Skipping Breakfast and Eating Breakfast Away From Home Were Prospectively Associated With Emotional and Behavioral Problems in 115,217 Chinese Adolescents.

Wei-Jie Gong,Sai-Yin Ho,Man-Ping Wang,Daniel Yee-Tak Fong,Thomas Wai-Hung Chung,Tai-Hing Lam

doi:10.2188/jea.je20210081

Abstract

Breakfast is deemed the most important meal of the day. We examined the prospective associations of breakfast habits with emotional/behavioral problems in adolescents and potential effect modification. 115,217 Primary 6 students (United States Grade 6; mean age, 11.9; standard deviation [SD], 0.59 years) who attended the Student Health Service of Department of Health in Hong Kong in 2004/05, 2006/07, 2008/09 were followed till Secondary 6 (United States Grade 12). Emotional/behavioral problems were biennially examined using Youth Self-Report since Secondary 2 (United States Grade 8). Lifestyles were biennially examined using standardized questionnaires since Primary 6. Prospective associations of breakfast habit with emotional/behavioral problems and potential effect modification were examined using generalized estimating equations. Compared with eating breakfast at home, eating breakfast away from home was significantly associated with total emotional/behavioral problems and seven syndromes, including withdrawal, somatic complaints, anxiety/depression, thought problems, attention problems, delinquent behaviors, and aggressive behaviors (adjusted odds ratios [AORs] 1.22-2.04), while skipping breakfast showed stronger associations with the above problems and social problems (AORs 1.34-2.29). Stronger associations were observed in younger students for total and attention problems (P < 0.03) and in those with lower weight status for delinquent behaviors (P = 0.005). Eating breakfast away from home and especially skipping breakfast were prospectively associated with adolescent emotional/behavioral problems. The associations weakened with increasing age for total emotional/behavioral and attention problems, and weakened with higher weight status for delinquent behaviors, highlighting the vulnerability of younger and underweight children. If the associations are causal, increasing home breakfast may reduce adolescent emotional/behavioral problems and benefit psychosocial health.

Highlights

Adolescents are vulnerable to psychological problems with longterm implications on health and well-being.[1]
We estimated the mean and standard error of the total and subscale Youth Self-Report (YSR) scores across sex, grade, and breakfast habits, and their adjusted regression coefficients with 95% confidence intervals (CIs) using generalized estimating equations (GEE) models, adjusted for academic year enrolled in P6, parental educational level and occupation, and time-dependent factors in Primary 6 and Secondary 2 and 4, including weight status and frequency=duration of extracurricular physical activity, and mutually adjusted for each other
Eating breakfast away from home was associated with higher odds of total emotional=behavioral problems and seven syndromes except for social problems, and skipping breakfast was associated with higher odds of total emotional=behavioral

Summary

Introduction

Adolescents are vulnerable to psychological problems with longterm implications on health and well-being.[1] Half of all mental disorders are symptomatic by the age of 14, most of them remain undiagnosed and untreated until later in life.[2] Worldwide, around 10–20% of children and adolescents are affected by mental health problems.[3] adolescents with aggressive and delinquent behaviors have a high risk of becoming adult offenders.[4] Such emotional and behavioral problems in adolescents could be influenced by their lifestyles and health-related behaviors,[5] including physical activity and dietary habits.[6,7]. We examined the prospective associations of breakfast habits with emotional=behavioral problems in adolescents and potential effect modification

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