be active, and light soft drink consumption after controlling for differences in sex, age, and parental education (P < 0.05 for all). Conversely, overweight was associated with less active transport to school, eating before sleep, and consumption of breakfast, full-sugar soft drinks, fried food and confectionery (P < 0.05 for all).

Conclusions

Our results show that obesity in São Paulo children and adolescents has reached a level equivalent to that seen in many developed countries. We have also identified three key modifiable factors related to obesity that may be appropriate targets for future intervention in Brazilian youth: transport mode to school, computer usage, and breakfast consumption.

Prevalence of overweight and obesity among preadolescent schoolchildren in Galicia, Spain

BACKGROUND

Childhood obesity is rising rapidly in many countries. Preadolescents appear to be at particularly high risk. This study estimated the prevalence of overweight and obesity in preadolescent schoolchildren in Galicia, Spain.

METHODS

The heights and weights of a random sample of 2305 Galician schoolchildren aged 10-12 years were measured using calibrated standardized scales and measures. Overweight and obesity were identified using the criteria of the International Obesity Task Force.

RESULTS

The prevalences of obesity and overweight were respectively 9.2% and 31.0% among boys, 8.6% and 28.8% among girls and 8.9% and 29.9% overall. Taking boys and girls together, the combined prevalence of overweight and obesity fell significantly with increasing age. Overweight was more prevalent in rural than urban areas (30.7% vs. 28.4%), as also was obesity (9.8% vs. 7.2%).

CONCLUSIONS

Our study evidences the emergence of the obesity epidemic among preadolescents in Galicia, especially in rural areas. Both overweight and obesity in this age group are more prevalent in Galicia than in other areas of Spain or most other Western nations.

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.

Validity of the Bouchard activity diary in Spanish adolescents

Objective

Valid and simple instruments to assess physical activity (PA) in specific populations are required for health-related research. The aim of the present study was to assess the validity of the Bouchard activity diary (AD) in Spanish adolescents using an activity monitor to compare total PA and moderate-to-vigorous PA (MVPA) obtained by both instruments.

Design

Sixty-one Spanish adolescents, aged 12–16 years, completed the Bouchard AD and wore the ActiGraph activity monitor for three consecutive days. Validity was assessed with the Spearman correlation coefficient (ρ), the Bland–Altman method and the κ coefficient.

Results

Thirty-seven adolescents were included in the final analysis. Correlations between the activity monitor and the AD administered over the three days (Thursday–Saturday) were moderate (ρ = 0·33–0·35, P < 0·05) or non-significant for total PA and moderate (ρ = 0·36, P < 0·05) for MVPA. Correlations between the two methods were progressively lower for each subsequent day of testing, for both total PA and MVPA. The Bland–Altman plot illustrated that the Bouchard AD overestimated MVPA (mean difference −32·05 (sd 74·56) min; 95 % limits of agreement 109·61, −173·31 min). Agreements for classification into MVPA tertiles and accordance with the international recommendations of MVPA were fair and moderate, respectively, for the 3 d means.

Conclusions

The Bouchard AD has reasonable validity to assess total PA and MVPA in Spanish adolescents. The results show lower levels of agreement on the third day but it is not clear if this is due to design features (weekday v. weekend) or to participant compliance with the survey or the activity monitoring protocol.