The relationship between modifiable lifestyle behaviours and self-reported health in children and adolescents in the United Kingdom

Obesity, along with its associated health issues, is closely tied to lifestyle habits. While certain elements affecting childhood health, such as genetics and ethnicity, are beyond individuals' control, there exists modifiable lifestyle behaviours that can facilitate healthier living. This study employed multiple regression analysis to investigate the relationship between specific modifiable lifestyle behaviours and self-reported health. The independent variables considered included days of moderate to vigorous physical activity (MVPA), fruit and vegetable consumption, breakfast frequency, school night sleep duration, and non-school night sleep duration. These variables were chosen for their practical modifiability within participants' daily lives. The analysis revealed a highly significant overall model (F(13,11363) = 191.117, p < .001), explaining 17.9% of the variance in self-reported health. Notably, higher MVPA levels were associated with improved self-reported health (B = 0.136 to 0.730, p < .001). Additionally, regular breakfast consumption and increased fruit and vegetable intake exhibited positive associations with self-reported health (B = 0.113 to 0.377, p < .001), while girls reported lower self-reported health (B = -0.079, p < .001). School night sleep duration was positively linked to self-reported health (B = 0.071, p < .001). Furthermore, a dose-response relationship between MVPA, dietary habits, and health was identified. These findings hold substantial potential for public health campaigns to promote healthy behaviours and prevent chronic diseases in young individuals. It is imperative to emphasise that all the variables considered in this study are readily modifiable aspects of individuals' lives, offering a promising avenue for personal health and well-being enhancement.

Association between patterns of biological rhythm and self-harm: evidence from the baoxing youth mental health (BYMH) cohort

BACKGROUND

Self-harm, a severe mental health concern among children and adolescents, has varying global prevalence rates. Previous studies have suggested potential associations between specific behavioral aspects of biological rhythm and self-harm risk in these populations.

OBJECTIVE

Our study aimed to elucidate the relationship between biological rhythm patterns and the propensity of self-harm among Chinese children and adolescents using the Baoxing Youth Mental Health (BYMH) cohort.

METHODS

We included 1883 Chinese children and adolescents from the BYMH cohort. The self-report questions used to assess biological rhythm and self-harm. We applied Principal Component Analysis (PCA) to distinguish patterns of biological rhythms. Logistic regression models were conducted to estimate the associations between biological rhythm, as well as biological rhythm patterns and risk of self-harm.

RESULTS

Of the participants, 35.0% reported experiencing lifetime self-harm. PCA revealed six significantly predominant biological rhythm patterns. Elevated risks of self-harm were linked with unhealthy eating practices, daytime tiredness, and unhealthy bedtime snacking. Conversely, patterns emphasizing physical exercise, family meals for breakfast, and nutritious diet exhibited decreased self-harm propensities. These trends persisted across varied self-harm attributes, including type, recency, and frequency of self-harm.

CONCLUSIONS

This study underscores the critical impact of biological rhythms on self-harm risks among Chinese youth. Targeted lifestyle interventions, focusing on improved sleep and dietary habits, could serve as potent preventive measures. Our findings lay the groundwork for future longitudinal studies to further probe these associations, fostering the creation of tailored interventions to curb self-harm and enhance mental well-being in younger populations.

Frequency of breakfast consumption and its associations with food consumption by degree of industrial processing and with indicators of overweight in Brazilian adolescents (EVA-JF Study)

OBJECTIVE

The aim of this study was to investigate the frequency of breakfast consumption and estimate its associations with the consumption of food at different degrees of industrial processing and with overweight indicators in Brazilian adolescents.

METHODS

This cross-sectional study involved a probabilistic sample of 14- to 19-y-old adolescents enrolled in 29 public schools in the municipality of Juiz de Fora, MG, Southeast Brazil (n = 805). The frequency of breakfast consumption was evaluated via a questionnaire (classified into "do not consume", "sometimes consume", and "regularly consume"). The evaluation of food consumption involved two 24-h dietary recalls, the items of which were analyzed according to the NOVA classification system. Overweight indicators (waist circumference, body mass index for age (BMI-for-age), and body fat percentage) were evaluated according to a standard protocol. Linear regression models were performed, first without and then with adjustments for sociodemographic characteristics.

RESULTS

We found that 20% of adolescents skipped breakfast, and ∼46% of the caloric intake came from ultra-processed foods. Breakfast omission was associated with a mean increase of 3.02% (95% confidence interval [CI], 0.52-5.53) in energy intake from ultra-processed foods, in addition to a mean increase of 0.28 z-score (95% CI, 0.05- 0.52) of BMI-for-age and of 1.64% (95% CI, 0.21-3.08) in body fat.

CONCLUSIONS

We verified that the omission of breakfast was associated with higher consumption of ultra-processed foods, as well as a higher BMI-for-age and higher percentage of body fat, reinforcing the importance of actions to encourage the consumption of this meal and the adoption of healthy eating practices in adolescents.

Breakfast patterns in relation to physical activity among school adolescents in Karachi, Pakistan

BACKGROUND

Unhealthy habits and poor diet patterns are significant concerns among adolescents, impacting their overall quality of life. This study aimed to assess and improve these habits in adolescents.

METHODS

This is a cross-sectional study conducted in 2017-2018 in Karachi. The research participants, aged 11-17 years, were drawn from lower-middle-income secondary schools using multistage random selection. Sociodemographics, the Physical Activity Questionnaire for Adolescents (PAQ-A), and breakfast consumption were determined through questionnaire and a food frequency survey.

RESULTS

A study of 334 school-going adolescents in Karachi, Pakistan, found that 82% consumed breakfast daily, with chapatti being the preferred choice (72.2%). Physical activity levels varied, but 56.6% engaged in regular activity. No significant differences were found in breakfast consumption by age or parental education.

CONCLUSIONS

Understanding South Asian adolescents' breakfast habits is crucial. Promoting healthier breakfast options and increased physical activity are recommended for long-term well-being, with further research needed for targeted interventions.

Describing the longitudinal breakfast quality index trajectories in early childhood: results from Melbourne InFANT program

BACKGROUND

Breakfast quality in early childhood remains understudied. This study describes the changes in breakfast quality index (BQI) (i.e. trajectory) in early childhood and assesses its associations with obesity outcomes.

METHODS

Data from children who participated in the Melbourne InFANT Program were used (n = 328). The Melbourne InFANT Program was a 15-month early obesity prevention intervention conducted from 2008 to 2013. Dietary intakes at ages 1.5, 3.5 and 5.0 years were assessed using three parent-proxy reported 24 h recalls. A revised nine-item BQI tool developed based on Australian dietary recommendations for young children was used to calculate BQI scores. Group-based trajectory modelling identified BQI trajectory groups. Multivariable linear and logistic regression examined the associations between identified BQI trajectory groups and obesity outcomes at age 5 years.

RESULTS

Mean BQI at ages 1.5, 3.5 and 5.0 years was 4.8, 4.8, 2.7 points, respectively. Two BQI trajectory groups were identified, and both showed a decline in BQI. The mean BQI of most children (74%) decreased from 5.0 to 4.0 points from ages 1.5 to 5.0 years (referred as "High BQI" group). The remaining children (26%) had a mean BQI of 4.8 and 1.2 points at age 1.5 and 5.0 years, respectively (referred as "Low BQI" group). The "Low BQI" group appeared to show higher risk of overweight (OR:1.30, 95% CI: 0.60, 2.81, P = 0.66) at age 5 years than the "High BQI" group. No difference in body mass index (BMI) z-score was found between the two groups.

CONCLUSIONS

Two BQI trajectory groups were identified. Both groups showed a decline in breakfast quality from ages 1.5 to 5.0 years. Our study highlights the need for early health promotion interventions and strategies to improve and maintain breakfast quality across early childhood.

Skipping breakfast associated with socioeconomic and lifestyle factors in Brazilian adolescents

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

Efficacy of school-based intervention programs in reducing overweight: A randomized trial

Childhood obesity represents a serious public health problem and this study evaluates the effectiveness of a 6-month educational intervention on lifestyle, nutrient adequacy, and diet quality in the school setting in improving the knowledge and behavior of primary school children regarding correct eating habits. The strategy was implemented over a 6-month period and participants were randomly assigned to either the intervention group (n = 200) or the non-intervention group (control group, n = 197). Participants had a mean body mass index of 18.3 ± 2.7 kg/m² and its variation in the intervention group (−2.7 ± 0.5 kg/m²) was significantly different from that in the control group (3.41 ± 0.8 kg/m²). In the experimental group, there were significant differences between the proportion of children who were overweight, underweight, normal weight, or obese before and after intervention (p < 0.05). The best results were seen in the female sex, and after the intervention, there were no more girls with obesity. Furthermore, there were significant waist circumference decrement effects in the intervention group compared to the control group (p < 0.05). Finally, many of the participating children acquired healthy eating habits. Therefore, the quantitative results obtained suggest that a school intervention program represents an effective strategy to prevent and improve the problem of childhood overweight and obesity.

Anthropometric, Lifestyle Characteristics, Adherence to the Mediterranean Diet, and COVID-19 Have a High Impact on the Greek Adolescents’ Health-Related Quality of Life

Objective: The study aimed at analyzing the relationship between anthropometric characteristics, lifestyle, and dietary habits, as well as the burden of the pandemic on the health-related quality of life among Greek pupils. Research methods and procedures: On the whole, 2088 adolescents aged 12–18 years from Attica, Greece, were enlisted in this school-based cross-sectional study that took place in May–December 2021. Health-related quality of life was estimated through the KIDSCREEN-27 questionnaire, adherence to the Mediterranean diet—through the KIDMED test. For the empirical and econometric analyses, the Mann–Whitney U and Kruskal–Wallis means comparison tests were utilized; multiple linear regression was used accordingly. Results: The present study provides evidence to the fact that boys, younger adolescents, adolescents living with both parents and with highly educated mothers had a better health-related quality of life. Concerning their eating practices, positive predictors were consuming a better-quality breakfast, having all five meals daily, consuming lunch and dinner with parents, and higher adherence to the Mediterranean diet. Moreover, sufficient night sleep time, fewer hours spent on screen viewing, more frequent walks, and having hobbies were linked to the health-related quality of life with a positive sign. In contrast, negative predictors were higher body mass index and everyday life difficulties due to the COVID-19 pandemic crisis. Conclusions: Greek adolescents’ anthropometric characteristics, BMI, lifestyle and sedentary habits, eating habits, and adherence to the Mediterranean diet were significantly related to their perceived health-related quality of life during the pandemic.

Factors associated with non-frequent breakfast consumption in adolescents (EVA-JF Study)

ABSTRACT Objective To estimate the association of infrequent breakfast consumption with socioeconomic, behavioral, and individual factors in a sample of Brazilian adolescents from public schools. Methods Cross-sectional study with adolescents aged from 14 to 19 from public schools in Juiz de Fora, state of Minas Gerais. The frequency of consumption of breakfast, snacks, soft drinks, industrialized drinks, the usual food consumption, body mass index, body fat percentage, and waist circumference were evaluated. Other socioeconomic, behavioral, and individual data were obtained through questionnaires. Logistic regression analysis and hierarchical selection of variables were used to verify the associated factors. Results The sample consisted of 805 adolescents; 53.4% reported infrequent breakfast consumption. Through hierarchical logistic regression analysis, it was evidenced that the house occupancy status (OR: 0.618; 95%CI: 0.4410.865; p=0.005) was the distal factor associated with infrequent breakfast consumption; the intermediate factors were the consumption of industrialized beverages (OR: 0.658; 95%CI: 0.486-0.890; p=0.007) and percentage of energy from processed foods (OR: 0.935; 95%CI: 0.907-0.964; p<0.001); and the proximal factors were the male gender (OR: 0.696; 95%CI: 0.520-0.932; p=0.0015) and being nonwhite (OR: 1.529; 95%CI: 1.131-2.069; p=0.006). Conclusion Male adolescents who lived in owned houses, with occasional consumption of industrialized beverages and a higher percentage of energy derived from processed foods, had lower chances of infrequent breakfast consumption, while non-white adolescents had higher chances.

Breakfast Consumption and Academic Achievement Among Chinese Adolescents: A Moderated Mediation Model

The studies have shown that a healthy lifestyle has a significant impact on the academic achievement of adolescents. Behavior of breakfast eating is considered a hallmark of dietary patterns and an important component of a healthy lifestyle. The prior study explained that students had a lower level of achievement motivation at school because they were exposed to some militating factors in their families such as absenteeism, ill health, malnutrition, and hunger. This study examined the mediating role of achievement motivation and moderating role of socioeconomic status (SES) in the association between breakfast consumption and academic achievement. This study used a sample of 15-year-old Chinese students who participated in Program for International Student Assessment (PISA) 2015. In terms of gender, female students accounted for 47.2% and male students accounted for 52.8%. The results showed that (1) breakfast consumption had a positive predictive effect on academic achievement; (2) achievement motivation played a partial mediating role in the relationship between breakfast consumption and academic achievement; and (3) the direct and indirect effects were moderated by the SES of students, which meant that the effect of breakfast consumption on achievement motivation can differ depending on the SES of students. Besides, both the effects were stronger for individuals with higher SES. The conclusion of this study has an important theoretical value and reference value to guide the Chinese parents and Chinese adolescents to pay more attention to breakfast consumption and healthy lifestyles.

Breakfast Frequency and Composition in a Group of Polish Children Aged 7-10 Years

Breakfast is considered one of the crucial elements of a healthy diet. Most studies evaluate breakfast consumption with the risk of obesity and other health effects. Less attention is paid to the evaluation of breakfast composition and patterns. Thus, this study aimed to describe the most frequently observed breakfast patterns and to assess breakfast composition and quality in a group of Polish early school-age children. The cross-sectional survey study was conducted in school years 2017/2018 and 2018/2019. Information regarding breakfast was obtained with the use of an original paper-based weekly observation diary, and breakfast quality was assessed with a special scoring designed to be used together with the diary. In total, 223 schoolchildren of the second and third grades participated in the study, and 200 diaries were analyzed. More than ¾ of the participants consumed breakfast every day. Nearly 68% of meals were classified as well balanced, but only 16.5% of children eat a well-balanced breakfast every day. The number of children who usually (≥5 times per week) eat a sandwich for breakfast was 94 (47%), and that of those who habitually eat cereal and milk or porridge was 29 (14.5%). Only 7% of children consumed fruit or vegetables for breakfast daily, and 26.5% never eat fruit or vegetables for breakfast. Concluding, most children eat breakfast regularly, but the meal composition and quality might be improved.

Impacts of a School-Based Intervention That Incorporates Nutrition Education and a Supportive Healthy School Canteen Environment among Primary School Children in Malaysia

In this study, a school nutrition program (SNP) that incorporates nutrition education and a healthy school canteen environment was developed to improve nutrition knowledge among intervention respondents and provide a healthier environment for them to practice healthy eating. In the current study, we evaluated the impacts of the SNP on eating behaviors, physical activity, body mass index-for-age (BAZ), and cognitive performance at pre-intervention, post-intervention, and 3-month follow-up points between intervention and comparison groups. This intervention study involved 523 primary school children (7–11 years old) from six selected schools in Batu Pahat District, Malaysia. Each respondent completed anthropometric and cognitive performance assessments and a set of standardized questionnaire at pre-intervention, post-intervention, and 3-month follow-up points. Multiple linear mixed model analysis was performed to determine the impacts of that SNP after being adjusted for covariates. After the program, the intervention group increased their frequency of breakfast, lunch, and dinner consumption and morning tea snacking and showed more frequent physical activity and better cognitive performance as compared to the comparison group overtime (p < 0.05). At 3-month follow-up, the intervention group showed lower BAZ scores than their comparison counterparts (p < 0.05). The SNP showed positive effects on eating behaviors, physical activity, BAZ, and cognitive performance in school children. Hence, the SNP is highly recommended for all primary school children.

Breakfast Characteristics and Its Association with Daily Micronutrients Intake in Children and Adolescents-A Systematic Review and Meta-Analysis

Breakfast is an important source of key nutrients in the diet. For this reason, the aim of this review was to investigate the associations between breakfast consumption and daily micronutrients intake in both children and adolescents (aged 2-18 years). A peer-reviewed systematic search was conducted in three datasets (PubMed, Scopus and Cochrane Library) in February 2020 in English and Spanish. Two independent reviewers evaluated 3188 studies considering the AXIS critical appraisal and PRISMA methodologies. Meta-analysis was carried out comparing results according to type of breakfast consumed (Ready to eat cereals (RTEC) breakfast or other types of breakfast) and breakfast skipping. Thirty-three articles were included in the systematic review (SR) and 7 in the meta-analysis. In the SR, we observed that those children and adolescents who usually consume RTEC at breakfast had a higher consumption of B-vitamins than those not consuming RTEC at breakfast. Breakfast consumers had a higher mineral intake (iron, calcium, magnesium, potassium, zinc, and iodine) than breakfast skippers. In the Meta-Analysis, RTEC consumers had significantly higher vitamin C intake than breakfast skippers (SMD, -4.12; 95% confidence intervals (CI): -5.09, -3.16). Furthermore, those children who usually consume breakfast had significantly higher daily intake of calcium than breakfast skippers (SMD, -7.03; 95%CI: -9.02, -5.04). Our review proposes that breakfast consumption seems to be associated with higher daily micronutrients intake than breakfast skippers.

The prevalence and comorbidity rates of specific learning disorder among primary school children in Turkey

Purpose: The aim of the present study was to investigate the prevalence of specific learning disorder (SLD), comorbid disorders, and risk factors in primary school children for the first time in two-stage design in Turkey.Materials and methods: Participants were 1041 pupils in 28 primary schools and aged from 7 to 11. The Mathematics, Reading, Writing Assessment Scale (MOYA) teacher and parent forms were used in the screening stage and parents and teachers of each child completed MOYA. Ninety-five children were screen positive and eighty-three of these children participated in the interview. SLD diagnoses were based on DSM V criteria. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was used for the comorbid psychiatric disorders.Results and conclusions: The prevalence rate of the SLD was 6.6%, impairment in reading was 4%, in mathematics was 3.6%, and in written expression was 1.8%. About 62.75% of children with SLD had one or more comorbid diagnoses. ADHD was the most common comorbid mental disorder in SLD (54.9%). SLD prevalence was higher among males. The prevalence of SLD in primary school children in Turkey is consistent with previous studies.

Skipping breakfast, poor sleep quality, and Internet usage and their relation with unhappiness in Japanese adolescents

Subjective happiness is often regarded as a major life goal. Although Japan is an economically powerful country, the level of subjective well-being reported among Japanese adolescents is lower than in other countries. We aimed to investigate the lifestyle factors related to unhappiness in Japanese adolescents. We collected data through the 2017–2018 Lifestyle Survey of Adolescents, a nationally representative cross-sectional study enrolled in randomly selected junior and senior high schools throughout Japan. We assessed the prevalence of subjective unhappiness in junior and senior high school students according to school life factors and daily lifestyle habits. A multivariable logistic regression analysis was used to examine the associations between these factors and unhappiness. A total of 64,329 students were included in the sample (mean age 15.7 years, 53.9% boys). The average prevalence of unhappiness was 10.2%. The logistic regression analyses indicated that unhappiness was strongly associated with being male and with engaging in unhealthy lifestyle behaviors such as not having breakfast, poor sleep quality, and some problematic Internet usage. Although the prevalence of unhappiness was significantly higher among current smokers and alcohol drinkers, these behaviors were not associated with unhappiness in the multivariable logistic regression analysis. Unhappiness among Japanese adolescents appears to be strongly related to how they spend their daily life. We therefore consider it desirable for school officials to educate students on the importance of happiness and lifestyle factors conducive to happiness.

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.

Impact of Breakfast in the Classroom on Participation and Food Waste

OBJECTIVE

To investigate differences in school breakfast participation and food waste in 1 school district before and after the adoption of Breakfast in the Classroom.

METHODS

Using a pretest-posttest design, participation and food waste were measured from 7 elementary schools in a rural area of southwest Virginia during the 2014-2015 school year. Participation and waste were measured on 4 days in each school (twice before and twice after Breakfast in the Classroom implementation) using the quarter-waste method.

RESULTS

Across all schools, food waste decreased from 43.0% to 38.5% with Breakfast in the Classroom, with significant decreases for entrée items, juice, and savory snack foods (P < .01). Fruit and cheese items generated the greatest amount of food waste at 58.2% and 49.0%, respectively.

CONCLUSIONS AND IMPLICATIONS

Breakfast in the Classroom may be an effective tool to decrease food waste while improving dietary intake. Future research is needed among more diverse populations.

Skipping Breakfast Affects the Early Steps of Cognitive Processing

Abstract. It has been generally accepted that skipping breakfast adversely affects cognition, mainly disturbing the attentional processes. However, the effects of short-term fasting upon brain functioning are still unclear. We aimed to evaluate the effect of skipping breakfast on cognitive processing by studying the electrical brain activity of young healthy individuals while performing several working memory tasks. Accordingly, the behavioral results and event-related brain potentials (ERPs) of 20 healthy university students (10 males) were obtained and compared through analysis of variances (ANOVAs), during the performance of three n-back working memory (WM) tasks in two morning sessions on both normal (after breakfast) and 12-hour fasting conditions. Significantly fewer correct responses were achieved during fasting, mainly affecting the higher WM load task. In addition, there were prolonged reaction times with increased task difficulty, regardless of breakfast intake. ERP showed a significant voltage decrement for N200 and P300 during fasting, while the amplitude of P200 notably increased. The results suggest skipping breakfast disturbs earlier cognitive processing steps, particularly attention allocation, early decoding in working memory, and stimulus evaluation, and this effect increases with task difficulty.

Prevalence of consumption and nutritional content of breakfast meal among adolescents from the Brazilian National Dietary Survey

OBJECTIVE

To estimate the prevalence of breakfast consumption and describe the foods and nutrients consumed at this meal and throughout the day by Brazilian adolescents.

METHOD

A total of 7276 adolescents aged 10-19 years were evaluated in the Brazilian National Dietary Survey 2008-9, a population-based cross-sectional study. Individuals' information was collected at home. Dietary data were obtained by two food records. Breakfast was defined as the first eating occasion of the day that occurred between 6 and 9:59am. Differences between breakfast consumers, occasional consumers, and skippers were tested through Pearson's chi-squared test or F-test of regression analysis.

RESULTS

Breakfast was consumed by 93% of adolescents and it was associated with age, income, geographic region and household area. The most frequently consumed foods at breakfast were white bread, coffee, butter/margarine, refined cookies and crackers, and whole milk. The mean daily intakes of total energy, sugar, and calcium were higher among occasional consumers and skippers. Breakfast consumers had higher intake of vitamins B12, C, and D. Breakfast contributed more to total intake of calcium, phosphorus, thiamin, riboflavin, and vitamins A, B6, and D (17-32%), trans fat and sodium (about 30%) and less to folate, vitamin C, iron, zinc, and fiber (8-12%) and energy intake (16%).

CONCLUSIONS

Although the prevalence of breakfast consumption among Brazilian adolescents was high, the overall nutritional quality of this meal is suboptimal, highlighting the need to support adolescents and their families to make more nutrient-dense food choices.

Breakfast Skipping and overweight/obesity among European adolescents, a cross-sectional analysis of the HELENA dataset: a DEDIPAC study

Background: The aim was to examine demographic and dietary factors associated with breakfast skipping, and the relationship of breakfast skipping with overweight/obesity among adolescents across Europe. Methods: Cross-sectional data from the Healthy Lifestyle in Europe by Nutrition in Adolescence study (n=3528) conducted in ten European cities: Athens (Greece), Dortmund (Germany), Ghent (Belgium), Herkalion (Greece), Lille (France), Pecs (Hungary), Rome (Italy), Vienna (Austria), Stockholm (Sweden) and Zaragoza (Spain) were used.  Analysis was carried out using a sub-sample of adolescents (n=1894) aged 12.5-17.49 years with data on breakfast skipping and two days of 24-Hour Diet Recall data. As 24-Hour Recall data was not available from Pecs (Hungary) this city was excluded. Using responses from the Food Choices and Preferences Questionnaire adolescents were classified as breakfast skippers or non-breakfast skippers. All analyses were stratified by sex. Differences in the intake of macronutrients, both overall and when breakfast was excluded, and key foods were compared between skippers and non-skippers using Wilcoxen Rank Sum test. Multivariate logistic regression was used to examine the relationship between breakfast skipping and overweight/obesity. Results: Overall, 44% of females were skippers compared to 36% of males. Among both male and female estimated mean fibre intake and median fruit intake were significantly lower among skippers compared to non-skippers. Male skippers were significantly more likely than non-skippers to be overweight/obese [AOR = 2.34, 95% CI, 1.40-3.90] but this was not observed among females [AOR = 0.89, 95% CI 0.59-1.34]. Conclusions: Different patterns of daily macronutrient intake were observed among adolescents who skip and do not skip breakfast.  In males, breakfast skipping was associated with increased odds of being overweight/obese. Gender may play a key part in breakfast skipping behaviours. These results present an opportunity to identify and target adolescents who may be at risk of a poorer nutritional profile or overweight/obesity.

Religious Affiliation Influences on the Health Status and Behaviours of Students Attending Seventh-Day Adventist Schools in Australia

Students attending Seventh-day Adventist (Adventist) schools in Australia have been shown to have better health status and behaviours compared to secular norms, yet these schools cater for a high percentage of non-Adventist students. The purpose of this study was to investigate the influence of religious affiliation (Adventist/non-Adventist) on the health status and behaviours of students attending Adventist secondary schools in Australia. The sample included 1734 students who responded to a health and lifestyle survey that captured demographic details, self-reported height and weight, self-reported health status, mental health and select health behaviours. Students who identified themselves as Adventist reported significantly better health behaviours than the non-Adventist students in several behavioural domains, especially among the male students. However, this did not translate to a difference in health status. Further research is needed to understand the causal mechanisms responsible for the potential health advantage of Adventist students, which may include family or church religious influences.

Assessing the relationship between smoking and abdominal obesity in a National Survey of Adolescents in Brazil

Abdominal obesity is even a stronger risk factor than overall obesity for noncommunicable chronic diseases. We examined the association between smoking and abdominal obesity among adolescents. Analyses were based on 38,813 subjects aged 15-17 years from the Study of Cardiovascular Risks in Adolescents (ERICA), a Brazilian school-based national survey. Abdominal obesity was defined considering waist circumference (WC) percentiles. Statistical analyses, stratified by sex, considered the sample complex design. Poisson regression with robust variance was used to estimate smoker-to-nonsmoker abdominal obesity prevalence ratio (PR), adjusting by sociodemographic and lifestyle variables. Higher prevalence of abdominal obesity was observed among adolescents who consumed >1 cigarettes/day, comparing to nonsmokers: considering WC >80th percentile, adjusted-PR for boys was 1.27 [95%CI:1.05,1.52] and, for girls, 1.09 [95%CI:1.00,1.19]; using the 90th percentile, adjusted-PR were 2.24 [95%CI:1.70,2.94] and 1.27 [95%CI:1.12,1.46], respectively for male and female adolescents. Our findings suggest a positive association between cigarette consumption and the prevalence of abdominal obesity, for both boys and girls. Although other studies had found this association in adults, our study contributes to this discussion by assessing it in adolescents using a nationwide representative sample of medium and large municipalities.

Prospective associations between toddler televiewing and subsequent lifestyle habits in adolescence

BACKGROUND

Watching television is a common pastime for very young children. High exposure may negatively influence physical and mental health outcomes. Not much is known about how early exposure relates to lifestyle choices in adolescence.

OBJECTIVE

To estimate how toddler televiewing is subsequently associated with lifestyle indicators at adolescence.

METHODS

Participants are 986 girls and 999 boys from the Quebec Longitudinal Study of Child Development birth cohort (Canada). Child self-reports lifestyle habits at age 13 that were linearly regressed on parent-reported televiewing at age 2 while adjusting for potential confounders.

RESULTS

Every 1 h 13 m increase in daily televiewing was prospectively associated with a 8.2% increased risk of unhealthy eating habits (unstandardized b = 0.05; 95% CI, 0.02 to 0.07), 10.1% decrease in eating breakfast on weekdays (unstandardized b = -0.06; 95% CI, -0.09 to -0.04), 13.3% increase in BMI (unstandardized b = 0.38; 95% CI, 0.26 to 0.50), 4.7% decrease in student engagement (unstandardized b = -0.07; 95% CI, -0.14 to -0.004), and 5.8% increase in concurrent screen time (unstandardized b = 0.06; 95% CI, 0.02 to 0.11). Post hoc simulations of noncompliance with AAP recommendations support their implementation.

CONCLUSIONS

Excessive toddlerhood televiewing was prospectively associated with less optimal health and self-invested behavioral dispositions. Lifestyle habits not only affect metabolic risk but may also influence personal success outcomes. These independent relationships, observed more than a decade later, suggest a need for better parental awareness of the way children invest their limited waking hours could affect their long-term life course trajectories.

Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents

AIM

We investigated the demographic, anthropometric, clinical, biochemical and behavioural factors associated with children and adolescents who missed breakfast.

METHODS

This 2012 cross-sectional study was carried out in the city of Juiz de Fora, Brazil, with a sample of 684 students: 191 children aged 7-9 and 493 adolescents aged 10-14. Data on demographic, physical activity and breakfast consumption were based on a 24-hour recall record and a three-day dietary record. Weight, height, body fat, waist circumference and blood pressure were also measured. Finally, samples were collected for analysis of blood total cholesterol, low-density and high-density lipoproteins, triglycerides and glucose. The statistics are presented as prevalence ratios (PR) with 95% confidence (95% CI) intervals.

RESULTS

Missing breakfast was more common among adolescents than children (30% versus 22%) and among girls of all ages than among boys (33% versus 22%). It was also associated with children, but not adolescents, with increased levels of diastolic blood pressure (PR 5.6, 95% CI 1.8-17.4), total cholesterol (PR 1.5, 95% CI 1.2-1.9) and low-density lipoprotein (PR 2.1, 95% CI 1.5-2.9).

CONCLUSION

Missing breakfast was more common among adolescents and females and associated with increased levels of diastolic blood pressure, total cholesterol and low-density lipoprotein in children.

Breakfast Quality Varies by Location among Low-Income Ethnically Diverse Children in Public Urban Schools

OBJECTIVE

To evaluate breakfast location and children's food choices.

METHODS

Cross-sectional analysis of 1,371 fourth- through sixth-grade students in 2013. Foods and beverages in 17 categories characterized breakfast choices: (1) ≥ 1 fruits or vegetables, (2) ≥ 1 foods high in saturated fats and added sugars (SFAS), and (3) meeting School Breakfast Program (SBP) requirements.

RESULTS

Among breakfast eaters (n = 1,133; 82.6%), 46.0% ate at home, 13.1% ate at school, 41.0% ate at multiple locations; and 21.8% ate at a corner store. Those eating at school were more likely to consume ≥1 fruit or vegetable (odds ratio [OR] = 1.90; 95% confidence interval [CI], 1.26-2.87), less likely to eat ≥1 SFAS food (OR = 0.46; 95% CI, 0.22-0.94), and more likely to meet SBP requirements (OR = 2.47; 95% CI, 1.42-4.29). Those eating at corner stores (n = 247) were more likely to consume high-SFAS foods (63.9% vs 9.2%; P < .001).

CONCLUSIONS AND IMPLICATIONS

Eating school breakfast increased the odds of consuming fruit, choosing lower SFAS, and meeting nutritional requirements of the SBP relative to other locations.

Prevalence and Correlates of Missing Meals Among High School Students-United States, 2010

PURPOSE

To determine the prevalence and correlates of missing meals among adolescents.

DESIGN

The 2010 National Youth Physical Activity and Nutrition Study, a cross-sectional study.

SETTING

School based.

PARTICIPANTS

A nationally representative sample of 11 429 high school students.

MEASURES

Breakfast, lunch, and dinner consumption; demographics; measured and perceived weight status; physical activity and sedentary behaviors; and fruit, vegetable, milk, sugar-sweetened beverage, and fast-food intake.

ANALYSIS

Prevalence estimates for missing breakfast, lunch, or dinner on ≥1 day during the past 7 days were calculated. Associations between demographics and missing meals were tested. Associations of lifestyle and dietary behaviors with missing meals were examined using logistic regression controlling for sex, race/ethnicity, and grade.

RESULTS

In 2010, 63.1% of students missed breakfast, 38.2% missed lunch, and 23.3% missed dinner; the prevalence was highest among female and non-Hispanic black students. Being overweight/obese, perceiving oneself to be overweight, and video game/computer use were associated with increased risk of missing meals. Physical activity behaviors were associated with reduced risk of missing meals. Students who missed breakfast were less likely to eat fruits and vegetables and more likely to consume sugar-sweetened beverages and fast food.

CONCLUSION

Breakfast was the most frequently missed meal, and missing breakfast was associated with the greatest number of less healthy dietary practices. Intervention and education efforts might prioritize breakfast consumption.

Breakfast and Breakfast Cereal Choice and Its Impact on Nutrient and Sugar Intakes and Anthropometric Measures among a Nationally Representative Sample of Australian Children and Adolescents

There is limited evidence in Australia that compares the nutritional impact of a breakfast cereal breakfast to a non-cereal breakfast, and includes the type of cereal. This study investigated the impact of breakfast choice and the total sugar content of breakfast cereal on nutrient intakes and anthropometric measures among Australian children and adolescents. Data from 2 to 18-year-old in the 2011–2012 National Nutrition and Physical Activity Survey were used (n = 2821). Participants were classified as breakfast cereal consumers (minimally pre-sweetened (MPS) or pre-sweetened (PS)), non-cereal breakfast consumers, or breakfast skippers. Foods consumed for breakfast, foods added to the cereal bowl, and the impact of breakfast choice on daily nutrient intakes and anthropometric measures were determined. Although only 9% of children skipped breakfast, 61% of skippers were aged 14–18 years. Among breakfast consumers, 49% had breakfast cereal, and 62% of these exclusively consumed MPS cereal. Breakfast skippers had a higher saturated fat intake than breakfast cereal consumers, and lower intakes of dietary fibre and most micronutrients (p < 0.001). Compared with non-cereal breakfast consumers, breakfast cereal consumers had similar added and free sugars intakes, lower sodium, and higher total sugars, carbohydrate, dietary fibre, and almost all other micronutrients (p < 0.001). The only difference in nutrient intakes between MPS and PS cereal consumers was higher folate among PS consumers. No associations between anthropometric measures and breakfast or breakfast cereal choice were found. The highest prevalence of breakfast skipping was among 14–18-year old. Breakfast cereal consumers had higher intakes of dietary fibre and most micronutrients compared with non-cereal breakfast consumers and skippers, and almost no differences were found between MPS and PS cereal consumers.

Breakfast consumption and nutrient intakes in 4-18-year-olds: UK National Diet and Nutrition Survey Rolling Programme (2008-2012)

Although breakfast consumption is widely considered to be an important component of a healthy lifestyle, few UK studies have examined differences in nutrient intakes between breakfast consumers and breakfast skippers among children and adolescents. We investigated associations between breakfast skipping in 4-18-year-olds and their nutrient intakes using data from the UK's National Diet and Nutrition Survey Rolling Programme. Dietary data were derived from 4-d estimated food diaries of 802 children aged 4-10 years and 884 children aged 11-18 years (1686 in total). Daily nutrient intakes of children with different breakfast habits were compared by one-way ANCOVA adjusting for relevant covariates (sex, age, ethnicity, equivalised household income and BMI). Within-person analysis was carried out on children with an irregular breakfast habit (n 879) comparing nutrient intakes on breakfast days with those on non-breakfast days using repeated measures ANCOVA. We observed that the overall nutritional profile of the children in terms of fibre and micronutrient intake was superior in frequent breakfast consumers (micronutrients: folate, Ca, Fe and I (P<0·01)) and, for the 4-10 years age group, on breakfast days (micronutrients: folate, vitamin C, Ca and I (P<0·01)). Also, significantly higher proportions of breakfast-consuming children met their reference nutrient intakes of folate, vitamin C, Ca, Fe and I compared with breakfast skippers (χ 2 analysis, P<0·001). Our study adds to the body of data linking breakfast consumption with higher quality dietary intake in school-age children, supporting the promotion of breakfast as an important element of a healthy dietary pattern in children.

Characterization of Breakfast Cereals Available in the Mexican Market: Sodium and Sugar Content

Preschool Mexican children consume 7% of their total energy intake from processed breakfast cereals. This study characterized the nutritional quality and labelling (claims and Guideline Daily Amount (GDA)) of the packaged breakfast cereals available in the Mexican market. Photographs of all breakfast cereals available in the 9 main food retail chains in the country were taken. The nutrition quality of cereals was assessed using the United Kingdom Nutrient Profiling Model (UKNPM). Claims were classified using the International Network for Food and Obesity/non-communicable Diseases Research, Monitoring and Action Support (INFORMAS) taxonomy and the GDA was defined according to the Mexican regulation, NOM-051. Overall, a total of 371 different breakfast cereals were analysed. The nutritional profile showed that 68.7% were classified as “less healthy”. GDAs and claims were displayed more frequently on the “less healthy” cereals. Breakfast cereals within the “less healthy” category had significantly higher content of energy, sugar and sodium (p < 0.001). Most of the claims were displayed in the “less healthy” cereals (n = 313). This study has shown that there is a lack of consistency between the labelling on the front of the pack and the nutritional quality of breakfast cereals.

Regular breakfast consumption is associated with higher blood vitamin status in adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study

Objective

The present study aimed to examine the association between different breakfast consumption patterns and vitamin intakes and blood vitamin concentrations in European adolescents.

Design

Breakfast consumption was assessed by a questionnaire. Vitamin intake was calculated from two 24 h recalls. Blood vitamin and total homocysteine (tHcy) concentrations were analysed from fasting blood samples.

Setting

The European Commission-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

Subjects

Participants were 1058 (52·8 % females) European adolescents (aged 12·5–17·5 years) from ten cities.

Results

Lower vitamin D and vitamin C concentrations were observed in male and female breakfast skippers than in consumers (P<0·05). Female breakfast consumers presented higher holo-transcobalamin and lower tHcy (P<0·05), while males had higher cobalamin concentrations, compared with skippers (P<0·05). Higher vitamin D and total folate intakes were observed in adolescents who consumed breakfast compared with skippers (P<0·05). Likewise, female consumers had higher intakes of vitamin B6and vitamin E than occasional consumers (P<0·05).

Conclusions

Regular breakfast consumption is associated with higher blood vitamin D and cobalamin concentrations in males and with higher vitamin D and holo-transcobalamin and lower tHcy concentrations in females. Moreover, breakfast consumption is associated with high intakes of vitamin D and total folate in both sexes, and with high intakes of vitamin B6and vitamin E in females.

Examining Guidelines for School-Based Breakfast Programs in Canada: A Systematic Review of the Grey Literature

School breakfast programs are widespread and serve varying objectives regarding youth health promotion. Evidence-based guidelines for breakfast programs may be important in maximizing their effectiveness related to student outcomes, yet it is unclear what is available in Canada. A systematic review was conducted to identify and compare Canadian guidelines related to breakfast programs. Data sources included grey literature databases, customized search engines, targeted websites, and content expert consultations. Eligible guidelines met the following criteria: government and nongovernment sources at the federal and provincial/territorial levels, current version, and intended for program coordinators. Recommendations for program delivery were extracted, categorized, and mapped onto the 4 environments outlined in the ANGELO framework, and they were classified as "common" or "inconsistent" across guidelines. Fifteen sets of guidelines were included. No guidelines were available from federal or territorial governments and 4 provincial governments. There were few references to peer-reviewed literature within the guidelines and despite many common recommendations for program delivery, conflicting recommendations were also identified. Potential barriers to program participation, including a lack of consideration of allergies and other dietary restrictions, were identified. Future research should identify how guidelines are implemented and evaluate what effect their implementation has on program delivery and student outcomes.

Daily meal frequency and associated variables in children and adolescents

OBJECTIVE

To investigate the frequency distribution of daily meals and its relation to demographic, socioeconomic, behavioral, anthropometric and biochemical factors in children and adolescents.

METHODS

This was a cross-sectional study with a representative sample of 708 schoolchildren aged 7-14 years. Data on personal information, socioeconomic status, physical activity and number of meals were obtained through semi-structured questionnaire and consumption by 24-h recall and food record. Weight and height measurements were also performed to calculate the body mass index. Finally, blood samples were collected for analysis of total cholesterol, high- and low density lipoprotein, triglyceride, and glucose levels. Descriptive statistics, the Mann-Whitney test, and Poisson regression were used in statistical analysis.

RESULTS

Meal frequency <4 was associated in children, family income <3 Brazilian minimum wages (PR=5.42; 95% CI: 1.29-22.77; p=0.021) and adolescents, the number of sons in the family >2 (PR=1.53; 95% CI: 1.11-2.11; p=0.010). Even in the age group of 10-14 years, <4 meals was related to higher prevalence of body mass index (PR=1.33; 95% CI: 1.02-1.74; p=0.032) and low-density lipoprotein (PR=1.39; 95% CI: 1.03-1.87; p=0.030) higher after adjustments.

CONCLUSION

Lower frequency of meals was related to lower income in children and adolescents, larger number of sons in the family, and increased values of body mass index and low-density lipoprotein.

Intakes of Energy and Discretionary Food in Mexico Are Associated with the Context of Eating: Mealtime, Activity, and Place

BACKGROUND

The prevalence of obesity and the intake of discretionary foods [high saturated fat and/or added sugar (HSFAS) products and sugar-sweetened beverages (SSBs)] are high in Mexico. It is important to understand whether the intakes of HSFAS products and SSBs are associated with the context in which they are consumed.

OBJECTIVE

Our aim was to estimate the associations between total energy and discretionary food (HSFAS products and SSBs) intakes and the context of eating (mealtime, activity, and place).

METHODS

We used data from 10,087 participants aged ≥1 y from the Mexican National Health and Nutrition Survey 2012. Dietary intake was estimated through a 24-h dietary recall that included questions on mealtime, activity, and place in which each food item was consumed. The associations between energy and discretionary food intakes and the context of eating were estimated by using multiple linear regression stratified by age group and adjusted for sociodemographic variables.

RESULTS

Compared with breakfast, the percentage of energy that HSFAS products contributed was 16-29 (range in all age groups) percentage points higher during midafternoon snacks and 16-23 percentage points lower at lunch and almuerzo (Mexican brunch); the percentage of energy from SSBs was 3.4-7.6 percentage points higher during midmorning snacks (P < 0.05). In many age groups and mealtimes, we found that compared with eating only while seated, the percentage of energy as HSFAS was 5.3-14 percentage points higher when watching television (P < 0.05). Compared with eating at home, the percentage of energy from HSFAS was 12-26 percentage points higher on the street and the percentage of energy from SSBs was 3.4-6.0 percentage points higher at school and 2.9-15 percentage points higher at work (P < 0.05).

CONCLUSIONS

These results highlight the need to promote healthier food selection among the Mexican population when snacking and watching television and healthier food environments at work, school, and on the street.

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.

Socioeconomic status and dietary habits as predictors of home breakfast skipping in young women

BACKGROUND AND OBJECTIVES

Breakfast skipping is prevalent among adolescents and young women, and deprives the body of important nutrients. This study was conducted to assess the correlation between breakfast eating and sociodemographic and lifestyle criteria.

PARTICIPANTS AND METHODS

A cross-sectional study was carried out on a convenient sample of 400 female students selected from the female sector of King Abdulaziz University, Jeddah, Saudi Arabia. Home breakfast habit and other lifestyle characteristics were studied using a standardized questionnaire. Logistic regression was used to examine the relationship between home breakfast habit and different predictors.

RESULTS

Home breakfast skippers constituted 71.75% of the whole sample. Breakfast eaters had a significantly higher BMI compared with breakfast skippers (22.66±4.88 vs. 21.58±4.09 in home breakfast skippers; P=0.025). Irrespective of other sociodemographic and lifestyle variables, fathers' education lower than university level negatively predicted home breakfast eating [Exp B=0.40, confidence interval (CI)=0.21-0.77], and being employed positively predicted breakfast eating (Exp B=2.31, CI=1.04-5.15). Likewise, consuming less amount of junk food and fewer soft drinks (Exp B=2.57, CI=1.54-4.28, and Exp B=2.59, CI=1.39-4.81, respectively) and consuming more milk and dairy products (Exp B=1.91, CI=1.16-3.15) correlated positively with home breakfast eating.

CONCLUSION AND RECOMMENDATIONS

Breakfast skipping was prevalent among adolescents and young women in the studied sample. Unhealthy dietary habits, father's education lower than university level, and father being unemployed positively predicted breakfast skipping of daughters at home. This implies that breakfast eating can be encouraged by approaching parents in addition to their daughters.

School Breakfast-Club Program Changes and Youth Eating Breakfast During the School Week in the COMPASS Study

BACKGROUND

Despite the importance of breakfast consumption, breakfast skipping is common among Canadian youth. This study examines how changes to school-based breakfast programs are associated with breakfast-skipping behavior.

METHODS

Using school-level longitudinal data from Year 1 (Y1 : 2012-2013) and Year 2 (Y2 : 2013-2014) of the COMPASS study, quasi-experimental methods evaluated the impact over time that changes to school-based breakfast programs had on breakfast skipping or participating in school-based breakfast program.

RESULTS

Between Y1 and Y2 , the school-level prevalence of breakfast skipping (54.5%-54.9%) and breakfast program participation (12.3%-13.6%) increased. Of the 43 participating schools, 5 implemented a new school breakfast program. Among the intervention schools, 1 school (School 4) observed a significant, and 1 school (School 3) observed a significant increase in the school-level prevalence of skipping breakfast; there was no significant change in the other 3 intervention schools.

CONCLUSIONS

Despite the availability of free school breakfast programs, the majority of youth skipped breakfast at least once a school week. Owing to the variation in the types of programs implemented, additional evaluation evidence is necessary to determine which students benefited the most from these programs.

Eating Habits of Malaysian Children: Findings of the South East Asian Nutrition Surveys (SEANUTS)

This article aims to describe the eating habits of Malaysian children using a nationally representative data set from the South East Asian Nutrition Surveys (SEANUTS) in Malaysia. A total of 2797 children aged 2 to 12 years were included in this analysis. Eating habits and dietary intakes of children were assessed using questionnaires. Overall, 56.1% of children consumed 3 main meals every day. Approximately 20% of children snacked 3 times per day, whereas 9.7% ate fast food on a weekly basis. Irregular meal patterns were significantly associated with lower micronutrient intakes, and the groups with higher odds for this pattern were older children, Malays, and those living in rural areas. Considering the relatively high rate of irregular meal consumption and its potential influence on dietary nutrient intake, persistent efforts must be continued to promote and inculcate healthy eating habits among children from an early age.

Health Related Behaviours in Normal Weight and Overweight Preschoolers of a Large Pan-European Sample: The ToyBox-Study

The aim of this study was to investigate the associations of health related behaviours (HRB) with Body Mass Index (BMI) in preschoolers, and to study the likelihood of being overweight/obese in relation to compliance with recommended HRB. The sample consisted of 3301 normal weight and overweight/obese preschoolers (mean age: 4.7 years; 52% boys, 85% normal weight) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain). Height and weight were measured, total daily step counts were registered during six days, and HRB were assessed with validated parental surveys in 2012. Multiple linear and logistic regression analyses were performed. Only few HRB were significantly associated with BMI. In boys, higher water intake and higher soft drink and higher fruit consumption were significantly associated with higher BMI. Boys drinking less water than recommended were less likely to be overweight/obese (OR = 0.60), while boys who consume soft drinks were more likely to be overweight/obese (OR = 1.52). In girls, higher water intake, higher vegetable consumption, and more TV time on weekend days were significantly associated with higher BMI. Girls eating less vegetables than recommended were less likely to be overweight/obese (OR = 0.62), and girls who engaged in quiet play for more than 90 minutes on weekend days were more likely to be overweight/obese (OR = 1.64). In general, the associations between HRB and BMI or being overweight/obese were limited and mainly related to dietary intake. Awareness campaigns for caregivers should stress that HRB of young children are important and independent of children’s weight status.

ERICA: prevalence of healthy eating habits among Brazilian adolescents

OBJECTIVE To describe the prevalence of eating habits considered healthy in adolescents according to sex, age, education level of the mother, school type, session of study, and geographic region. METHODS The assessed data come from the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional, national and school-based study. Adolescents of 1,247 schools of 124 Brazilian municipalities were evaluated using a self-administered questionnaire with a section on aspects related to eating behaviors. The following eating behaviors were considered healthy: consuming breakfast, drinking water, and having meals accompanied by parents or legal guardians. All prevalence estimates were presented proportionally, with their respective 95% confidence intervals. The Chi-square test was used to evaluate the differences in healthy eating habits prevalences according to other variables. The module survey of the Stata program version 13.0 was used to analyze complex data. RESULTS We evaluated 74,589 adolescents (72.9% of the eligible students). Of these, 55.2% were female, average age being 14.6 years (SD = 1.6). Among Brazilian adolescents, approximately half of them showed healthy eating habits when consuming breakfast, drinking five or more glasses of water a day, and having meals with parents or legal guardians. All analyzed healthy eating habits showed statistically significant differences by sex, age, type of school, session of study, or geographic region . CONCLUSIONS We suggest that specific actions of intersectoral approach are implemented for the dissemination of the benefits of healthy eating habits. Older female adolescents (15 to 17 years old) who studied in public schools, resided in the Southeast region, and whose mothers had lower education levels, should be the focus of these actions since they present lower frequencies concerning the evaluated healthy habits.

School staff, parent and student perceptions of a Breakfast in the Classroom model during initial implementation

Objective

To understand perspectives of stakeholders during initial district-wide implementation of a Breakfast in the Classroom (BIC) model of the School Breakfast Program.

Design

Qualitative data were collected from twenty-nine focus groups and twenty interviews with stakeholders in a school district early in the process of implementing a BIC model of the School Breakfast Program.

Setting

Ten elementary schools within a large, urban school district in the USA that served predominantly low-income, racial/ethnic minority students.

Subjects

Purposively selected stakeholders in elementary schools that had implemented BIC for 3–6 months: students (n 85), parents/guardians (n 86), classroom teachers (n 44), cafeteria managers (n 10) and principals (n 10).

Results

Four primary themes emerged, which were interpreted based on the Diffusion of Innovations model. School staff had changed their perceptions of both the relative disadvantages and costs related to time and effort of BIC over time; the majority of each stakeholder group expressed an appreciation for BIC; student breakfast consumption varied from day to day, related to compatibility of foods with child preferences; and stakeholders held mixed and various impressions of BIC’s potential impacts.

Conclusions

The study underscores the importance of engaging school staff and parents in discussions of BIC programming prior to its initiation to pre-emptively address concerns related to cost, relative disadvantages and compatibility with child preferences and school routines/workflow. Effectively communicating with stakeholders about positive impacts and nutritional value of the meals may improve support for BIC. These findings provide new information to policy makers, districts and practitioners that can be used to improve implementation efforts, model delivery and outcomes.

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.

Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada

BACKGROUND

Grey literature is an important source of information for large-scale review syntheses. However, there are many characteristics of grey literature that make it difficult to search systematically. Further, there is no 'gold standard' for rigorous systematic grey literature search methods and few resources on how to conduct this type of search. This paper describes systematic review search methods that were developed and applied to complete a case study systematic review of grey literature that examined guidelines for school-based breakfast programs in Canada.

METHODS

A grey literature search plan was developed to incorporate four different searching strategies: (1) grey literature databases, (2) customized Google search engines, (3) targeted websites, and (4) consultation with contact experts. These complementary strategies were used to minimize the risk of omitting relevant sources. Since abstracts are often unavailable in grey literature documents, items' abstracts, executive summaries, or table of contents (whichever was available) were screened. Screening of publications' full-text followed. Data were extracted on the organization, year published, who they were developed by, intended audience, goal/objectives of document, sources of evidence/resources cited, meals mentioned in the guidelines, and recommendations for program delivery.

RESULTS

The search strategies for identifying and screening publications for inclusion in the case study review was found to be manageable, comprehensive, and intuitive when applied in practice. The four search strategies of the grey literature search plan yielded 302 potentially relevant items for screening. Following the screening process, 15 publications that met all eligibility criteria remained and were included in the case study systematic review. The high-level findings of the case study systematic review are briefly described.

CONCLUSIONS

This article demonstrated a feasible and seemingly robust method for applying systematic search strategies to identify web-based resources in the grey literature. The search strategy we developed and tested is amenable to adaptation to identify other types of grey literature from other disciplines and answering a wide range of research questions. This method should be further adapted and tested in future research syntheses.

More than Just a Meal: Breakfast Club Attendance and Children's Social Relationships

The health benefits of school food have been widely promoted in recent years while the social opportunities that surround eating occasions at school have received little attention. Breakfast clubs (BCs), which take place at the start of the school day, offer a unique opportunity for children to consume a breakfast meal on their school premises in the company of their peers. Alternatively, after-school clubs (ASCs), which take place on school premises at the end of the school day, whilst also providing children with social opportunities tend to focus on sports engagement and skill development. The aim of the current paper is to investigate whether attendance at BCs and ASCs has an impact on children's friendship quality and experiences of peer victimization. BC attendees, ASC attendees, and non-attendees completed the Friendship Qualities Scale and the Multidimensional Peer Victimization Scale (MPVS) at two time points. Time-1 data were collected 2 months after the introduction of school clubs. Time-2 data were then collected on the same measures again 6 months later. Results of the analyses of Time-1 data showed no significant differences between groups on any of the measures at Time-1. However, at Time-2, BC attendees showed improved levels of friendship quality compared to the other two groups. Moreover, analysis of the MPVS data at Time-2 showed that children who attended BC or ASC experienced a decline in victimization across time. The current findings suggest that BC attendance facilitates the quality of children's relationships with their best friend over time. Additionally, attendance at a breakfast or ASC was associated with a reduction in victimization over time. The results have implications for utilization of breakfast and ASCs to aid children's social relationships in school over time.

IV. The cognitive implications of obesity and nutrition in childhood

The prevalence of childhood obesity in the United States has tripled since the 1980s and is strongly linked to the early onset of several metabolic diseases. Recent studies indicate that lower cognitive function may be another complication of childhood obesity. This review considers the research to date on the role of obesity and nutrition on childhood cognition and brain health. Although a handful of studies point to a maladaptive relationship between obesity and aspects of cognitive control, remarkably little is known regarding the impact of fat mass on brain development and cognitive function. Further, missing from the literature is the role of nutrition in the obesity-cognition interaction. Nutrition may directly or indirectly influence cognitive performance via several pathways including provision of key substrates for optimal brain health, modulation of gut microbiota, and alterations in systemic energy balance. However, in the absence of malnutrition, the functional benefits of specific nutrient intake on particular cognitive domains are not well characterized. Here, we examine the literature linking childhood obesity and cognition while considering the effects of nutritional intake. Possible mechanisms for these relationships are discussed and suggestions are made for future study topics. Although childhood obesity prevalence rates in some developed countries have recently stabilized, significant disparities remain among groups based on sex and socioeconomic status. Given that the elevated prevalence of pediatric overweight and obesity may persist for the foreseeable future, it is crucial to develop a comprehensive understanding of the influence of obesity and nutrition on cognition and brain health in the pediatric population.

Universal Free School Breakfast: A Qualitative Model for Breakfast Behaviors

In recent years, the provision of school breakfast has increased significantly in the UK. However, research examining the effectiveness of school breakfast is still within relative stages of infancy, and findings to date have been rather mixed. Moreover, previous evaluations of school breakfast schemes have been predominantly quantitative in their methodologies. Currently, there are few qualitative studies examining the subjective perceptions and experiences of stakeholders, and thereby an absence of knowledge regarding the sociocultural impacts of school breakfast. The purpose of this study was to investigate the beliefs, views and attitudes, and breakfast consumption behaviors, among key stakeholders, served by a council-wide universal free school breakfast initiative, within the North West of England, UK. A sample of children, parents, and school staff were recruited from three primary schools, participating in the universal free school breakfast scheme, to partake in semi-structured interviews and small focus groups. A Grounded Theory analysis of the data collected identified a theoretical model of breakfast behaviors, underpinned by the subjective perceptions and experiences of these key stakeholders. The model comprises of three domains relating to breakfast behaviors, and the internal and external factors that are perceived to influence breakfast behaviors, among children, parents, and school staff. Findings were validated using triangulation methods, member checks, and inter-rater reliability measures. In presenting this theoretically grounded model for breakfast behaviors, this paper provides a unique qualitative insight into the breakfast consumption behaviors and barriers to breakfast consumption, within a socioeconomically deprived community, participating in a universal free school breakfast intervention program.