Overweight in children: the role of breakfast

Overweight in children is becoming more common and is a major public health issue worldwide. Different factors interplay in the development of overweight, such as birth weight, genetic implications and socioeconomic status. Besides, nutrition and dietary habits play a role, in particular breakfast.
  • Overweight in children is becoming more common and is a major public health issue worldwide. Eating behavior is involved in the development of overweight.
  • The systematic review of Monzani et. a. (1) shows that children and adolescent who skip breakfast more often have overweight or obesity.
  • As a possible explanation, children who regularly have breakfast have been shown to have a healthier eating pattern compared to children who skip breakfast

Several observational studies have shown a positive association between skipping breakfast and overweight in children. As a possible explanation, children who regularly have breakfast have been shown to have a healthier eating pattern compared to children who skip breakfast. The systematic review of Monzani et. al (1) gives an overview of studies in the last 10 year that assessed the association between skipping breakfast and overweight and obesity in children and adolescents. The review also includes studies that assessed the association between skipping breakfast and cardiometabolic risk factors, such as high blood pressure. This article is a summary of the review of Monzani et. al (1).

How the study was conducted

A total of 39 observational studies were included in the review. These studies assessed the association between skipping breakfast and at least one of the following outcome measures: body weight, body weight excess (e.g. overweight), metabolic syndrome, arterial hypertension, lipid profile, glucose levels, type 2 diabetes, insulin resistance and uric acid. The participants of the studies were on average between the ages of 2 and 18.

Results

Of the 39 studies, 37 studies investigated the association between skipping breakfast and overweight or obesity. Most of the studies had a cross-sectional design. How often children skipped breakfast varied between the studies: from 1% of children to 75%. This difference can be partly explained by the fact that each study used a different definition for skipping breakfast. Almost all he studies concluded that skipping breakfast is associated with a higher risk or higher prevalence of overweight or obesity. Only 7 studies did not find this association or only found it in specific categories of subjects.

Besides, 6 cross-sectional studies assessed the association between overweight and several cardiometabolic risk factors: high blood pressure (3 studies), cholesterol levels (4 studies), insulin resistance (3 studies) and metabolic syndrome (5 studies). Two out of three studies that investigated blood pressure found that children who skipped breakfast more often had a high blood pressure. Likewise, two out of three studies found a higher prevalence of insulin resistance in children who skipped breakfast. Two studies (out of four) found lower HDL-cholesterol levels and higher total- and LDL-cholesterol levels in children who skipped breakfast. One study also found increased triglyceride levels in these children. Lastly, the five studies that assessed the association with metabolic syndrome all found that skipping breakfast is associated with a higher prevalence of metabolic syndrome.

Discussion

There is still no explanation why skipping breakfast is associated with overweight. The studies in this review are observational studies, which means the findings cannot establish causality. Besides, only a few studies corrected for other factors that are possibly associated with skipping breakfast and overweight (confounders). Therefore, it is not clear whether skipping breakfast is directly associated with overweight, or if other factors play a role. However, a few studies have demonstrated that children who regularly have breakfast generally have a healthier eating pattern with higher intakes of foods and nutrients such as fruit, dairy and fiber. In contrast, children who skip breakfast more often have an unhealthy eating pattern with more high-calorie food. Besides, the association between skipping breakfast and overweight is mainly found in adolescents: a few studies failed to find the association in (young) children. The authors suggest that a disturbed circadian rhythm possibly plays a role in weight balance. A disturbed circadian rhythm may be more common in adolescents, which may explain why the association is demonstrated more clearly in this group.

Conclusion

The authors conclude that there is evidence that children and adolescents who skip breakfast have a higher risk to be or become overweight or obese. Besides, there seems to be an association between skipping breakfast and metabolic syndrome, but the evidence is still small. Skipping breakfast is possibly a marker of unhealthy eating behaviour that promotes overweight and obesity.

Reference

  1. Monzani, A., Ricotti, R., Caputo, M., Solito, A., Archero, F., Bellone, S., & Prodam, F. (2019). 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? Nutrients11(2), 387