Daily meal frequency and associated variables in children and adolescents

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

CONTEXT

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

OBJECTIVE

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

DATA EXTRACTION

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

DATA ANALYSIS

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

CONCLUSION

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

Association of main meal frequency and skipping with metabolic syndrome in Korean adults: a cross-sectional study

BACKGROUND

Reduced meal frequency can increase the risk of metabolic syndrome (MetS). However, limited studies have examined the association between meal frequency and skipping meals with MetS. This study aims to analyze the association between main meal frequency and meal skipping with MetS in Korean adults aged ≥ 19 years.

METHODS

In this study, we included data from 22,699 Korean adult participants from the 2016-2020 Korea National Health and Nutrition Examination Survey (KNHANES). The 24-h dietary recall method was used to classify the participants into three groups based on main meal frequency (one, two, or three meals per day) and seven groups based on the type of main meal they skipped. Multivariable logistic regression analysis was conducted to determine the association between main meal frequency and the types of main meals skipped with the odds of MetS and its associated components. Appropriate estimates were accounted for using sampling weights, stratification, and clustering.

RESULTS

The prevalence of MetS in the study population was 33.8%. The average age of the participants was 47.2 years with 42.6% being men, and 57.4% being women. Men who consumed two meals per day had higher odds of MetS than those who consumed three meals per day (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.01-1.33). Women who consumed two meals per day, and skipped breakfast had increased odds of having elevated fasting blood glucose levels (OR 1.18, 95% CI 1.02-1.35), and elevated triglycerides (OR 1.19, 95% CI 1.02-1.39). However, women who skipped dinner had reduced odds of having elevated fasting blood glucose levels (OR 0.74, 95% CI 0.58-0.94).

CONCLUSIONS

Our findings suggest that meal frequency and the type of main meal skipped may be associated with MetS and emphasize the importance of consuming breakfast to prevent MetS.

Association of malnutrition and main-meal- and snack-predominant intake among female adolescent students in boarding schools in Tasikmalaya, Indonesia

Background: Balanced dietary intake is needed to prevent malnutrition which is one of the nutritional problems faced by adolescents. Aim: To study the association between predominant dietary intake and nutritional status of female adolescent students in boarding schools in Tasikmalaya, Indonesia. Method: This cross-sectional study was conducted on 323 female adolescent students residing full-time in eight boarding schools in Tasikmalaya, West Java. Students' dietary intake was measured using the 3-non-consecutive-day 24-h recall method. The association between the predominant dietary intake and nutritional status was evaluated using binary logistic regression. Results: Of the 323 students, 59 (18.3%) were overweight/obese (OW/OB) and 102 (31.6%) had stunted growth. The predominant dietary intake in the OW/OB group was snacks, whereas, in the stunted group, it was main meals. Snack-predominant dietary intake was a risk factor for overweight and obesity (p  =  0.008; adjusted odds ratio [AOR]: 2.276; 95% confidence interval [CI]: 1.244-4.164), but it was a protective factor against stunting (p  =  0.008; AOR: 0.521; 95% CI: 0.322-0.842). Conclusion: The predominance of main meals and snacks as components of total dietary intake affected the nutritional status of female adolescent students living in boarding schools. Therefore, the dietary intake interventions should tailor and design the nutritional contents of main meals and snacks according to the nutritional status of the targeted individuals.

Gender, Age, Family and Territorial Features of Dietary and Physical Activity Patterns in Russian Youths

OBJECTIVE

Identifying dietary and physical activity (PA) patterns in Russian youths and examining their dependence on gender, age, family characteristics and area of residence features. The research involved 783 school students 10-17 years of age and their parents living in the cities of Moscow and Murmansk. Using the principal component analysis, four integral indices were identified that characterized the habits and dietary patterns, PA and lifestyle. Boys, compared with girls, were more likely to consume unhealthy foods but less likely to practice malnutrition. Within the age ranges of 13-15 years old and 16-17 years old, the proportions of school students with a poor sleep pattern and low PA were higher than in children 10-12 years of age. In smoking families, children were less likely to consume healthy foods and more likely to eat unhealthy foods. In Murmansk school students, compared with their Moscow peers, a reduction in both sleep time and PA was observed less often. Our study demonstrated that the most significant factors of a balanced and healthy diet, rational daily routine and lifestyle in school students were their gender and age characteristics, as well as some contextual factors.

A cross-sectional study examining self-reported anthropometric measurements with adolescents' nutrition attitudes, obesity awareness and diet quality indices during the pandemic

PURPOSE

The purpose of this study is to evaluate the relationship between adolescents' nutritional attitudes, obesity awareness, and diet quality with their self-reported anthropometric measurements taken during the COVID-19 pandemic.

DESIGN AND METHODS

This cross-sectional type of study was conducted in a district in the south of Turkey. The research was carried out online with 907 adolescents who agreed to participate voluntarily.

RESULTS

Among the adolescents, 28.5% considered themselves overweight, and 32.1% were currently trying to lose weight. According to BMI, 16.1% were affected by overweight/obesity. Adolescents' nutritional attitudes and obesity awareness levels were moderate, while their KIDMED nutritional habits were also moderate. In this study, a negative relationship was found between the adolescents' ASHN mean scores and their body weight, waist circumference, hip circumference, neck circumference, waist/hip ratio and waist/height ratio measurements; and between their OAS mean scores and their body weight, waist circumference, waist/hip ratio and waist/height ratio measurements; and between their KIDMED index scores and their waist/height ratio measurements (p < 0.001).

CONCLUSIONS

The rate of adolescents who perceive themselves as overweight is higher than the results obtained from the measurement values. BMI levels and other anthropometric measurement values of adolescents with positive nutrition attitudes and physical activity behaviours are also positively affected.

PRACTICE IMPLICATIONS

This study may have a significant impact on the formulation and implementation of interventions to prevent obesity and increase physical activity for school health nurses. Since the pandemic is still continuing, healthcare providers must stress the risk of obesity in adolescence.

Analysis of Food Habits during Pandemic in a Polish Population-Based Sample of Primary School Adolescents: Diet and Activity of Youth during COVID-19 (DAY-19) Study

The improper dietary behaviors of children and adolescents during the COVID-19 pandemic, which are associated with lockdowns and reduced physical activity, are a complex problem, potentially resulting in increased risk of diet-related diseases, including overweight and obesity and their consequences. The aim of the study was to assess the food habits during the COVID-19 pandemic and to define their association with physical activity and body mass changes in a Polish population of primary school adolescents within the Diet and Activity of Youth During COVID-19 (DAY-19) Study. The DAY-19 Study was conducted in June 2020 in a national cohort of 1334 primary school students aged 10–16 years, recruited based on a stratified random sampling of schools (sampling counties from voivodeships and schools from counties). The Adolescent Food Habits Checklist (AFHC) was used to assess food habits, associated with food purchase, preparation, and consumption, which in the studied group were analyzed separately for the period before (retrospective data) and during the COVID-19 pandemic (prospective data). The recognizable physical activity changes and recognizable body mass changes were also assessed (retrospective data) and respondents were classified as those declaring that their physical activity and body mass decreased, remained stable, or increased during the COVID-19 pandemic. It was observed that during the COVID-19 pandemic the majority of food habits changed in a statistically significant way (p < 0.05). Within food purchase habits, the number of respondents who declared choosing a low-fat lunch away from home decreased, often buying pastries or cakes decreased, and buying a low-fat crisps brand increased (p < 0.05). Within food preparation habits, the number of respondents who declared trying to keep overall fat intake down increased, trying to keep overall sugar intake down increased, eating at least one serving of vegetables or salad with evening meal increased, and usually including some chocolate and/or biscuits in a packed lunch decreased (p < 0.05). Within food consumption habits, the number of respondents who declared making sure that they eat at least one serving of fruit a day increased, eating at least three servings of fruit most days increased, making sure that they eat at least one serving of vegetables or salad a day increased, trying to ensure that they eat plenty of fruit and vegetables increased, often choosing a fruit when they have a snack between meals increased, eating at least three servings of fruit most days increased, and generally trying to have a healthy diet increased (p < 0.05). It was concluded that in the period of the COVID-19 pandemic and resultant remote education, adolescents in Poland presented different food habits than before, while the majority of changes were positive. The positive food purchase, preparation, and consumption habits were observed mainly in sub-groups of adolescents declaring decreased body mass or increased physical activity during the COVID-19 pandemic. It may be suggested that physical activity may support positive changes of dietary behaviors and while combined positive changes of diet and increased physical activity, they may effectively promote body mass reduction in adolescents.

Abdominal obesity-related risk factors in children from public schools of Barbacena, Minas Gerais, Brazil

OBJECTIVE

To evaluate the sociodemographic and lifestyle factors associated with abdominal obesity in children from public schools in Barbacena, state of Minas Gerais, Brazil.

METHODS

This is a cross-sectional study conducted on 326 students aged 7 to 9 years from public schools in the urban area of the city. Anthropometric data included body weight, height, body mass index according to age, waist circumference, and waist-to-height ratio. Food consumption was evaluated using the Previous Day Food Questionnaire. Abdominal obesity was assessed based on waist circumference and waist-to-height ratio. The bivariate and multivariate analyses were performed by logistic regression, estimating the crude and adjusted odds ratio (OR), with 95% confidence interval.

RESULTS

The prevalence of overweight was 30.7%; whereas the prevalence of abdominal obesity was 9.2 and 12.6% according to waist circumference and waist-to-height ratio, respectively. Boys (OR 2.76; 95%CI 1.22-6.25) and children from central schools (OR 2.73; 95%CI 1.08-6.80) presented an increased chance of abdominal obesity according to waist circumference. Abdominal obesity according to waist-to-height ratio was associated with the central location of the schools (OR 2.18; 95%CI 1.02-4.63) and the habit of skipping supper (OR 2.01; 95%CI 1.00-4.09).

CONCLUSIONS

The findings showed that being a boy, studying in a central school, and skipping supper were the main risk factors associated with abdominal obesity.

Evaluation of body mass index and related lifestyle factors among 14-17-year-old Turkish adolescents

OBJECTIVE:

During adolescence, unhealthy body weight status is considered as a global concern as it may lead to adverse health consequences in adulthood, therefore evaluation of the risk factors is crucial. The aim of the study was to determine the prevalence of adolescents under the risk of being underweight, overweight, and obese among 14–17-year-old Turkish adolescents. In addition, we examined the association between unhealthy body weight categories and lifestyle factors.

METHODS:

This study was designed as cross-sectional study which included body weight status and associated parameters of 1561 adolescents aged between 14 and 17 who were registered 25 different high schools in Istanbul, Uskudar. Height and body weight of participants were measured and related factors were obtained through a questionnaire. Differences in distributions were analyzed using the Chi-square test and to control confounding factors, multivariate logistic regression analysis was performed. As statistical significance limit of p<0.05 was determined.

RESULTS:

Body mass index (BMI) percentile analyses indicated that 3.6% of participants were underweight, 14.3% were overweight, and 13.8% were obese. We demonstrated that age, gender, and school types were statistically very significantly associated with BMI (p<0.001) and daily meal frequency, eating speed, and mealtime regularity were significantly related with BMI (p<0.05). In addition, according to multivariate analysis results, gender and school types were closely related with obesity among 14–17-year old Turkish adolescents.

CONCLUSION:

This study has been demonstrated that frequency of adolescent obesity in Istanbul, Turkey, has increased and obesity closely related to gender and type of school. Further educational and interventional studies should be organized in this region with consideration of relevant risk factors.

FREQUENCY OF MEALS CONSUMED BY BRAZILIAN ADOLESCENTS AND ASSOCIATED HABITS: SYSTEMATIC REVIEW

OBJECTIVE

To analyze the studies that identified the frequency of meals ingested by Brazilian adolescents and associated habits.

DATA SOURCES

A systematic search was made in the databases and electronic databases: MEDLINE/PubMed, The Latin American and Caribbean Center of Information in Health Sciences (BIREME), Scopus, Web of Science and Embase, with articles published between January/2007 until December/2017, which addressed the evaluation of the frequency of meals performed by adolescents, considering or not associations with eating patterns and meal replacement.

DATA SYNTHESIS

6,608 studies were obtained through the search and nine were included in this review, all of them with a cross-sectional design. Eight studies used school surveys and only one was a population survey. Seven studies evaluated the frequency of the main daily meals that ranged from 47.0 to 79.0% at breakfast, from 65.0 to 98.4% at lunch, and from 51.0 to 94.0% at dinner. Five studies identified the frequencies of consumption of snacks between meals, finding higher values for afternoon snack (variation from 42.0 to 78.0%). Regarding the substitution of meals for snacks, in three of the four selected studies; it was observed that this practice occurred mainly in substitution of dinner (24.6 to 42.0%).

CONCLUSIONS

Breakfast was the most omitted meal for adolescents, and dinner was replaced with snacks. Among the between meal snacks, the afternoon snack was the most consumed.

Impact of Bean Consumption on Nutritional Outcomes amongst Adolescents

Brazilian adolescents have undergone a noteworthy nutritional epidemiological transition. There is an increase in the prevalence of overweight and high consumption of ultra-processed foods in parallel with patterns of traditional meals that include beans. This study analyzed associations between bean consumption in the diet of adolescents and nutrition outcomes. Multiple regression analysis showed a significant reduction in body mass index (BMI), body fat percentage (%BF) and LDL-cholesterol (LDL-c) values among those with bean consumption equal to or greater than five times a week. Adolescents who had lunch outside the home and those who did not have the habit of having lunch showed a significantly higher BMI. There was an increase in the %BF among married adolescents and those who did not have lunch. There was a reduction of LDL-c among those with intermediate per capita income and those who consumed processed juice less than 5 times a week, and an increase among those who did not have breakfast. There were significant interactions between sexual maturation, energy consumption, physical activity and energy consumption. Thus, in the context of this study, the presence of beans in the diet, at frequencies equal to or greater than five times a week, can be considered a proxy for healthy eating.

Food environment, social deprivation and obesity among students from Brazilian public schools

Objective

To investigate the relationship between social deprivation and the food environment. Furthermore, to evaluate if the food environment is associated with the prevalence of obesity among students in Brazilian public schools.

Design

Cross-sectional. For the classification of obesity, weight and height were measured, and the cut-off point of BMI-for-age Z-score >+2 was adopted. Social deprivation level was determined from the Health Vulnerability Index (HVI). To assess the food environment, the density of food establishments in urban residential areas was calculated. Associations between the food environment and the presence of obesity were estimated by binary logistic regression through a generalized estimating equations model.

Setting

Juiz de Fora, Minas Gerais, Brazil.

Subjects

Children and adolescents (n 661) aged 7–14 years.

Results

The lowest social deprivation level showed a higher density of all types of establishments that sold predominantly unhealthy foods. An inverse association was found between the density of supermarkets and hypermarkets and the presence of obesity (OR=0·58; 95 % CI 0·36, 0·93). For the other categories of food retailers, no significant differences were found.

Conclusions

The findings reinforce the need for public policies that promote equality in the food environments of the city. Also, further investigations into the influence of the presence of supermarkets on the nutritional status of children and adolescents are required.

Meal habits and anthropometric indicators in adolescents from public and private schools of the metropolitan region of Rio de Janeiro

ABSTRACT Objective To describe meal consumption habits and assess their associations with anthropometric indicators. Methods A cross-sectional study was performed on 1,749 elementary and high school students from public and private schools in the city of Rio de Janeiro, Brazil (mean age=15.3 years), who were selected for the baseline of the Longitudinal Study for Nutritional Assessment of Adolescents. Meal habits and meals consumed in the company of parents were assessed using a self-administered questionnaire. The consumption of the main meals was categorized as regular (daily) or irregular (≤6 times a week). The meal consumption profile was considered either satisfactory (breakfast, lunch, and dinner consumed on a daily basis) or unsatisfactory. Body Mass Index, waist-to-height ratio, and body fat percentage were calculated. The association between meal consumption habits and anthropometric indicators was estimated using multivariate logistic regression models, adjusted for age and sex and stratified according to the type of school. Results Regular lunch consumption was more frequent among private schools students, who also had higher frequency of eating dinner irregularly. Among students from private schools, the unsatisfactory meal consumption profile and irregular meal habits were associated with being overweight, having a high waist-to-height ratio, and increased body fat percentage. Among students from public schools, it was observed association between being overweight with irregular breakfast habits. Conclusion In adolescents, the association between meal habits and weight status may be modulated by socioeconomic condition.