Infrequent breakfast consumption is associated with higher body adiposity and abdominal obesity in Malaysian school-aged adolescents

Prevalence of Breakfast Skippers among Tunisian Preschool and School Children and Association with Weight Status: A Cross-Sectional Study

Breakfast is considered the most important meal of the day. This study aimed to assess breakfast frequency and quality in Tunisian children and to determine the relationship between breakfast skipping and the weight status of the children. A total of 1200 preschool and school children aged 3 to 9 years were randomly selected under a cross-sectional design. Breakfast habits and socio-economic characteristics were collected using a questionnaire. Participants who consumed breakfast less than five times the previous week were categorized as breakfast skippers. The other breakfast consumers were considered as non-skippers. The overall prevalence of breakfast skipping in Tunisian children was 8.3% and 83% of them consumed breakfast all the weekdays. At least two out of three children had a poor breakfast quality. Only 1% of children consumed breakfast in accordance with the composition guidelines. No relationships between breakfast skipping and weight status were detected in this study after adjustment for age, sex and all socio-economic factors (OR = 1.16, 95% CI = 0.72-1.89, p = 0.541). Further school-based interventions should be implemented to improve breakfast quality and to promote a healthy weight in Tunisian children.

The Association between Breakfast Macronutrient Composition and Body Weight, in Preadolescence: An Epidemiological Study among Schoolchildren

Over the last few decades, childhood overweight and obesity tend to reach epidemic proportions. The present study aimed to examine whether the composition of breakfast, through the prism of its macronutrient content, could play a part in the development of excess body weight in children. A sample of 1728 Greek students from 47 primary schools was enrolled for the purposes of this study. Their weight and height were measured and their Body Mass Index was calculated and classified according to the International Obesity Task Force criteria. Their dietary habits, breakfast foods of choice, and physical activity were assessed through the use of a self-completed questionnaire. Further assessment of breakfast composition was carried out in order to evaluate its macronutrient content. Initial analysis, which was only energy-adjusted, showed a negative association between body weight and breakfast protein content and a positive association for lipid content. After further adjustment for age, sex, level of adherence to the Mediterranean diet, and physical activity, there was a significant negative association between breakfast protein and excess body weight in children (p = 0.029), as well as a significant positive association of breakfast lipid content (p = 0.028). Breakfast macronutrient content seems to have an effect on body composition in children, independently of overall adherence to the Mediterranean diet and physical activity, however further research is needed in order to elucidate potential pathways.

Assessing adolescent diet and physical activity behaviour, knowledge and awareness in low- and middle-income countries: a systematised review of quantitative epidemiological tools

PURPOSE

Quantitative epidemiological tools are routinely used to assess adolescent diet and physical activity (PA) constructs (behaviour, knowledge, and awareness) as risk factors for non-communicable diseases. This study sought to synthesize evidence on the quantitative epidemiological tools that have been used to assess adolescent diet and PA constructs in low to middle-income countries (LMIC).

METHODS

A systematised review was conducted using 3 databases (EbscoHost, Scopus and Web of Science).

RESULTS

We identified 292 LMIC studies assessing adolescent diet and PA. Identified studies predominantly explored behavioural (90%) constructs with a paucity of studies investigating knowledge and awareness. The majority of studies used subjective (94%) and self-administered (78%) tools. Only 39% of LMIC studies used tools validated for their contexts.

CONCLUSIONS

The findings highlight the need for more contextual tools for assessing adolescent diet and PA in LMICs. Diet and PA measurement tools used in future research will need to incorporate measures of knowledge and awareness for a more comprehensive understanding of the epidemiology of diet and PA in adolescents. Furthermore, there is a need for more evidence on the reliability and validity of these tools for use, in both cross sectional and longitudinal studies, in LMIC contexts.

Association Between Breakfast Consumption and Anthropometrically Determined Nutritional Status of Secondary-School Adolescents in Lagos, Southwest Nigeria

BACKGROUND AND OBJECTIVES

Breakfast skipping has been associated with obesity among adolescents in some studies but little is known about the relationship between breakfast consumption and obesity among secondary-school adolescents in Nigeria. This study contributes to the empirical literature by analyzing the relationship between breakfast consumption and anthropometrically determined nutritional status of secondary-school adolescents in Lagos, Nigeria.

METHODS

This was a descriptive cross-sectional study in which multi-stage sampling was used to select 397 secondary-school adolescents (10 to 19 years, mean = 13.8 ± 1.7 years). They were classified into student groups from public or private schools in Lagos. Data were collected using a semi-structured self-administered questionnaire and analyzed using Epi-info version 7. The independent variables were the proportion of adolescents who had a high level of knowledge about breakfast consumption, while the outcome variable was the proportion of adolescents who were overweight or obese. World Health Organization (WHO) AnthroPlus software was used to determine the nutritional status of adolescents. Mean and standard deviations were computed for continuous variables, and frequency tables were generated for categorical variables. Significant associations between variables were obtained using Chi-square with the level of significance set at p < 0.05.

RESULTS

Only 17% of the adolescents had good knowledge of breakfast consumption. More than half (57.4%) of the participants ate a daily breakfast. The percentage of adolescents who skipped breakfast was higher among older 16-19 years (52.2%) and middle 13-15 years (43%) than the younger adolescents (34.7%). Girls skipped breakfast more than boys. Most respondents were in the normal Body Mass Index (BMI) ranges for their genders. Prevalence of overweight and obesity were 7.1% and 3.3% among males and 7.1% and 2.8% among females respectively. The mean BMI of those who skipped breakfast (19.33 ± 3.27kg/m²) was significantly higher than the BMI of those who ate breakfast (18.56 ± 3.05 kg/m²) (p=0.019). Most of the adolescents who ate a daily breakfast had mothers who had completed only primary school education although the relationship was not statistically significant (χ² =5, p=0.172).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Breakfast knowledge was low, while breakfast consumption was average. Adolescents who skipped breakfast had a significantly higher BMI (19.33 ± 3.27kg/m²) than those who ate breakfast (18.56 ± 3.05 kg/m²) (p=0.019). Nutrition education that emphasizes the importance of breakfast consumption with the purpose of behavioral change should be intensified among adolescents.

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.

Effect of a nutritional education intervention on breakfast consumption among preparatory school students in Egypt

OBJECTIVES

The current study evaluates the effect of nutritional education based on Pender's health promotion model on breakfast consumption behavior among Egyptian school students.

METHODS

A pre-posttest intervention study through a nutritional education message based on Pender's health promotion model was carried on 244 preparatory school students. Data were collected using questionnaires and measuring weight, height and blood pressure before and after educational intervention was conducted to the intervention group.

RESULTS

The educational intervention was having a significant positive effect on all components of the model in the intervention group, the mean breakfast consumption, frequency of non-skipping and healthy breakfast per week (p ≤ 0.05). Overweight and obesity and higher blood pressure were significantly present among breakfast skippers.

CONCLUSIONS

The nutritional educational intervention based on Pender's health promotion model was effective in increasing the frequency of healthy breakfast among the school students. There is a need to develop evidence-based policies, community, family, and school-based interventions to promote healthy lifestyle and nutritional behavior among adolescents for a better quality of life.

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

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

Eating Habits and Their Association with Weight Status in Chinese School-Age Children: A Cross-Sectional Study

BACKGROUND

Poor eating habits increase children's risk of chronic diseases such as overweight and obesity, adult diabetes, and cardiovascular and cerebrovascular diseases. Therefore, this study aimed to examine the eating habits of school-age children and their impact on children's body mass index.

METHODS

Multistage cluster sampling was used to sample 2224 students in grades 4 to 6 from 16 primary schools in Changsha. A self-designed questionnaire was used to collect general demographic, eating habit, and snack consumption data from school-age children. Height and weight were measured so that the body mass index Z-score could be calculated and evaluated according to the 2007 World Health Organization's Body Mass Index (BMI) reference standard.

RESULTS

The prevalence rates of overweight and obesity in school-age children were 17.0% and 8.3%, respectively. Boys had higher rates of overweight and obesity than girls (19.9% vs. 13.6%, 12.9% vs. 3.0%, respectively, p < 0.05). Among the total population of children, 71.6% reported picky eating habits, and 55.1% had late-night snacks. Children who skipped breakfast (OR 1.507 and 95% CI 1.116~2.035) and ate puffed food (OR 1.571 and 95% CI 1.170~2.110) were more likely to be overweight/obese.

CONCLUSIONS

The eating habits of school-age children are closely related to their weight status. Poor eating habits can be risk factors for overweight and obesity. The dietary management of children should be strengthened so that they develop good eating habits and the incidence of overweight and obesity in school-age children decreases.

Malaysian adolescents' perceptions of healthy eating: a qualitative study

OBJECTIVE

To explore the concepts of healthy eating and to identify the barriers and facilitating factors for dietary behaviour change in adolescents.

DESIGN

A qualitative study involving twelve focus groups.

SETTING

Two secondary schools in the district of Hulu Langat in Selangor, Malaysia.

PARTICIPANTS

Seventy-two adolescents aged 13-14 years.

RESULTS

Adolescents had some understanding regarding healthy eating and were able to relate healthy eating with the concepts of balance and moderation. The adolescents' perceptions of healthy and unhealthy eating were based on food types and characteristics, cooking methods and eating behaviours. Facilitators for healthy eating were parents' control on adolescents' food choices, feeling concern about own health and body, being influenced by other's health condition, and knowledge of healthy or unhealthy eating. On the other hand, barriers for healthy eating were the availability of food at home and school, taste and characteristics of foods, and lack of knowledge on healthy or unhealthy foods.

CONCLUSIONS

The findings contribute to a better understanding of the adolescents' concept of healthy eating, as well as the facilitators and barriers to practising healthy eating. Future interventions should include a method of promoting the immediate benefits of healthy eating, the way to cope with environmental barriers for healthy eating, and increasing the availability of healthy food choices at home and in the school environment. The health and nutrition education programmes should also focus on educating parents, as they can be role models for adolescents to practise more healthful behaviours.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

School-based intervention that integrates nutrition education and supportive healthy school food environment among Malaysian primary school children: a study protocol

BACKGROUND

Malnutrition among school children may contribute to adverse health consequences such as non-communicable diseases, poor cognitive performance, psychological distress and poor quality of life that may persist into adulthood. In order to prevent childhood malnutrition, an intervention programme that integrates nutrition education and healthy school food environment is needed to provide nutrition information and reinforce the skills on healthy eating behaviours in schools. This paper describes a study protocol of a school-based intervention programme that integrates nutrition education and healthy school food environment, namely School Nutrition Programme (SNP). The SNP is a primary prevention programme that promotes healthy lifestyle among primary school children in light of the high prevalence of malnutrition in Malaysian children.

METHODS/DESIGN

This quasi-experimental study aimed to evaluate the effectiveness of the SNP between intervention and comparison groups before and after the SNP, and after a 3-month follow-up. The SNP consisted of two main components, whereby three nutrition education sessions were implemented by trained teachers using three standardised modules, and healthy school food environment was implemented by the canteen food handlers with the provision of healthy menu to children during school recess times. Children from intervention group participated in the SNP, in addition to the standard Physical and Health Curriculum. The comparison group attended only the standardised Physical and Health Curriculum and the school canteen food handlers were reminded to follow the standard canteen guidelines from the Ministry of Education Malaysia. The assessment parameters in evaluating the effectiveness of the programme were knowledge, attitude and practice on nutrition, eating behaviours, physical activity, body composition, psychological distress, cognitive performance and health-related quality of life. Assessments were conducted at three time points: pre-intervention, post-intervention and 3-month follow-up.

DISCUSSION

It was hypothesised that the SNP would be effective in promoting healthy lifestyle among school children, and further contributes in preventing malnutrition problem, enhancing cognitive performance and improving health-related quality of life among school children. Findings of the present study can be expanded to other schools in future on ways to improve nutrition education and healthy school food environment.

TRIAL REGISTRATION

UMIN Clinical Trial Registration UMIN000032914 (Date of registration: 7th June 2018, retrospectively registered).

PROTOCOL VERSION

16th September 2019 & Version 4.

Nutritional Quality of Breakfast Consumed by the Low-Income Population in Brazil: A Nationwide Cross-Sectional Survey

Objective: This study aimed to characterize the nutritional quality of breakfast consumed by the low-income Brazilian population. Methods: A cross-sectional study was conducted with a sample of 1547 low-income individuals attending 36 Community Restaurants (CRs) in Brazil. Food consumption was analyzed by the frequency of food groups presented in the 24 h recall for three days. The nutritional consumption consisted of the analysis of the total energetic value (TEV) and the macronutrients, fibers, monounsaturated fatty acids, saturated fatty acids, trans fatty acids, calcium, and sodium. The nutrients were evaluated considering the percentage of contribution concerning the daily recommendation of consumption. Results: Among the 4641 breakfasts expected to be consumed and reported, 17.2% (n = 797) of the consumers did not consume breakfast. Therefore, we analyzed the 3844 breakfasts. The analysis of food groups showed a high consumption of dairy and cereals, and low consumption of fruits, roots/tubers, and meat/eggs. The percentages of energy contribution of the macronutrients in the TEV were adequate for a balanced diet. The mean intake of monounsaturated fatty acids was low, and the contribution percentages of saturated fatty acids and trans fatty acids were within the recommendations. The mean fiber intake of the breakfast was low, agreeing with the result of low fruit consumption. Calcium intake covered 73.49% of that expected for this meal, and sodium intake was adequate in breakfast. Conclusion: The individuals studied consumed a nutritionally balanced breakfast. Although dairy was one of the most consumed groups, calcium consumption was low, indicating the need to consume higher portions of food sources of this nutrient.

Dietary patterns and associated socio-economic factors in rural Mozambican adolescents

Background

Assessing food consumption in adolescents is essential for the determination of an appropriate nutritional status. This study intended to assess dietary patterns and its associated factors in rural Mozambican adolescents.

Methods

This was a cross-sectional study of 323 adolescents. A food frequency questionnaire was used and food was grouped into nine groups. An exploratory factorial analysis identified the food patterns. A principal component analysis provided food consumption scores in each factor, split into three groups. An adjustment of multinomial regression models was made.

Results

Two diet patterns were identified: pattern 1 (fats, beans, meats and eggs, cereals and sugars) and pattern 2 (vegetables, roots and tubers, fruits, chestnuts and walnuts). The proportional model for pattern 1 indicated highest consumption for adolescents with per capita family income equal to or greater than 78.13 meticais (Mozambique's currency) and for adolescents whose parents had a formal job. For pattern 2, consumption was lower for adolescents whose guardians had high school education or more. The consumption in the first three quartiles was lower for individuals with an income between 1 and 78.12 meticais.

Conclusions

For Mozambican adolescents, higher income, education and parents' jobs were predictive variables for consumption of fats, beans, meats and eggs, cereals, and sugars, while higher education and higher income implies lower consumption of vegetables, roots and tubers, fruits, chestnuts, and walnuts.

Risk Factors and Prevalence of Abdominal Obesity among Upper-Secondary Students

Inadequate eating habits, as well as a low level of physical activity, influence adipose tissue deposition. The aim of the study was to assess the prevalence of central obesity in upper-secondary students and to determine the factors related to its occurrence. The survey included 309 participants, aged 16 to 18 years from Krakow (Poland). Anthropometric measurements were taken during the periodic assessment of students’ health status. An anonymous questionnaire was used to assess the nutritional and non-nutritional risk factors of participants. According to different methods of measurement, abdominal obesity (AO) was observed in 15.5% (WC—waist circumference), 10.7% (WHtR—waist to height ratio) or 21.7% (WHR—waist to hip ratio) participants. Abdominal obesity (WC) was significantly associated with family history of excess body weight and higher economic status of the family. The risk of AO (WC) was significantly lower among adolescents who declared higher physical activity. Boys who eat first breakfasts have lower AO risk according to WHtR interpretation. Abdominal obesity in gender group was related to the self-esteem of one’s own appearance according to WHtR and WC. Abdominal obesity was associated with the family environment and modifiable lifestyle factors and was dependent on gender.

Dietary Habits and Physical Activity of 18-Year-Old Adolescents in Relation to Overweight and Obesity

BACKGROUND

The purpose of this study was to evaluate the correlations between the nutritional status, nutritional habits, and physical activity in the representative population of 18-year-old students.

METHODS

A total of 1,631 participants aged 18 years, originating from secondary schools/senior high schools in the city of Bialystok, Szpitalna, Bialystok, Poland were enrolled. Participants completed anonymous questionnaires, and their body mass index was assessed. Data were analyzed using standard statistical procedures with Statistical PL 12.0.

RESULTS

The analysis showed that consumption of only one to two or three meals was associated with an increased risk of overweight and obesity-in case of one or two meals among girls, OR=1.78 (P<0.05), in case of one or two meals among boys, OR=2.325 (P<0.01), and in case of three meals, OR=1.771 (P<0.05). First breakfast was consumed by 82.1% of boys with normal BMI and 73.1% overweight and obesity (OR=0.593; P<0.05). 24.5% of the eutrophic compared to only 20.3% of adolescents with elevated BMI reported attending all PE classes. Physical activity undertaken after school was associated with a 35.9% decrease risk of overweight and obesity among girls and 57.7% among boys.

CONCLUSION

A specific pattern of nutritional habits, that is, decreased meal frequency in adolescents, skipping meals, appear the most frequent nutritional mistakes associated with overweight and obesity. Insufficient physical activity and exposure to sedentary behaviors among adolescents are disturbing. The obesity problem requires monitoring, prevention and the change of nutritional habits and physical activity early in childhood.

The Association of Breakfast Frequency and Cardiovascular Disease (CVD) Risk Factors among Adolescents in Malaysia

Breakfast frequency is associated with cardiovascular disease (CVD) risk in Western populations, possibly via the types of food eaten or the timing of food consumption, but associations in Malaysian adolescents are unknown. While the timing of breakfast is similar, the type of food consumed at breakfast in Malaysia differs from Western diets, which allows novel insight into the mechanisms underlying breakfast-CVD risk associations. We investigated foods eaten for breakfast and associations between breakfast frequency and CVD risk factors in the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). Breakfast (frequency of any food/drink reported as breakfast in 7-day diet history interviews) and CVD risk factors (body mass index (BMI), waist circumference, fasting blood glucose, triacylglycerol, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and systolic and diastolic blood pressure) were cross-sectionally associated using linear regression adjusting for potential confounders (n = 795, age 13 years). Twelve percent of adolescents never ate breakfast and 50% ate breakfast daily, containing mean (SD) 400 (±127) kilocalories. Commonly consumed breakfast foods were cereal-based dishes (primarily rice), confectionery (primarily sugar), hot/powdered drinks (primarily Milo), and high-fat milk (primarily sweetened condensed milk). After adjustment, each extra day of breakfast consumption per week was associated with a lower BMI (-0.34 kg/m², 95% confidence interval (CI) -0.02, -0.66), and serum total (-0.07 mmol/L 95% CI -0.02, -0.13) and LDL (-0.07 mmol/L 95% CI -0.02, -0.12) cholesterol concentrations. Eating daily breakfast in Malaysia was associated with slightly lower BMI and total and LDL cholesterol concentrations among adolescents. Longitudinal studies and randomized trials could further establish causality.

A Median Analysis of Factors Influencing Body Fatness in Urban School-Age Children in Cameroon

Background

Childhood overweight/obesity is a fast growing public health problem in developing countries. The adverse health consequences of obesity have been attributed to higher body fat levels and this has drawn overwhelming attention towards more accurate assessment of body fat. The goal of this study is to evaluate the relationships between selected behavioral factors and percentage body fat (%BF) estimated using bioelectrical impedance analysis in school-age children.

Methods

A cross-sectional analysis was carried out in randomly selected 6- to 11-year-old children (507 boys and 501 girls). Percentage body fat was assessed using bioelectrical impedance analysis. The behavioral factors were reported by parents using a structured questionnaire. Multiple quantile regression analysis was used to evaluate the relationship between the selected behavioral factors and %BF.

Results

With quantile regression, the daily consumption of fruits and vegetables, daily breakfast consumption, and high physical activity (>4–7 times/week) were significantly (p < 0.001) associated with a 4.95, 3.29, and 3.66 decrease in median %BF, respectively. Also, consumption of snacks (>3 times a day) (p < 0.001), high sedentary lifestyle (>3–6 hours/day) (p < 0.001), and motorization to school (p < 0.005) significantly increased the median %BF by 3.69, 3.01, and 1.39, respectively. The largest changes in median %BF were observed in girls.

Conclusions

Efforts are needed using longitudinal studies to clarify the effects of these behavioral factors on %BF in different regions and ethnic groups of Cameroon and also to assess whether any observed differences are of clinical relevance.

Dietary and physical activity patterns related to cardio-metabolic health among Malaysian adolescents: a systematic review

BACKGROUND

A sedentary lifestyle and an unhealthy diet are major factors in the increasing prevalence of obesity among Malaysian adolescents. The purpose of this systematic review is to compile the evidence from observational and intervention studies among Malaysian adolescents to evaluate the associations between diet and physical activity (PA) as determinants of cardio-metabolic risk factors.

METHODS

A systematic search of Medline via the PubMed, Science Direct, Cochrane Review and Web of Science databases was conducted for studies on the associations between diet and PA factors and cardio-metabolic risk factors among Malaysian adolescents aged 13-18 years that were published until 31 August 2017. The search results were independently screened and extracted by two reviewers.

RESULTS

From over 2,410 references retrieved, 20 full texts articles were screened as potentially relevant. Seventeen (16 cross-sectional and one intervention) met the inclusion criteria for data extraction and analysis. All 17 studies were rated as poor quality and the majority had made insufficient adjustment for confounders. As regards the effect of diet and PA on cardio-metabolic health, the intakes of energy (n = 4) and macronutrients (n = 3) and meal frequency (n = 5) were the most commonly studied dietary factors, while the PA score and level were the most commonly studied PA factors. In addition, BMI and body weight were the most common cardio-metabolic health outcomes. The studies showed that obese and overweight adolescents consume significantly more energy and macronutrients. They are also more likely to skip their daily meals compared to their normal weight peers. In most studies, the direction of the PA effect on body weight was unclear. Some studies found that higher PA is associated with a lower risk of overweight and obesity. However, the associations are often small or inconsistent, with few studies controlling for confounding factors.

CONCLUSIONS

This review identified a lack of evidence and well-conducted prospective studies on the effect of diet and PA on cardio-metabolic health of Malaysian adolescents.

Determinants of Diet and Physical Activity in Malaysian Adolescents: A Systematic Review

The increased prevalence of unhealthy eating habits and sedentary lifestyles among Malaysian adolescents has become a public health concern. The aim of this systematic review was to summarize evidence from observational studies related to diet and physical activity (PA) among Malaysian adolescents (13–18 years) and to recognize the associations between determinants of diet and PA and diet and PA behaviours. A systematic search for observational studies published from August 1990 through August 2017 was conducted via PubMed, Science Direct, Cochrane and Web of Science. A total of 18 studies met the inclusion criteria; these were independently extracted by two reviewers. Gender and ethnicity were the most commonly studied correlates of diet and PA; males were more physically active and they tended to have poorer diet quality and higher energy and macronutrient intakes in comparison to females; Malay adolescents had a lower diet quality and Chinese adolescents spent less time in PA compared to other ethnicities. However, the significance of these associations was often small or inconsistent. This review highlights the lack of longitudinal observational studies but summarizes the best available evidence for policymakers and public health practitioners to improve the diet and the level of PA in Malaysian adolescents.

Association of Breakfast Quality and Energy Density with Cardiometabolic Risk Factors in Overweight/Obese Children: Role of Physical Activity

There is a general belief that having breakfast is an important healthy lifestyle factor; however, there is scarce evidence on the influence of breakfast quality and energy density on cardiometabolic risk in children, as well as on the role of physical activity in this association. The aims of this paper were (i) to examine the associations of breakfast quality and energy density from both solids and beverages with cardiometabolic risk factors, and (ii) to explore whether physical activity levels may attenuate these relationships in children with overweight/obesity from two projects carried out in the north and south of Spain. Breakfast consumption, breakfast quality index (BQI) score, BEDs/BEDb (24 h-recalls and the KIDMED questionnaire), and physical activity (PA; accelerometry) were assessed, in 203 children aged 8–12 years who were overweight or obese. We measured body composition (Dual X-ray Absorptiometry), uric acid, blood pressure, lipid profile, gamma-glutamyl-transferase (GGT), glucose, and insulin, and calculated the HOMA and metabolic syndrome z-score. The BQI score was inversely associated with serum uric acid independently of a set of relevant confounders (β = −0.172, p = 0.028), but the relationship was attenuated after further controlling for total PA (p < 0.07). BEDs was positively associated with total and HDL cholesterol, and systolic blood pressure regardless of confounders (all p < 0.05), while BEDb was positively associated with HOMA in either active/inactive children (all p < 0.03). In conclusion, higher breakfast quality and lower breakfast energy density should be promoted in overweight/obesity children to improve their cardiometabolic health.

Cardio-metabolic and socio-environmental correlates of waist-to-height ratio in German primary schoolchildren: a cross-sectional exploration

BACKGROUND

Controversial messages of childhood obesity emerge: Levelling off in terms of body mass index (BMI) is foiled by increases in abdominal obesity. Waist-to-height ratio (WHtR) may be used as a screening tool for abdominal obesity in children. The aim of this study was to investigate clinical and socio-environmental correlates of abdominal obesity in primary schoolchildren.

METHODS

Cross-sectional data from 753 children participating in baseline assessments of the outcome evaluation of a school-based prevention program were analysed. Abdominal obesity was defined as WHtR ≥0.5. According to German age and sex-specific BMI-percentiles, overweight (>90th percentile) and obesity (>97th percentile) were determined. Anthropometric and sonographic measurements, blood pressure and blood samples were taken by clinical staff in a standardized manner. Socio-environmental and lifestyle data were assessed via parental questionnaires. Differences between abdominally obese children and others, and correlations of WHtR with clinical data were tested. Socio-environmental correlates of abdominal obesity were explored in a logistic regression analysis.

RESULTS

At the time of the examination children were 7.57 ± 0.42 years old. Abdominal obesity was observed in 132 (17.5%) children. According to BMI-percentiles, 22.9% of these children were obese, 38.2% overweight, and 38.2% normal weight. Affected children more often used screen media and less often participated in club sports. Abdominal obesity was associated with higher blood pressure, lower HDL- and higher LDL-cholesterol. WHtR significantly correlated with intra-abdominal fat thickness (IAF). The logistic regression model revealed migration background (odds ratio (OR) 2.12, 95% confidence interval (CI) [1.41, 3.19]), smoking during pregnancy (OR 2.30, 95% CI [1.37, 3.86]), parental obesity (OR 1.95, 95% CI [1.22, 3.10]) and higher educational level (OR 0.64, 95% CI [0.42, 0.98]) to be significantly associated with abdominal obesity in children.

CONCLUSION

WHtR correlates strongly with IAF. Abdominal obesity in primary schoolchildren is associated with cardio-metabolic risk factors and also occurs in otherwise normal weight children. Against the background of rising numbers of abdominal obesity in children, targeted preventive measures are long overdue. The focus of such measures should be used on children with migration background and involve parents, especially those who are obese and those with lower educational levels.

Breakfast habits and differences regarding abdominal obesity in a cross-sectional study in Spanish adults: The ANIBES study

BACKGROUND

Previous studies have indicated that breakfast has a protective effect against obesity. The aim of this study was to describe the breakfast habits of the Spanish adult population and to assess the possible association between breakfast frequency and the presence of abdominal obesity, in a cross-sectional analysis of the ANIBES Study.

METHODS

A representative sample of 1655 Spanish adults (aged 39±12 y; (mean±sd)) from the ANIBES Study was investigated. The final field work was carried out from mid-September to November (three months) 2013. Collected data included a dietary data collected by a 3-days food record, and health, socioeconomic, physical activity and anthropometric (weight, height and waist circumference) data. Abdominal obesity was defined as having a waist-to-height ratio ≥0.5. The adults were also classified into three groups based on the number of days they ate breakfast (never (0/3 days), sometimes (1-2/3 days) and always (3/3 days)). Logistic regression analyses were used to evaluate the association between breakfast and abdominal obesity.

RESULTS

In total, 3.6% of adults skipped breakfast and 14.1% ate breakfast sometimes. Having always breakfast was negatively associated with abdominal obesity [OR = 0.738 (0.558-0.975) p = 0.033]. The odds of abdominal obesity after full adjustment (age, gender, and educational and activity level) were 1.5 times higher for those who skipped breakfast when compared to those who always have breakfast. By correcting the model considered for other variables, the odds among smokers decreased when they have breakfast sometimes [OR = 0.032 (0.003-0.387) p = 0.007] and always [OR = 0.023 (0.002-0.270) p = 0.003] comparing with smokers who skip breakfast.

CONCLUSION

Breakfast frequency could be negatively associated with abdominal obesity, especially among smokers.

Dietary iron intake and availability are related to maternal education level in overweight/obese adolescents

PURPOSE

To compare intakes of dietary iron and enhancers and inhibitors of iron absorption between overweight/obese (OW/OB) adolescents and their normal weight (NW) peers, and between parental education levels stratified by weight status.

METHODS

This was a comparative cross-sectional study of adolescents (n 121 OW/OB and n 102 NW) aged 12-14 years, attending a secondary school in Nonthaburi province, Thailand. Socio-demographic data were obtained from participants' parents using a questionnaire. Participants recorded their intakes for 3 non-consecutive days, using a prospective food record.

RESULTS

Compared with NW adolescents, OW/OB adolescents consumed more total protein and animal protein after adjustment for energy intake (both p = 0.047). OW/OB adolescents whose mothers were less educated consumed more total iron and available iron after adjustment for energy intake, compared with their OW/OB peers whose mothers were more educated (p = 0.045 and p = 0.040). NW adolescents with more highly educated mothers had higher absolute and energy-adjusted fibre intakes (both p = 0.047). However, NW adolescents of mothers with a high-intermediate level of education consumed less calcium, after adjustment for energy intake (p = 0.028).

CONCLUSIONS

OW/OB adolescents with less educated mothers had higher energy-adjusted intakes of iron and available iron. Dietary differences in OW/OB adolescents relative to maternal education, and other socioeconomic indicators, should be explored in a nationally representative data set.

Consumption of ready-to-eat cereals (RTEC) among Malaysian children and association with socio-demographics and nutrient intakes - findings from the MyBreakfast study

Background: The association between different types of breakfast meals and nutrient intakes has been studied to a lesser extent. Objective: This study compared nutrient intakes at breakfast and throughout the day between Malaysian children who consumed ready-to-eat cereals (RTEC) and those who did not. Methods: Anthropometric and dietary data for 1955 children aged 6-12 years from the MyBreakfast study were used in the analysis. Results: Overall, 18% of the children consumed RTEC at breakfast on at least one of the recall days. RTEC consumption was associated with younger age, urban areas, higher income and education level of parents. Among consumers, RTEC contributed 10% and 15% to daily intakes of calcium and iron respectively and ≥20% to daily intakes of vitamin C, thiamin, riboflavin and niacin. RTEC consumers had significantly higher mean intakes of vitamin C, thiamin, riboflavin, niacin, calcium, iron and sugar but lower intakes of fat and sodium than non-RTEC consumers at breakfast and for the total day. Conclusion: Consumption of fortified RTEC at breakfast was associated with lower fat and sodium intakes and higher intakes of several micronutrients both at breakfast and for the total day. However, total sugar intakes appeared to be higher.

Risk factors associated with abdominal obesity in suburban adolescents from a Malaysian district

INTRODUCTION

We aimed to determine the risk factors associated with abdominal obesity (AO) in suburban adolescents.

METHODS

This cross-sectional study included adolescents aged 15-17 years from five randomly selected secondary schools in the Hulu Langat district of Selangor state, Malaysia. Waist circumference (WC) was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest. Information on sociodemographic data, dietary habits, physical activity levels and duration of sleep was obtained via interviewer-administered questionnaires. Participants' habitual food intake was determined using a 73-item Food Frequency Questionnaire.

RESULTS

Among 832 participants, 56.0% were girls; 48.4% were Malay, 40.5% Chinese, 10.2% Indian and 0.8% of other ethnic groups. Median age and WC were 16 (interquartile range [IQR] 15-16) years and 67.9 (IQR 63.0-74.6) cm, respectively. Overall prevalence of AO (> 90th percentile on the WC chart) was 11.3%. A higher proportion (22.4%) of Indian adolescents were found to have AO compared with Malay and Chinese adolescents. Logistic regression analysis showed that female gender (adjusted odds ratio [OR] 7.064, 95% confidence interval [CI] 2.087-23.913; p = 0.002), Indian ethnicity (adjusted OR 10.164, 95% CI 2.182-47.346; p = 0.003), irregular meals (adjusted OR 3.193, 95% CI 1.043-9.774; p = 0.042) and increasing body mass index (BMI) (adjusted OR 2.867, 95% CI 2.216-3.710; p < 0.001) were significantly associated with AO.

CONCLUSION

AO was common among Malaysian adolescents. Female gender, Indian ethnicity, irregular meals and increasing BMI were significant risk factors.

Ethnic Differences in the Food Intake Patterns and Its Associated Factors of Adolescents in Kelantan, Malaysia

Objective: The aim of the study was to identify the ethnic differences in dietary patterns and its association with socio-economic, dietary and lifestyle practices among adolescents in Kelantan, Malaysia. Methods: A population-based study of 454 adolescents aged 12 to 19 years was included. A validated food frequency questionnaire was used to assess dietary patterns and three dietary patterns were identified based on the principal component analysis method. Results: Malay adolescents had significantly higher scores for the Western-based food pattern and local-based food pattern, whereas Chinese adolescents showed higher scores for the healthy-based food pattern. Multivariate analyses show that age and physical activity (PA) levels were positively associated with healthy-based food pattern in Malay (All, p < 0.001), whereas higher consumption of eating-out from home (EatOut) (p = 0.014) and fast food (p = 0.041) were negatively associated. High weekly breakfast skipping (p < 0.001) and EatOut (p = 0.003) were positively associated with a Western-based pattern, whereas age (p < 0.001) and household income (p = 0.005) were negatively associated. Higher frequency of daily snacking (p = 0.013) was positively associated with local-based food pattern. For Chinese adolescents, age (p < 0.001), PA levels (p < 0.001) and maternal education level (p = 0.035) showed positive associations with the healthy-based pattern, whereas high EatOut (p = 0.001) and fast food intakes (p = 0.001) were negatively associated. Higher weekly consumption of EatOut (p = 0.007), fast food (p = 0.023) and carbonated beverages (p = 0.023), and daily snacking practice (p = 0.004) were positively associated with higher Western-based food pattern, whereas age (p = 0.004) was inversely associated. Conclusion: This study showed that there were significant differences in dietary patterns and its association factors between Malay and Chinese adolescents. More importantly, these findings suggest that unhealthy dietary and lifestyle practices could increase the risk of adherence to unhealthy Western-based food pattern that is high in fat, sugar and salt contents, and, consequently, increase the risk of developing obesity and metabolic-related disorders during these critical years of growth.

Correlates of longitudinal changes in the waist-to-height ratio of primary school children: Implications for prevention

OBJECTIVE

To investigate correlates of changes in waist-to-height ratio (WHtR) in primary school children in order to identify modifiable factors usable for prevention.

METHODS

Outcome evaluation of a statewide health promotion program in Baden-Württemberg, Germany. Baseline (2010) and follow-up (2011) measurements provided data for the calculation of changes in WHtR. Further information on the health and living conditions of the children were assessed in parental questionnaires. Anthropometric measures were taken in 1733 (50.8% male) first and second grade children (age at baseline 7.1 ± 0.6 years) by staff trained according to ISAK-standards. Stepwise linear regression analysis was applied to identify variables with influence on changes in WHtR.

RESULTS

According to the resulting regression model, changes in WHtR towards an increase were influenced by at least one parent being overweight/obese, at least one parent who smoked, low household income, higher age of the child and the skipping of breakfast. There was no clustering effect in schools observed.

CONCLUSION

A promising target for prevention of gain in WHtR in primary school children is to ensure the regularity of breakfast. Smoking cessation as well as dietary improvements would not only help children's health but also the health of their parents. The socioeconomic influence on the development of an unhealthy weight status has already been acknowledged and should be extensively targeted by all of society and policy makers.

The relation between intra- and interpersonal factors and food consumption level among Iranian adolescent girls

Background:

Poor nutrition habits in adolescent girls endanger their health and are followed by serious systemic diseases in adulthood and negative effects on their reproductive health. To design health promotion programs, understanding of the intra- and interpersonal associated factors with treatment is essential, and this was the aim of this study.

Materials and Methods:

This cross-sectional study was conducted on 193 adolescent girls of age 11-15 years. Random cluster selection was used for sample selection. Food group consumption pattern was assessed by food frequency questionnaire. Also, perceived susceptibility/severity and nutritional attitude as intrapersonal factors and social support as interpersonal factor were assessed. The relationship between food group consumption level and nutritional attitude and perceived treat (susceptibility/severity) as intrapersonal factors and perceived social support as interpersonal factor were assessed by linear multiple regression and analysis of variance (ANOVA).

Results:

Results showed that the level of sweetmeat food consumption was related to perceived social support (P = 0.03) and nutritional attitude (P = 0.01) negatively. In addition, an inverse and significant association was found between the level of junk food intake and informational perceived social support (P = 0.004). The association between the level of fast food intake and the perceived parental social support for preparation of healthy food was negatively significant (P = 0.03). Breakfast consumption was related to nutritional attitude (P = 0.03), social support (P = 0.03), and perceived severity (P = 0.045).

Conclusions:

Results revealed that perceived social support and nutritional attitude are the important and related factors in dietary intake among girls, and promotion of social support and modification of nutritional attitude may lead to healthy nutritional behaviors among them.

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.

Characteristics associated with the consumption of malted drinks among Malaysian primary school children: findings from the MyBreakfast study

BACKGROUND

The consumption of beverages contributes to diet quality and overall nutrition. Studies on malted drinks, one of the widely consumed beverage choices among children in Asia, however, have received limited attention. This study aimed to examine the prevalence of malted drink consumption and explored associations of sociodemographic characteristics, nutrient intakes, weight status and physical activity levels with malted drink consumption among primary school children in Malaysia.

METHODS

Data for this analysis were from the MyBreakfast Study, a national cross-sectional study conducted from April to October 2013 throughout all regions in Malaysia. A total of 2065 primary school children aged 6 to 12 years were included in the present analysis. Data on two days 24-h dietary recall or record, anthropometry, physical activity and screen time were recorded. Associations between malted drink consumption and related factors were examined using binary logistic regression, adjusting for region, area, gender, ethnicity and household income.

RESULTS

Among children aged 6 to 12 years, 73.5% reported consuming malted drinks for at least once per week. Consumption of malted drinks was significantly associated with region (χ(2) = 45.64, p < 0.001), gender (χ(2) = 4.41, p = 0.036) and ethnicity (χ(2) = 13.74, p = 0.008). Malted drink consumers had similar total energy intake but higher micronutrient intakes compared to non-consumers. High physical activity level (OR = 1.77, 95% CI = 1.06, 2.99) and lower screen time during weekends (OR = 0.93, 95% CI = 0.86, 0.99) were independently associated with malted drink consumption among 6 to 9 year-old children, but not among 10 to 12 year-old children. No association was observed between malted drink consumption and weight status.

CONCLUSIONS

Malted drink consumption is prevalent among Malaysian primary school children, particularly higher among boys, indigenous children and those who lived in the East Coast region of Malaysia. Consuming malted drinks is associated with higher micronutrient intakes and higher levels of physical activity, but not with body weight status.

Higher body fat and lower fat-free mass in girls with premature adrenarche

OBJECTIVE

Idiopathic premature adrenarche (PA) refers to presence of androgenic signs before the age of eight years in girls in the absence of thelarche. In children with PA, increased adrenal androgens lead to changes in body composition and transient growth acceleration. Although the association between PA and some components of the metabolic syndrome is well known, body composition has not been extensively studied in these patients.

METHODS

We examined 47 girls with PA with a median age of 7.39 years and 57 healthy controls with a median age of 7.11 years. For PA group, the inclusion criteria were appearance of pubic/axillary hair before 8 years of age, absence of findings of central puberty and absence of use of any medication. Patients with steroidogenic enzyme defects and virilizing tumors were excluded. Height, body weight, waist and hip circumference were measured. The bioelectrical impedance method was used for body composition analysis.

RESULTS

In the PA group, both body weight standard deviation score (SDS) and height SDS were significantly higher than in the controls (p<0.001 for both). While total body fat percentage values were significantly higher in the PA group than in the controls (median 22.8% vs. 19.95%, p=0.049), fat-free mass (FFM) and total muscle mass percentages were significantly lower than in the controls (median 76.8% vs. 79.9%, p=0.024 and 72.6% vs. 75.7%, p=0.018, respectively).

CONCLUSION

Our findings revealed that girls with PA have higher body weight and height for age values. They also show significant changes in body composition such as an increase in total body fat percentage with a concomitant decrease in the percentages of FFM, muscle mass and total body water.

Breakfast Eating Pattern and Ready-to-Eat Cereals Consumption among Schoolchildren in Kuala Lumpur

BACKGROUND

Studies from the West have demonstrated that ready-to-eat cereals (RTECs) are a common form of breakfast and more likely to be consumed by children. This study aimed to investigate the breakfast eating pattern and RTECs consumption among schoolchildren in Kuala Lumpur.

METHODS

In this cross-sectional study, a total of 382 schoolchildren, aged 10 and 11 years old, were recruited from seven randomly selected primary schools in Kuala Lumpur. Information on socio-demographics, breakfast eating patterns, and perceptions of RTECs and dietary intake (24-hour dietary recalls) were obtained.

RESULTS

Among the respondents, only 22% of them consumed breakfast on a regular basis. The most commonly eaten food by children at breakfast was bread (27.2%), followed by biscuits (22.2%) and RTECs (20.5%). The majority of them (93%) reported that they consumed RTECs sometimes during the week. Chocolate RTECs (34.1%), corn flake RTECs (30.3%), and RTECs coated with honey (25.1%) were the most popular RTECs chosen by children. Respondents who consumed RTECs showed a significantly higher intake in calories, carbohydrate, vitamin A, vitamin B1, vitamin B2, vitamin B3, folate, vitamin C, calcium, iron, and fibre (P < 0.05), compared to those who skipped breakfast and those who had breakfast foods other than RTECs.

CONCLUSION

The lower levels of breakfast consumption among schoolchildren in Kuala Lumpur need serious attention. RTEC is a nutritious food which is well accepted by a majority of the schoolchildren in Kuala Lumpur. Nutrition intervention should be conducted in the future to include a well-balanced breakfast with the utilisation of RTECs for schoolchildren.