Breakfast Consumption in Low-Income Hispanic Elementary School-Aged Children: Associations with Anthropometric, Metabolic, and Dietary Parameters

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.

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.

Integration of Time-Based Recommendations with Current Pediatric Health Behavior Guidelines: Implications for Obesity Prevention and Treatment in Youth

PURPOSE OF REVIEW

Youth-onset obesity is associated with negative health outcomes across the lifespan including cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, dyslipidemias, asthma, and several cancers. Pediatric health guidelines have traditionally focused on the quality and quantity of dietary intake, physical activity, and sleep.

RECENT FINDINGS

Emerging evidence suggests that the timing (time of day when behavior occurs) and composition (proportion of time spent allocated to behavior) of food intake, movement (i.e., physical activity, sedentary time), and sleep may independently predict health trajectories and disease risks. Several theoretically driven interventions and conceptual frameworks feature behavior timing and composition (e.g., 24 h movement continuum, circadian science and chronobiology, intermittent fasting regimens, structured day hypothesis). These literatures are, however, disparate, with little crosstalk across disciplines. In this review, we examine dietary, sleep, and movement guidelines and recommendations for youths ages 0-18 in the context of theoretical models and empirical findings in support of time-based approaches. The review aims to inform a unifying framework of health behaviors and guide future research on the integration of time-based recommendations into current quantity and quality-based health guidelines for children and adolescents.

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.

Assessing readiness to change in regular breakfast consumption among elementary students

BACKGROUND

Motivation and desire are the main psychological factors associated with regular breakfast consumption among elementary students. The purpose of this study was to assess the readiness of students to regular breakfast consumption.

MATERIALS AND METHODS

This research was cross-sectional study; 300 students participated who were selected based on cluster sampling from elementary schools in different parts of Ardabil and were interviewed using a motivational questionnaire according to SOC model. The acquired data was then analyzed by ANOVA and linear regression.

RESULTS

Cognitive processes of change such as social liberation (β = 0.31, α = 0.001) and self-reevaluation (β = 0.13, α = 0.04) and self-efficacy (β = 0.44, α = 0.001) played a significant role in motivating students to move from the inactive stage to preparation stage.

CONCLUSION

By understanding the motivational factors of regular breakfast consumption, a regular program can be implemented to increase breakfast consumption and ensure the health of students and help them to grow in learning ability and abstract thinking.

Comparison of School vs Home Breakfast Consumption with Cardiometabolic and Dietary Parameters in Low-Income, Multiracial/Ethnic Elementary School-Aged Children

BACKGROUND

Breakfast consumption is often associated with improving cardiometabolic parameters and diet quality. However, literature evaluating breakfast consumption with these outcomes between the school and home environments is limited.

OBJECTIVE

This study examined relationships between breakfast consumption locations (school vs home) and cardiometabolic parameters, breakfast dietary intake, and daily dietary intake.

DESIGN

This cross-sectional study used baseline data from TX Sprouts, a 1-year school-based gardening, nutrition, and cooking cluster-randomized trial, implemented in 16 elementary schools in Austin, TX, during 2016 to 2019.

PARTICIPANTS/SETTING

Analyses included 383 low-income, multiracial/ethnic elementary school-aged children (mean age = 9.2 years; 60.6% Hispanic; 70.5% free/reduced lunch; 58.5% home breakfast consumers).

MAIN OUTCOME MEASURES

Cardiometabolic parameters were obtained via fasting blood draws, and dietary intake was assessed using one 24-hour dietary recall conducted on a random, unannounced weekday. Cardiometabolic and dietary parameters (ie, energy intake, macronutrients, and food group servings) for breakfast and for the day were evaluated.

STATISTICAL ANALYSES PERFORMED

Multivariate analysis of covariance was performed to examine cardiometabolic parameters and dietary intake between school and home breakfasts.

RESULTS

School breakfast consumers (SBC) had lower fasting triglyceride levels than home breakfast consumers (HBC) (89.0 mg/dL vs 95.7 mg/dL; P = 0.03) (to convert to mmol/L, multiply by 0.0113). SBC had lower total fat for the day (P = 0.02) and lower total and saturated fat, sodium, and refined grains at breakfast (P ≤ 0.01) than HBC. However, SBC had lower protein at breakfast (P = 0.01) and higher carbohydrates, total sugar, and added sugar for the day and at breakfast (P ≤ 0.03) than HBC.

CONCLUSIONS

SBC compared with HBC had lower fat intake, which may have contributed to the lower triglyceride level observed in SBC, but also had lower protein intake at breakfast and higher added sugar intake for the day and at breakfast. These results suggest dietary intake differed between HBC and SBC; that is, the home and school environments, but more research is needed to evaluate if such differences are due to School Breakfast Program guidelines.

Skipping breakfast among preschoolers: associated factors and its dose-response relationship with overweight/obesity

ABSTRACT Objective To investigate factors associated with skipping breakfast in preschoolers and test a dose-dependent relationship between the frequency of breakfast consumption and the prevalence of overweight/obesity. Methods This is a cross-sectional study, carried out with 463 children (24 to 59 months of age) who live in the urban location of Goiânia, Goiás, Brazil. Sociodemographic data, maternal and child nutritional status, lifestyle, and dietary practices were collected using a standardized questionnaire and Habitual Food Recall during a home-based interview. Skipping breakfast was defined as a frequency of consumption “less than seven days a week”. Based on body mass index by age, children were classified as overweight/obese if Z-score ≥2. Multiple logistic regression was used to assess the association between the variables surveyed and skipping breakfast. The dose-dependent relationship between breakfast frequency and overweight/obesity was determined by the trend test. Results The prevalence of skipping breakfast was 8.42% (95%IC: 6.1-11.3). There was an association between the habit of substituting dinner for a sandwich/snack (adjusted OR: 2.61, 95%IC: 1.25-5.46; p=0.010) and the mother’s overweight (adjusted OR: 2.63; 95%CI: 1.29-5.37; p=0.008) with the habit of skipping breakfast. The trend test shows that the prevalence of overweight/obesity decreases as the frequency of breakfast consumption increases (p=0.035). Additionally, when assessing the quality of breakfast, frequent consumption of foods considered unhealthy was observed. Conclusion There is a dose-response association between overweight/obesity and skipping breakfast. Children who substitute traditional dinner for a sandwich/snack and whose mothers are overweight are more likely to skip breakfast.

Breakfast Food Advertisements in Mediterranean Countries: Products' Sugar Content in the Adverts from 2015 to 2019

Although Spain was considered to be the healthiest country in the world in 2019, some studies reported that Mediterranean diet (MD) adherence, especially for breakfast, is low among children in Mediterranean countries, where child obesity is increasing alarmingly. This study correlated longitudinally the sugar content of breakfast products with advertising strategies. The research design applied quantitative analysis to compile the advertising data from 2015 to 2019 for all media, qualitative analysis of the content, and the use of popular characters to promote the food purchase. Additionally, a nutritional analysis was used to determine the products’ sugar content. The results were analyzed according to the target they were aimed at (adults or children). Results showed that the Spanish food industry promoted unhealthy products for breakfast, especially those targeted to children, with very high sugar content. To improve the childhood obesity rate in Spain, greater involvement from the food industry is needed. The reformulation of breakfast products must be a priority along with additional sugar reduction strategies so as not to lose adherence to MD in younger generations. More nutrition education is necessary among children, especially on balanced breakfast consumption, a basic meal that helps children to concentrate better in class during the morning.