Abstract
Regular breakfast consumption may protect against type 2 diabetes risk in adults but little is known about its influence on type 2 diabetes risk markers in children. We investigated the associations between breakfast consumption (frequency and content) and risk markers for type 2 diabetes (particularly insulin resistance and glycaemia) and cardiovascular disease in children. We conducted a cross-sectional study of 4,116 UK primary school children aged 9-10 years. Participants provided information on breakfast frequency, had measurements of body composition, and gave fasting blood samples for measurements of blood lipids, insulin, glucose, and glycated haemoglobin (HbA1c). A subgroup of 2,004 children also completed a 24-hour dietary recall. Among 4,116 children studied, 3,056 (74%) ate breakfast daily, 450 (11%) most days, 372 (9%) some days, and 238 (6%) not usually. Graded associations between breakfast frequency and risk markers were observed; children who reported not usually having breakfast had higher fasting insulin (percent difference 26.4%, 95% CI 16.6%-37.0%), insulin resistance (percent difference 26.7%, 95% CI 17.0%-37.2%), HbA1c (percent difference 1.2%, 95% CI 0.4%-2.0%), glucose (percent difference 1.0%, 95% CI 0.0%-2.0%), and urate (percent difference 6%, 95% CI 3%-10%) than those who reported having breakfast daily; these differences were little affected by adjustment for adiposity, socioeconomic status, and physical activity levels. When the higher levels of triglyceride, systolic blood pressure, and C-reactive protein for those who usually did not eat breakfast relative to those who ate breakfast daily were adjusted for adiposity, the differences were no longer significant. Children eating a high fibre cereal breakfast had lower insulin resistance than those eating other breakfast types (p for heterogeneity <0.01). Differences in nutrient intakes between breakfast frequency groups did not account for the differences in type 2 diabetes markers. Children who ate breakfast daily, particularly a high fibre cereal breakfast, had a more favourable type 2 diabetes risk profile. Trials are needed to quantify the protective effect of breakfast on emerging type 2 diabetes risk. Please see later in the article for the Editors' Summary.
Highlights
The high prevalence of type 2 diabetes both globally and in the UK, which affects increasingly younger individuals [1], presents a major public health challenge [2]
We investigated the associations between breakfast consumption and risk markers for type 2 diabetes and cardiovascular disease in a large multi-ethnic population of children in order to test our main research hypothesis that both breakfast frequency and composition would be associated with type 2 diabetes risk markers in childhood, and with insulin resistance and glycaemia, which are strongly related to the development of insulin resistance, hyperglycaemia, the metabolic syndrome, and type 2 diabetes in adult life [15]
No adjustments were made for multiple comparisons as a strong a priori hypothesis that both breakfast frequency and content will be associated with insulin resistance and glycaemia was to be tested
Summary
The high prevalence of type 2 diabetes both globally and in the UK, which affects increasingly younger individuals [1], presents a major public health challenge [2]. In adults, skipping breakfast has been associated with higher risk of overweight and obesity [4,5] and with a higher risk of type 2 diabetes [6,7]. Breakfast content may be important; studies in the US have shown that the consumption of breakfast cereal is associated with a more favourable risk factor profile for type 2 diabetes and cardiovascular disease [9]. We investigated the associations between breakfast consumption (frequency and content) and risk markers for type 2 diabetes ( insulin resistance and glycaemia) and cardiovascular disease in children. Blood sugar levels are usually controlled by insulin, a hormone released by the pancreas after meals (digestion of food produces glucose). Risk factors for the condition include being over 40 years old and being overweight or obese
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