A Systematic Review of the Association of Skipping Breakfast with Weight and Cardiometabolic Risk Factors in Children and Adolescents. What Should We Better Investigate in the Future?

PROTOCOL: Breakfast consumption, anthropometry, and nutrition-related outcomes in adolescents from low- and middle-income countries: Protocol for a systematic review and meta-analysis

Objectives This is the protocol for a Campbell systematic review. The objectives are as follows: The aim of this systematic review is to examine the scientific evidence available from low- and middle-income countries on the association of breakfast consumption habits and anthropometry/adiposity- and nutrition-related outcomes in adolescents aged 10-19 years old.

Associations of Eating Habits with Self-Rated Health and Life Satisfaction in Adolescents: A 42-Country Cross-Sectional Study

OBJECTIVE

The aim of this study was to explore the associations of eating habits with self-rated health and life satisfaction in adolescents using a multiple-country sample.

METHODS

Cross-sectional data from the Health Behavior in School-Aged Children (HBSC) 2013/2014 wave was used in this study. A self-reported questionnaire was used to collect data on independent variables including breakfast on weekdays, breakfast at weekends, and consumption of fruits, vegetables, sweets, and soft dirks. Outcomes included self-rated health and life satisfaction. Regression models were used to assess the associations between the independent variables and the two outcomes, separately, after controlling for covariates. Results were presented using odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Of all the study participants (aged 11-15 years), 50.8% were girls. Compared with no consumption of breakfast on weekdays, eating breakfast for five days had 1.22 times greater likelihood for improved self-rated health (OR = 1.22, 95% CI: 1.19-1.25, p < 0.001). Participants who ate breakfast for both days (OR = 1.41, 95% CI: 1.36-1.46, p < 0.001) and one day (OR = 1.12, 95% CI = 1.08-1.17, p < 0.001) were more likely to experience improved self-rated health compared to never eating breakfast at weekends. Five or more days for fruit and vegetable consumption resulted in better self-rated health (all p < 0.001). Similar results were found in terms of the associations of breakfast, fruit, and vegetable consumption with life satisfaction. For example, a higher frequency of fruit intake was associated with enhanced self-rated health (e.g., OR for more than once daily = 1.42, 95% CI: 1.34-1.51, p < 0.001) compared to no fruit consumption. Similarly, a higher-frequency vegetable intake, such as more than once daily (OR = 1.33, 95% CI: 1.26-1.39, p < 0.001), was associated with improved self-rated health.

CONCLUSIONS

Healthy eating habits, especially regular breakfast and a higher consumption of vegetables and fruit, are associated with better self-rated health and life satisfaction in school-aged children. Of note, the consumption of fruit would have the greatest impact on health and wellbeing outcomes. This study offers evidence that healthy eating habits can play a vital role in school-aged children's health and wellbeing, highlighting the practical significance of educating adolescents to develop healthy eating habits.

Association between breakfast skipping and psychosomatic symptoms among Canadian adolescents

This cross-sectional study aimed to examine the mediating roles of gender and substance use in the influence of breakfast skipping on psychosomatic symptoms. The study used data among a nationally-representative sample of 2855 Canadian adolescents who participated in the 2018 Health Behavior in School-aged Children (HBSC) survey. Sequential logistic regressions were used to estimate the associations between breakfast skipping and psychosomatic symptoms. Path analysis using a non-parametric bootstrapping technique tested the hypothesized mediating roles. Results showed that adolescents who skipped breakfast were 2.55 times more likely to report higher psychosomatic symptoms compared to non-breakfast skippers (AOR = 2.55; 95% CI = 1.75-3.82). The bootstrapping mediation models showed that breakfast skipping indirectly influenced psychosomatic symptoms through substance use and gender, accounting for 18.47% ( β = 0.0052, Boots 95% CI = 0.0025, 0.00730) and 10.70% ( β = 0.0091, Boots 95% CI = 0.0052, 0.0125), respectively, of the total effect. Our findings have important implications for targeted public and mental health interventions to address both breakfast skipping and psychosomatic symptoms among adolescents.  Conclusion: The study compellingly underscores the significance of incorporating gender-specific factors and substance use in understanding the correlation between breakfast skipping and psychosomatic symptoms. These insights hold importance for tailoring public health interventions to alleviate the prevalence of psychosomatic symptoms among adolescents by actively addressing breakfast skipping. What is Known: • Breakfast is considered the most important meal of the day due to its role in providing the brain with the energy necessary to enhance cognitive functions. • Adolescents commonly exhibit a prevalent lifestyle behaviour of skipping breakfast. What is New: • This study provides robust evidence supporting the association between breakfast skipping and elevated psychosomatic symptoms in adolescents. • Gender and substance use mediate this association, offering novel insights into the complex interplay that contributes to psychosomatic symptoms among this demographic group. • Longitudinal research is needed to unravel causal relationships and illuminate the underlying mechanisms of this intricate connection.

Associations between dietary behaviours and the mental and physical well-being of Swedish adolescents

AIMS

This study aims to investigate the association between dietary behaviours, overweight/obesity, and mental health and well-being among Swedish adolescents.

METHODS

Data from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey of 3692 adolescents aged ≈11, ≈13, and ≈15 years was analysed. We evaluated the prevalence and association of dietary behaviours, characterised by daily intake of fruits and vegetables, consumption of sugar-sweetened beverages (SSBs) and sweets once per week, and daily consumption of family meals and breakfast, with socioeconomic and demographic factors. Multivariate logistic regression models (adjusted and unadjusted) were then used to examine the relationship between dietary behaviours, overweight/obesity, and mental health and well-being including psychosomatic complaints, life satisfaction, and school-related pressure.

RESULTS

Boys were more likely to eat breakfast and have meals together with their family than girls, but their fruit and vegetable intake was lower compared to girls. Adolescents with lower socioeconomic status (low family affluence, families perceived 'not well-off' and two unemployed parents), single-parent households and twoforeign born parents were more likely to engage in poorer dietary behaviours. Daily breakfast, family meals, fruit and vegetable intake were positively associated with mental health and well-being. Specifically, daily family meals were linked to higher life satisfaction, fewer psychosomatic complaints, and reduced school-related pressure. Breakfast emerged as a beneficial dietary habit, associated with higher life satisfaction, and a lower likelihood of psychosomatic complaints, school-related pressure, and overweight/obesity. Fruit and vegetable consumption was consistently associated with better mental health and well-being while associations between SSBs and sweets were mixed.

CONCLUSIONS

Improving mental health and well-being, along with tackling the rising rates of mental illness and challenges related to overweight/obesity in adolescents constitute key public health priorities. Implementing policies that promote the intake of fruits and vegetables, reducing the consumption of SSBs and sweets, and emphasizing the value of having breakfast and sharing family meals could offer a cost-effective public health intervention.

Daily Duration of Eating for Children and Adolescents: A Systematic Review and Meta-Analysis

Time-limited eating is a dietary intervention whereby eating is limited to a specific window of time during the day. The usual eating windows of adults, and how these can be manipulated for dietary interventions, is well documented. However, there is a paucity of data on eating windows of young people, the manipulation of which may be a useful intervention for reducing obesity. This paper reviewed the existing literature on the eating windows of children and adolescents, aged 5-18 years, plus clock times of first and last intakes and variations by subgroup. Two databases (Medline and Embase) were searched for eligible papers published between February 2013 and February 2023, with forward searching of the citation network of included studies on Web of Science. Articles were screened, and data extracted, in duplicate by two independent reviewers. Ten studies were included, with both observational and experimental designs. Narrative synthesis showed large variations in eating windows with average values ranging from 9.7 h to 16.4 h. Meta-analysis, of five studies, showed a pooled mean daily eating window of 11.3 h (95% CI 11.0, 11.7). Large variations in eating windows exist across different study populations; however, the pooled data suggest that it may be possible to design time-limited eating interventions in paediatric populations aimed at reducing eating windows. Further high-quality research, investigating eating windows and subsequent associations with health outcomes, is needed.

Is time of eating associated with BMI and obesity? A population-based study

PURPOSE

Time-related eating patterns have been associated with metabolic and nutritional diseases such as obesity. However, there is a lack of representative studies on this subject. This study's aim was to assess the association between the timing of eating and obesity in a large and representative sample of the Brazilian adult population (POF 2008-2009 survey).

METHODS

Two days of adults' food diary (n = 21,020) were used to estimate tertiles of first and last meal intake times, eating midpoint, caloric midpoint time, and calories consumed from 18:00 h onwards. BMI was estimated and its values, as well as excess weight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) were used as outcomes. Multiple linear and logistic regressions were performed.

RESULTS

The first (β = 0.65, 95% CI 0.37-0.93) and last food intake time (β = 0.40, 95% CI 0.14-0.66), eating midpoint (β = 0.61, 95% CI 0.34-0.88) and calories consumed after 21:00 h (β = 0.74, 95% CI 0.32-1.16) and 22:00 h (β = 0.75, 95% CI 0.18-1.32) were positively associated with BMI. The likelihood of having excess weight or obesity was significantly higher in the third tertile of the first food intake time (OR = 1.28, 95% CI 1.13-1.45 and OR = 1.34, 95% CI 1.13-1.58, respectively), last food intake time (OR = 1.16, 95% CI 1.03-1.32; and OR = 1.18, 95% CI 1.00-1.41, respectively), eating midpoint (OR = 1.28, 95% CI 1.13-1.45; and OR = 1.35, 95% CI 1.14-1.59, respectively) and energy consumption after 21:00 h (OR = 1.33, 95% CI 1.10-1.59).

CONCLUSION

Chrononutrition meal patterns indicative of late meal intake were significantly associated with high BMI, excess weight and obesity in the Brazilian population.

Weight Loss Diets, Fads, and Trends

PURPOSE OF REVIEW

To review popular dietary trends and provide recommendations regarding validated dietary approaches for weight loss in the pediatric population.

RECENT FINDINGS

Like adults, children and adolescents trying to lose weight will succumb to diets promoted by the media. Many of these so-called "fad" diets tout unsupported claims for health but prove very difficult for long-term adherence. Since childhood is a pivotal time for establishing lifestyle habits, we need to provide practical dietary advice supported by scientific research. Studies suggest that emphasizing macronutrient balance while limiting both ultraprocessed foods and sugar-sweetened beverages can help our pediatric patients achieve and maintain a healthy weight. We review literature discouraging the use of restrictive dieting in the pediatric population and instead encourage a whole-foods-based, balanced dietary approach, along with regular physical activity. The goal is to support reasonable and sustainable lifestyle habits that ultimately allow children to establish lifelong health-promoting behaviors.

Associations of regular consumption of breakfast, lunch and dinner with Body Mass Index during adolescence: longitudinal findings by weight status among the Eating and Activity over Time 2010-2018 cohort

OBJECTIVE

To examine how the associations between meal consumption and BMI over 8 years differ by weight status in a sample of adolescents.

DESIGN

Longitudinal, population-based study. Breakfast, lunch and dinner consumption and BMI were self-reported. Linear regressions were used to examine how the associations between meal consumption and BMI differed by weight status.

SETTING

Adolescents in the Minneapolis/St. Paul metropolitan area.

PARTICIPANTS

Adolescents (n 1,471) were surveyed as part of the EAT 2010-2018 in 2009-2010 (Mage = 14·3 years) and 2017-2018 (Mage = 22·0 years).

RESULTS

The prevalence of regular breakfast, lunch and dinner consumption (≥ 5 times/week) ranged from 45 to 65 %, 75 to 89 % and 76 to 94 %, respectively, depending on weight status category. Among adolescents with a sex- and age-specific BMI < 15th percentile, regular consumptions of breakfast, lunch and dinner during adolescence were positively associated with BMI in emerging adulthood compared with irregular consumption of breakfast, lunch and dinner (<5 times/week) after adjustment for socio-demographic characteristics (β = 5·43, β = 5·39 and β = 6·46, respectively; all P-values <0·01). Among adolescents in the BMI 15-85th and 85-95th percentiles, regular consumptions of breakfast, lunch and dinner were positively associated with BMI but to a lesser extent (P-values <0·01). For participants with a BMI ≥ 95th percentile, regular consumptions of breakfast, lunch and dinner were positively associated with BMI, but the associations were not statistically significant (P-values > 0·05).

CONCLUSIONS

The relationship between meal consumption during adolescence and BMI in emerging adulthood differs by adolescent weight status. Future studies should investigate underlying factors related to meal consumption routines and BMI.

Meal patterns, including intermittent fasting - a scoping review for Nordic Nutrition Recommendations 2023

Introduction

'Meal patterns' refers to eating frequency, snacking, regularity, and timing. Here also including intermittent fasting. The effect of meal patterns on health is inconsistent and when updating the Nordic Nutrition Recommendations 2023 (NNR2023), summarizing the evidence is important.

Aims

To describe the evidence for the role of meal patterns on bodyweight, body composition, and cardiovascular risk factors (i.e. blood pressure and lipid- and glukose metabolism) in healthy people living with normal weight, overweight, or obesity in all age groups.

Methods

An initial search in PubMed found 481 reviews, of which 104 were identified based on titles. Of these, 47 were excluded based on title and abstracts. Of the remaining 57 reviews, 16 were included reporting search terms and inclusion/exclusion criteria. In addition, 8 reviews from reference list or known by authors were included. In total, 24 reviews were relevant. Cochrane Library was searched with no results.

Results

All reviews were rated low or critically low (AMSTAR 2). No consistent findings on eating frequency and body weight or composition were found in children/adolescents or adults. In snacking, mixed results were found, although among adults, some consistent results showed positive associations between snacking and body weight. In regularity, breakfast skipping showed mixed results in children/adolescents on body weight and composition. Among adults, randomized controlled trials on breakfast skipping showed a minor impact on improved weight loss. In prospective studies on timing, lower energy intake during late afternoon/evening was related to less body weight. Intermittent fasting reduced body weight but was not superior to continuous energy restrictions. Cardiovascular risk factors were assessed in a minority of the reviews, and despite some beneficial effects, the evidence was limited.

Conclusion

Given the overall low to critically low quality of the reviews, the evidence is limited and inconclusive. No consistent results providing evidence for setting recommendations for meal patterns were shown. In this regard, meal patterns may vary within the context of an energy balanced and nutritionally adequate diet.

The effects of early time restricted eating plus daily caloric restriction compared to daily caloric restriction alone on continuous glucose levels

Background

The median eating duration in the U.S. is 14.75 h, spread throughout the period of wakefulness and ending before sleep. Food intake at an inappropriate circadian time may lead to adverse metabolic outcomes. Emerging literature suggests that time restricted eating (TRE) may improve glucose tolerance and insulin sensitivity. The aim was to compare 24-h glucose profiles and insulin sensitivity in participants after completing 12 weeks of a behavioral weight loss intervention based on early TRE plus daily caloric restriction (E-TRE+DCR) or DCR alone.

Methods

Eighty-one adults with overweight or obesity (age 18-50 years, BMI 25-45 kg/m2) were randomized to either E-TRE+DCR or DCR alone. Each participant wore a continuous glucose monitor (CGM) for 7 days and insulin sensitivity was estimated using the homeostatic model assessment of insulin resistance (HOMA-IR) at Baseline and Week 12. Changes in CGM-derived measures and HOMA-IR from Baseline to Week 12 were assessed within and between groups using random intercept mixed models.

Results

Forty-four participants had valid CGM data at both time points, while 38 had valid glucose, insulin, HOMA-IR, and hemoglobin A1c (A1c) data at both timepoints. There were no significant differences in sex, age, BMI, or the percentage of participants with prediabetes between the groups (28% female, age 39.2 ± 6.9 years, BMI 33.8 ± 5.7 kg/m2, 16% with prediabetes). After adjusting for weight, there were no between-group differences in changes in overall average sensor glucose, standard deviation of glucose levels, the coefficient of variation of glucose levels, daytime or nighttime average sensor glucose, fasting glucose, insulin, HOMA-IR, or A1c. However, mean amplitude of glycemic excursions changed differently over time between the two groups, with a greater reduction found in the DCR as compared to E-TRE+DCR (p = 0.03).

Conclusion

There were no major differences between E-TRE+DCR and DCR groups in continuous glucose profiles or insulin sensitivity 12 weeks after the intervention. Because the study sample included participants with normal baseline mean glucose profiles and insulin sensitivity, the ability to detect changes in these outcomes may have been limited.

Healthy Snack Project: Improving Healthy Choices through Multidisciplinary Food Education Actions

School is one of the main settings where it is useful to guarantee health promotion actions, as it is well known that diet and eating habits that are shaped in the early stages of life are maintained through adulthood. The objective of this study was to carry out the "Healthy Snack" project to promote nutritional education in primary schools in the Province of Belluno in the 2022-2023 school year, in which 925 students were enrolled, and to evaluate the intervention in terms of changes in eating habits during their school breaks. Following the workshops performed by the healthcare workers (HCWs), medals were awarded, taking into account the quality of the participating students' mid-morning snacks, considering the food pyramid. The results collected in the annual survey period were related to the type and quantity of snacks consumed at school, and allowed students to gain a final score, comparing the period before and after the educational intervention to demonstrate the effectiveness of the actions promoted by HCWs and the increased nutritional quality of meals. In light of this evidence, public health strategies must continue to emphasize the importance of implementing health promotion interventions and actions aimed at children in order to prevent weight gain in this age group, and the potential development of cardiometabolic pathologies over their lifetime.

Breakfast Skipping and Associated Factors Among Jordanian University Students

Background

Although breakfast skipping among university students is a significant concern, its prevalence and the contributing factors among university students have received little attention in the literature. This study aims to determine the prevalence of skipping breakfast among Jordanian university students and examine the associated factors and variations in rates of skipping breakfast by day of the week.

Materials and Methods

A cross-sectional study was conducted among undergraduate students between March and May 2022 through a self-questionnaire. A convenience sample of 891 students was chosen at four Jordanian public universities. The data were analyzed using descriptive and inferential statistics.

Results

The prevalence of skipping breakfast among university students was 66%. The reasons for skipping breakfast were having no time due to oversleeping and having no feeling of hunger (59% for both), followed by having no energy to prepare the breakfast and making no difference (49% and 48%), and not being able to afford to eat or buy breakfast (19%). There is a strong correlation between eating fast food and skipping breakfast. With whom the student eats breakfast is significantly associated with breakfast skipping, revealing that the highest percentages of skipping occur with friends. About 63% of students skipped breakfast through university days compared with 37% on the weekend, while 37% of them had breakfast through university days compared with 67% on the weekend.

Conclusions

A high percentage of university students in Jordan skip breakfast. More attention should be paid to correlating factors and developing interventions to help students adhere to the breakfast.

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.

No food for thought-How important is breakfast to the health, educational attainment and wellbeing of school-aged children and young people?

There have been reports from teachers of pupils in the United Kingdom arriving at school hungry. Poor nutritional intake during childhood can increase the risk of developing both short- and long-term health problems. Breakfast consumption has been associated with several outcomes including better diet quality and healthier weight status. Nevertheless, skipping breakfast is a frequent behaviour in young people, particularly adolescents, and those from lower socio-economic groups, who are less likely to meet dietary recommendations and nutritional targets. The aim of this narrative review is to explore the contribution of breakfast consumption at home or at school and the impact of breakfast skipping on nutrient intakes in school-aged children (aged 4-18 years), and their effect on weight and cardiometabolic health. We will also summarise evidence for a link with cognitive function and educational attainment. A broadly positive effect of breakfast intake on diet quality, weight status and school-related outcomes was found in the literature, although inconsistencies in findings and methodological limitations within the evidence base are notable. Further research is warranted to better understand impact of breakfast intake and school breakfast provision on longer-term learning, educational attainment and health outcomes. This also needs to consider the cost benefit, type of breakfast and any unintended consequences such as encouraging multiple breakfasts. Breakfast consumption could improve the nutritional intakes of the most vulnerable young people and may help to address inequalities in educational outcomes at least in the short term.

The path between breakfast eating habit, sleep duration and physical activity on obesity status: An epidemiological study in schoolchildren

Background: Although the literature suggests that skipping breakfast, insufficient sleep, and reduced physical activity are associated with childhood obesity their co-influence and their in-between interactions on weight status have rarely been studied. Aim: To examine the co-influence of breakfast eating habits, sleep duration, and physical activity on the weight status of children 10-12 years old from several schools of Greece. Methods: A cross-sectional study was conducted on 1688 students in Greece, during 2014-2016. Children's Body Mass Index (BMI) was calculated and classified according to the International Obesity Task Force (IOTF) classification. Logistic regression models and path analysis were used. Results: Overweight/obesity prevalence was higher in boys (32.5% vs. 20.4%; p < 0.001). Average sleep duration decreased the odds of overweight/obesity [OR (95% CI): 0.86 (0.76, 0.97)] independently of the frequency of breakfast habit. Interaction between sleep duration with breakfast habit (p = 0.002) and physical activity (p < 0.001) was observed. Path analysis showed a negative association of BMI with sleep duration (standardized beta = -0.095, p < 0.001). A third-order interaction between breakfast habit, sleep duration, and physical activity revealed that daily breakfast eating along with adequate sleep and moderate/adequate physical activity levels, decreased the odds of over-weight/obesity by 55% [OR 0.45, 95% CI (0.27, 0.72)]. Conclusion: Although sleep duration is inversely associated with weight status independently of breakfast habit, the co-influence of adequate sleep duration with frequent breakfast eating and moderate/adequate physical activity seems to be a profoundly higher associated as a result of synergy against childhood obesity.

Validation of the Childhood Family Mealtime Questionnaire in Mexican Adolescents with Obesity and Their Caregivers

BACKGROUND

Childhood obesity is a significant public health concern in Mexico, with far-reaching implications for the nation's healthcare system and economy. In light of this challenge, our study sought to validate the Childhood Family Mealtime Questionnaire (CFMQ) in Mexican adolescents living with obesity and their primary caregivers.

METHODS

A sample of 56 adolescents ages 13 to 17 years and their primary caregivers from one pediatric obesity clinic participated in the study. We conducted a comprehensive assessment of the CFMQ's consistency, reliability, and construct validity among all participants. Internal consistency was determined using Cronbach's α, and the questionnaire's reliability was assessed through test-retest and intraclass correlation coefficients. Construct validity was assessed through an exploratory factor analysis.

RESULTS

Our findings confirmed strong internal consistency and reliability for both adolescents and caregivers. Construct validity was established through exploratory factor analysis, refining the questionnaire while preserving its original seven dimensions. This validation of the CFMQ highlights its applicability in evaluating family mealtime experiences in this context, providing valuable insights into the dynamics that influence adolescent nutrition and health.

CONCLUSION

The CFMQ proves to be a reliable tool for assessing family mealtime experiences in Mexican adolescents living with obesity and their caregivers who seek care at third-level public hospitals.

Chrononutrition and metabolic health in children and adolescents: a systematic review and meta-analysis

CONTEXT

Obesity has emerged as a global health issue for the pediatric population, increasing the need to investigate physiopathological aspects to prevent the appearance of its cardiometabolic complications. Chrononutrition is a field of research in nutritional sciences that investigates the health impact of 3 different dimensions of feeding behavior: regularity of meals, frequency, and timing of food intake.

OBJECTIVE

We carried out a systematic review and meta-analysis to investigate the association between chrononutrition in children and adolescents and the risk of overweight/obesity or a cluster of metabolic abnormalities related to glucose and lipid metabolism, blood pressure, and cardiovascular disease risk.

DATA EXTRACTION

A literature search was performed using PubMed, EMBASE, and The Cochrane Library for relevant articles published before August 2022.

DATA ANALYSIS

A total of 64 articles were included in the narrative synthesis (47 cross-sectional and 17 cohort studies), while 16 studies were included in the meta-analysis. Meta-analysis showed that non-daily breakfast consumers (≤6 d/wk) had a higher risk of overweight/obesity (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.08-1.82] compared with daily breakfast eaters (7 d/wk). Similarly, irregular breakfast consumption (only 0-to-3 times/wk) increased the risk of abdominal obesity (waist-to-height ratio ≥ 0.5) compared with regular consumption (5-to-7 times/wk) (OR, 1.38; 95% CI, 1.26-1.49). There was evidence to suggest that a regular frequency of meal consumption (≥4 times/d) is preventive against overweight/obesity development compared with fewer meals (≤3 times/d) (OR, 0.83; 95% CI, 0.70-0.97). In the narrative synthesis, snacking habits showed controversial results, while food timing was the most understudied dimension.

CONCLUSION

Overall, our data indicate a potential implication of chrononutrition in affecting pediatric metabolic health; however, the evidence of this association is limited and heterogeneous. Further prospective and intervention studies with a consistent approach to categorize the exposure are needed to elucidate the importance of chrononutrition for pediatric metabolic health.

Trend in Breakfast Consumption among Primary School Children in Italy

Eating breakfast daily improves cognitive function, may contribute to learning and academic performance in children and can decrease the risk of childhood obesity. The aim of this study was to analyse how breakfast consumption changed in the period from 2008/9 to 2019 in Italy among children aged 8-9 years old participating in the OKkio alla SALUTE surveys and to explore the associations with some socio-demographic and lifestyle factors. Information about children's daily breakfast consumption (adequate, inadequate, and no breakfast) and the socio-demographic characteristics of the children and their mothers was collected through four questionnaires addressed to parents, children, teachers and head teachers. Data were analysed for the 272,781 children from 21 Italian regions from 2008/9 to 2019. The prevalence of adequate breakfast decreased from 60.7% in 2008/9 to 55.7% in 2019 and no breakfast from 10.9 to 8.7%; conversely, inadequate breakfast increased from 28.4 to 35.6%. Logistic regression models showed that the occurrence of inadequate or no breakfast consumption was significantly higher among girls, children living in the southern regions and children with less educated mothers. These findings highlight the need for effective interventions to increase daily breakfast consumption and its adequacy among children.

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

Objective

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

Methods

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

Results

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

Conclusion

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

Enhancing cardiometabolic health through physical activity and breakfast manipulations in children and adolescents: good for humans, good for the planet

The human health benefits of cardiometabolic disease prevention can be accompanied by planetary co-benefits. Focusing efforts towards young people, including children and adolescents, is conducive to disease prevention. In the context of cardiometabolic disease prevention, this review paper critically summarises the available literature on the acute cardiometabolic responses to physical activity and breakfast manipulations among young people. Given the seriousness of global climate change, which will disproportionally affect our younger generations, this review paper offers new insights into the inherent interactions between child-adolescent behaviour and cardiometabolic health from an environmental sustainability perspective to aid climate change mitigation efforts, including exploring future research avenues. A growing evidence base suggests acute moderate- to high-intensity exercise bouts can attenuate postprandial plasma glucose, insulin and triacylglycerol concentrations for up to 24-48 h in young people. Whether accumulating physical activity throughout the day with short, frequent bouts promotes cardiometabolic risk marker attenuations is unclear. Breakfast consumption may enhance free-living physical activity and reduce glycaemic responses to subsequent meals for a possible additive impact. If repeated habitually, attenuations in these cardiometabolic risk factors would be conducive to disease prevention, reducing the greenhouse gas emissions associated with disease diagnosis and treatment. To progress current understanding with high public health and planetary relevance, research among samples of 'at risk' young people that span cellular-level responses to ecologically valid settings and address human and planetary health co-benefits is needed. Indeed, certain physical activity opportunities, such as active travel to school, offer important direct co-benefits to humans and planetary health.

Eating Behavior and Factors of Metabolic Health in Primary Schoolchildren: A Cross-Sectional Study in Greek Children

Childhood obesity has been associated with altered blood lipids and bad eating habits. In this cross-sectional study, we assessed cardiorespiratory fitness and metabolic health markers in regard to weight status and dietary habits in schoolchildren. In 134 children (6-11 years), we conducted: (1) Anthropometry, namely z-score BMI (z-BMI), waist-to-height ratio (WHtR), and body composition analysis. (2) Measurements of handgrip strength (HGS), resting metabolic rate (RMR) and VO2max. (3) Quantification of blood lipids and antioxidant vitamins A, E, C. (4) Eating breakfast assessment. About 35% of children were overweight/obese. The z-BMI positively correlated with WHtR (r = 0.637, p < 0.001), and adversely correlated with fat-free mass (r = -0.728, p < 0.001) and vitamin E (r = -0.286, p < 0.001). RMR and VO2max were greater in normal weight children compared to those with overweight/obesity (p < 0.001). HGS did not differ between these groups, but was negatively correlated with dyslipidemia as shown by TG/HDL-C ratio (r = -0.224, p = 0.037). According to regression analysis, eating breakfast routinely at home was positively associated with RMR and adversely associated with z-BMI. Hence, regular breakfast consumption at home may improve RMR in kids. Cardiorespiratory fitness and physical strength are key modulators of metabolic health in Greek children added to a social determinant of health i.e., eating breakfast at home.

A lifestyle pattern characterised by high consumption of sweet and salty snacks, sugar sweetened beverages and sedentary time is associated with blood pressure in families at risk for type 2 diabetes mellitus in Europe. The Feel4Diabetes Study

BACKGROUND

Individuals from families at high-risk for type 2 diabetes mellitus (T2DM) are also at high risk for hypertension (HTN) and cardiovascular disease. Studies identifying lifestyle patterns (LPs) combining dietary, physical activity or sedentary variables and examining their possible role with respect to developing blood pressure (BP) are limited. The present study aimed to examine the association of different LPs with BP levels in families at high risk for T2DM in Europe.

METHODS

In total, 1844 adults (31.6% males) at high-risk for T2DM across six European countries were included in this cross-sectional study using data from the baseline assessment of the Feel4Diabetes Study. BP measurements and dietary and physical activity assessments were conducted, and screen times were surveyed. LPs were revealed with principal component analysis of various data regarding diet, physical activity, screen time and smoking.

RESULTS

Three LPs were identified. LP3 (high consumption of sweet and salty snacks, sugar sweetened soft drinks and juices, and high amount of screen time) was positively associated with diastolic BP (B, 0.52; 95% confidence interval = 0.05-0.99) and the existence of HTN (odds ratio = 1.12; 95% confidence interval = 1.00-1.25). Participants in the highest tertile of LP3 spent mean 3 h of screen time, consumed 1.5 portions of sweet and/or salty snacks and 1 L of soft drinks on a daily basis, were associated with 12% higher risk of HTN.

CONCLUSIONS

Focusing on the combination of eating and lifestyle behaviours may more accurately identify, and therefore guide preventive measures tailored to the specific needs of high-risk populations.

Prevalence of Obesity and the Factors Associated with Low Obesity Awareness among Urban Adolescents in Harare, Zimbabwe

Obesity is a global health problem. In developing countries such as Zimbabwe, obesity is both an emerging health problem and a grey area, particularly among adolescents. This study assessed the prevalence of obesity and factors associated with low obesity awareness among adolescents.

METHOD

A cross-sectional survey was performed using an interviewer-administered questionnaire. The participants were 423 adolescents aged 14-19 years recruited from 10 schools in Harare using a stratified random sampling technique. Data were analyzed using SPSS software (version 23) and binary logistics regression was used to examine the factors associated with low obesity awareness. The level of significance was set at p < 0.05.

RESULTS

The median± IQR age was 16 (14-18) years, and overweight and obesity affected 15.8% of the participants with higher proportions among girls (73.1%, p = 0.002). Low obesity awareness was observed in 27.1% of the adolescents with a higher proportion among girls (67.0%, p = 0.001), 14-16-year-olds (51.3%, p = 0.317), and obese adolescents (56.7%, p = 0.001). Significant factors associated with low obesity awareness were household heads lacking formal education [OR = 9.41 (2.20-40.36), p = 0.003] and inadequate (poor) food habits [OR = 2.58 (1.33-5.01), p = 0.005].

CONCLUSIONS

Our study showed that adolescents had different obesity awareness levels and diverse perceptions in terms of obesity causes, and a range of potential solutions. Obesity awareness and nutrition education should address adolescents' poor eating habits while taking cognizance of the different education levels of household heads.

Childhood Obesity and Plasma Micronutrient Deficit of Chilean Children between 4 and 14 Years Old

Objective: To analyze the nutritional status and plasma levels of vitamins and minerals in a cohort of Chilean children between 4 and 14 years old from three cities in Chile (Santiago, Antofagasta, and Concepcion). Design: This is a descriptive analysis of micronutrient levels in Chilean children as it relates to obesity and food consumption. Setting: This study included 1235 children from schools in Santiago (central area), Antofagasta (northern area), and Concepcion (southern area) in Chile. Results: Plasma levels of micronutrients revealed deficiencies in children from all these cities. Copper (26.4%) and calcium (33.0%) deficiencies were found in the children from Antofagasta, whereas iron (26.7%) and zinc (20.8%) deficiencies were found in the children from Concepcion and Santiago, respectively. The percentage of children with vitamin D deficiencies was exceptionally high in all cities (over 78%). The analysis of micronutrients and nutritional status revealed that vitamin D deficiencies were significantly higher (p = 0.02) in overweight children, particularly in Antofagasta. In the analysis of the nutritional status of children and their food consumption habits, the proportion of overweight and obesity was significantly higher (p = 0.001) in children that skipped breakfast compared to children that did not. Finally, children from low socioeconomic levels were significantly more overweight and obese compared to children from high socioeconomic levels (p < 0.05). Conclusions: this is the first study to describe plasma levels of micronutrients in Chilean children and adolescents. High percentages of obesity, overweight, and vitamin D deficiency were detected in children. These results are of significant relevance to future public health policies in Chile.

The effect of nutritional and lifestyle education intervention program on nutrition knowledge, diet quality, lifestyle, and nutritional status of Croatian school children

Introduction

Nutrition education during adolescence has proven effective in increasing knowledge, attitudes, and practices in the diet. The Mediterranean diet has proven health benefits and is proposed as a model of a sustainable diet that is beneficial for health and the environment. Its promotion with the educational program can have a significant effect on improvements in nutrition knowledge, diet quality, and nutritive status of adolescents for their healthy adulthood.

Objective

This study aimed to investigate the effect of the educational program on the nutrition knowledge, diet quality, lifestyle, and nutritional status of school children from the littoral part of Croatia.

Methods

An education-based intervention study was carried out on 2,709 schoolchildren aged 10–12 years (educated/control group: 2617/92). The questionnaire about sociodemographic, anthropometric, dietary, physical activity, screen time, sleep habits, and nutrition knowledge was assessed at the baseline and after a 6- to 9-month follow-up for the medium-term effect of education. Nutrition knowledge was provided after 3 weeks for the short-term education effect assessment.

Results

Educated schoolchildren achieved a significant increase in nutrition knowledge (+75.5%), expressed as a short-term effect of the education and maintained at the 6- to 9-month follow-up (+66.8%, p &lt; 0.001). Follow-up of children significantly improved their nutritional status (underweight −56.6%, normal weight 24.8%, overweight −22.1%, and obesity −57.5%) and physical activity engagement (+13.2%). The proportion of children with a diet highly adhering to the Mediterranean diet significantly doubled (+105.0). Those children with the highest nutrition knowledge at the follow-up significantly improved their nutritional status (+218.9%), participated in organized sports (+204.7%), and had a diet that highly adhered to the MD (+291.8%).

Conclusion

A significantly good medium-term effect of education-based nutrition and lifestyle intervention program on nutrition knowledge, diet quality, lifestyle, and nutritional status of schoolchildren aged 10–12 years was shown. The educational program promoted a Mediterranean diet and lifestyle as a healthy and sustainable way of living, important for children's future health and wellbeing. New research-based approaches are needed for making children more aware and capable of handling the complexity of sustainable living.

Obesity, overweight and hyperglycemia among primary school children in a low-middle income country with a multiethnic population

Objective

The number of children with cardiovascular risk factors is increasing steadily. However, limited data are available on the prevalence of overweight, obesity, and hyperglycemia among children in low-middle-income countries with multiethnic populations. Therefore, we assessed these factors in a school-based survey in Suriname, a low-middle-income country.

Methods

We invited pupils of 5th and 6th grade visiting the primary school to participate in this survey. We used a questionnaire and face to face interviews, and conducted measurements to collect data on biological factors (ethnicity, sex, length, weight, waist circumference, and fasting blood glucose levels), behavior (frequency of physical activity, breakfast, bedtime, screentime), consumption (fruit and vegetables, snack, dairy products) and social factors (parental education, living area).

Results

Overall, the percentage of children with overweight was 13.9%, obesity 13.3% and for elevated fasting blood glucose level (> 6 mmol/L) 4.5%. In the investigated group of individuals, obesity and overweight were associated with sex (girls showed a lower OR of 0.54 [95%CI: 0.39-0.75] for obesity), ethnicity (Javanese 2.1, 1.5-3.0 for overweight and 5.0, 3.1-8.2 for obesity, Maroon 2.2, 1.2-4.1 and Mixed ethnicity 1.7, 1.1-2.6, for obesity compared to Hindustani), behavior (Skip Breakfast: 1.4, 1.2-1.7, physical activity: 0.8, 0.7-0.9) and maternal education level (high 1.7, 1.0-2.7). Children with elevated fasting blood glucose levels showed an association with obesity (1.8, 1.2-2.7) and waist circumference (1.02, 1.01-1.03).

Conclusion

The results show that there is a high prevalence for overweight, obesity and elevated fasting blood glucose among children in Suriname. Furthermore, during childhood ethnicity is associated with obesity and overweight. We suggest that the modifiable risk factors such as BMI, WC, behavior, consumption are interesting for early intervention in children in a developing country.

Breakfast Quality of Preschool-aged Canadian Children

Purpose: To investigate the breakfast quality of preschool-aged children through a comparison of their energy and nutrient intakes at breakfast to published benchmarks for a balanced breakfast.Methods: Dietary data were collected for 163 children aged 3-5 years enrolled in the Guelph Family Health Study using one parent-reported online 24-hour recall and analyzed for energy and nutrient intakes. Breakfast quality was assessed by tallying the frequency of participants whose nutrient and energy intakes at their breakfast meal met the recommendations for a balanced breakfast established by the International Breakfast Research Initiative (IRBI).Results: Almost all participants (98%) consumed breakfast, and most participants (82.5%) met the energy IRBI recommendation. However, the majority of participants did not meet the IRBI recommendations for breakfast intakes of most macronutrients and micronutrients. In particular, fewer than 25% of participants met the IRBI recommendations for breakfast intakes of dietary fibre, niacin, folate, vitamin C, calcium, potassium and zinc.Conclusions: Almost all preschool-aged children in this study consumed breakfast, but the nutritional quality of their breakfast did not meet recommendations for most nutrients. These results can inform nutrition education and intervention programs for children that aim to improve the nutritional quality of breakfast.

Impacts of parental breakfast consumption literacy on children's home breakfast consumption

Aim: This study aimed to investigate the relationship between parental breakfast consumption literacy and their children's home breakfast consumption. Methods: This study, employing a cross-sectional design, conducted in September 2021, consisted of a total of 275 children aged 6-7 years and 275 parents. One-way analysis of variance and independent-sample t-test were applied to compare children's home breakfast consumption amongst sub-groups. The relationship between parental breakfast consumption literacy and children's home breakfast consumption was assessed utilising multiple linear regression models controlling for socio-demographic factors. All data were analysed by the software of R Commander. Results: Parents with inadequate breakfast consumption literacy had less children's home breakfast consumption (p = 0.006), such relationship (p = 0.002, 95% CI: 4.76-7.65) had significance controlling for socio-demographic factors. Living in urban areas (p = 0.006, 95% CI: 6.43-9.92), parental unemployment (p = 0.004, 95% CI: 5.47-9.43), and low parental educational level (p = 0.005, 95% CI: 2.34-4.76) were significantly associated with less children's home breakfast consumption. Conclusion: Adequate parental breakfast consumption literacy was associated with more children's home breakfast consumption. Parental-based health education interventions show promise in promoting home breakfast consumption in the family setting. Residential status, parental level of education, and parental employment were associated with children's home breakfast consumption. Future research should understand more about the experiences and contexts of children's home breakfast consumption within the family environments, with a focus on employing qualitative approaches.

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.

Assessing policies to reduce adolescent overweight and obesity: Insights from a system dynamics model using data from the Health Behavior in School-Aged Children study

Adolescent overweight and obesity (AdOWOB) in Europe has proven to be a persistent and complex problem, and appropriate systems methods may help in evaluating potential policy options. This paper describes the development of a system dynamics model of AdOWOB as part of the EU-funded CO-CREATE project. The model was developed using literature and data from the Health Behavior in School-Aged Children (HBSC) study across 31 European countries. We identified 10 HBSC variables that were included as direct or indirect drivers of AdOWOB in the dynamic model, seven at the level of the individual, and three related to the social environment. The model was calibrated to 24 separate cases based on four gender and perceived wealth segments for each of the five CO-CREATE countries (The Netherlands, Norway, Poland, Portugal, and the UK) and for Europe overall. Out of 10 possible intervention points tested, exercise, fruit, life dissatisfaction, school pressure, and skipping breakfast were identified as the top five most influential ones across the 24 cases. These model-based priorities can be compared with the policy ideas suggested by the CO-CREATE adolescents.

Weight Status Among Minnesota Hispanic or Latino/a Youth: An Exploration of Protective Factors

PURPOSE

Pediatric obesity disproportionately impacts Hispanic or Latino/a adolescents. Culturally appropriate family-based behavioral initiatives to improve weight status are warranted. The purpose of this research was to determine prevalence rates and identify protective factors associated with having overweight/obesity (body mass index ≥ 85^th percentile) to inform Hispanic or Latino/a-targeted behavioral intervention development.

DESIGN

Secondary data analyses of a population-based statewide survey.

SETTING

Minnesota public high schools.

PARTICIPANTS

Male (n = 2,644) and female (n = 2,798) Hispanic or Latino/a 9^th and 11^th graders (N = 5,442).

MEASURES

Obesity-related behaviors (meeting fruit and vegetable [F&V] and physical activity [PA] recommendations), family caring, family country/region of origin, and weight status.

ANALYSIS

Stepwise logistic regression models (F&V, PA), stratified by biological sex, were used to identify protective factors of overweight/obesity.

RESULTS

The overall prevalence of meeting F&V and PA recommendations was 11.0% and 11.8%, respectively. Meeting F&V recommendations was not protective against overweight/obesity in either sex. Yet, males and females who met PA recommendations had significantly lower odds of having overweight/obesity (p < .05). In F&V and PA models, family caring was protective against overweight/obesity in females (p < .05), and family country/region of origin was protective against overweight/obesity in both sexes (p < .05).

CONCLUSION

Findings illustrate a need for obesity prevention initiatives for Hispanic or Latino/a youth. More research is needed to understand the protective nature of family caring and country/region of origin.

The socioecological correlates of meal skipping in community-dwelling older adults: a systematic review

CONTEXT

Meal skipping may contribute to nutrient deficiency across the lifespan. Multiple socioecological factors have been identified as correlates of meal skipping in adolescents and adults, but evidence in older adults is limited.

OBJECTIVE

To determine the socioecological correlates of meal skipping in community-dwelling older adults.

DATA SOURCE

Embase, PsycINFO, CINAHL, and MEDLINE electronic databases were systematically searched from inception to March 2021.

DATA EXTRACTION

A total of 473 original research studies on socioecological factors and meal skipping among community-dwelling adults aged ≥65 years were identified. Title, abstract, and full-text review was performed by 2 reviewers independently, and a third reviewer resolved disagreements. A total of 23 studies met our inclusion criteria. Data were extracted by 1 reviewer from these studies and independently verified by another. The Newcastle-Ottawa Scale was used to assess methodological quality.

DATA ANALYSIS

The frequency of meal skipping in included studies ranged between 2.1% and 61%. This review identified 5 domains of socioecological correlates associated with meal skipping in older adults: sociodemographic, behavioral, biomedical, psychological, and social.

CONCLUSION

Understanding the factors associated with meal skipping in older adults can inform the development of targeted interventions to improve nutrition and health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42021249338.

Breakfast Quality and Insulin Resistance in Spanish Schoolchildren: A Cross-Sectional Study

Background: Breakfast has traditionally been considered one of the most important meals of the day; however, there is little evidence for the influence of breakfast quality and insulin resistance (IR). This study aimed to assess the quality of breakfast in a group of schoolchildren, and its association with IR. Methods: A cross-sectional study with 852 children (8−13 years) was carried out. Fasting plasma glucose, insulin and anthropometric parameters were measured. A three-day dietary record was used to assess their diet and to calculate the Breakfast Quality Index (BQI). The sample was divided into tertiles according to the BQI (tertile 3: better breakfast quality). The homeostatic model was used to assess insulin resistance (HOMA-IR), and IR was defined as HOMA-IR > 3.16. Results: The prevalence of IR was 5.2%. The mean BQI score was 4.50 ± 1.25, and boys had lower scores than girls. Children in the BQI tertile 3 had a better global diet quality. In boys, being in the BQI tertile 3 was associated with a lower risk of IR (OR [95% CI]: 0.10 [0.01−0.77], p < 0.05). Conclusions: A higher-quality breakfast was associated with better overall diet quality and a lower risk of IR, especially in boys.

Multilevel correlates of abdominal obesity in adolescents and youth living with HIV in peri-urban Cape Town, South Africa

BACKGROUND

Chronic non-communicable disease comorbidities are a major problem faced by people living with HIV (PLHIV). Obesity is an important factor contributing to such comorbidities and PLHIV face an elevated risk of obesity. However, there is data paucity on the intersection of obesity and HIV in adolescents and youth living with HIV (AYLHIV) in sub-Saharan Africa. We therefore aimed to investigate the prevalence of abdominal obesity and associated multilevel factors in AYLHIV in peri-urban Cape Town, South Africa.

METHODS

We conducted a cross-sectional study enrolling AYLHIV aged 15-24 years attending primary healthcare facilities in peri-urban Cape Town in 2019. All measures, except for physical examination measures, were obtained via self-report using a self-administered electronic form. Our outcome of interest was abdominal obesity (waist-to-height ratio ≥ 0.5). We collected individual-level data and data on community, built and food environment factors. Data was summarized using descriptive statistics, stratified by obesity status. Multilevel logistic regression was conducted to investigate factors associated with abdominal obesity, adjusted for sex and age.

FINDINGS

A total of 87 participants were interviewed, 76% were female and the median age was 20.7 (IQR 18.9-23.0) years. More than two fifths had abdominal obesity (41%; 95% CI: 31.0-51.7%), compared to published rates for young people in the general population (13.7-22.1%). In multilevel models, skipping breakfast (aOR = 5.42; 95% CI: 1.32-22.25) was associated with higher odds of abdominal obesity, while daily wholegrain consumption (aOR = 0.20; 95% CI: 0.05-0.71) and weekly physical activity (aOR = 0.24; 95% CI: 0.06-0.92) were associated with lower odds of abdominal obesity. Higher anticipated stigma was associated with reduced odds of obesity (aOR = 0.58; 95% CI: 0.33-1.00). Land-use mix diversity (aOR = 0.52; 95% CI: 0.27-0.97), access to recreational places (aOR = 0.37; 95% CI: 0.18-0.74), higher perceived pedestrian and traffic safety (aOR = 0.20; 95% CI: 0.05-0.80) and having a non-fast-food restaurant within walking distance (aOR = 0.30; 95% CI: 0.10-0.93) were associated with reduced odds of abdominal obesity. The main limitations of the study were low statistical power and possible reporting bias from self-report measures.

CONCLUSIONS

Our findings demonstrate a high prevalence of abdominal obesity and highlight multilevel correlates of obesity in AYLHIV in South Africa. An intersectoral approach to obesity prevention, intervening at multiple levels is necessary to intervene at this critical life stage.

Distribution of energy and macronutrient intakes across eating occasions in European children from 3 to 8 years of age: The EU Childhood Obesity Project Study

PURPOSE

We aimed to characterize the distribution of energy and macronutrient intakes across eating occasions (EO) in European children from preschool to school age.

METHODS

Data from 3-day weighed food records were collected from children at ages 3, 4, 5, 6 and 8 years from Belgium, Germany, Italy, Poland and Spain. Food intakes were assigned to EO based on country-specific daytimes for breakfast, lunch, supper and snacks (morning, afternoon). The average energy and nutrient intakes were expressed as percentage of total energy intake (%E). Nutrients were additionally expressed as percentage per EO (%E_EO). Foods were assigned to food groups; variation in intake was calculated via coefficient of variation (CV). We analyzed age trends in diurnal intake using mixed-effects beta regression.

RESULTS

The 740 healthy children included in the analysis consumed the largest proportion of daily energy at lunch (31%E ± 8, M ± SD) and supper (26%E ± 8), followed by breakfast (19%E ± 7) and snacks [afternoon (16%E ± 8); morning (8%E ± 7)], with the most variable intake at morning snack (CV = 0.9). The nutrient composition at lunch and supper was highest for fat (36 ± 9%E_Lunch; 39 ± 11%E_Supper) and protein (18 ± 5%E_Lunch; 18 ± 6%E_Supper) and at breakfast and snacks for carbohydrates (54 ± 12%E_Breakfast; 62 ± 12%E_Snacks). High-sugar content foods were consumed in relatively large proportions at breakfast and snacks. Food intakes varied significantly with age, with lower snack intakes at later ages (p < 0.001).

CONCLUSION

Possibly unhealthy EOs with high-fat intakes and high-sugar-content foods were observed. Changes in nutrient composition of EOs may be beneficial for health.

TRIAL REGISTRY

ClinicalTrials.gov: NCT00338689; 19/June/2006.

Skipping Breakfast and Eating Breakfast Away From Home Were Prospectively Associated With Emotional and Behavioral Problems in 115,217 Chinese Adolescents

BACKGROUND

Breakfast is deemed the most important meal of the day. We examined the prospective associations of breakfast habits with emotional/behavioral problems in adolescents and potential effect modification.

METHODS

115,217 Primary 6 students (United States Grade 6; mean age, 11.9; standard deviation [SD], 0.59 years) who attended the Student Health Service of Department of Health in Hong Kong in 2004/05, 2006/07, 2008/09 were followed till Secondary 6 (United States Grade 12). Emotional/behavioral problems were biennially examined using Youth Self-Report since Secondary 2 (United States Grade 8). Lifestyles were biennially examined using standardized questionnaires since Primary 6. Prospective associations of breakfast habit with emotional/behavioral problems and potential effect modification were examined using generalized estimating equations.

RESULTS

Compared with eating breakfast at home, eating breakfast away from home was significantly associated with total emotional/behavioral problems and seven syndromes, including withdrawal, somatic complaints, anxiety/depression, thought problems, attention problems, delinquent behaviors, and aggressive behaviors (adjusted odds ratios [AORs] 1.22-2.04), while skipping breakfast showed stronger associations with the above problems and social problems (AORs 1.34-2.29). Stronger associations were observed in younger students for total and attention problems (P < 0.03) and in those with lower weight status for delinquent behaviors (P = 0.005).

CONCLUSION

Eating breakfast away from home and especially skipping breakfast were prospectively associated with adolescent emotional/behavioral problems. The associations weakened with increasing age for total emotional/behavioral and attention problems, and weakened with higher weight status for delinquent behaviors, highlighting the vulnerability of younger and underweight children. If the associations are causal, increasing home breakfast may reduce adolescent emotional/behavioral problems and benefit psychosocial health.

The importance of eating patterns for health-related quality of life among children aged 10-11 years in Alberta of Canada

Children with unhealthy eating behaviours are more likely to experience poor physical and mental health. Few studies have investigated the importance of eating patterns for health-related quality of life (HRQoL) among children. This study aimed to identify common eating patterns, and their associations with HRQoL among Canadian children. Data were collected from 9150 grade five students (aged 10-11 years) in repeat cross-sectional population-based surveys in Alberta, Canada. Students' eating behaviours were analyzed using latent class analysis to identify the eating patterns. We applied multilevel multivariable logistic regression to examine the association of the eating patterns with HRQoL. We identified three groups of children with distinct eating patterns: eating healthy (52%), less healthy (31%) and unhealthy (17%). The first group had a higher proportion of students engaged in healthy eating behaviours. The unhealthy pattern group (third group) included a higher proportion of students with poor eating behaviours. Students' eating behaviours in the second group were healthier than the third group but less healthy than the first group. Children with unhealthy and less healthy patterns were more likely to experience lower HRQoL than children with the healthy pattern. Health promotion programs effective in improving healthy eating patterns may not only reduce the risk for chronic diseases in the long term, but also improve the HRQoL in the short term.

Breakfast consumption and its relationship with diet quality and adherence to Mediterranean diet in European adolescents: the HELENA study

OBJECTIVE

The aim of the current study is to analyze the associations between breakfast consumption and adherence to diet quality index (DQI) and Mediterranean Diet Score (MDS) in European adolescents.

METHODS

A multinational cross-sectional study was carried out in 1804 adolescents aged 12.5-17.5 years. The Food Choices and Preferences questionnaire was used to ascertain breakfast consumption (consumers, occasional consumers and skippers), and two non-consecutive 24 h dietary recalls were used to estimate the total daily intake and to calculate the subsequent DQI and MDS. Mixed linear regression models were used to examine the relationship between breakfast consumption and DQI-A and MDS. Age, maternal education, BMI, country and total energy intake were included as covariates.

RESULTS

In both sexes, significant differences were observed among the breakfast consumption categories. In both boys and girls, breakfast consumers had significantly higher DQI indices than those adolescents who skipped breakfast regularly (p < 0.001). Regarding total MDS, in both boys and girls, breakfast consumers had a higher total MDS than breakfast skippers (p < 0.001), however, no associations were shown between occasional breakfast consumers and DQI indices and MDS.

CONCLUSION

Breakfast consumption has been linked with better dietary quality scores compared with those children who usually skip breakfast. Promotion of regular breakfast consumption in adolescents could be an effective strategy to improve the overall diet quality.

Association of insufficient sleep and skipping breakfast with overweight/obesity in children and adolescents: Findings from a cross-sectional provincial surveillance project in Jiangsu

BACKGROUND

Insufficient sleep and skipping breakfast are very common phenomena in China and have been proposed as possible causes of overweight/obesity, but the results of former studies remain inconsistent.

OBJECTIVE

To investigate the individual and joint association of insufficient sleep and skipping breakfast with overweight/obesity among children and adolescents in Jiangsu Province, China.

METHODS

Participants were 36 849 students aged 8-17 years from the 2019-2020 project "Surveillance for common disease and health risk factors among students." Self-reported insufficient sleep and skipping breakfast were ascertained by self-reported sleep duration and breakfast habit. Overweight/obesity was assessed according to the gender- and age-specific body mass index. We used logistic regression models to explore the association of sleep and breakfast with overweight/obesity, and stratification analyses to test age or gender differences.

RESULTS

The overall prevalence of overweight/obesity was 33.2%. Insufficient sleep (OR = 1.09, 95% CI = 1.03-1.16) or skipping breakfast (OR = 1.14, 95% CI = 1.07-1.21) was associated with overweight/obesity. Compared to participants with 'sufficient sleep and breakfast', ORs were 1.25 (95% CI = 1.15-1.35) for those with 'both insufficient sleep and skipping breakfast'. The separate and joint association of sleep and breakfast with overweight/obesity remained generally consistent across different age and gender subgroups, except that the 8-12-year-olds group and female students appear more susceptible.

CONCLUSIONS

Insufficient sleep and skipping breakfast were jointly associated with overweight/obesity in children and adolescents. Appropriate attention should be paid to these modifiable behaviours including sleep and breakfast in the context of the rapidly growing obesity epidemic among children and adolescents.

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.

Dietary Risk Factors and Eating Behaviors in Peripheral Arterial Disease (PAD)

Dietary risk factors play a fundamental role in the prevention and progression of atherosclerosis and PAD (Peripheral Arterial Disease). The impact of nutrition, however, defined as the process of taking in food and using it for growth, metabolism and repair, remains undefined with regard to PAD. This article describes the interplay between nutrition and the development/progression of PAD. We reviewed 688 articles, including key articles, narrative and systematic reviews, meta-analyses and clinical studies. We analyzed the interaction between nutrition and PAD predictors, and subsequently created four descriptive tables to summarize the relationship between PAD, dietary risk factors and outcomes. We comprehensively reviewed the role of well-studied diets (Mediterranean, vegetarian/vegan, low-carbohydrate ketogenic and intermittent fasting diet) and prevalent eating behaviors (emotional and binge eating, night eating and sleeping disorders, anorexia, bulimia, skipping meals, home cooking and fast/ultra-processed food consumption) on the traditional risk factors of PAD. Moreover, we analyzed the interplay between PAD and nutritional status, nutrients, dietary patterns and eating habits. Dietary patterns and eating disorders affect the development and progression of PAD, as well as its disabling complications including major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Nutrition and dietary risk factor modification are important targets to reduce the risk of PAD as well as the subsequent development of MACE and MALE.

Lifestyle Factors Associated with Metabolic Syndrome in Urban Cambodia

This study aimed to identify lifestyle factors associated with metabolic syndrome (MetS) in urban Cambodia. In this cross-sectional study, we used existing health checkup data from a private hospital in Phnom Penh, Cambodia. The participants comprised 5459 Cambodians aged ≥20 years who underwent health checkups between 2017 and 2019. The harmonized diagnostic definition was used as the MetS criteria. The prevalence of MetS was 56.6% overall, 60.4% in men and 52.6% in women. The lifestyle factor significantly associated with MetS in both sexes were "eating quicker than others", (men: odds ratio [OR]= 2.25, 95% confidence interval [CI] = 1.68-3.03, women: OR = 1.92, 95%CI = 1.41-2.60), "walking faster than others", (men: OR = 0.78, 95% CI = 0.67-0.92, women: OR = 0.75, 95% CI = 0.62-0.89) and "drinking alcohol" (men: OR = 1.33, 95% CI = 1.10-1.61, women: OR = 1.33, 95% CI = 1.09-1.62). Other significant associations with MetS for men was "eating speed is normal", (OR = 1.73, 95%CI = 1.30-2.31), and, for women, "eating food after dinner at least 3 days a week", (OR = 1.25, 95%CI = 1.01-1.55), "skipping breakfast at least 3 days a week", (OR = 0.83, 95%CI = 0.69-0.99) and "getting enough rest from sleep" (OR = 1.19, 95% CI = 1.01-1.42) were significantly associated with MetS. Lifestyle interventions through health education and guidance may be effective in preventing MetS in Cambodia.

Eating contexts and their associations with socio-demographic factors in Brazilian adolescents (EVA-JF Study)

OBJECTIVE

To describe the eating contexts and estimate their associations with socio-demographic factors in a sample of Brazilian adolescents.

DESIGN

Cross-sectional study. We used an exploratory questionnaire about eating contexts (encompassing regularity of meals, places where they occur and if they take place with attention and in company), which was submitted to cluster analysis. Subsequently, three clusters were identified: cluster 1, 'appropriate eating contexts at breakfast, lunch and dinner'; cluster 2, 'inappropriate eating context at breakfast' and cluster 3, 'inappropriate eating context at dinner'. Multinomial logistic regression models were performed, without and with adjustments, using cluster 1 as reference.

SETTING

Twenty-nine public schools of Juiz de Fora, MG, Southeast Brazil.

PARTICIPANTS

Adolescents, 14-19-year-olds (n 835).

RESULTS

We observed relevant prevalence of adolescents omitting breakfast (52·9 %) and dinner (39·3 %), and who had the habit of eating sitting/lying on the couch/bed or standing/walking, and in front of screens. Breakfast usually occurred unaccompanied (70·8 %); around half (47·5 %) and little over a third (36·1 %) of the sample also would usually have lunch and dinner unaccompanied, respectively. Furthermore, through multivariate analysis, we found associations of eating contexts clusters with female sex (more likely in clusters 2 and 3), age range 14-15-year-olds (less likely in cluster 2) and higher mother's schooling (more likely in cluster 3).

CONCLUSIONS

We verified an alarming prevalence of adolescents with eating contexts unaligned with healthy eating recommendations. Additionally, inappropriate eating contexts at breakfast and/or at dinner were associated with socio-demographic factors (sex, age range and mother's schooling).

Lifestyle Screening Tools for Children in the Community Setting: A Systematic Review

Screening of children’s lifestyle, including nutrition, may contribute to the prevention of lifestyle-related conditions in childhood and later in life. Screening tools can evaluate a wide variety of lifestyle factors, resulting in different (risk) scores and prospects of action. This systematic review aimed to summarise the design, psychometric properties and implementation of lifestyle screening tools for children in community settings. We searched the electronic databases of Embase, Medline (PubMed) and CINAHL to identify articles published between 2004 and July 2020 addressing lifestyle screening tools for children aged 0–18 years in the community setting. Independent screening and selection by two reviewers was followed by data extraction and the qualitative analysis of findings. We identified 41 unique lifestyle screening tools, with the majority addressing dietary and/or lifestyle behaviours and habits related to overweight and obesity. The domains mostly covered were nutrition, physical activity and sedentary behaviour/screen time. Tool validation was limited, and deliberate implementation features, such as the availability of clear prospects of actions following tool outcomes, were lacking. Despite the multitude of existing lifestyle screening tools for children in the community setting, there is a need for a validated easy-to-administer tool that enables risk classification and offers specific prospects of action to prevent children from adverse health outcomes.

Why The Knowledge of Indian School-Going Adolescents Regarding NCDs is Not Transforming into Lifestyle Changes?

Background

There is a paucity of research to demonstrate the quantification of adolescents' risk behavior toward Non-Communicable Diseases (NCD) in India. This study aims to explain the knowledge of school-aged adolescents about NCD and whether their knowledge is truly translating into lifestyle changes and if not, what are the potential underlying factors responsible for that.

Methodology

A school-based cross-sectional study was conducted on adolescents in Jodhpur district, India, in grades 6 to 12. The data was gathered via a semi-structured questionnaire. The participant's weight and height were assessed using a digital weighing machine and a stadiometer, respectively. SPSS v.23 was used to analyze the data. Univariate (chi-square) and multivariate (logistic regression) analysis were used to quantify knowledge and risk factors, and inferences were derived.

Results

A total of 1010 students participated in the study. The mean scores of knowledge and risk behavior were 32.82±6.43 (out of 40) and 9.23+2.63 (out of 30), respectively. Adolescent risk behavior and knowledge were not found to be significantly related. Physical activity, spending fewer hours sitting, not skipping breakfast, and habit of fruit and vegetable consumption were significant factors for a healthy lifestyle among them.

Conclusion

Due to differences in underlying predictors, adolescents' understanding of NCDs did not translate into healthy lifestyle modifications. These findings highlight the importance of developing tailored interventions for adolescents that target identified risk domains.

Breakfast Consumption May Improve Fasting Insulin, HOMA-IR, and HbA1c Levels in Predominately Low-Income, Hispanic Children 7-12 Years of Age

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.

Haemoglobin status to determine nutritional anaemia and its association with breakfast skipping and BMI among nursing undergraduates of Farasan Island, KSA

The present study was conducted to determine nutritional anaemia using haemoglobin levels of female nursing undergraduates studying at Farasan Island with the purpose to intervene at a point, before the potential problems become serious later in life. In total, 130 apparently healthy, female students of Department of Nursing were recruited by a random sampling method to collect information on socio-demographic, lifestyle and anthropogenic characteristics, and dietary habits including breakfast skipping. Haemoglobin content was estimated using Sahli's Haemoglobinometer and observations were interpreted as per WHO's criteria for anaemia. Body mass index (BMI) was recorded using a digital weighing machine. Correlation between haemoglobin concentration, breakfast skipping and body mass index of study participants was assessed by Pearson's correlation. Data analyses were done using Origin software. Overall, 51⋅6 % (n = 67) students were all together anaemic with 28⋅5 % (n = 37) had mild anaemia, 15⋅4 % (n = 20) moderate and 7⋅69 % (n = 10) had severe anaemia. Of these, 20⋅8 % (n = 27) were underweight, 63⋅8 % (n = 83) normal weight and 15⋅4 % (n = 20) were above normal weight (over weight and obese). The Hb content showed a positive correlation with the BMI and exhibited an increasing trend with increase in the BMI among study participants (P < 0⋅05). Questionnaire analyses revealed that the majority (96⋅9 %, n = 126) of students were taking junk food as bulk of their meal. A strong negative correlation was recorded between Hb contents and breakfast skipping tendencies (r = −0⋅987, P < 0⋅05). Findings of the present study are of high significance for public health professionals and educators to prioritise actions that could motivate these future nurses to adapt healthy lifestyles to strategically combat nutritional anaemia.

Dietary patterns, breakfast consumption, meals with family and associations with common mental disorders in adolescents: a school-based cross-sectional study

Background

Adolescence is a period of transition and vulnerabilities, in which mental illnesses can develop more easily. The objective of this work is to analyze the association of dietary patterns, breakfast consumption, and the practice of having meals accompanied by the family with the presence of Common Mental Disorders in Brazilian adolescents.

Methods

This is a cross-sectional study which analyzed data from 71,553 Brazilian adolescents aged 12–17 years, from the Study of Cardiovascular Risk in Adolescents (Portuguese acronym, “ERICA”). Principal Component Analysis was performed to identify dietary patterns, and Logistic Regression Models were performed to identify the associations between Common Mental Disorders, dietary patterns, and eating practices that are breakfast consumption and practice of having meals accompanied by family.

Results

Two patterns were found, a Healthy Dietary Pattern and an Unhealthy Dietary Pattern. Adolescents classified in the second (OR: 0.79; 95% CI 0.70—0.89) or third (OR: 0.86; 95% CI 0.77—0.96) tercile of the Healthy Dietary Pattern had a lower chance of having Common Mental Disorders. Eating breakfast sometimes (OR: 0.71; 95% CI 0.61—0.83) or almost every day/every day (OR: 0.54; 95% CI 0.47—0.62), and the practice of having the main meals with the family sometimes (OR: 0.69; 95% CI 0.57—0.84) or almost every day/every day (OR: 0.50; 95% CI 0.44–0.58), decreased the chance for Common Mental Disorders.

Conclusion

This study observed that healthy dietary patterns are associated with better mental health in adolescents, thus should be encouraged and promoted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13367-7.