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Wang Z, Pu R, Zhang J, Yang G. The mediating role of sugar and lipid metabolism and systemic inflammation in the association between breakfast skipping and periodontitis: A population-based study. J Periodontol 2024. [PMID: 38850405 DOI: 10.1002/jper.24-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/01/2024] [Accepted: 05/11/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND This study investigated the association between breakfast skipping and periodontitis and the mediating role of sugar and lipid metabolism and systemic inflammation in this association using data from the Korea National Health and Nutrition Examination Survey 2016-2018. METHODS This study included 11,953 participants, representing an estimated 33.9 million people. Complex sample logistic regression was used to assess the independent association between breakfast skipping and periodontitis. Subgroup analysis was conducted with modifiers including age, sex, body mass index (BMI), urban residence, education level, marital status, and diabetes. Structural equation modeling assessed potential mediation by biomarkers related to glucose and lipid metabolism along with systemic inflammation. RESULTS The fully adjusted logistic regression model indicated a positive association between breakfast skipping and periodontitis (odds ratio [OR] = 1.234 (1.026-1.483), p = 0.025). This association was highlighted in middle-aged (40-60 years), female, highly educated, married individuals with BMI < 25 kg/m2, and those in urban areas without diabetes. Blood glucose (β ± SE = 0.006 ± 0.002, p = 0.014), triglycerides (β ± SE = 0.004 ± 0.002, p = 0.033), and white blood cell count (β ± SE = 0.011 ± 0.003, p = 0.003) were identified as partial mediators. CONCLUSIONS A new, independent association between breakfast skipping, and periodontitis has been discovered, which is partially mediated by sugar and lipid metabolism, and systemic inflammation. The findings provide new insights into the benefits of chrononutrition for periodontal health.
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Affiliation(s)
- Zhikang Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Rui Pu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Jing Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
| | - Guoli Yang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province, Hangzhou, China
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Olarte DA, Tsai MM, Chapman L, Hager ER, Cohen JFW. Alternative School Breakfast Service Models and Associations with Breakfast Participation, Diet Quality, Body Mass Index, Attendance, Behavior, and Academic Performance: A Systematic Review. Nutrients 2023; 15:2951. [PMID: 37447277 DOI: 10.3390/nu15132951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The United States (US) School Breakfast Program provides Breakfast After The Bell (BATB) to alleviate hunger, provide nutrition, and ensure students have a healthy start to the day. This study aims to review the evidence regarding the impact of BATB on students' diet and academic outcomes, including participation, diet quality and consumption, body mass index (BMI) and weight status, attendance, classroom behavior, and academic performance. The articles were extracted from three electronic databases and published since the start of the literature through December 2022. Studies were peer-reviewed; quantitative research articles or government reports; and conducted in public or private elementary, middle, and high schools. Quality was assessed using the Newcastle-Ottawa Scale. Thirty-seven studies were included in this review. This review found BATB increased school breakfast participation, improved diet quality, and improved classroom behavior particularly among students from racial and ethnic minority backgrounds and students eligible for free or reduced-price meals. The impact of BATB on BMI and weight status, academic achievement and attendance was mixed. This review is particularly timely given free school meals and updated school nutrition standards are being prioritized over the next decade in the US. Thus, it is important to evaluate the nutritional and educational outcomes of BATB. (PROSPERO registration: CRD42021289719).
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Affiliation(s)
- Deborah A Olarte
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
| | - Marisa M Tsai
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA 94704, USA
| | - Leah Chapman
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
| | - Erin R Hager
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Juliana F W Cohen
- Center for Health Inclusion, Research and Practice (CHIRP), Merrimack College, 315 Turnpike Street, North Andover, MA 01845, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA 02115, USA
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Jensen C, Sprunace L, Leavitt T, Stokes N. Educational Video Intervention Improves Perceptions of Breakfast in the Classroom Among College Students in Elementary Education. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:304-310. [PMID: 37028899 DOI: 10.1016/j.jneb.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/16/2022] [Accepted: 01/22/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Evaluate Elementary Education college students' familiarity and perceptions of Breakfast in the Classroom (BIC) before and after an educational video intervention. METHODS A 5-minute educational video was developed as an intervention in a pilot study. Quantitative data were collected from Elementary Education students using preintervention and postintervention surveys and analyzed using paired sample t tests (P < 0.001). RESULTS A total of 68 participants completed preintervention and postintervention surveys. Postintervention survey scores indicated that participants' perceptions of BIC improved after watching the video. Paired sample t tests also showed an increase in preference for BIC, familiarity with the 5 school breakfast service models, and confidence to implement BIC in future classrooms. CONCLUSIONS AND IMPLICATIONS An educational video intervention effectively improves Elementary Education students' perceptions of BIC. Elementary Education students who gain a positive perception of BIC may influence the program's success and ability to benefit students.
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Affiliation(s)
- Camilla Jensen
- Department of Nutrition, Dietetics, and Food Science, Brigham Young University, Provo, UT
| | - Lori Sprunace
- Department of Public Health, Brigham Young University, Provo, UT
| | - Teresa Leavitt
- Department of Teacher Education, Brigham Young University, Provo, UT
| | - Nathan Stokes
- Department of Nutrition, Dietetics, and Food Science, Brigham Young University, Provo, UT.
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Fornaro EG, McCrossan E, Hawes P, Erdem E, McLoughlin GM. Key determinants to school breakfast program implementation in Philadelphia public schools: Implications for the role of SNAP-Ed. Front Public Health 2022; 10:987171. [PMID: 36304238 PMCID: PMC9592801 DOI: 10.3389/fpubh.2022.987171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023] Open
Abstract
Background Policies addressing food insecurity are only effective if they are implemented successfully, serving those most at risk. Universal school meals provide a key intervention to schools that serve predominantly low-income families by providing free school breakfast and lunch to all. Unfortunately, low uptake of such provisions among students is concerning especially regarding school breakfast, warranting key implementation support for schools to ensure student nutrition needs are met. Thus, the purpose of this study was to evaluate the determinants of implementing two different school breakfast programs and pragmatic strategies for serving breakfast in ways that maximize student participation. Methods A qualitative study was conducted between 2018 and 2020 within the School District of Philadelphia (SDP) comprising surveys, interviews, and observations to assess contextual determinants of two distinctive breakfast models: Breakfast in the Classroom (BIC) and Cafeteria after the Bell (CAB). Principals and lead kitchen staff completed surveys to assess determinants of breakfast model adoption. Principals, lead kitchen staff, classroom teachers, climate (i.e., social emotional wellbeing), and facilities staff subsequently participated in interviews to discuss implementation determinants (i.e., facilitators and challenges) and strategies for maximizing student participation. Observations provided rich data to triangulate interviews and survey data. Survey data were analyzed using frequency analysis, and observation and interview data were analyzed through thematic analysis. Presentation of themes was framed by the Consolidated Framework for Implementation Research. Results Results highlighted several positive determinants to participation including addressing student and family needs, making data-informed decisions, and providing hot meals and fruit based on student tastes. Negative determinants to implementation comprised challenges to SNAP-Ed-funded policy changes to promote student breakfast participation, lack of communication between administration, and staff and turnover among food service staff. Strategies included modifying school entrance procedures and combining breakfast with other education-related tasks to minimize instructional time lost through breakfast after the bell schedules. Discussion Data highlight the need to include implementation partner expertise when designing interventions for increasing reach and effectiveness of school meal programs. Future research that directly tests implementation strategies and key outcomes of reach/participation, among others, is critical to bridging the policy to practice gap in school nutrition programs.
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Affiliation(s)
- Elisabeth G. Fornaro
- Office of Research and Evaluation, School District of Philadelphia, Philadelphia, PA, United States
| | - Erin McCrossan
- Office of Research and Evaluation, School District of Philadelphia, Philadelphia, PA, United States
| | - Peter Hawes
- Office of Research and Evaluation, School District of Philadelphia, Philadelphia, PA, United States
| | - Ebru Erdem
- Office of Research and Evaluation, School District of Philadelphia, Philadelphia, PA, United States
| | - Gabriella Maria McLoughlin
- College of Public Health, Temple University, Philadelphia, PA, United States,Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States,*Correspondence: Gabriella Maria McLoughlin
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Breakfast Consumption May Improve Fasting Insulin, HOMA-IR, and HbA1c Levels in Predominately Low-Income, Hispanic Children 7-12 Years of Age. Nutrients 2022; 14:nu14112320. [PMID: 35684120 PMCID: PMC9182585 DOI: 10.3390/nu14112320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 12/10/2022] Open
Abstract
Children from low-income households and minority families have high cardiometabolic risk. Although breakfast consumption is known to improve cardiometabolic health in children, limited randomized control trials (RCT) have explored this association in low-income and racial/ethnic U.S. minority families. This study conducted secondary analyses from TX Sprouts, a school-based gardening, cooking, and nutrition education RCT, to examine the intervention effect on breakfast consumption and how changes in breakfast consumption impact cardiometabolic risk in predominately low-income, multi-ethnic children. TX Sprouts consisted of 16 schools (8 intervention; 8 control) in greater Austin, TX. A total of 18 lessons were taught, including topics on breakfast consumption benefits and choosing healthy food options at school. Children completed clinical measures (e.g., anthropometrics, body composition via bioelectrical impedance), and the number of breakfast occasions (BO) per week (at home and school) was captured via validated survey at baseline and post-intervention. Post-study—Baseline changes in breakfast consumption were used to categorize students as: maintainers (BO −1 to 1 day/week), decreasers (BO ≤−2 day/week), and increasers (BO ≥2 day/week). Optional fasting blood draws were performed on a subsample. Generalized weighted linear mixed modeling tested differences between intervention and control, with schools as random clusters. Analysis of covariance and linear regression examined changes in breakfast consumption on cardiometabolic outcomes, controlling for age, sex, race/ethnicity, free and reduced-price school meal participation (FRL), school site, breakfast location, physical activity, baseline cardiometabolic measures, and BMI z-score. This study included 1417 children (mean age 9 years; 53% male; 58% Hispanic, 63% FRL; breakfast consumption patterns: 63% maintainers, 16% decreasers, and 21% increasers). There was no intervention effect on changes in breakfast consumption. Compared to decreasers, increasers had an increase in insulin (−0.3 µIU/mL vs. +4.1 µIU/mL; p = 0.01) and a larger increase in HOMA-IR (+0.4 vs. +1.5; p < 0.01). Every one-day increase in breakfast consumption decreased fasting insulin by 0.44 µIU/mL, HOMA-IR by 0.11, and hemoglobin A1c by 0.01% (p ≤ 0.03). Increased breakfast consumption was linked to improved glucose control, suggesting breakfast can mitigate risk in a high-risk population. To better understand underlying mechanisms linking breakfast consumption to improved metabolic health, RCTs focusing on breakfast quality and timing are warranted.
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Luan D, Foster GD, Fisher JO, Weeks HM, Polonsky HM, Davey A, Sherman S, Abel ML, Bauer KW. Breakfast in the Classroom Initiative Does Not Improve Attendance or Standardized Test Scores among Urban Students: A Cluster Randomized Trial. J Acad Nutr Diet 2021; 122:1168-1173.e2. [PMID: 34923177 DOI: 10.1016/j.jand.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Breakfast in the Classroom (BIC), a common approach to implementing the federal School Breakfast Program, is advocated as a method to improve students' academic performance. However, the impacts of BIC on academic outcomes are unclear. OBJECTIVE To examine the effect of a BIC initiative which provided free, universal BIC on attendance and standardized test performance over 2.5 years, versus free universal breakfast served in the cafeteria before school, among students in an urban school district serving a low-income population. DESIGN Secondary analysis of data from a cluster randomized controlled trial conducted between 2013 and 2016; sixteen kindergarten through 8th grade public schools in Philadelphia, Pennsylvania were enrolled and randomized to condition. Baseline data for 1,362 4th through 6th grade students were provided by the school district. Midpoint data were collected after 1.5 years and endpoint data after 2.5 years. PARTICIPANTS/SETTING Schools were eligible if ≥50% of students qualified for free/reduced-priced meals, did not offer BIC, and received programming as part of the USDA's Supplemental Nutrition Assistance Program. Parents consented for their children to participate. INTERVENTION Intervention schools provided BIC and breakfast-related nutrition promotion activities. Control schools provided breakfast in the cafeteria before the school day. MAIN OUTCOME MEASURES Student attendance and standardized exam scores. STATISTICAL ANALYSES PERFORMED Weighted generalized estimating equations were used to evaluate differences in outcomes between conditions at midpoint and endpoint. RESULTS The BIC initiative did not impact attendance (Beta (SE) = 0.004 (0.06), P = 0.94) or standardized reading exam scores (Beta (SE) = 0.02 (0.06), P = 0.79) after 2.5 years. Students in BIC initiative schools had lower standardized math exam scores than those in control schools although this difference was small (Beta (SE) = -0.20 (0.07), P = 0.005). CONCLUSIONS BIC did not improve academic outcomes among students attending low-income, urban schools.
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Affiliation(s)
- Danny Luan
- Graduate student at the University of Michigan School of Public Health, Ann Arbor, MI at the time of this research. Mr. Luan is currently a medical student at Weill Cornell Medicine, New York, NY
| | - Gary D Foster
- WW International, New York NY and Adjunct Professor, Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA
| | - Jennifer O Fisher
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, Philadelphia PA
| | - Heidi M Weeks
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor MI
| | - Heather M Polonsky
- Study coordinator Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia PA at the time of this research. Ms. Polonsky is currently Associate Director of Evaluation, FoodCorps, Portland OR
| | - Adam Davey
- College of Health Sciences and Department of Behavioral Health and Nutrition, University of Delaware, Newark DE
| | | | - Michelle L Abel
- School Breakfast Policy Manager at The Food Trust, Philadelphia PA at the time of this research. Ms. Abel is currently a Program Manager at Children's Hospital of Philadelphia, Philadelphia PA
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor MI.
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Indriasari R, Nadjamuddin U, Arsyad DS, Iswarawanti DN. School-based nutrition education improves breakfast-related personal influences and behavior of Indonesian adolescents: a cluster randomized controlled study. Nutr Res Pract 2021; 15:639-654. [PMID: 34603611 PMCID: PMC8446687 DOI: 10.4162/nrp.2021.15.5.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 09/10/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES Many adolescents in developing countries skip breakfast. Innovative nutrition education (NE) strategies are needed to enhance knowledge and skills related to the breakfasts of adolescents in a low socioeconomic setting. The objective was to evaluate short- and long-term effects of a multi-strategy, school-based NE intervention on adolescents' breakfast-related personal influences and behaviors. SUBJECTS/METHODS An intervention study with a cluster randomized controlled trial design was conducted in 4 senior high schools in Makassar, Indonesia. The multi-strategy NE intervention was delivered for 3 months. Data were collected using a self-administered questionnaire and a 3-day breakfast recall (face-to-face interview). Wilcoxon, McNemar, and Mann-Whitney tests were used to determine intra- and intergroup differences. RESULTS Unlike knowledge, improvement was observed in attitude and self-efficacy scores in the intervention groups (IGs) (P < 0.01); however, no significant changes were observed in the control group (CG). More students showed improved motivation in the IG than in the CG (P > 0.05). Changes in breakfast frequency and macronutrient intake from breakfast were greater in the IG than in the CG (P < 0.05). CONCLUSIONS A multi-strategy NE intervention is effective in producing positive changes in breakfast-related attitude, self-efficacy, and motivation of adolescents from a low-middle socioeconomic setting. The intervention improved breakfast frequency and nutrient intake. This intervention has promise for sustaining the observed changes over the long-term.
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Affiliation(s)
- Rahayu Indriasari
- Department of Nutrition Science, Faculty of Public Health, Hasanuddin University, Makassar, South Sulawesi 90245, Indonesia.,Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON)-Pusat Kajian Gizi Regional (PKGR) Universitas Indonesia, DKI Jakarta 10430, Indonesia
| | - Ulfah Nadjamuddin
- Department of Nutrition Science, Faculty of Public Health, Hasanuddin University, Makassar, South Sulawesi 90245, Indonesia
| | - Dian Sidik Arsyad
- Department of Epidemiology, Faculty of Public Health, Hasanuddin University, Makassar, South Sulawesi 90245, Indonesia
| | - Dwi Nastiti Iswarawanti
- Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON)-Pusat Kajian Gizi Regional (PKGR) Universitas Indonesia, DKI Jakarta 10430, Indonesia.,Institute of Health Science of Kuningan, Kuningan, West Java 45561, Indonesia
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Breakfast Skipping, Weight, Cardiometabolic Risk, and Nutrition Quality in Children and Adolescents: A Systematic Review of Randomized Controlled and Intervention Longitudinal Trials. Nutrients 2021; 13:nu13103331. [PMID: 34684332 PMCID: PMC8539462 DOI: 10.3390/nu13103331] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 01/21/2023] Open
Abstract
Breakfast skipping increases with age, and an association with a high risk of being overweight (OW) and of obesity (OB), cardiometabolic risk, and unhealthy diet regimen has been demonstrated in observational studies with children and adults. Short-term intervention trials in adults reported conflicting results. The purpose of this systematic review was to summarize the association of breakfast skipping with body weight, metabolic features, and nutrition quality in the groups of young people that underwent randomized controlled (RCT) or intervention longitudinal trials lasting more than two months. We searched relevant databases (2000–2021) and identified 584 articles, of which 16 were suitable for inclusion. Overall, 50,066 children and adolescents were included. No studies analyzed cardiometabolic features. Interventions were efficacious in reducing breakfast skipping prevalence when multi-level approaches were used. Two longitudinal studies reported a high prevalence of OW/OB in breakfast skippers, whereas RCTs had negligible effects. Ten studies reported a lower-quality dietary intake in breakfast skippers. This review provides insight into the fact that breakfast skipping is a modifiable marker of the risk of OW/OB and unhealthy nutritional habits in children and adolescents. Further long-term multi-level intervention studies are needed to investigate the relationship between breakfast, nutrition quality, chronotypes, and cardiometabolic risk in youths.
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