Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents

Irregular breakfast eating in type 2 diabetes mellitus is associated with greater social jetlag and poorer metabolic health

Circadian disruption, arising from conflict between internal circadian time and behavioural sleep-wake and fasting-feeding rhythms, may contribute to the prevalence of type 2 diabetes mellitus and disease severity. Previous studies have demonstrated a link between irregular breakfast eating and poorer metabolic health. We aimed to further explore the relationships between breakfast habits, circadian misalignment (social jetlag), and metabolic parameters in a cohort of adult participants with type 2 diabetes mellitus. A total of 330 adult participants with type 2 diabetes mellitus attending for routine clinical review completed structured questionnaires to assess habitual sleep timing, chronotype, and social jetlag. Statistical analysis was via inferential groupwise approaches and path analysis to establish interdependencies of effects of social jetlag, chronotype, and breakfast eating regularity on HbA1c. 22.7% of the participants reported eating breakfast five times or fewer a week, and were categorised as irregular breakfast eaters. Compared with those who ate breakfast six or seven times a week, irregular breakfast eaters had significantly higher HbA1c and diastolic blood pressure, were younger and had greater social jetlag. In the path analysis, irregular breakfast eating exerted a direct effect on HbA1c, whilst social jetlag exerted only an indirect effect on HbA1c through breakfast eating regularity. Chronotype did not exert any effect on HbA1c, but did exert an indirect effect on breakfast eating regularity via social jetlag. Our results showed that adult participants with type 2 diabetes mellitus, who ate breakfast irregularly had poorer metabolic health and greater social jetlag. The relationship between social jetlag and glycaemic control appears to be mediated through breakfast eating habits.

Rise and dine: unraveling breakfast habits among tenth graders - a cross-sectional study among 646 students in the City of Witten, Germany (GeWIT study)

BACKGROUND

Despite widespread recognition of breakfast as a key contributor to adolescent health, breakfast skipping remains common and concerning. It has been associated with increased consumption of energy-dense snacks, lower intake of essential nutrients, and irregular eating patterns throughout the day. This study aimed to assess the prevalence of breakfast skipping on the day of the survey among adolescents in Witten, Germany, and to explore its associations with selected sociodemographic characteristics, health-related behaviours, and self-reported health indicators.

METHODS

Between November 2, 2021, and February 25, 2022, a cross-sectional, survey-based study was conducted among 10th-grade students in all nine municipally managed secondary schools in Witten. The questionnaire assessed breakfast consumption on the surveyed day, school type, sociodemographic factors, health status, and physical activity. Statistical analyses were conducted using SPSS, including chi-square tests and multivariable logistic regression to estimate odds ratios and identify predictors of breakfast skipping.

RESULTS

In a sample of 646 students (response rate 98.3%), 50.6% (n = 327) reported skipping breakfast before school on the day of the survey. Students attending intermediate secondary schools (aOR 1.66, 95% CI 1.1-2.51) or comprehensive schools (aOR 1.62, 95% CI 1.11-2.36), and those with a migration background (defined in Germany as having at least one parent born abroad) (aOR 1.46, 95% CI 1.04-2.04), were significantly more likely to skip breakfast. In contrast, students reporting "excellent" (aOR 0.29, 95% CI 0.17-0.48) or "very good" (aOR 0.63, 95% CI 0.43-0.91) general health, and those categorized as underweight (aOR 0.44, 95% CI 0.2-0.98), were significantly less likely to skip breakfast. No significant associations were found for gender, age, socioeconomic status, physical activity, or family doctor consultations.

CONCLUSION

This study indicates that the educational environment and cultural background might significantly impact adolescents' breakfast consumption behaviours on the surveyed day, underscoring the need for targeted educational interventions. Promoting a positive perception of personal health is key to encouraging regular breakfast consumption among adolescents. These findings provide important insights for public health strategies to enhance adolescents' dietary habits.

TRIAL REGISTRATION

Not applicable.

The Simple Evaluation of Food Intake (SEFI®) Junior as diagnostic test for malnutrition in children aged 10 to 18: prospective non-interventional multicentre transversal study

INTRODUCTION AND AIMS

The Self Evaluation of Food Intake (SEFI®) is a visual tool to assess food intake and malnutrition risk in adults. The wording and graphics have been adapted for children and adolescents under the name SEFI® Junior (Jr).

AIMS

to assess the SEFI® Jr reliability to screen for malnutrition in hospitalized children and adolescents (main); the correlation between the SEFI® given by the patient and the parent; iii) if the reason for hospitalization affects the SEFI® Jr diagnosis value (secondary).

METHODS

Prospective non-interventional multicentre transversal study.

INCLUSION CRITERIA

age 10-18 years, hospitalization in the Pediatrics or Child Surgery departments of four academic hospitals. The patient and one of her/his parents answered to the SEFI® Jr food intake visual scale blind to each other. Body mass index (BMI) < IOTF curve 18.5 and 17, Waterlow index (WI) < 90 %, height-for-age ratio <95 %, were compared to the score <7 of the SEFI® Jr reported by the child.

STATISTICS

sensitivity (Se), specificity (Spe), positive (PPV) and negative (NPV) predictive values, area under the curve (AUC), Spearman coefficient.

RESULTS

363 patients were included: mean age±SD 13.5 ± 2.1 yr, BMI 19.5 ± 4.3, WI 105.7 ± 26.0, 55 % boys, 61 % chronic diseases, SEFI® Jr 7.8 ± 2.5, <7, n = 107 (29 %). Diagnosis of malnutrition: BMI < IOTF 18.5, n = 69 (19.0 %); BMI < IOTF 17, n = 26 (7.2 %); WI <90 %, n = 95 (26.2 %); height-for-age ratio <95 %, n = 62 (17.1 %). SEFI® Jr feasibility: 100 %. The SEFI® Jr overall performance for malnutrition diagnosis was poor: AUC 0.53 [95 % confidence interval (CI), 0.45-0.61] (vs height-for-age ratio) to 0.62 [0.55-0.68] (vs WI). SEFI® Jr < 7 Spe (71.2-75.8 %), Se (35.5-44.2 %), PPV (9.4-39.3 %), NPV (79.3-93.8 %) varied according to the malnutrition diagnosis criterion. The correlation between the SEFI® scores given by the patient and the parent was high: rho = 0.87, P < 0.0001. SEFI® Jr < 7 performance was the best in children hospitalized for an acute disease: vs BMI IOTF<17 (AUC = 0.74 [0.52-0.96], Spe 65.7, NPV 97.9 %), vs. height-for-age ratio <95 % (AUC = 0.69 [0.54-0.83], Spe 66.7, NPV 89.4 %), vs. IW <90 % (AUC = 0.68 [0.52-0.85], Spe 71.2, NPV 78.7 %).

CONCLUSIONS

SEFI®Jr is feasible and may be helpful to rule out the diagnosis of malnutrition in children aged 10-18 yr and hospitalized for an acute disease.

Hypoglycemic timeslots after hospital discharge in patients with diabetes on multiple daily insulin injection: Dose of Insulin CHanged According to the Reported Glucose by Libre Pro (DISCHARGe study)

INTRODUCTION

Insulin improves clinical outcomes in hospitalized patients; however, hypoglycemia hinders discharge transition in patients with insulin-treated diabetes. Studies on hypoglycemic timeslots, rates, and risk factors during discharge transition are lacking.

MATERIALS AND METHODS

Fifteen patients with type 2 diabetes (T2D) receiving multiple daily insulin (MDI) injections participated. Glucose variability metrics and hypoglycemia were monitored using a continuous glucose monitoring system starting a day pre-discharge through 13 days of discharge transition. Hypoglycemia was analyzed chronobiologically using Cosinor analysis. Anthropometric measurements, C-peptide, insulin dose, and glucagon were assessed.

RESULTS

The mean patient age was 52.7 ± 12.6 years; 13/15 were male; body mass index was 28.1 ± 5.9 kg/m2, T2D duration was 8.6 ± 8.8 years, HbA1c was 12.4 ± 2.5%, and total daily insulin dose averaged 36.6 ± 15.1 units and hospitalization lasted 13.1 ± 2.3 days. Time in range decreased post-discharge. Time below range increased from 7.0% at discharge to 17.6% by the study end (manova, P < 0.001). Hypoglycemic events peaked post-breakfast, with the highest amplitude (42 points) recorded at 12:00. The highest and lowest numbers of hypoglycemia occurred at 12:00 and 17:30, respectively. However, the highest hypoglycemic timeslot (11:00-12:00) was not significantly associated with clinical and biochemical parameters.

CONCLUSIONS

The chronobiology of hypoglycemia exists during the discharge transition in patients with MDI-treated T2D. Hypoglycemia frequency and severity peaked pre-lunch, reached a nadir at 17:30, and exaggerated post-discharge, emphasizing the need for pre-breakfast insulin dose reductions on the discharge day.

Prospective association between breakfast consumption frequency and BMI z-score among European school-aged children. The Feel4Diabetes Study

BACKGROUND

The long-term effects of breakfast on childhood z-BMI remain inconclusive.

OBJECTIVE

To prospectively assess the impact of stable and altered breakfast consumption habits on z-BMI change over two years, in school-aged children across six European countries.

METHODS

Data of 6,528 children (8.2 ± 1.0 years, 48.9% male) from the Feel4Diabetes study were used. Children's lifestyle behaviors, including breakfast frequency, were assessed through parent-reported questionnaires. Weight and height were objectively measured and converted to z-BMI. Participants were categorized into trajectories combining breakfast consumption habit (i.e., regular consumption, irregular consumption or omission) at baseline and follow up. Logistic regression analyzed the prospective association between breakfast trajectories and z-BMI increase, with adjustment for demographic and lifestyle variables.

RESULTS

A statistically significant effect of breakfast trajectories was observed in z-BMI, both at baseline and follow up. Stable skippers was the only trajectory that showed a significant increase in BMI z-score from baseline to follow up (0.891 ± 1.058 vs. 1.034 ± 1.072 respectively, p < 0.05). BMI z-score at follow up of regular eaters (0.615 ± 0.967) was significantly lower, compared to both irregular eaters (1.229 ± 0.890) and stable skippers (both p < 0.05). Stable regular consumption and transition from omission to regular consumption were independently associated with significantly lower risk of z-BMI gain, compared to stable omission [OR, 95% CI: 0.55 (0.31, 0.97), p = 0.039 and 0.43 (0.21, 0.88), p = 0.021 respectively].

CONCLUSION

Stable regular breakfast consumption or transition from omission to regular consumption seem to contribute to superior weight regulation in children and to independently protect against z-BMI gain, compared to stable omission. Further studies are warranted to extend the evidence on the breakfast habit-BMI association among children.

Breakfast skipping and academic achievement at 8-16 years: a population study in South Australia

OBJECTIVE

While studies have highlighted a link between breakfast consumption and cognitive performance, evidence for how breakfast influences academic outcomes is mixed. This study explored the association between student breakfast skipping and academic achievement.

DESIGN

This cross-sectional investigation employed population data. Self-reported breakfast consumption was used to categorise students as never, sometimes and always breakfast skippers. Scores on five standardised literacy and numeracy tests were used to classify students to have low or high achievement according to national minimum standards. Poisson regression analyses estimated the relative risk (RR) of low academic achievement among students across breakfast skipping categories, adjusting for student, family and community-level confounding.

SETTING

Government schools in South Australia.

PARTICIPANTS

Participants included 28 651 students in grades 5, 7 and 9 (aged 8-16 years).

RESULTS

Overall, 32·3 % of students reported never skipping breakfast, 57·6 % reported sometimes skipping and 10·1 % reported they always skip breakfast. Students who sometimes and always skipped breakfast had an increased risk of low achievement on all five tests, after adjustment for confounding. Greatest risk for low achievement was on numeracy (RR = 1·78, 95 % CI 1·64, 1·94) and reading (RR = 1·63, 95 % CI 1·49, 1·77) among students who always skipped breakfast. Students who sometimes skipped breakfast were also at increased risk for low achievement, though not as higher risk as that among students who reported skipping breakfast every day.

CONCLUSIONS

Results suggest breakfast consumption plays an important role in academic success. Supports to promote regular student breakfast consumption may be one mechanism through which education stakeholders and policymakers can strengthen academic achievement.

Minimum diet diversity-women score and predictors of school adolescent girl stunting and thinness in Northwest Ethiopia

BACKGROUND

Limited data exist on adolescent nutrition. This school-based cross-sectional study aimed to assess dietary practices, nutritional status, and associated factors among adolescent girls.

METHODS

Two hundred seventy-nine primary and secondary school girls were selected via multistage sampling. A pretested questionnaire and 24-h recall method were employed to gather data on background characteristics and dietary practices. The questionnaire was pretested with 20 adolescents from nonparticipating schools to assess clarity and reliability. Feedback from the pretest was used to refine the questionnaire. The minimum dietary diversity for women (MDD-W) was used as an indicator of diet quality, where women were considered to have adequate dietary diversity if they consumed at least five of ten food groups in the past 24 h. Key informant interviews were used to explore nutritional problems, while anthropometric measurements were taken to assess nutritional status. Height and weight, combined with age, were used to calculate height-for-age and BMI-for-age z scores via WHO AnthroPlus software. Nutritional status was categorized as stunted (< -2SD), thin (< -2SD), normal (-2SD to + 2SD), or overweight (> + 2SD). A multivariate binary logistic regression model identified predictors of nutritional status. The quantitative data were analyzed via SPSS, and the qualitative data were analyzed via ATLAS.ti.

RESULTS

Only 24% of the students met the MDD-W. Predominant consumption of plant-source foods (100%) and low animal-source food intake (< 20%) were observed. Environmental, social, and cultural factors are barriers to nutrition, whereas cultural food preferences act as reinforcing factors. The prevalence rates of thinness, stunting, and overweight were 7.2%, 6.4%, and 5.7%, respectively, with undernutrition being more prevalent in younger adolescents (10-14 years). Adolescents with low fast food consumption and those in late adolescence were less likely to be stunted or thin.

CONCLUSION

Poor dietary practices and undernutrition, particularly among younger adolescents, were observed. Comprehensive programs addressing environmental, social, and cultural barriers are needed to improve adolescent nutrition.

Each Indicator of Socioeconomic Status (Education, Occupation, Income, and Household Size) Is Differently Associated with Children's Diets: Results from a Cross-Sectional CroCOSI Study

Background: There has yet to be an agreement on which specific socioeconomic status (SES) indicator most effectively reflects disparities in children's diets. However, children from lower SES backgrounds are particularly vulnerable, as research in other countries indicates that their diets contain fewer fruits and vegetables and more sweetened beverages. This paper aims to evaluate the associations between dietary habits and various SES indicators (education, occupation, income, and household size) among a representative sample of children in Croatia aged 7-10. Methods: Parents of children were asked to complete a questionnaire that contained indicators of their children's dietary habits and socioeconomic status (n = 5608). Associations between SES and children's dietary habits were assessed using logistic regression models. Results: The mother and father's educational attainment were strongly positively associated with breakfast consumption. Children of parents with a lower educational level consumed sweetened beverages, sweet snacks, and fast food slightly more often than children in families with a higher educational background. The mother's education was inversely associated with vegetable and cereal consumption, while the father's education was inversely associated with fruit and bakery product consumption. Meanwhile, household income per unit had a significant influence on the consumption of soft drinks and bakery products. Household size had a significant influence solely on sweet snack consumption. Conclusions: Each SES indicator showed an independent association with at least one particular dietary habit, except for the parent's employment status.

Association between breakfast nutrient density, subsequent meal quality, and overall diet quality in Iranian adults: a cross-sectional study

There's more to a healthy diet than merely getting the desirable calories. At the present cross-sectional study, dietary consumption was measured using 24-hour dietary recall method. Nutrient density was evaluated using the NRF 9.3 index, which is based on nine recommended nutrients and three nutrients to limit. The link between carbohydrate, protein, fat, fiber and sugar intake at breakfast and the nutrient density in subsequent meals was evaluated using dose-response analysis. A total of 427 adults (199 men and 228 women) were included. The study found an inverse relationship between sugar intake at breakfast and nutrient density at lunch. Specifically, consuming up to 10 g of sugar at breakfast was associated with a reduction in the NRF profile, Additionally, breakfasts containing 12 g of fat were linked to the lowest nutrient density (p non-linearity < 0.001). The dose-response test showed a non-linear relationship (p non-linearity < 0.001); the intake of fiber in breakfast up to 1.5 g was associated with a steep increase in dinner NRF while higher intakes resulted in a more gradual slope of improvement (p non-linearity < 0.001). This study revealed that increment in fat and sugar intake at breakfast is associated with decrease in NRF score at lunch. Moreover, increasing fiber consumption at breakfast is associated with increasing the dinner quality. Consuming a higher quality breakfast is associated with better overall diet quality.

Risk Factors Associated With Food Selectivity in Infants and Toddlers

Families of patients aged 3 to 6, evaluated between January and March 2023, were invited to respond to a questionnaire to investigate attitudes toward food in the first years of life. Based on the presence of food selectivity, 2 study groups were compared: 39 selective (42%) and 54 non-selective children (58%). Selective children tended to be less exposed to game activities with food (P < .01), did not show curiosity toward new flavors (P < .01), and presented a diet lacking a group of macronutrients (P < .01). Moreover, selective eaters were more likely to use pacifier and baby bottle (P = .02), to demand something different from what was presented on the dish (P = .04), to be distracted by screens during meals (P = .04). Also, selective children considered mealtime stressful (P < .01) and were forced to eat (P = .03). Finally, selectivity is a frequent reason of discussion between parents on their children nutrition (P = .02).

A Cross-Sectional Study on the Prevalence of Skipping Breakfast Among College-Going Students in a Private University

Background Breakfast is considered one of the important meals of the day as it repletes glucose supply to the brain and improves learning. Skipping breakfast has become more common among college students. It is prompting them to adopt unhealthy lifestyles which might affect their health in the long term. The present study aimed to assess the health effects of skipping breakfast among college students. The main objective of this study is to estimate the prevalence of breakfast-skipping patterns and the factors associated with skipping breakfast among college students. Methods This descriptive cross-sectional study involved 540 college students from four institutions (Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Karpaga Vinayaga Institute of Dental Sciences, Chengalpattu, Karpaga Vinayaga Institute of Dental Sciences, Chengalpattu, and Karpaga Vinayaga College of Nursing, Chengalpattu) in Tamil Nadu. A Simple Random Sampling method was used to select the sample. Data were gathered using a pre-tested, semi-structured questionnaire, and ethical clearance was obtained from the institution. The data were analyzed with IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States), employing both descriptive and inferential statistics. Results The prevalence of breakfast skipping among college-going students was 368 (68.2%). The timing of breakfast was a strong predictor; those eating after 10 AM had an adjusted odds ratio of 3.98 (95% CI: 1.65 - 9.61). The use of snacks as meal replacements also showed a significant association, with an odds ratio of 2.90 (95% CI: 1.95 - 4.32). Spending pocket money on breakfast was linked to an increased likelihood of skipping, with an adjusted odds ratio of 1.251 (95% CI: 0.82 - 1.90). Conclusion This study shows that a higher proportion of college students skip their breakfast at least once a week. This study also showed that male gender, lower socioeconomic status, mealtime after 11 a.m., and snacking as a meal substitute more than four times a week are important risk factors for college students who were skipping breakfast. The results indicate that specific programs that encourage eating breakfast earlier and adopting healthy eating behavior may enhance student's general dietary habits.

Delayed school start time is associated with better sleep, mental health, and life satisfaction among residential high-school students: a prospective study

This study examined the longer-term individual- and school-level changes in students 7 months after a 1-hour delay in school start time (SST). Two cohorts of grade 11 students (N = 227; 60.8% female, age = 17.0 [0.85]) at a residential high school in Hong Kong completed a questionnaire assessing sleep duration, insomnia symptoms, depression, anxiety, stress, and subjective well-being in 2017 and 2018, respectively. One of the cohorts was reassessed 7 months after the implementation of a delay in SST, from 07:30 am to 08:30 am (n = 83, 65.1% female). School-level data on breakfast consumption, attendance, tardiness, and health clinic visits were collected. Between-group and within-group prospective comparisons suggest that the delay in SST was associated with improved sleep duration, mental health, and life satisfaction. School-level data revealed increased breakfast consumption and decreased unexcused absences, tardiness, and clinic visits.

Dietary and Physical Activity Habits of Children and Adolescents before and after the Implementation of a Personalized, Intervention Program for the Management of Obesity

BACKGROUND

Obesity in childhood and adolescence represents a major public health problem, mostly attributed to dietary and physical activity factors. We aimed to determine the dietary and physical activity habits of participants before and after the implementation of a personalized, multidisciplinary, lifestyle intervention program for the management of obesity in the context of the Horizon Research Project 'BigO: Big Data against Childhood Obesity'.

METHODS

Three hundred and eighty-six (n = 386) children and adolescents (mean age ± SD: 12.495 ± 1.988 years, 199 males and 187 females) participated in the study prospectively. Based on body mass index (BMI), subjects were classified as having obesity (n = 293, 75.9%) and overweight (n = 93, 24.1%) according to the International Obesity Task Force (IOTF) cut-off points. We implemented a personalized, multidisciplinary, lifestyle intervention program providing guidance on diet, sleep, and exercise, and utilized the BigO technology platform to objectively record data collected via a Smartphone and Smartwatch for each patient.

RESULTS

Following the intervention, a statistically significant decrease was noted in the consumption of cheese, cereal with added sugar, savory snacks, pasta, and fried potatoes across both BMI categories. Also, there was an increase in daily water intake between meals among all participants (p = 0.001) and a reduction in the consumption of evening snack or dinner while watching television (p < 0.05). Boys showed a decrease in the consumption of savory snacks, fried potato products, and pasta (p < 0.05), an increase in the consumption of sugar-free breakfast cereal (p < 0.05), and drank more water between meals daily (p < 0.001).

CONCLUSIONS

Our findings suggest that a personalized, multidisciplinary, lifestyle intervention improves the dietary habits of children and adolescents.

Dietary habits across the primary-secondary school transition: A systematic review

INTRODUCTION

The transition to secondary school involves significant changes in children's social and physical environment, which are often accompanied by changes in dietary habits. However, evidence around how dietary habits change during this life-stage transition is variable.

OBJECTIVE

This review aimed to identify, critically appraise, and summarise the wide-ranging evidence on changes in dietary habits across the primary-secondary school transition.

METHODS

Four electronic databases (PubMed, Embase, Web of Science, and Scopus) were searched for relevant studies published in English or Spanish from inception to February 2024. Longitudinal studies with a baseline quantitative assessment of dietary habits when children were in their last year or two of primary/elementary school with at least one follow-up assessment of dietary habits when children were in their first or second year of secondary/middle/junior-high school were eligible for inclusion.

RESULTS

Seven studies (10 independent samples) were eligible for inclusion, and fourteen different dietary habits outcomes were reported across the seven studies. The frequency of consuming breakfast, fruit, vegetables, and milk decreased across the primary-secondary school transition. Inconsistent results were found regarding changes in the frequency of consumption of sugar-sweetened beverages, fruit juice, snacks, and fast-foods. Many dietary habits were only evaluated in single studies.

CONCLUSIONS

There is moderate evidence for a decrease in the frequency of consumption of breakfast, fruit, vegetables, and milk in children across the transition from primary to secondary school. This highlights this timeframe as a valuable period for intervention to promote the continuation of positive dietary habits. More high-quality longitudinal studies using homogeneous methodologies to evaluate changes in dietary habits across the school transition are needed to fully understand the implications of this transition on children's diet and health behaviours.

Physical inactivity and breakfast skipping caused visceral fat accumulation in rats

Physical inactivity as well as breakfast skipping is known as risk factor for various metabolic diseases, such as obesity and type 2 diabetes. We have previously reported that a breakfast skipping model, in which the timing of feeding is delayed, induces abnormal lipid metabolism by altering the circadian rhythm of lipid metabolism-related genes in rats. The purpose of this study was to elucidate the synergistic effect of physical inactivity and breakfast skipping on lipid metabolism. We adopted sciatic neurectomized rats as physically inactive models, because we confirmed that the rats mildly decreased their spontaneous locomotor activity compared to sham-operated rats. And then the physically inactive model rats were fed a mild high-fat diet during zeitgeber time (ZT) 12-0 in the control group and ZT16-0 in the breakfast skipping group for 11 days. Body weight gain and total food intake were similar in both groups. Breakfast skipping induced a significant visceral fat accumulation, which was not observed in our previous breakfast skipping or physically inactive studies. The mRNA levels of clock and lipogenesis-related genes were altered by breakfast skipping in the liver and epididymal adipose tissue, and serum insulin level was altered by breakfast skipping. These results suggest that physical inactivity and breakfast skipping synergistically induces drastic visceral fat accumulation due to the alteration of circadian clock and lipid metabolism in the liver and adipose tissue. Therefore, regular feeding timing plays an important role in the health of a sedentary modern society.

Skipping breakfast is associated to inadequate nutrient intakes among Tunisian children: a cross-sectional study

Introduction

Breakfast is widely acknowledged as a crucial meal of the day, particularly for children, owing to its role in supplying essential nutrients and energy necessary for optimal growth and cognitive function. This study aims to examine differences in nutrient intake between breakfast skippers and non-skippers among children.

Methods

A representative sample of 1,200 Tunisian preschool and schoolchildren, aged 3-9 years, was randomly selected from kindergartens and primary schools in the Greater Tunis region which includes four governorates (Tunis, Ariana, Manouba and Ben Arous) using a two-stage cross-sectional design. Stratification was carried out depending on each of the selected governorates and urban/rural areas. Dietary intake was evaluated using the 24-hour recall method and a diet history covering the week preceding the survey. Nutritional food composition was derived from a specific Tunisian food composition database. Nutrient intake below age- and sex-specific reference values was considered inadequate.

Results and Discussion

The findings indicate that the daily intake of energy and nutrients was lower among breakfast skippers compared to regular breakfast eaters. After adjusting for energy, gender, age, BMI and household economic proxy, the daily consumption of total sugar, riboflavin, vitamin B-5, phosphorus and calcium was higher among breakfast consumers while saturated fatty acid intake was higher among skippers. A comparative analysis of daily mean food category intake between the two groups revealed a higher consumption of milk and dairy products among breakfast consumers. Regular breakfast consumption is an important part of maintaining a balanced diet and healthy weight.

Socioeconomic inequality in breakfast skipping among Norwegian adolescents

BACKGROUND

Skipping breakfast is associated with negative health-related and school-related outcomes. Breakfast is the most frequently skipped meal among adolescents. Thus, there is a need to explore the reasons for breakfast skipping across population subgroups to better inform policy makers. The purpose of this study was to present the prevalence of adolescents skipping breakfast on schooldays, analyse the reasons for skipping breakfast and assess associations between the prevalence of skipping breakfast and the reasons for skipping breakfast according to sociodemographic variables.

METHODS

The data of a random sample of 10 000 upper secondary school students (aged 16-18 years) from Viken County, Norway, were collected. Students completed a questionnaire measuring breakfast skipping, reasons for skipping breakfast, and sociodemographic variables. Chi-square tests were used to assess differences between the independent groups (family affluence scale (FAS), parental education, and gender) and skipping breakfast and reasons for skipping breakfast.

RESULTS

22% of adolescents reported that they usually skipped breakfast on all schooldays. Skipping breakfast was more prevalent among females, older students, students with lower socioeconomic status and students in vocational education programmes. The difference in breakfast skipping between students with low and high FAS scores was 31% versus 16%, respectively. The most common self-reported reasons for skipping breakfast were time (59%) and not wanting to eat breakfast (48%). Furthermore, 9% reported health issues, and 3% reported economic constraints as a reason for skipping breakfast. Not wanting to eat breakfast was related to a higher FAS score, health issues were more common among girls, and economic constraints were more common among those with low socioeconomic status.

CONCLUSIONS

Skipping breakfast was common among Norwegian upper secondary school students. Lack of time and not wanting breakfast were clearly the most cited reasons for skipping breakfast. Health issues and economic constraints were also cited but were less common. The results showed diverging associations between different demographic characteristics and reasons for skipping breakfast. These results are important for developing effective programs to improve diet among adolescents.

Assessing prevalence, factors and health consequences and academic performance of undergraduate students with breakfast skipping during COVID-19 using statistical modeling: a cross-sectional study

The study was conducted in order to study breakfast skipping (BKS) frequency, factors associated with, health consequence and undergraduate students academic performance during Covid-19 pandemic as earliest studies focusing on this area. A cross-sectional study was carried out among 2225 of undergraduate students. The study was carried between the period of 15/1/2020 to 3/4/2020 using an online self-report Breakfast Eating Habit Survey (BEHS). The BEHS survey was divided into two sections. The first sections included sociodemographic information (gender, BMI, age, smoking, residency, parental education, family income, studying system and stage (public or private), and studying institution (university or institute) academic performance. The second part included questions regarding breakfast eating habits including frequency of skipping meals, factors related to BKS health consequences and types of snacks. Logistic regression is a common technique used for modeling outcomes that fall into the range of 1 and 0. For this purpose, a logistic regression was performed to find adjusted odds ratio and crude odds ratio. The results showed that the majority of participants were female (1238, 55.7%). Out of 2,224 students, 2059 are aged between 18 to 24 years. Most of the participants were from first level (26.5%), second level (32.8%), third level (17.6%) or the fourth level (21.3%). Over 92% of participants were single and about 68% came from families of medium income families. The statistical analysis showed that the odds of BKS is reduced among students who live in accommodation by 54% (odds ratio = 54%, CI (41-71%), p value = 0.000). It seems that students with low income and normal or higher BMI are more likely to skip breakfast more regularly. The odds of skipping breakfast among students with BMI of 18-24.9 is reduced by 41% (odds ratio = 59%, CI (27%-93%), p value = 0.027) and the odds of BKS is reduced among students with BMI of 25-29.9 by 45% (odds ratio = 55%, CI (31-95%). Additionally, students with medium or high incomes are more likely to skip breakfast as much as twofold in comparison with students with low income (medium income (odds ratio = 1.85, CI (1.08-3.17), p-value = 0.024), high income (odds ratio = 1.98, CI (1.12-3.51), p-value = 0.019). The most common reasons for skipping breakfast included include time constraint, not hungry, breakfast is not ready, afraid to be overweight and lack of appetite. The consequences of skipping breakfast were feeling hungry throughout the day, feeling tired, and not paying attention in class and low academic performance. To concluded, BKS during Covid-19 is more common among students with higher BMI, higher income and living in accommodation. The main reason is time constraint and the most common health problems are being tired and luck of attention.

Combined effects of a Mediterranean diet and respiratory muscle training on higher education woodwind musicians: A randomized controlled trial

A two-factor within subjects and randomized controlled was conducted with three groups (two experimental and one control) to explore the effects of the Mediterranean diet and respiratory muscle training on ventilatory fatigue, stress, and emotional performance of woodwind musicians. 70 students from the Valencia Conservatory of Music were recruited and randomized into three groups: respiratory training group + nutrition program (RTG; n = 17), control group (CG; n = 35) and nutrition program group (NPG; n = 18). The nutritional program was based on Mediterranean a diet. Body composition, emotional intelligence, physiological stress and ventilatory response were assessed for all groups before and after intervention. Mixed ANOVA showed main effects of diet and training interventions on emotional attention (F = 8.042; p = 0.006), clarity (F = 9.306; p = 0.003), repair (F = 5.527; p = 0.022), Forced-Expiratory-Volume (F = 30.196; p < 0.000) and Forced-Vital-Capacity (F = 21.052; p < 0.000), with both interventions improving emotional intelligence and ventilatory variables. Bonferroni post-hoc analysis revealed significant differences of RTG and CG for emotional attention (MD = 4.60; p = 0.023), comprehension (MD = 5.734; p = 0.005), repair (MD = 8.576; p < 0.000), FEV1 (MD = 0.862; p = 0.005), and FCV (MD = 1.608; p < 0.001); with similar results when comparing NTG and CG: emotional attention (MD = 4.156; p = 0.041), comprehension (MD = 4.473; p = 0.033), repair (MD = 6.511; p = 0.001), Forced-Expiratory-Volume (MD = 1.608; p < 0.001), and Forced-Vital-Capacity (MD = 1.183; p < 0.001). No significant effects of experimental groups were observed for physiological stress variables (p > 0.05). This results suggests that respiratory training enhances emotional intelligence and lessens respiratory fatigue in musicians, and a combination of a Mediterranean diet and respiratory muscle training further boosts emotional intelligence, albeit with limited impact on physiological stress. This study represents a novel investigation into the approach by dietary interventions and respiratory muscle training in wind musicians since there are no studies that analyze it.

Nutritional Quality of Breakfast Cereals on the French, Belgian and Luxembourg Markets: Which Cereals for Children?

Objective: Analyse the breakfast cereal market to help to help healthcare professionals to guide parents in choosing healthy products for their children. Study design: Observational study of the breakfast cereals available in the biggest supermarkets, discount stores and organic chains in France, Belgium and Luxembourg. Methods: An analysis of nutritional qualities using three indicators: Nutri-Score (initial and modified version), WHO Europe nutrient profile model, and Nova. Results: 645 products were listed; 559 excluding duplicates. A total of 28.8% are marketed to children and make up the group of "children's" cereals, 62.1% of cereals are Muesli, Oats and other cereal flakes (MOCF), and 54.9% are "organic". The study shows that "children's" cereals have a poorer nutritional profile: a higher proportion of Nutri-Score D, higher sugar content, lower fibre content, less conformity with the WHO Europe nutrient profile model and a higher proportion ofultra-processed. On the other hand, MOCF and "organic" products generally have a better nutritional profile: less sugar, more fibre, more Nutri-Score A, less Nutri-Score D and fewer ultra-processed products. Conclusions: Parents should therefore opt for cereals that do not bear any reference to children on the packaging.

Effect of Customized Nutritious Breakfast and Nutrition Education on Nutritional Status of Preschool Children in Economically Underdeveloped Multi-Ethnic Areas: A Cluster Randomized Clinical Trial in Linxia, China

The nutritional status of preschool children in economically underdeveloped multi-ethnic areas is a global concern. This study aimed to examine the effect of a 2.2-year cluster randomized clinical trial that provided customized nutritious breakfast and nutrition education to preschool children in Linxia County, China. A total of 578 children aged 3 to 6 years were enrolled. After the intervention, the incidence of undernourishment was significantly lower in the intervention group compared to the control group (8.73% vs. 9.92%, OR = 0.01 [95%CI 0.00, 0.39], p = 0.014). Additionally, children with non-Muslim dietary habits had a lower incidence of undernourishment compared to those with Muslim dietary habits (OR = 0.05 [95%CI 0.00, 0.88]; p = 0.010). The intervention group also had a lower prevalence rate of wasting (OR = 0.02 [95%CI 0.00, 0.40]; p = 0.011) and a higher mean BMI-for-age Z-score (β = 1.05 [95%CI 0.32, 1.77]; p = 0.005) compared to the control group. These findings suggest that providing nutritious breakfast and nutrition education is an effective strategy to improve the nutrition and health of preschool children, particularly in economically disadvantaged regions and among children with Muslim dietary habits.

Evaluation of the nutritional quality of French children breakfasts according to the Breakfast Quality Score (BQS)

Background

Breakfast meals provide essential nutrients and energy to children and adolescents. Based on recommendations from the International Breakfast Research Initiative (IBRI), the Breakfast Quality Score (BQS) was developed to assess breakfast nutritional value among the French adult population. However, its application to children remains unexplored.

Objective

This study aimed to evaluate the BQS in assessing the nutritional quality of breakfasts consumed by French children aged 4-17 years.

Methods

A total of 4,015 breakfasts, obtained from dietary recalls provided by 1,448 children participating in the French representative dietary survey (INCA3), were analyzed. As for adults, the performance of the BQS was tested through correlations with other nutritional indicators and comparison of nutrients and dietary components between tertiles of scores. The study examined the regularity of breakfast consumption and compared the BQS of children's breakfasts across socio-demographic modalities and breakfast categories distinguished by their primary grain component. Additionally, a predictive modeling using Partial Least Squares (PLS) regression identified influential INCA3 food groups.

Results

The majority of children consumed solid breakfasts regularly. Socio-professional category, household income and food insecurity influenced BQS, revealing contradictory disparities. Ready-to-eat cereal (RTEC) breakfasts had the highest BQS (73.5% for children and 73.1% for adolescent), while biscuits and viennoiseries scored the lowest (52% for children and 49.1% for adolescent). PLS highlighted RTECs, milk, and hot beverages (mainly containing chocolate milk) as being positively associated with BQS, while sweet beverages and viennoiseries were negatively associated.

Conclusion

The study demonstrates the effectiveness of the BQS in assessing children's breakfast quality, with RTEC breakfasts showing the highest nutritional value. The findings provide insights into factors influencing breakfast nutritional quality and underscore the importance of promoting healthier breakfast choices among all children.

Nutrition-Related Knowledge and Nutrition-Related Practice among Polish Adolescents-A Cross-Sectional Study

The aim of this study was to examine the association between nutrition-related knowledge (NRK) and nutrition-related practice (NRP) among 1440 Polish students (aged 10-18 years) and identify the determining factors. Questions about NRK and NRP were thematically similar and referred to the recommendations of the Polish Pyramid of Healthy Nutrition and Lifestyle for Children and Adolescents (4-18 years). A cross-sectional study was conducted using the CAWI method. The respondents obtained an average of 51% of points in the NRK examination and 32% of points in the NRP examination. It was shown that NRP was positively associated with NRK (p < 0.001). The students' NRK was positively determined by the following factors: being female (p < 0.001), older age of students (p < 0.001), living in a larger town (p = 0.012) and a higher level of education of the mother/legal guardian (p < 0.001). NRP was positively associated with greater physical activity of the students (p < 0.001). NRK and NRP were negatively associated with the subjects' BMI (p = 0.029; p = 0.040, respectively). The analysis of NRK shows that the students' knowledge regarding the consumption of milk, milk products and fish should be increased (17-20% correct answers). The analysis of NRP reveals that only 4-14% of students declared appropriate eating habits regarding the consumption of sweet and salty snacks, fish, wholegrain products and milk. This study highlights the need for targeted educational strategies to increase both the understanding and application of dietary guidelines among Polish adolescents for the prevention of diet-related diseases.

Healthy diets positively associated with health-related quality of life in children and adolescents from low socioeconomic areas: Findings from the Greek Food Aid Program, DIATROFI

OBJECTIVES

To assess the relationship of diet with health-related quality of life (HRQoL) in vulnerable children and adolescents.

METHODS

Data included 6583 children and adolescents (aged 3-18 years old) from the Greek Food-Aid DIATROFI Program in the 2015 to 2016 and 2017 to 2018 school years. HRQoL was measured with the Pediatric Quality of Life Inventory questionnaire and diet with food frequency questionnaires. The healthy plant-based diet index (hPDI), animal score, and dietary patterns were investigated.

RESULTS

The hPDI and animal score were associated with good HRQoL (odds ratio [OR] [95% confidence interval], 10-unit increase: ORhPDI = 1.28 [1.05, 1.57], ORanimal = 1.51 [1.14, 2.00]) and physical (ORanimal = 1.62 [1.23, 2.13]), emotional (ORhPDI = 1.30 [1.07, 1.58], ORanimal = 1.41 [1.08, 1.85]) and school function (ORhPDI = 1.32 [1.09, 1.59], ORanimal = 1.46 [1.12, 1.89]). Dietary patterns of fruits, raw vegetables, and cheese were associated with good HRQoL (OR of 1-unit increase: 1.22 [1.13, 1.32]), and physical OR = 1.18 [1.09, 1.27]) and emotional function (OR = 1.09 [1.02, 1.18]). Starchy foods and sweetened beverages were associated with poor HRQoL (OR = 0.75 [0.63, 0.90]), and emotional (OR = 0.80 [0.68, 0.95]) and school function (OR = 0.72 [0.61, 0.85]).

CONCLUSION

Healthy diets and dietary patterns were positively associated with the HRQoL of vulnerable children and adolescents, which may offer opportunities for prevention.

Healthy School Meals for All in Utah

BACKGROUND

The National School Lunch and School Breakfast programs reduce food insecurity and improve dietary intake. During the COVID-19 pandemic, school meals were provided to all children at no cost, regardless of income. This policy is known as Healthy School Meals For All (HSMFA). The purpose of the study was to examine the feasibility of a HSMFA policy in Utah.

METHODS

A mixed-methods approach was used, including qualitative interviews for policymakers, surveys for school foodservice directors, and financial modeling of Utah Child Nutrition Programs data. Analysis included a phenomenological analytic approach for qualitative data, descriptive statistics for surveys, and development of a cost model with 6 scenarios.

RESULTS

Qualitative data revealed themes of (1) awareness; (2) responsibility; (3) perspectives on school meals; and (4) new opportunities. Most (81%) foodservice directors believed HSMFA should continue post-pandemic. HSMFA would cost $51,341,436 to $82,358,375 per year.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

HSMFA would result in the equitable treatment of all children regarding access to healthy school meals.

CONCLUSIONS

Given the support of foodservice directors but the lack of political consensus, considering stepwise implementation and providing cost estimates may increase feasibility of a HSMFA policy in Utah.

School type and oral conditions associated with school performance and absenteeism in adolescents: A multilevel analysis

BACKGROUND

Investigations assessing how oral health status affects school performance and attendance considering individual and community variables are lacking.

AIM

To analyze the association of school contextual factors and oral conditions with school performance and absenteeism in early adolescence.

DESIGN

This cross-sectional study was carried out with 593 12-year-old students from 20 schools in Passo Fundo, a southern city in Brazil. The caregivers provided sociodemographic information by means of a questionnaire. Oral health status was clinically examined for dental caries and gingival bleeding. Students answered the CPQ11-14 questionnaire to assess the oral health-related quality of life (OHRQoL). Information on contextual factors was obtained from the schools' administrators. "School performance" was measured by Portuguese and Mathematic tests' scores, and "school absenteeism" by the number of school days missed. Descriptive statistics was conducted, followed by unadjusted and adjusted multilevel linear regression.

RESULTS

At the individual level, low OHRQoL was associated with lower school performance and higher absenteeism. At the contextual level, students from private schools had higher school performance and lower mean of school days missed.

CONCLUSIONS

The type of school and OHRQoL were associated with school performance and attendance of adolescents.

Emotion-Driven Eating and Overeating Among Fourth Graders: The Roles of Body Image, Academic Achievement, and Peer and School Factors

BACKGROUND

Eating patterns such as breakfast consumption and fruit and vegetable intake have been associated with academic achievement and cognitive function.

METHOD

The purpose of this study was to learn more about psychological (emotion-driven eating) and behavioral (over-eating) eating patterns and motives, and the roles of body image, academic achievement (reading and math), and social supports (peer acceptance and school attachment), among 378 fourth-grade students (55% boys) from 14 classrooms across 6 schools within a large Midwestern urban area.

RESULTS

Results were analyzed through a 2-group (male and female) path analysis. Boys' overeating (R2  = 9%) was not significantly predicted. Their emotional eating (R2  = 22.2%) was negatively, significantly predicted by peer acceptance and interaction of peer acceptance and school attachment. Girls' overeating (R2  = 13.6%) was negatively, significantly predicted by positive body image. Girls' emotional eating (R2  = 24.1%) was negatively significantly predicted by positive body image, math scores, and peer acceptance.

CONCLUSIONS

Boys' and girls' eating patterns are differentially affected by their school experiences.

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.

Attitude towards healthy nutrition and mental toughness: a study of taekwondo athletes

Healthy nutrition is widely considered the cornerstone of optimal athletic performance, both physically and mentally. This study investigates the critical role of healthy nutrition in shaping the physical and mental performance of athletes, with a specific focus on taekwondo. This research aims to explore the potential relationship between taekwondo athletes' attitudes towards healthy nutrition and their mental toughness. The research group comprised 276 active and licensed taekwondo athletes who voluntarily participated in the study (Age M = 17.18 ± SD = 7.13, N = 125 women, N = 151 men). Ethical approval for the research was obtained prior to the commencement of the study. Data collection instruments included the Healthy Nutrition Attitude Scale, Mental Toughness Scale, and a personal information form. Confirmatory factor analysis was conducted to confirm the validity and reliability of the scales. Descriptive statistics, correlation analysis, and regression analysis were performed to explore the relationship between the variables within the research model. The correlation analysis identified two significant, positive, and moderate correlations: (1) between knowledge about nutrition and mental toughness (r = 0.626) and (2) between positive nutrition and mental toughness (r = 0.672). The regression analysis revealed that both knowledge about nutrition (β = 0.360) and positive nutrition (β = 0.461) significantly contribute to mental toughness. The findings suggest that as athletes' knowledge of nutrition expands and their attitudes towards healthy eating become more positive, their mental toughness also appears to improve. These results are both important and original, adding significant new insights to the existing research landscape.

Changes in breakfast and water consumption among adolescents in Canada: examining the impact of COVID-19 in worsening inequity

BACKGROUND

To assess whether changes in breakfast and water consumption during the first full school year after the emergence of the COVID-19 pandemic varied based on sex/gender, race/ethnicity, and socioeconomic status among Canadian adolescents.

METHODS

Prospective annual survey data collected pre- (October 2019-March 2020) and post-COVID-19 onset (November 2020-June 2021) the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study. The sample consisted of 8,128 students; mean (SD) age = 14.2 (1.3) years from a convenience sample of 41 Canadian secondary schools. At both timepoints self-reported breakfast and water consumption were dichotomized as daily or not. Multivariable logistic generalized estimating equations with school clustering were used to estimate differences in maintenance/adoption of daily consumption post-COVID-19 based on demographic factors, while controlling for pre-COVID-19 behaviour.

RESULTS

Adjusted odds ratios (AOR) with 95% confidence intervals are reported. Females (AOR = 0.71 [0.63, 0.79]) and lower socioeconomic status individuals (AORLowest:Highest=0.41 [0.16, 1.00]) were less likely to maintain/adopt daily breakfast consumption than male and higher socioeconomic status peers in the 2020-2021 school year. Black identifying individuals were less likely than all other racial/ethnic identities to maintain/adopt plain water consumption every day of the week (AOR = 0.33 [0.15, 0.75], p < 0.001). No significant interaction effects were detected.

CONCLUSIONS

Results support the hypothesis that changes in nutritional behaviours were not equal across demographic groups. Female, lower socioeconomic status, and Black adolescents reported greater declines in healthy nutritional behaviours. Public health interventions to improve adherence to daily breakfast and water consumption should target these segments of the population.

TRIAL REGISTRATION

Not a trial.

Breakfast Skipping and Determinant Factors among Moroccan School Adolescents (12-19 Years): The Case of Beni Mellal City

Introduction

Breakfast skipping is an unhealthy eating behavior reportedly common among adolescents. The aim of the present study was to determine the prevalence and factors associated with breakfast skipping among schoolchildren aged 12-19 years in Beni Mellal city, Morocco, and to assist in the design of interventions to improve breakfast consumption habits of school-aged children in this region.

Methods

A school-based cross-sectional study was carried out. A total of 550 children were included in the study. Multivariable logistic regression analysis was used to identify factors associated with skipping breakfast consumption. The association between dependent and independent variables was assessed using an odds ratio (OR) with a 95% confidence interval and p value <0.05 was considered statistically significant.

Results

Among 550 Moroccan adolescents evaluated, 25.6% reported not consuming breakfast every day. Breakfast eating was statistically associated with gender (OR = 7.13 [95% CI 1.32-3.84], p = 0.008); mother's low educational level (OR = 2.86 [95% CI 1.89-4.71], p = 0.091); nonworking mothers (OR = 13.71 [95% CI 1.16-5.29], p < 0.001); not eating between meals (OR = 15.49 [95% CI 2.15-5.49], p < 0.001); eating dinner regularly each day (OR = 17.79 [95% CI 2.81-8.01], p = 0.005); eating vegetables 1-3 times per week (OR = 10.21 [95% CI 1.44-4.67], p = 0.001); consuming milk and dairy product 1-3 times per week (OR = 13.88 [95% CI 1.59-5.56], p < 0.001); and never consuming sodas and soft drink in week (OR = 3.12 [95% CI 1.90-4.50], p = 0.003).

Conclusions

This study revealed that the prevalence of skipping breakfast consumption among school-aged children in Beni Mellal city was high. Thus, the findings suggest a community health education program, conducted by school nurses, nutritionists, and other health professionals, is needed.

Effect of habitual breakfast skipping on information processing capacity, cortical response, and cognitive flexibility among medical collegiate - a cross-sectional study

OBJECTIVES

Breakfast replenishes glucose homeostasis and provides other micro-nutrients for the normal functioning of the body after a long night at night. Habitually skipping breakfast leads not only to metabolic disturbances but also to neurocognitive impairment. Hence, the current study was carried out to study the effect of skipping breakfast on neurocognitive functions.

METHODS

A 9-item breakfast questionnaire was distributed online to students for identifying habitual breakfast skippers from non-skippers based on inclusion criteria. Random blood glucose was noted and visual and auditory reaction time, critical flicker fusion frequency, and Stroop test were assessed in both groups to assess cognition.

RESULTS

Forty one habitual breakfast skippers who met the inclusion criteria showed increased visual reaction time, and auditory reaction time indicating cognitive impairment. A significant reduction in the Stroop test was observed among the non-skipper group when compared to the skipper group.

CONCLUSIONS

This study suggests that skipping breakfast diminishes neurocognitive functions like problem-solving, planning, judgment, information retention, and reasoning.

Low levels of serum vitamin C in children with limb fractures: a case-control study

Introduction

The role of vitamin C in pediatric fractures has not received much attention, although it is known to be a factor in osteoporotic fractures in the elderly. This case-control study aimed to investigate the changes in serum vitamin C levels among children with limb fractures.

Methods

We recruited 325 children with and 316 children without limb fractures hospitalized between January 2021 and December 2021. Following admission, basic demographic data of all participants were collected, and fasting serum vitamin C levels were determined using ultra-high-performance liquid chromatography-tandem mass spectrometry.

Results

The mean age of the fracture group was 5.1 years (95% CI, 4.83-5.33). The serum vitamin C levels in the fracture group (4.48 µg/ml) were significantly lower than those in the control group (8.38 µg/ml) (p < 0.0001). Further subgroup analysis of the fracture group revealed that serum vitamin C levels decreased significantly after 4 years of age and there was a significant difference in the duration after injury between <6 and >6 h (p = 0.0224). Spearman's rank correlation coefficient suggested that age and vitamin C levels were negatively correlated in the fracture group.

Conclusion

In general, children with limb fractures had lower serum vitamin C levels, especially those aged 4 years and over.

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.

Clustering of Mediterranean dietary patterns linked with health-related quality of life in adolescents: the EHDLA study

The aim of this cross-sectional study was to analyze the association between adherence to the Mediterranean diet (MedDiet) and its dietary components and health-related quality of life (HRQoL) in a sample of Spanish adolescents. A total sample of 634 adolescents was included (mean age: 13.96 ± 1.54 years; 56.9% girls). The Mediterranean Diet Quality Index in children and adolescents (KIDMED) and the KIDSCREEN-10 were used to assess adherence to the MedDiet and its components and HRQoL, respectively. Linear regression was applied to estimate the association between overall adherence to the MedDiet and HRQoL. Cluster analysis was used to establish subgroups according to different patterns of MedDiet component consumption. Higher overall adherence to the MedDiet was significantly associated with greater HRQoL (unstandardized beta coefficient [β] = 0.329; 95% CI: 0.108, 0.550; p = 0.004), even after adjustment for sociodemographic, physical and lifestyle covariates (β = 0.228; 95% CI: 0.007, 0.449; p = 0.043). When different clusters were established according to similar features of MedDiet component consumption, the cluster with a higher percentage of individuals who skipped breakfast had significantly lower scores on the HRQoL scale (p < 0.05)  Conclusions: Our findings highlight the relevance of considering the specific patterns of food group consumption and MedDiet-related behaviors and not just the overall measure of MedDiet adherence for promoting HRQoL in adolescents. What is Known: • Previous studies have shown that some lifestyle behaviors, such as dietary habits, could be associated with health-related quality of life. • According to our results, higher adherence to the Mediterranean diet pattern was associated with greater health-related quality of life in adolescents. What is New: • Skipping breakfast seems to have a crucial role in health-related quality of life among adolescents. • These results could lead to the development of more specific dietary strategies for increasing health-related quality of life in adolescents.

Association of breakfast styles such as Japanese, Western, and cereals with sleeping habits, eating habits, and lifestyle in preschool and elementary school children

Introduction

In Japan, breakfast styles are categorized into five groups; Japanese breakfast (JB; rice and miso soup), Western breakfast (WB; bread and milk), Japanese-Western breakfast (J-WB; alternative daily serving), cereal breakfast (CB), and breakfast skipping. In our recent studies, breakfast style was highly associated with the daily sleep-wake phase (chronotype), and healthy eating habits. In contrast with other breakfast style consumers, JB-consumers were positively associated with the morning chronotype and healthy eating habits such as a high consumption of a variety of protein sources, vegetables, and dietary fibers, and low consumption of sweetened juices. These previous studies included only adult participants; hence, in the current study, we investigated whether similar observations can be made in children.

Methods

Preschool (aged 3-5 years) and elementary school children (6-8 years) (N = 6,104, 49.87% boys, 50.13% girls, mean body mass index 15.39 ± 0.03 kg/m² for preschoolers and percentage of overweight -2.73 ± 0.22 for elementary school children) participated in this cross-sectional online survey on lifestyle, including eating and sleep habits, through their mother's responses.

Results

The results showed that the morning-evening type index values (chronotype indicator, smaller indicates morning type) were negatively correlated with JB intake (-0.05, p < 0.01) and positively correlated with WB (0.03, p < 0.05) and CB intake (0.06, p < 0.01), suggesting that the JB group exhibited the morning chronotype and the WB and CB groups exhibited the evening chronotype. The JB group consumed a variety of protein sources (mean ± SE; days/week) with more frequency (fish 2.95 ± 0.038 p < 0.001, soy 3.55 ± 0.043 p < 0.001, egg 3.82 ± 0.044 p < 0.001) compared with the WB group (fish 2.58 ± 0.033, soy 3.00 ± 0.038, egg 3.49 ± 0.039). On the other hand, the JB group consumed snacks (5.48 ± 0.042 p < 0.001) and sweetened juice (2.50 ± 0.050 p < 0.001) less frequently than the WB group (snacks; 5.80 ± 0.037 and sweetened juice; 2.74 ± 0.049).

Discussion

JB-eating children with a morning chronotype exhibited better sleep and eating habits than WB-eating children with an evening type pattern. The results suggest that JB eating habits may be associated with good eating and sleeping lifestyles, even among preschool and elementary school children.

The Correlation between Adolescent Daily Breakfast Consumption and Socio-Demographic: Trends in 23 European Countries Participating in the Health Behaviour in School-Aged Children Study (2002-2018)

Breakfast is often considered the most important meal of the day and can benefit adolescent health in several ways. The aims of the present study were (1) to identify adolescents' socio-demographic (sex, family affluence and family structure) determinants of daily breakfast consumption (DBC) and (2) to describe trends in DBC among adolescents across 23 countries. Cross-sectional surveys of nationally representative samples of adolescents (aged 11, 13, and 15 years) (n = 589,737) participating in the Health Behaviour in School-aged Children (HBSC) survey from 2002 to 2018 were used. Multilevel logistic regression analyses modeled DBC over time, adjusted for family affluence, family structure and year of survey. Four countries showed an increased trend in DBC (the Netherlands, Macedonia, Slovenia, and England). A significant decrease in DBC was observed in 15 countries (Belgium-Fr, France, Germany, Croatia, Portugal, Spain, Hungary, Poland, Russian Federation, Ukraine, Denmark, Finland, Latvia, Lithuania and Sweden). In 4 countries no significant change was observed (Czech Republic, Scotland, Ireland and Norway). In most of the countries (n = 19), DBC was higher among the adolescents from high-affluence homes. In all the countries analysed, the adolescents living in two-parent households report higher DBC use than those in single-parent households. More than half of the countries showed a decrease in DBC. There is a need to implement key interventions by developing different strategies (education, incorporating educational curriculum and counselling programmes) to increase DBC. Comparing DBC patterns across HBSC countries is important for understanding regional and global trends, monitoring strategies, and developing health promotion programmes.

Effects of Additional Granola in Children's Breakfast on Nutritional Balance, Sleep and Defecation: An Open-Label Randomized Cross-Over Trial

The contribution of breakfast to daily nutrient intake is low, particularly among children, at only about 20%, and it is difficult to determine whether children are receiving adequate nutrients at breakfast. Although alterations in breakfast content are considered to affect lifestyle habits such as sleep and defecation, there have been few intervention studies in children. The relationship between nutritional balance, dietary intake, and lifestyle habits in children remains unclear. We conducted an intervention study on elementary school children's breakfasts and observed the effects of improving the nutritional balance of breakfast on sleep parameters and defecation status. An intervention study was conducted with 26 elementary school students in Tokyo. The study design was an open-label randomized cross-over trial. Subjects consumed their usual breakfast during the control period and a granola snack containing soy protein in addition to their usual breakfast during the intervention period. Questionnaires regarding breakfast, sleep, and bowel movements were administered during each period. Based on the answers to these questionnaires, we compared the nutritional sufficiency of macronutrients, vitamins, and minerals (29 in total), as well as changes in sleep parameters and defecation status. The additional consumption of granola snacks increased the breakfast intake of 15 nutrients. The changes were particularly significant for iron, vitamin B1, vitamin D, and dietary fiber. During the intervention, sleep duration was decreased and wake-up time became earlier. In terms of defecation, the intervention did not change stool characteristics, but the frequency of defecations per week increased on average by 1.2 per week. These results suggest that the nutritional balance and the amount of breakfast are linked to sleep and defecation and that improving breakfast content can lead to lifestyle improvements in children.

Health-Related Quality of Life in Childhood and Adolescence: The Interrelation with Level of Adherence to Mediterranean Diet and Dietary Trajectories: Highlights from the DIATROFI Program (2021-2022)

Children's dietary habits can have a key role in contributing to an improvement in their Health-Related Quality of Life (HRQoL). This study aims to assess the connection between Mediterranean diet adherence and HRQoL in a sample of Greek students, utilizing data from the DIATROFI program. The parents of 3774 students (mean age 7.8 (2.6) years) reported their children's HRQoL and level of adherence to the Mediterranean dietary pattern at the beginning and end of the 2021-2022 school year. At baseline, most students' adherence was characterized as moderate (55.2%) or high (25.1%). Students with moderate or high adherence tο the Mediterranean diet were less likely to report a total HRQoL below the median at baseline (OR = 0.56, 95%CI = 0.44, 0.70), along with all its dimensions (physical, emotional, social, and school functions). A one-unit improvement in KIDMED score _{(beginning-end of schoolyear)} was associated with the likelihood of an improvement in total HRQoL _{(beginning-end of schoolyear)} (OR = 1.09, 95%CI = 1.02, 1.17), emotional (OR = 1.09, 95%CI = 1.02, 1.17), and social functions (OR = 1.13, 95%CI = 1.05, 1.22), but not with physical and school functions. The health benefits of the Mediterranean diet in children may not be limited to disease prevention but also extend to their overall wellbeing.

Educational Video Intervention Improves Perceptions of Breakfast in the Classroom Among College Students in Elementary Education

OBJECTIVE

Evaluate Elementary Education college students' familiarity and perceptions of Breakfast in the Classroom (BIC) before and after an educational video intervention.

METHODS

A 5-minute educational video was developed as an intervention in a pilot study. Quantitative data were collected from Elementary Education students using preintervention and postintervention surveys and analyzed using paired sample t tests (P < 0.001).

RESULTS

A total of 68 participants completed preintervention and postintervention surveys. Postintervention survey scores indicated that participants' perceptions of BIC improved after watching the video. Paired sample t tests also showed an increase in preference for BIC, familiarity with the 5 school breakfast service models, and confidence to implement BIC in future classrooms.

CONCLUSIONS AND IMPLICATIONS

An educational video intervention effectively improves Elementary Education students' perceptions of BIC. Elementary Education students who gain a positive perception of BIC may influence the program's success and ability to benefit students.

Integration of Food-based Learning With Science in the Preschool Classroom: Implementation Gaps and Opportunities

OBJECTIVE

To explore Head Start teachers' use and integration of food-based learning (FBL) with science learning in the Head Start classroom.

DESIGN

Phenomenological approach using in-depth semistructured telephone interviews.

SETTING

North Carolina Head Start preschools.

PARTICIPANTS

Thirty-five Head Start lead and assistant teachers.

PHENOMENON OF INTEREST

All interviews were transcribed verbatim. Authors coded interview data for emergent themes.

ANALYSIS

Eleven primary themes were identified during analysis and inductively organized using the Systems Thinking Iceberg Model.

RESULTS

Teachers described most frequently using FBL during mealtimes. Teachers stated they felt successful when children were engaged and willing to try a new food. However, they struggled to connect food to science concepts. Teachers reported several motivators (eg, improving health) and barriers (eg, food waste) to integrating FBL. Teachers prioritized preparing children for kindergarten, but most teachers did not see how FBL could help them achieve this goal.

CONCLUSIONS AND IMPLICATIONS

Head Start teacher professional development programs could impact all 4 levels of the Systems Thinking Model to improve teachers' perceptions, underlying structures, and mental models regarding integrative FBL. Additional research is warranted to investigate the adoption, implementation, and potential impact of FBL on academic outcomes.

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.

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.

Body Composition, Eating Habits, and Disordered Eating Behaviors among Adolescent Classical Ballet Dancers and Controls

Adolescent classical ballet dancers are nutritionally vulnerable, as they try to retain a lean body shape during a life period of high nutritional requirements due to rapid growth. Studies conducted on adult dancers have indicated a high risk for the development of disordered eating behaviors (DEBs), but research on adolescent dancers remains scarce. The aim of the present case-control study was to compare the body composition, dietary habits, and DEBs of female adolescent classical ballet dancers and their non-dancer same-sex peers. Self-reported questionnaires, namely the Eating Attitudes Test-26 (EAT-26) and a 19-item Food Frequency Questionnaire (FFQ), were used for the assessment of habitual diet and DEBs. The assessment of body composition included the measurements of body weight, height, body circumference, and skinfolds and bioelectrical impedance analysis (BIA). The results indicate that the dancers were leaner than the controls, with lower weight, BMIs, and hip and arm circumferences, leaner skinfolds, and less fat mass. No differences were observed between the two groups regarding eating habits and the EAT-26 scores, but almost 1 out of 4 (23.3%) participants scored ≥ 20, indicative of DEBs. Participants with an EAT-26 score ≥ 20 had significantly higher body weight, BMIs, body circumferences, fat mass, and fat-free mass than those with a score < 20. Adolescents must be educated on nutrition and healthy methods to control body weight through evidence-based information and programs, and whenever appropriate, also through individual counseling by the appropriate health professionals.

Associations between adolescents' energy drink consumption frequency and several negative health indicators

BACKGROUND

The purpose of this study was to identify how various negative health indicators are associated with energy drink consumption frequency among 13- and 15-year-old Finnish adolescents.

METHODS

Data (N = 2429) from the nationally representative international Health Behaviour in School-aged Children study (2018) were analyzed via descriptive analysis and logistic regression analyses, with control for salient covariates. Relative risks (RR) were derived from the adjusted odds ratios.

RESULTS

Even infrequent energy drink consumption was associated with various negative health indicators. Moreover, as compared to non-users, frequent energy drink consumers were more likely to report several health-compromising behaviors: current smoking (RR = 9.85, 95% CI: 5.68-16.02), current snus use (RR = 3.62, 95% CI: 1.80-6.85), cannabis use (RR = 3.42, 95% CI: 1.69-6.52), alcohol consumption (RR = 3.08, 95% CI: 2.49-3.71), problematic social media use (RR = 2.53, 95% CI:1.68-3.72), short sleep (RR = 2.12, 95% CI: 1.69-2.60), skipping breakfast (RR = 1.87, 95% CI: 1.51-2.29), drunkenness (RR = 1.59, 95% CI: 1.11-2.23), inadequate tooth brushing (RR = 1.28, 95% CI: 1.05-1.54). In addition, frequent energy drink consumption was associated with perceived negative health indicators: feelings of insufficient sleep (RR = 1.56, 95% CI: 1.11-2.15), low self-rated health (RR = 1.48, 95% CI: 1.15-1.87), and multiple health complaints (RR = 1.31, 95% CI: 1.07-1.56).

CONCLUSIONS

Energy drink consumption, even infrequent, was associated with several negative health indicators, and the reporting of these increased with the frequency of energy drink consumption. The findings support the concerns of health authorities regarding the negative associations between energy drink consumption and health, even among persons as young as 13 years. There is evidence to support specific policy level actions, including restrictions on the sale of energy drinks to adolescents. This measure has been proposed in a Finnish government program, but implementation has yet to occur. Moreover, marketing of these beverages in platforms that are popular among adolescents (e.g., the social media) should be rigorously evaluated, and comprehensive interventions and actions implemented to ensure that adolescents, parents/guardians, and professionals working with adolescents (e.g., in schools) have a good understanding of the links between energy drink consumption and health.

Meal Timing and Sleeping Energy Metabolism

There is a physiological link between sleep and eating. Insufficient sleep is a risk factor for overeating and excess body weight gain, and molecules such as orexin and insulin play a role in the control of sleep and energy intake. The effects of dietary timing on sleep and energy metabolism were examined in this review. First, we examined sleep energy metabolism and sleep quality under time-restricted eating, including skipping breakfast or dinner. Second, the mechanisms, benefits, and translational potential of the effects of time-restricted diets on sleep were discussed. Time-restricted eating under controlled conditions, in which daily caloric intake was kept constant, affected the time course of energy metabolism but did not affect total energy expenditure over 24 h. In free-living conditions, time-restricted eating for extended durations (4-16 weeks) decreased energy intake and body weight, and the effects of early time-restricted eating were greater than that of midday time-restricted eating. Although assessment of sleep by polysomnographic recording remains to be performed, no negative effects on the subjective quality of sleep have been observed.

Breakfast Consumption and Diet Quality of Teens in Southwestern Ontario

Background

Breakfast skipping has previously been associated with worse diet quality among adolescents; the latter increases the risk of chronic disease. However, many studies do not consider diet quality as a function of calories, which is problematic as skippers tend to consume less energy than consumers. Additionally, due to the lack of one accepted definition of both breakfast skipping and diet quality, it is unclear how differences found may change when using varying definitions.

Objectives

We aimed to compare the Healthy Eating Index-2015 (HEI-2015) scores and nutrient intakes of teen breakfast skippers and consumers in Southwestern Ontario, Canada.

Methods

Cross-sectional, baseline data were used from SmartAPPetite, an ongoing nutrition intervention study. Singular 24-h dietary recalls and sociodemographic data from 512 adolescents aged 13-19 y were used to compare HEI-2015 scores and nutrient intakes via multivariable linear regression.

Results

Previous day breakfast skippers had significantly lower HEI-2015 scores (-4.4; 95% CI: -8.4, -0.4) and significantly lower intakes of calories, saturated fat, and vitamin C, as well as significantly higher intake of sodium and total fat.

Conclusions

Previous day breakfast consumers had significantly higher diet quality scores and better nutrient intakes than breakfast skippers, although, on average, both had poor diet quality. Consequently, it is unlikely that simply advising teens to consume breakfast will result in meaningful change in diet quality, and more effort should be placed on promoting nutritious breakfasts.

Liver glycogen stores via 13C magnetic resonance spectroscopy in healthy children: randomized, controlled study

BACKGROUND

Owing to its role in glucose homeostasis, liver glycogen concentration ([LGly]) can be a marker of altered metabolism seen in disorders that impact the health of children. However, there is a paucity of normative data for this measure in children to allow comparison with patients, and time-course assessment of [LGly] in response to feeding has not been reported. In addition, carbon-13 magnetic resonance spectroscopy (¹³C-MRS) is used extensively in research to assess liver metabolites in adult health and disease noninvasively, but similar measurements in children are lacking.

OBJECTIVES

The main objectives were to quantify the depletion of [LGly] after overnight fasting and the subsequent response to feeding.

METHODS

In a randomly assigned, open-label, incomplete block design study, healthy, normal-weight children (8-12 y) attended 2 evening visits, each separated by ≥5 d and directly followed by a morning visit. An individually tailored, standardized meal was consumed 3-h prior to evening assessments. Participants then remained fasted until the morning visit. [LGly] was assessed once in the fed (20:00) and fasted state (08:00) using ¹³C-MRS. After the 8:00 assessment, 200 ml of a mixed-macronutrient drink containing 15.5 g (402 kJ) or 31 g carbohydrates (804 kJ), or water only, was consumed, with ¹³C-MRS measurements then performed hourly for 4 h. Each child was randomly assigned to 2 of 3 drink options across the 2 mornings. Data are expressed as mean (SD).

RESULTS

Twenty-four children including females and males (13F:11M) completed the study [9.9 (1.1) y, BMI percentile 45.7 (25.9)]. [LGly] decreased from 377.9 (141.3) to 277.3 (107.4) mmol/L overnight; depletion rate 0.14 (0.15) mmol/L min. Incremental responses of [LGly] to test drinks differed (P < 0.001), with incremental net area under the curve of [LGly] over 4 h being higher for 15.5 g [-67.1 (205.8) mmol/L·240 min; P < 0.01] and 31 g carbohydrates [101.6 (180.9) mmol/L·240 min; P < 0.005] compared with water [-253.1 (231.2) mmol/L·240 min].

CONCLUSIONS

After overnight fasting, [LGly] decreased by 22.9 (25.1)%, and [LGly] incremental net area under the curve over 4 h was higher after subsequent consumption of 15.5 g and 31 g carbohydrates, compared to water. Am J Clin Nutr 20XX;xx:xx-xx.

An exposome connectivity paradigm for the mechanistic assessment of the effects of prenatal and early life exposure to metals on neurodevelopment

The exposome paradigm through an integrated approach to investigating the impact of perinatal exposure to metals on child neurodevelopment in two cohorts carried out in Slovenia (PHIME cohort) and Greece (HERACLES cohort) respectively, is presented herein. Heavy metals are well-known neurotoxicants with well-established links to impaired neurodevelopment. The links between in utero and early-life exposure to metals, metabolic pathway dysregulation, and neurodevelopmental disorders were drawn through urinary and plasma untargeted metabolomics analysis, followed by the combined application of in silico and biostatistical methods. Heavy metal prenatal and postnatal exposure was evaluated, including parameters indirectly related to exposure and health adversities, such as sociodemographic and anthropometric parameters and dietary factors. The primary outcome of the study was that the identified perturbations related to the TCA cycle are mainly associated with impaired mitochondrial respiration, which is detrimental to cellular homeostasis and functionality; this is further potentiated by the capacity of heavy metals to induce oxidative stress. Insufficient production of energy from the mitochondria during the perinatal period is associated with developmental disorders in children. The HERACLES cohort included more detailed data regarding diet and sociodemographic status of the studied population, allowing the identification of a broader spectrum of effect modifiers, such as the beneficial role of a diet rich in antioxidants such as lycopene and ω-3 fatty acids, the negative effect the consumption of food items such as pork and chicken meat has or the multiple impacts of fish consumption. Beyond diet, several other factors have been proven influential for child neurodevelopment, such as the proximity to pollution sources (e.g., waste treatment site) and the broader living environment, including socioeconomic and demographic characteristics. Overall, our results demonstrate the utility of exposome-wide association studies (EWAS) toward understanding the relationships among the multiple factors that determine human exposure and the underlying biology, reflected as omics markers of effect on neurodevelopment during childhood.