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

Lifestyle Behaviors Associated with Weight Loss Intent in Adolescent Girls: Findings from the US 2021 National Youth Risk Behavior Survey

Background: External social influences on body image affect females differently than males, and adolescent girls are more likely to want to change their weight status. Understanding the healthy and unhealthy habits of adolescent girls is vital for developing effective and targeted health promotions and interventions. Methods: Using data from the 2021 Youth Risk Behavior Surveillance System (YRBS) survey, this cross-sectional study compares dietary habits, physical activity, vaping, alcohol use, sleep, and screen time in females (9th-12th grades) who intend to lose weight versus those who want to maintain their current weight. Results: The sample consisted of 4362 females, of which 56.7% reported an intent to lose weight. The average BMI percentile was 64.1 compared to 75.4 among those trying to lose weight and 50.1 among those not trying to lose weight. Adolescent girls intending to lose weight also reported less frequent breakfast consumption (OR 0.52; 0.40-0.69), less sleep (OR 0.72; 0.59-0.89), more screen time (OR 1.27; 1.02-1.58), engaging in muscle toning exercises (OR 1.30; 1.07-1.57), vaping (OR 1.22; 1.01-1.47), and alcohol use (OR 1.61; 1.32-1.98) compared to those not intending to lose weight. Conclusions: Adolescent girls trying to lose weight would likely benefit from interventions to help them improve sleep, reduce screen time, improve dietary and exercise habits, and monitor alcohol and vaping use.

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.

The associations between irregular breakfast and late-night snacking with metabolic dysfunction-associated steatotic liver disease

BACKGROUND

The newly coined term Metabolic dysfunction-associated steatotic liver disease (MASLD) emphasizes the critical role of metabolic risk factors in the pathogenesis of fatty liver disease. The consumption of irregular breakfasts or late-night snacks has been identified as a factor closely associated with disruptions in the body's energy homeostasis and metabolic balance. However, the relationship between these behaviors and MASLD has not been previously examined.

METHODS

Participants in this study were recruited from the Kailuan cohort, a prospective cohort. All participants completed questionnaires regarding breakfast and late-night snack frequencies. The primary outcomes were MASLD and MASLD with increased alcohol intake (MetALD). Cox regression analysis was utilized to calculate the hazard ratios (HR) and 95 % confidence intervals (CI) for MASLD and MetALD in different groups. Mediation analysis was used to assess the mediating effect of BMI on this relationship.

RESULTS

A total of 32,030 participants were included in the study. Both irregular breakfast consumption and late-night snacking were associated with an increased risk of MASLD. Compared to participants who consumed regular breakfast and no late-night snacks, the risk of MASLD was elevated in participants who consumed regular breakfast but late-night snacks (HR = 1.12, 95 % CI: 1.05-1.20), irregular breakfast but no late-night snacking (HR = 1.16, 95 % CI: 1.05-1.27), irregular breakfast and late-night snacking (HR = 1.26, 95 % CI: 1.13-1.42), never ate breakfast and no late-night snacking (HR = 1.33, 95 % CI: 1.23-1.44), and never ate breakfast and late-night snacking (HR = 1.52, 95 % CI: 1.30-1.77).

CONCLUSION

Irregular or skipped breakfast and late-night snacking were associated with an increased risk of MASLD and MetALD.

Skipping breakfast and nutrient density: Influence on obesity, blood pressure, glucose, and cholesterol in elementary school students

BACKGROUND

Skipping breakfast is a public health issue affecting childhood obesity worldwide. However, how skipping breakfast adversely affects metabolic health in children has not been investigated comprehensively. This study investigated the associations between breakfast skipping, obesity, and cardiometabolic risk in elementary school students and identified its association with nutritional patterns.

METHODS

Data on 3590 elementary school students were obtained from the Korea National Health and Nutrition Examination Survey (2013-2020). Participants self-reported weekly breakfast frequency, and dietary nutrient intake was assessed using a 24-h recall survey. The associations of breakfast frequency with obesity, cardiometabolic risk factors, and nutrient density were analyzed using a survey multivariate linear regression analysis.

RESULTS

The lowest breakfast frequency group (0-2 times/week) had a higher mean body mass index (estimated mean differences; 0.80 kg/m2, 95 % confidence interval (CI) 0.30-1.31) and waist circumference (2.20 cm, 0.83-3.57) than the highest frequency group (5-7 times/week). Additionally, they had higher systolic blood pressure (1.68 mmHg, 0.12-3.24), diastolic blood pressure (2.24 mmHg, 1.09-3.39), fasting glucose (1.58 mg/dL, 0.40-2.75) than the highest breakfast group. Furthermore, this group had higher percentages of energy from fat (1.96 %, 0.90-3.02), sodium density (10.29 mg/100 kcal, 0.75-19.82) and Na/K ratio (0.25 mmol/mmol, 0.11-0.40) than the highest frequency group, despite lower caloric intake.

CONCLUSIONS

Elementary school students who skipped breakfast had higher obesity and cardiometabolic risk factors. These associations might be assumed from dietary nutrient patterns characterized by higher fat and sodium density despite lower daily caloric consumption.

Differences in frequency of selected risk factors of overweight and obesity in adolescents in various social environments within Slovakia

OBJECTIVES

Analysis of subnational regional differences in frequency of selected risk factors of overweight and obesity in adolescents in Slovakia.

STUDY DESIGN

Cross-sectional study.

METHODS

Health Behaviour in School-aged Children is an international cross-sectional questionnaire study using the standard protocol to create representative samples of adolescents. We analyse subnational regional differences in the occurrence of selected risk factors of overweight and obesity among 10-12-year-old (n = 4194) and 14-16-year-old (n = 3806) respondents of a survey conducted in Slovakia in 2022.

RESULTS

Overweight and obesity dominated especially in the regions with the Hungarian minority among boys aged 10-12 years (29.2 %) and 14-16 years (34.0 %). Consumption of energy (24.9 % of girls and 29.9 % of boys) and sweetened (25.0 % of girls and 27.1 % of boys) drinks dominated among 14-16-year-old respondents in the poverty regions with socio-economic problems. Skipping breakfast was most widespread among 14-16-year-old girls from regions with a Hungarian minority (72.6 %). Insufficient physical activity was most frequent among 10-12-year-old respondents, namely, in the poverty regions (85.0 % of girls) and the Hungarian minority (79.6 % of boys) regions. The differences also remained significant after weighting for a possible confounding effect of family socioeconomic status.

CONCLUSIONS

The regional social environment is associated with selected aspects of adolescents' behaviour related to overweight and obesity, namely, the poverty regions and Hungarian minority environments, and can be considered as an independent determinant regardless of a family background.

A snapshot of country-specific dietary habits and obesity in European children: the Feel4Diabetes study

This study assessed the dietary intake of European children by country, gender, and obesity degree across six European countries participating in the Feel4Diabetes study. It also compared food group intakes with European food-based dietary guidelines. The Feel4Diabetes study included 9,847 children (50.4% girls) from six European countries. Families provided baseline data on energy balance-related behaviors and socioeconomic factors via questionnaires. Children's dietary intake and breakfast consumption were assessed using semi-quantitative food frequency questionnaires, and anthropometric measurements were taken. Intake from 11 food groups was analyzed by country, gender, and obesity degree. Chi-square analyses compared food intake with dietary guidelines. "Nutrient-dense " foods (e.g., fruits, vegetables, whole grains) and "energy-dense, low-nutrient" foods (e.g., high in added sugars, saturated fats) were categorized based on the European food-based guideline. Over 85% of children consumed breakfast 5-7 days a week, with no significant differences by Body Mass Index (BMI) or country. Mean intakes of nutrient-dense food groups fell below recommendations, while the intake of energy-dense, low-nutrient foods exceeded limits, particularly in children with overweight/obesity (p = 0.048). No significant gender differences were observed in most food groups.

CONCLUSIONS

 Dietary intake varied by country and obesity degree among European children. Across the six countries, children's diets did not align with food-based dietary guidelines. These findings underscore the need for interventions promoting healthier eating habits among European children.

TRIAL REGISTRATION

The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872),  http://clinicaltrials.gov What is Known: • Childhood obesity is a growing concern across Europe, with some variations in food consumption observed between European countries • Previous studies have highlighted the role of diet in childhood obesity, but few have examined cross-country comparisons while accounting for gender and BMI status.

WHAT IS NEW

• This study provides a comprehensive cross-country analysis of children's dietary intake, considering gender, BMI status, and adherence to European dietary guidelines. • New insights into gender differences in sweets consumption and the positive association between BMI and food intake (such as soft drinks and sweets) are presented, which can inform targeted dietary interventions.

Body Weight Perception and Other Factors Associated with Overweight and Obesity in U.S. Adolescents

BACKGROUND/OBJECTIVES

This study examines the factors associated with U.S. adolescents' obesity and overweight status.

METHODS

Using a multivariable logistic regression, we analyzed the data from the 2021 Youth Risk Behavior Surveillance System (YRBSS), comprising 17,232 students.

RESULTS

The odds of being obese or overweight were significantly higher (p ≤ 0.05) for the participants who perceived themselves as slightly overweight (AOR, 13.31; 95% CI [11.83, 14.97]) or very overweight (AOR, 39.29; 95% CI [30.12, 51.25]) compared to those who perceived their weight as about right. The participants with significantly higher odds included those aged 14 years (AOR, 2.53) compared to those aged 13 years or younger; male students (AOR, 1.63) compared to female students; and American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander students (AOR, 2.11), Black or African American students (AOR, 2.63), Hispanic/Latino students (AOR, 1.54), and students of multiple races (AOR, 1.56), compared to White students. The odds were also significantly higher for the participants who did not eat breakfast on all seven days of a week (AOR, 1.21) and for the students who did not report their mental health status (AOR, 2.07) compared to those who reported their mental health as mostly or always not good.

CONCLUSIONS

These findings suggest schools are uniquely positioned to implement strategies for healthier behaviors designed and implemented with a focus on health equity.

Lifestyle Factors Associated with Children's and Adolescents' Adherence to the Mediterranean Diet Living in Mediterranean Countries: The DELICIOUS Project

Background/Objectives. Traditional dietary patterns are being abandoned in Mediterranean countries, especially among younger generations. This study aimed to investigate the potential lifestyle determinants that can increase adherence to the Mediterranean diet in children and adolescents. Methods. This study is a cross-sectional analysis of data from five Mediterranean countries (Italy, Spain, Portugal, Egypt, and Lebanon) within the context of the EU-funded project DELICIOUS (UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean Diet and LIfestyle in Children and adolescents through behavIOUral change actionS). This study comprised information on 2011 children and adolescents aged 6-17 years old collected during 2023. The main background characteristics of both children and parents, including age, sex, education, and family situation, were collected. Children's eating (i.e., breakfast, place of eating, etc.) and lifestyle habits (i.e., physical activity level, sleep, and screen time) were also investigated. The level of adherence to the Mediterranean diet was assessed using the KIDMED index. Logistic regression analyses were performed to test for likelihood of higher adherence to the Mediterranean diet. Results. Major determinants of higher adherence to the Mediterranean diet were younger age, higher physical activity level, adequate sleep duration, and, among dietary habits, having breakfast and eating with family members and at school. Parents' younger age and higher education were also determinants of higher adherence. Multivariate adjusted analyses showed that an overall healthier lifestyle and parents' education were the factors independently associated with higher adherence to the Mediterranean diet. Conclusions. Higher adherence to the Mediterranean diet in children and adolescents living in the Mediterranean area is part of an overall healthy lifestyle possibly depending on parents' cultural background.

Does the intervention of the school-based health promotion programme "Join the Healthy Boat" have equal or differential effects on weight status and health-related behaviours in children from a high or low socio-economic background? - A randomised controlled trial

BACKGROUND

Worldwide, the prevalence of childhood overweight and obesity increases. Children with low socioeconomic status (SES) are more often affected by overweight and obesity. SES is also associated with health behaviours. In order to avoid health disparities, school-based health promotion programmes such as "Join the Healthy Boat" can help. Intervention outcomes can differ by SES; therefore, the purpose of this study was to investigate whether the intervention had equal or differential effects both on weight status and health-related behaviours in children from high and low SES.

METHODS

One thousand six hundred twenty children's data (7.1 ± 0.6 years; 50.6% male) was analysed; anthropometric data was taken on-site, other health-related parameters, such as physical activity, nutrition, and screen media use, as well as SES were assessed subjectively. Logistic regression models and GEEs were calculated.

RESULTS

Comparisons by SES show that there were significant differences in children's characteristics and health behaviours such as migration background, height, weight, BMI percentiles, weight status, family education level, household income, physical activity behaviour, screen media use, soft drink intake and breakfast skipping. After one year, there were no intervention effects for overweight status, physical activity, or screen media use, but children with high SES in the intervention group skipped breakfast significantly less often than in the control group (5.34 [1.44;19.85], p = 0.01). Parental education level and household income were also assessed separately, with similar results. Interaction analysis revealed no significant effects apart from an interaction effect for breakfast behaviour (p = 0.02).

CONCLUSIONS

The health-promotion programme "Join the Healthy Boat" has the potential to promote children's health via a school-based intervention and therefore, reach all children independent from their background. This study shows vast gaps between several health behaviours of primary school children depending on their SES, favouring those children coming from more privileged families. A longer implementation may possibly show more effects.

TRIAL REGISTRATION

DRKS00000949.

Preliminary Evidence Supports that Long-Term Consumption of Higher-Protein Breakfast Promotes Higher Expression of Select miRNA Associated with Cardiometabolic Health in Adolescents

BACKGROUND

Increased dietary protein at breakfast promotes cardiometabolic health; however, whether these improvements occur at the molecular level is unknown.

OBJECTIVES

The objective was to examine whether long-term consumption of breakfast, varying in protein quantity, alters the expression of circulating microRNAs (miRNAs) associated with cardiometabolic health in "breakfast-skipping" adolescents.

METHODS

Thirty adolescents (age: 19 ± 1 y; body mass index: 25.4 ± 3 kg/m2) completed a 6-mo tightly controlled breakfast trial in which participants consumed 350 kcal normal-protein (NP, 10 g protein) or higher-protein (HP, 30 g protein) breakfasts or continued to BS for 6 mo. Fasting blood samples were collected at baseline (PRE) and 6 mo (POST) for assessment of 12 a priori circulating plasma miRNA expression levels (real-time quantitative polymerase chain reaction), glucose, insulin, IL-6, and C-reactive protein.

RESULTS

No main effects of group were observed for any miRNAs; however, a time-by-group interaction was detected for the expression of miR-126-3p (P = 0.05). HP breakfast tended to increase miR-126-3p expression throughout the study (POST-PRE, P = 0.09) leading to greater expression at POST compared with BS (P = 0.03), whereas NP breakfast did not. Additionally, several miRNAs predicted fasting concentrations of IL-6: miR-320a-3p, -146a-5p, -150-5p, -423-5p, -122-5p, glucose: miR-24-3p, -126-3p; insulin: miR-24-3p, -126-3p, -15b-5p; insulin sensitivity: miR-24-3p, -126-3p, -199a-5p, -15b-5p; and β-cell function: miR-15b-5p (R2 between 0.2 and 0.39; P < 0.05) from PRE and POST samples across groups.

CONCLUSIONS

These data support the daily consumption of a HP breakfast to promote cardiometabolic health, potentially through changes in miRNA expression, in a sensitive life-stage where early intervention strategies are critical to reduce the risk of adult-onset chronic disease.

TRIAL REGISTRATION NUMBER

NCT03146442.

Prevalence of Overweight and Obesity and Association with Risk Factors in Secondary School Children in Croatia

BACKGROUND

Childhood and adolescent overweight and obesity represent significant global health concerns. The primary objective of this study was to assess the prevalence and associations of some potential risk factors with overweight and obesity among Croatian adolescents aged 15 to 18.

METHODS

This cross-sectional study included 344 secondary school students from Croatia's Mediterranean region, with data collected through an anonymous questionnaire. The questionnaire gathered sociodemographic information, adherence to the Mediterranean diet of both children and their parents, and the children's dietary habits and physical activity levels.

RESULTS

Weight status data revealed that 2.6% of participants were underweight, 82% had normal weight, 11% were overweight, and 4.4% were classified as obese. The results indicated that boys (p < 0.001), children who skip breakfast (p = 0.031), those with less active lifestyles compared to their peers (p = 0.001), children whose mothers have a higher BMI (p < 0.001), and children from smaller families (p = 0.034) are at greater risk of being overweight or obese.

CONCLUSIONS

This study provides valuable insights into the risk factors associated with overweight and obesity in this age group, which can support the development of targeted strategies for this population.

Association of Dietary Patterns, C-Reactive Protein, and Risk of Obesity Among Children Aged 9-17 Years in Guangzhou, China: A Cross-Sectional Mediation Study

BACKGROUND

Childhood obesity is a major public health challenge in the 21st century, and diet is one of the key modifiable factors in its prevention. This study examined the link between dietary patterns of children and general and central obesity, including the role of C-reactive protein (CRP).

METHODS

This study enrolled 2413 children aged 9-17. Anthropometric measurements, CRP levels, and dietary data were collected. Factor analysis identified dietary patterns, and logistic regression examined the association between CRP levels and childhood obesity. Multiple linear regression determined the correlation between dietary patterns and CRP. Mediation analysis assessed the role of CRP in the link between dietary patterns and childhood obesity.

RESULTS

Three dietary patterns were identified. The rice and meat pattern was significantly correlated to the risk of childhood obesity (OR = 1.166, 95%CI: 1.000, 1.359 for general obesity; OR = 1.215, 95%CI: 1.071, 1.377 for central obesity). CRP was positively correlated with childhood obesity risk (OR = 2.301, 95%CI: 1.776, 2.982 for general obesity; OR = 2.165, 95%CI: 1.738, 2.697 for central obesity). The fruit and vegetable pattern was inversely related to CRP (β= -0.059, 95%CI: -0.081, -0.036), while the snack pattern was positively correlated (β= 0.043, 95%CI: 0.020, 0.065). CRP had a suppressive effect on the association between the fruit and vegetable pattern and snack pattern with childhood obesity.

CONCLUSIONS

This study revealed the rice and meat pattern as a risk factor for childhood obesity, and cross-sectional evidence linked the fruit and vegetable pattern and snack pattern to childhood obesity risk, mediated by CRP.

Influence of Nutrition on Growth and Development of Metabolic Syndrome in Children

Obesity is currently an increasing public health burden due to its related metabolic and cardiovascular complications. In Western countries, a significant number of people are overweight or obese, and this trend is, unfortunately, becoming increasingly common even among the pediatric population. In this narrative review, we analyzed the role of nutrition during growth and its impact on the risk of developing metabolic syndrome and cardiovascular complications later in life. An impactful role in determining the phenotypic characteristics of the offspring is the parental diet carried out before conception. During intrauterine growth, the main risk factors are represented by an unbalanced maternal diet, excessive gestational weight gain, and impaired glycemic status. Breastfeeding, on the other hand, has many beneficial effects, but at the same time the quality of breast milk may be modified if maternal overweight or obesity subsists. Complementary feeding is likewise pivotal because an early introduction before 4 months of age and a high protein intake contribute to weight gain later. Knowledge of these mechanisms may allow early modification of risk factors by implementing targeted preventive strategies.

Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity-MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2-19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted.

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.

Prevalence and Determinants of Obesity and Overweight Among Children and Adolescents in the Middle East and North African Countries: An Updated Systematic Review

In recent years, the countries of the Middle East and North Africa (MENA) region have experienced alarming increases in the prevalence of childhood overweight and obesity. This updated systematic review sought to measure the prevalence and determinants of obesity and overweight among children and adolescents in MENA countries. A literature search for relevant observational studies published in English was conducted using PubMed, Web of Science, Google Scholar, and Saudi Digital Library. The risk of bias was evaluated using the Newcastle-Ottawa Scale. Twenty-one published articles during the past five years were included in the systematic review. Varied approaches were used to diagnose childhood overweight and obesity, including the International Obesity Taskforce (IOTF), Centre for Disease Control (CDC), World Health Organization (WHO), and Saudi Growth Pattern Curves. We found that the combined prevalence of childhood overweight and obesity in the Middle East is up to 49.4%, depending on the methods applied in their studies. Risk factors identified were age, male gender, lack of sufficient physical activity, consumption of fried food, perceived stress level, number of family members, family size, mother's occupation, education level, family history of obesity, high energy consumption from carbohydrates, ≥2 hours spent on watching television on weekend days with overweight, and always eating breakfast while watching television with obesity. The results of this review indicate that the issue of childhood and adolescent overweight and obesity in the Middle East is substantial and concerning. Most of the risk factors identified are modifiable and, if given appropriate attention, could significantly reduce the burden of associated chronic complications.

Nutrition-Related Knowledge, Diet Quality, Lifestyle, and Body Composition of 7-12-Years-Old Polish Students: Study Protocol of National Educational Project Junior-Edu-Żywienie (JEŻ)

Increasing students' nutrition knowledge is an important goal of school education which may improve their lifestyle and consequently reduce the incidence of non-communicable chronic diseases, including obesity. This research aimed at assessing the dietary habits, nutrition-related knowledge and attitudes, and nutritional status of Polish students aged 7-12 years. Additional objectives included recognizing nutrition-related knowledge among their parents and teachers as well as the school food and nutrition environment. The final goal was to develop a nutrition education program. This study protocol presents a general and detailed approach for realizing the above-mentioned issues, including conducting quantitative and qualitative research. The study was designed as cross-sectional, covering primary school students from all over Poland, including rural, town, and metropolitan areas. Data on eating habits, lifestyle, nutrition-related knowledge, and attitudes were collected with questionnaires. Measurements of body weight, height, waist and hip circumferences, and handgrip strength were performed in accordance with the International Standards for Anthropometric Assessment (ISAK) recommendations. Body composition was assessed with bioelectrical impedance analysis. Ultimately, 2218 schools from all 16 voivodeships in Poland registered for the project. In total, quantitative data were collected among 27,295 students, 17,070 parents, and 2616 teachers. Anthropometric measurements were taken among 18,521 students. The results allow us to develop a multifaceted educational program based on knowledge and adapted to the perception of students. Our research may contribute to the identification of subpopulations of children and adolescents at risk of excessive body weight and define the predictors of obesity risk in Poland.

The Family Environment as a Source for Creating the Dietary Attitudes of Primary School Students-A Focus Group Interview: The Junior-Edu-Żywienie (JEŻ) Project

The family environment plays a crucial role in creating the health behaviours of children and youth. This study aimed to explore the attitudes of parents with children aged 7-12 who represent an influential environment for creating the eating behaviours of children. A qualitative study was conducted using focus-group interviews (FGI) involving 101 parents from various socioeconomic backgrounds. Three categories of parents were identified based on their level of involvement and awareness of nutrition: 'aware', 'determined', and 'relaxed'. Among parents of 10-12-year-old students, an additional category, 'distanced' parents, was identified. The study revealed that parents require support in terms of providing compelling arguments and practical recommendations related to meals and reducing or eliminating their children's consumption of sweets, snacks, fast food, and, in the case of older students, energy drinks. Parents reported that their children had a moderate understanding of the principles of proper nutrition. The majority of respondents viewed this knowledge as primarily theoretical and expressed a need for practical guidance and activities, which they believe should be offered by schools. To achieve positive outcomes in educational activities related to food and nutrition, it is essential to involve children, parents, guardians, teachers, and other school staff in these efforts.

The Attitudes of 7-9 Year Old Primary School Students towards Food and Nutrition: Insights from Qualitative FGI Research-The Junior-Edu-Żywienie (JEŻ) Project

Optimal nutrition is one of the most significant environmental factors affecting human health. The aim of this study was to assess the attitudes of primary school students aged 7-9 towards nutrition considering three fundamental components: knowledge, emotional disposition, and dietary behaviors. The research was conducted using the Focus Group Interview (FGI) technique among 78 children. Considering their attitudes towards food and nutrition, four profiles were identified: "engaged", "obedient", "reluctant", and "indifferent". Children who were "engaged" and "obedient" due to their parents' involvement in creating their dietary attitudes exhibited the most alignment with the principles of optimal nutrition. Regardless of profile type, it was observed that children were familiar with recommended and unrecommended food products, as well as the role of water in proper nutrition. It was demonstrated that parents wield the most substantial influence on children's nutrition. As a result, initiatives promoting the proper nutrition and a healthy lifestyle should commence with parents. Children of nutritionally conscious parents tend to eat more healthily and demonstrate a high nutritional awareness. Conversely, the children of busy parents who lack time for meal preparation more frequently replicate their parents' nutritional mistakes. These findings emphasize the importance of the family environment in shaping the dietary behaviors of children and youth.