Irregular Breakfast Consumption Research Articles

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

Abstract 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.

The Relationship between Dietary Intake and Adiposity in South African Female Adolescents: A Systematic Review

The prevalence of obesity has increased significantly in developing nations over the past decade, particularly among adolescent girls. To assess the scale of this epidemic among female adolescents in South Africa, a systematic review was undertaken to investigate the connection between diet and obesity. Multiple databases (Google Scholar, Science Direct, Cochrane Library, PubMed, and Web of Science) were searched to identify studies investigating the associations between diet and various adiposity indices as outcomes. Of the 56 studies identified, 7 met the inclusion criteria. The age range of participants spanned from 11 to 21 years. Tabulation was used to report the data, study by study. The consumption of nutrients from animal sources exhibited a positive correlation with higher BMI-for-age Z scores (p = 0.02). Eating habits such as sporadic family meals (p ≤ 0.02), irregular breakfast consumption (p ≤ 0.05), and a high energy intake derived from fat were linked to an increased risk of adiposity. Additionally, factors such as socioeconomic status and residential location revealed associations with certain dietary intakes and adiposity. As more studies identify the causative role of diet in obesity, there is an urgent need for policy intervention and strategies to address the growing non-communicable disease burden in South Africa.

Association between breakfast skipping and metabolic outcomes by sex, age, and work status stratification

BackgroundThe association between breakfast skipping and abnormal metabolic outcomes remains controversial. A comprehensive study with various stratified data is required.ObjectiveThe aim of this study was to investigate the relationship between abnormal metabolic outcomes and breakfast skipping by sex, age, and work status stratification.MethodsWe used data from the Korea National Health and Nutrition Examination Surveys from 2013 to 2018. A total of 21,193 (9022 men and 12,171 women) participants were included in the final analysis. The risk of metabolic outcomes linked to breakfast skipping was estimated using the negative binomial regression analysis by sex, work status, and age stratification.ResultsA total of 11,952 (56.4%) participants consumed breakfast regularly. The prevalence of abnormal metabolic outcomes was higher among those with irregular breakfast consumption habits. Among young male workers, negative binomial regression analysis showed that irregular breakfast eaters had a higher risk of abnormal metabolic outcomes, after adjusting for covariates (odds ratio, 1.15; 95% confidence interval, 1.03–1.27).ConclusionsThe risk of abnormal metabolic outcomes was significant in young men in the working population. Further studies are required to understand the association of specific working conditions (working hours or shift work) with breakfast intake status and the risk of metabolic diseases.

Prevalence of bullying/victimization behaviors among primary and middle school students and its relationship with breakfast consumption in Henan Province

Objective To investigate the prevalence of bullying/victimization behaviors among primary and middle school students and its relationship with breakfast consumption in Henan Province, so as to provide evidence for promoting students’ physical and mental health. Methods By stratified sampling, 103 106 primary and middle school students from 793 primary and middle schools in 45 sample couties (cities and districts) Henan Province were investigated online with Bullying/Victimization Questionnaire and Breakfast Consumption Questionnaire during Feb. to Mar. in 2019. Results The prevalences of physical, verbal, relational, cyber bullying and victimization were 4.5%, 9.4%, 4.6%, 3.3% and 11.5%, 25.2%, 16.0%, 14.5%, respectively. There were significant differences in bullying/victimization behaviors among students with different gender, grade, school location, boarding status, academic performance and academic burden (χ 2 = 13.37-5 511.09, P <0.01). The proportion of irregular breakfast consumers was 15.4% and there were significant differences in breakfast consumption among students with different grade, boarding status, academic performance and academic burden (χ 2 =945.45, 21.96, 3 591.83, 3 208.41,尸<0.01). The percentage of irregular breakfast consumers among bullies/victims were higher than those who were not involved (χ 2 = 1 589.99-2 602.78, P <0.01). Logistic regression analysis showed that physical bullying/victimization, relational bullying/victimization, cyber bullying/victimization and verbal victimization could positively predict irregular breakfast consumption ( OR = 1. 27, 1. 18, 1. 33, 1. 15, 1. 35, 1. 33 1.21, P <0.01). Conclusion Attention should be paid to the bullying/victimization behaviors of primary and middle school students in Henan Province. Getting involved in bullying/victimization was a risk factor for irregular breakfast consumption. 【摘要】 目的 了解河南省中小学生欺负/受欺负行为的发生状况及其与早餐食用的关联性, 为促进中小学生身心健康 发展提供参考依据。 方法 采用欺负/受欺负问卷和早餐食用问卷, 于2019年2—3月抽取河南省45个样本县 (市、区) 793所中小学样本校103 106名中小学生进行在线调查。 结果 河南省中小学生身体、言语、关系、网绺欺负行为的报告率 分别为4.5%, 9.4%, 4.6%, 3.3%; 受欺负行为的报告率为11.5%, 25.2%, 16.0%, 14.5%, 不同性别、学段、学校所在地、寄宿状 况、学业成绩、学业负担的学生之间欺负/受欺负行为报告率差异均有统计学意义(；χ 2 = 13.37~5 511.09, P 值均<0.01)。不 经常吃早餐的学生比例为15.4%, 不同学段、寄宿状况、学业成绩、学业负担的学生之间早餐食用频次差异均有统计意义 (χ 2 值分别为945.45,21.96,3 591.83,3 208.41, P 值均<0.01);欺负/受欺负者中不经常吃早餐的比例均高于未卷人者(χ 2 = 1 589.99~2 602.78, P 值均<0.01)。多因素Logistic回归分析显示, 身体欺负/受欺负、关系欺负/受欺负、网绺欺负/受欺负 和言语受欺负对不经常吃早餐均有正向预测作用 ( OR 值分别为1.27, 1.18, 1.33, 1.15, 1.35, 1.33, 1.21, P 值均<0.01)。 结论 河南省中小学生的欺负/受欺负行为应引起重视, 卷人欺负行为是导致中小学生不经常吃早餐的危险因素

Regional Features in Evaluating Nutrition and Health Conditions of Children and Adolescents

BACKGROUND: The frequency of breakfast consumption as a determinant of fruit and vegetable intake among children and adolescents has been poorly investigated.&#x0D; AIM: In this article, we examine whether irregular food intake is associated with fruit and vegetable intake among children and adolescents.&#x0D; METHODS: We use a separate analysis, with special attention being paid to the potentially changing effects of gender and age. The methodology of health behavior in school-aged children is used.&#x0D; RESULTS: The obtained results show that irregular breakfast consumption among children and adolescents is associated with a low frequency of fruit and vegetable intake and that gender and age can play a decisive role. Various associations observed in different age and gender groups indicate the importance of a separate analysis of fruit and vegetable intake and types of food.&#x0D; CONCLUSION: The results emphasize the importance of encouraging regular food intake while trying to increase fruit and vegetable intake among children and adolescents.

Risk Factors for Obesity Among Children Aged 24 to 80 months in Korea: A Decision Tree Analysis

PurposeThe purpose of this study was to examine the multiple intergenerational risk factors of obesity among children aged 24 to 80 months using national cohort data. Design and methodsThis is a retrospective longitudinal cohort study using the Korean National Health Insurance (KNHI) database, and the number of study participants was 1,001,775 families. Social-Economic Status (SES), parental and child-related factors were examined. Descriptive statistics and Chi-squared Automatic Interaction Detection (CHAID) for a decision tree analysis were conducted. ResultsThe prevalence of obesity was 6.57%, and that of overweight was 11.31% among the entire study population. The 17 groups with a prevalence of childhood obesity higher than the mean prevalence rate were classified as high-risk groups for childhood obesity; there were 6 groups with a prevalence of childhood obesity twice as high as the mean prevalence rate from this study. The best predictors were as follows: mothers being obese prior to conception, fathers being obese, non- medical aid beneficiaries, and mothers with hypertension during gestation. ConclusionsThe best predictors of children obesity were parental obesity history and SES. Other parental predictors of outcomes were gestational hypertension and diabetes, older pregnancy, drinking during gestation, and depression after delivery. Child-related outcome predictors were noncompliance with exclusive breastfeeding, a sugar-sweetened beverage intake ≥200 ml per day, and irregular breakfast consumption. Practice implicationsThese findings could help community health nurses assess high-risk groups for early childhood obesity and develop or provide effective interventions in the early stages of life.

Changes in breakfast frequency and composition during adolescence: The Adolescent Nutritional Assessment Longitudinal Study, a cohort from Brazil.

ObjectivesTo estimate changes over time of breakfast frequency and foods/food groups consumed at breakfast.MethodsCohort of 809 students aged 10–16 years old from Rio de Janeiro, Brazil, enrolled in 2010, and followed for three years. Breakfast skippers were those not eating breakfast. Those with breakfast frequency of 4 or less times per week were considered irregular breakfast eaters. Changes over time of breakfast frequency and breakfast foods/food groups were analyzed by generalized estimating equations.ResultsAt baseline, overweight/obese girls had higher prevalence of irregular breakfast than those non-overweight/obese (40% vs. 26%; p = 0.005); among boys, there was no significant difference in the prevalence of irregular breakfast according to weight status. After three years, among girls there was an increase in the risk of irregular breakfast consumption (RR = 1.29; 95% CI: 1.08; 1.54) and breakfast skipping (RR = 1.63; 95% CI: 1.12; 2.38). Also, overweight/obese boys (RR = 1.40, 95% CI: 1.03, 1.89) and non-overweight/obese girls (RR = 1.54, 95% CI: 1.17, 2.04) had higher risk of irregular breakfast in three years, compared to baseline. After three years, boys changed the consumption of foods/food groups at breakfast and presented higher risk of decreased intake of fruits (RR = 1.60, 95% CI: 1.20, 2.13), sandwiches and snacks (RR = 1.58, 95% CI: 1.12, 2.22), chips (RR = 1.43, 95% CI: 1.01, 2.13), and ham (RR = 1.52, 95% CI: 1.12, 2.07), and lower risk of cheese intake (RR = 0.73, 95% CI: 0.53, 1.00). Girls had higher risk of decreased intake of fruits (RR = 2.08, 95% CI: 1.47, 2.95), milk (RR = 1.49, 95% CI: 1.07, 2.08), chocolate powder (RR = 1.54, 95% CI: 1.11, 2.14) and ham (RR = 1.65, 95% CI: 1.16, 2.36).ConclusionsChanges in breakfast patterns are different according to sex. Also, different changes in breakfast frequency according to BMI category were found. Consumption patterns of some foods/food groups have a tendency to become changed from initial to middle adolescence.

Breakfast Consumption and Its Associations with Health-Related Behaviors among School-Aged Adolescents: A Cross-Sectional Study in Zhejiang Province, China.

Evidence indicates that breakfast consumption is associated with a cluster of health-related behaviors, yet studies in mainland China are scarce. This study is conducted to describe the frequency of breakfast consumption among Chinese adolescents and examine its associations with other dietary, physical activity, sedentary, sleep, cigarette-smoking, and alcohol-drinking behaviors. Breakfast consumption and other health-related behaviors data was collected via a self-administered questionnaire in a cross-sectional study in Zhejiang Province, China. A total of 19,542 school-aged adolescents were recruited in this survey. The associations between breakfast consumption and other health-related behaviors were examined using logistic regression models. A significantly higher prevalence of daily breakfast consumption was found among students who were younger (p for trend <0.001), from urban schools (p < 0.001), and academic high schools (p < 0.001). More frequent vegetable and milk consumption, greater physical activity, and longer sleep duration were positively associated with daily breakfast consumption, while soft drinks and fast food consumption, computer use, cigarette-smoking and alcohol-drinking behaviors were inversely associated. The prevalence of irregular breakfast consumption was relatively high among Chinese adolescents in Zhejiang Province. Daily breakfast consumption was associated with a constellation of health-related behaviors.

Factors associated with irregular breakfast consumption among high school students in a Japanese community.

This study evaluated the associations between the characteristics of high school students and irregular breakfast consumption and explored the association with knowledge regarding diet and dietary education in a community in Japan. A cross-sectional survey using a self-administered questionnaire was conducted in 2007 among all the high school students in the second grade in Imari, Saga. Data for 318 male and 292 female students were analyzed. Irregular breakfast consumption was defined as consuming breakfast three times or less in a week. The associations between the characteristics of students and irregular breakfast consumption were assessed using logistic regression with adjustments for sex and school. Among male students, a strong association between the consumption of juice or pop and irregular breakfast consumption was observed (OR comparing ">=2 servings" vs "rarely"=8.97, 95% CI=2.99-26.9). The associations with wake times and bed times were strong among male students, and the association with regular bowel movements was strong among female students. Students who had knowledge of regional agricultural and livestock products were more likely to consume breakfast regularly, and this association was significant among female students (OR=2.89, 95% CI=1.23-6.82). Significant associations were also observed with the consumption of snacks, and traditional greeting before meals. Several characteristics, including specific knowledge, were associated with the irregular consumption of breakfast. The results are of interest to policy makers, nutrition specialists, and educators working to enhance regular breakfast consumption among students.

Relationship between health behaviour and body mass index in the Serbian adult population: data from National Health Survey 2013.

To determine relationship between health behaviour and body mass index (BMI) in a Serbian adult population. Study population included adults aged 20 and more years. A stratified, two-stage national representative random sampling approach was used for the selection of the survey sample. Regarding BMI, out of the 12,461 subjects of both sexes, 2.4% were underweight, 36.5% overweight and 22.4% obese. Multivariate logistic regression analysis showed that both in men and women, risk factors for obesity were former smoking, irregular eating breakfast and low physical activity level, while in women only risk of obesity was associated with alcohol consumption. In both sexes, risk factors for overweight were former smoking and low physical activity level, and in women additionally those were alcohol consumption, irregular eating breakfast, always adding salt to meals and consumption of 2-4 portions of fruit daily. Smoking and irregular eating of breakfast in men were risk factors for underweight. Physical activity, alcohol consumption, smoking, irregular breakfast consumption, adding salt to meals, frequency of vegetable and fruit consumption were related to BMI in adult Serbian population.

Inequalities in adolescent: the lead role of social relations

Background This study aims to examine the influence of family affluence, school environment and peer group on unhealthy behaviours (irregular breakfast consumption, alcohol consumption, smoking, and sedentary lifestyle) and health outcomes (self-reported health, multiple health complaints and life satisfaction) within adolescent in an italian region. Methods The data from Health Behaviour in School-aged Children 2009/10 (HBSC), a WHO cross-National Survey, were used on a regional basis. The 3291 …

Factors associated with unhealthy behaviours and health outcomes: a cross-sectional study among Tuscan adolescents (Italy).

BackgroundWe aimed to determine the extent to which three core variables (school environment, peer group and family affluence) were associated with unhealthy behaviours and health outcomes among Tuscan adolescents. The unhealthy behaviours considered were smoking, alcohol consumption, sedentary lifestyle and irregular breakfast consumption; health outcomes were classified as self-reported health, multiple health complaints and life satisfaction. School environment was measured in terms of liking school, school pressure, academic achievement and classmate support; peer groups were evaluated in terms of the number of peers and frequency of peer contact. Family affluence was measured on a socioeconomic scale.MethodsData were taken from the Tuscan 2009/10 survey of “Health Behaviour in School-aged Children”, a WHO cross-national survey. A binary logistic multiple regression (95% confidence intervals) was implemented.ResultsThe total sample comprised 3291 school students: 1135 11-year-olds, 1255 13-year-olds and 901 15-year-olds. Peer group and school environment were associated with unhealthy behaviours such as smoking, alcohol consumption and sedentary lifestyle. Family affluence proved to have less impact on unhealthy behaviours, except in the case of adolescents living in low-income families. Poor health outcomes were directly related to a negative school environment. Regarding the influence of family affluence, the results showed higher odds of life dissatisfaction and poor self-reported health status in medium-income families, while low-income families had higher odds only with regard to life dissatisfaction. A consistent pattern of gender differences was found in terms of both unhealthy behaviours and health outcomes.ConclusionsUnhealthy behaviours are strongly related to the school environment and peer group. A negative school environment proved to have the strongest relation with poor health outcomes.

Association between fruits and vegetables intake and frequency of breakfast and snacks consumption: a cross-sectional study

BackgroundThere are very few studies on the frequency of breakfast and snack consumption and its relation to fruit and vegetable intake. This study aims to fill that gap by exploring the relation between irregular breakfast habits and snack consumption and fruit and vegetable intake in Tuscan adolescents. Separate analyses were conducted with an emphasis on the potentially modifying factors of sex and age.MethodsData was obtained from the 2010 Tuscan sample of the Health Behaviour in School-aged Children (HBSC) study. The HBSC study is a cross-sectional survey of 11-, 13- and 15-year-old students (n = 3291), selected from a random sample of schools. Multivariate logistic regression was used for analyzing the food-frequency questionnaire.ResultsA significant relation was found between low fruit and vegetable intake and irregular breakfast habits. Similarly, low fruit intake was associated with irregular snack consumption, whereas vegetable intake did not prove to be directly related to irregular snack consumption. Different patterns emerged when gender and age were considered as modifying factors in the analyses. A statistically significant relation emerged only among female students for irregular breakfast habits and fruit and vegetable intake. Generally, older female participants with irregular breakfast habits demonstrated a higher risk of low fruit and vegetable intake. Age pattern varied between genders, and between fruit and vegetable consumption.ConclusionsResults suggest that for those adolescents who have an irregular consumption of breakfast and snacks, fruit intake occurs with a lower frequency. Lower vegetable consumption was associated with irregular breakfast consumption. Gender and age were shown to be moderators and this indicated the importance of analyzing fruit and vegetable intake and meal types separately.This study also confirmed that health-promotion campaigns that aim to promote regular meal consumption and consumption of fruits and vegetables need to take into account gender and age differences in designing promotional strategies. Future research should identify evidence-based interventions to facilitate the achievement of the Italian guidelines for a healthy diet for fruit, vegetables and meals intake.

Eating patterns and type 2 diabetes risk in older women: breakfast consumption and eating frequency

Little is known about the association between eating patterns and type 2 diabetes (T2D) risk in women. The objective was to examine prospectively associations between regular breakfast consumption, eating frequency, and T2D risk in women. Eating pattern was assessed in 2002 in a cohort of 46,289 US women in the Nurses' Health Study who were free of T2D, cardiovascular disease, or cancer and were followed for 6 y. We used Cox proportional hazards analysis to evaluate associations with incident T2D. We documented 1560 T2D cases during follow-up. After adjustment for known risk factors for T2D-except for body mass index (BMI), a potential mediator-women who consumed breakfast irregularly (0-6 times/wk) were at higher risk of T2D than were women who consumed breakfast daily (RR: 1.28; 95% CI: 1.14, 1.44). This association was moderately attenuated after adjustment for BMI (RR: 1.20; 95% CI: 1.07, 1.35). In comparison with women who ate 3 times/d, the RRs were 1.09 (0.84, 1.41) for women who ate 1-2 times/d, 1.13 (1.00, 1.27) for women who ate 4-5 times/d, and 0.99 (0.81, 1.21) for women who ate ≥6 times/d. Among irregular breakfast consumers, women with a higher eating frequency (≥4 times/d) had a significantly greater T2D risk (RR: 1.47; 95% CI: 1.23, 1.75) than did women who consumed breakfast daily and ate 1-3 times/d. Adjustment for BMI attenuated this association (RR: 1.24; 95% CI: 1.04, 1.48). Irregular breakfast consumption was associated with a higher T2D risk in women, which was partially but not entirely mediated by BMI.

Adolescent dietary patterns in Fiji and their relationships with standardized body mass index

BackgroundObesity has been increasing in adolescents in Fiji and obesogenic dietary patterns need to be assessed to inform health promotion. The objective of this study was to identify the dietary patterns of adolescents in peri-urban Fiji and determine their relationships with standardized body mass index (BMI-z).MethodsThis study analysed baseline measurements from the Pacific Obesity Prevention In Communities (OPIC) Project. The sample comprised 6,871 adolescents aged 13–18 years from 18 secondary schools on the main island of Viti Levu, Fiji. Adolescents completed a questionnaire that included diet-related variables; height and weight were measured. Descriptive statistics and regression analyses were conducted to examine the associations between dietary patterns and BMI-z, while controlling for confounders and cluster effect by school.ResultsOf the total sample, 24% of adolescents were overweight or obese, with a higher prevalence among Indigenous Fijians and females. Almost all adolescents reported frequent consumption of sugar sweetened beverages (SSB) (90%) and low intake of fruit and vegetables (74%). Over 25% of participants were frequent consumers of takeaways for dinner, and either high fat/salt snacks, or confectionery after school. Nearly one quarter reported irregular breakfast (24%) and lunch (24%) consumption on school days, while fewer adolescents (13%) ate fried foods after school. IndoFijians were more likely than Indigenous Fijians to regularly consume breakfast, but had a high unhealthy SSB and snack consumption.Regular breakfast (p<0.05), morning snack (p<0.05) and lunch (p<0.05) consumption were significantly associated with lower BMI-z. Consumption of high fat/salt snacks, fried foods and confectionery was lower among participants with higher BMI-z.ConclusionsThis study provides important information about Fijian adolescents’ dietary patterns and associations with BMI-z. Health promotion should target reducing SSB, increasing fruit and vegetables consumption, and increasing regularity of meals among adolescents. Future research is needed to investigate moderator(s) of inverse associations found between BMI-z and consumption of snacks, fried foods and confectionery to assess for potential reverse causality.

Irregular breakfast consumption in adolescence and the family environment: Underlying causes by family structure

Data from the 2002, 2006 and 2010 Scottish Health Behaviour in School-aged Children (HBSC) surveys were analysed using logistic multilevel regression for outcome variable irregular breakfast consumption (IBC). IBC prevalence in Scotland was higher among young people from reconstituted and single parent families, and particularly single father families. Family characteristics, found previously to be associated with breakfast consumption, such as number of siblings, perceived parenting, parental involvement and family affluence, differed by family structure. Family structure inequalities in IBC existed, also after adjustment for year and child’s sex, age, grade and ethnicity. Across all family structures, IBC was more prevalent at the older age groups, among those who had difficult communication with their parents, and where household routines were infrequent. Greater number of siblings and lower family affluence were associated with higher odds of IBC in single mother and both parent families, while having a second home was associated with higher odds in reconstituted households. Fair parenting and being close to at least one parent was associated with reduced odds of IBC in single mother households, while being close to all parents was in single father households. In single mother homes, having a working mother was also positively associated with IBC. Family structure differences should be considered when addressing irregular breakfast consumption in adolescence.

Fruit and vegetable intake is associated with frequency of breakfast, lunch and evening meal: cross-sectional study of 11-, 13-, and 15-year-olds

BackgroundFrequency of eating breakfast, lunch and evening meal as a determinant of fruit and vegetable intake among young people is little studied. We investigated whether irregular meal consumption was associated with fruit and vegetable intake among adolescents. We used separate analyses, and special emphasis was on the potentially modifying effect of sex and age.MethodsData were from the Danish contribution to the international collaborative Health Behavior in School-Aged Children Study (HBSC) in 2002. We used a questionnaire-based, cross-sectional design to study schoolchildren aged 11, 13 and 15 years (n = 3913) selected from a random sample of schools in Denmark. Fruit intake and vegetable intake were measured by a food frequency questionnaire and analyses were conducted using multivariate logistic regression.ResultsOverall, statistically significant associations were found between irregular breakfast, lunch and evening meal consumption and low frequency of fruit intake and vegetable intake (breakfast: fruit OR = 1.42, vegetables OR = 1.48; lunch: fruit OR = 1.68, vegetables OR = 1.83; evening meal: vegetables OR = 1.70). No association was found for irregular evening meal consumption and low frequency of fruit intake. Analyses stratified by sex showed that the associations between irregular breakfast consumption and both fruit and vegetable intake remained statistically significant only among girls. When analyses were stratified by both sex and age, different patterns appeared. Overall, skipping meals seemed to be a less serious risk factor for low frequency of fruit and vegetable intake among younger participants compared with those who were older. This was especially evident for skipping breakfast. The same tendency was also seen for skipping lunch and evening meal, although the age pattern varied between boys and girls and between fruit and vegetable intake.ConclusionOur results showed that irregular breakfast, lunch and evening meal consumption among adolescents was associated with a low frequency of fruit and vegetable intake and that sex and age may play a modifying role. The different associations observed in different age and sex groups indicate the importance of analysing fruit and vegetable intake and meal types separately. The results highlight the importance of promoting regular meal consumption when trying to increase the intake of fruit and vegetables among adolescents.

Inequalities in Croatian pupils' unhealthy behaviours and health outcomes: role of school, peers and family affluence

To examine the influence of family affluence (measure of socioeconomic status), school environment (liking school, school pressure, academic achievement and classmates support) and peer group (size of the peer group and frequency of peer contact) on unhealthy behaviours (smoking, drunkenness, physical inactivity, irregular breakfast and soft drink consumption) and health outcomes (self-rated health, multiple health complaints and life satisfaction) in Croatian pupils. The Croatian data from Health Behaviour in School-aged Children 2005/06 (HBSC) were used (1666 11-year-olds, and 1630 15-year-olds). Binary logistic regression analysis was conducted (95% confidence intervals, P < 0.05 and P < 0.01). School environment and peer group were connected to more unhealthy behaviours along with greater differences in those behaviours than family affluence. The only exception was physical inactivity at age 11 (compared to high family affluence, low family affluence increased 80% odds for physical inactivity, whereas, compared to favourable school environment, poor school environment increased 50% odds). Compared to favourable school environment, poor school environment was the most consistent and strongest predictor of poor health outcomes (all three measures). No influence of peer group to health outcomes was found. Compared to high-affluent families, low-affluent families were associated to higher odds for poor self-rated health and life dissatisfaction, and, for 11-year-olds, medium-affluent families to lower odds for multiple health complaints. Gender differences in unhealthy behaviours and health outcomes were also found. Compared to socioeconomic inequalities, greater inequalities in unhealthy behaviours were connected to school environment and peer group, and in health outcomes to school environment.