Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: results of a cross-sectional study

BMC Public Health

Melissa H Stigler²  K Srinath Reddy³  Cheryl L Perry²  Vinay K Gupta³  Gaurang P Nazar¹  Monika Arora³ 

[1] Health Related Information Dissemination Amongst Youth (HRIDAY), Safdarjung Development Area, New Delhi 110016, India;UTHealth, School of Public Health, University of Texas, Austin Regional Campus Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe, Austin, TX 78701, USA;Public Health Foundation of India (PHFI), 4/2 Sirifort Institutional Area, August Kranti Marg, New Delhi 110016, India

关键词: Behavior;    Physical activity;    Diet;    Adolescent;    Obesity;    Breakfast;   

Others  :  1162960
DOI  :  10.1186/1471-2458-12-881

 received in 2012-04-06, accepted in 2012-10-12,  发布年份 2012

【 摘 要 】

Background

In developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors.

Methods

Design: Cross-sectional study. Setting: Eight schools (Private and Government) of Delhi in the year 2006. Participants: 1814 students from 8^th and 10^th grades; response rate was 87.2%; 55% were 8^th graders, 60% were boys and 52% attended Private schools. Main outcome measures: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors. Data analysis: Mixed effects regression models were employed, adjusting for age, gender, grade level and school type (SES).

Results

Significantly more Government school (lower SES) students consumed breakfast daily as compared to Private school (higher SES) students (73.8% vs. 66.3%; p<0.01). More 8^th graders consumed breakfast daily vs.10^th graders (72.3% vs. 67.0%; p<0.05). A dose–response relationship was observed such that overall prevalence of overweight and obesity among adolescents who consumed breakfast daily (14.6%) was significantly lower vs. those who only sometimes (15.2%) or never (22.9%) consumed breakfast (p<0.05 for trend). This relationship was statistically significant for boys (15.4 % vs. 16.5% vs. 26.0; p<0.05 for trend) but not for girls. Intake of dairy products, fruits and vegetables was 5.5 (95% CI 2.4-12.5), 1.7 (95% CI 1.1-2.5) and 2.2 (95% CI 1.3-3.5) times higher among those who consumed breakfast daily vs. those who never consumed breakfast. Breakfast consumption was associated with greater physical activity vs. those who never consumed breakfast. Positive values and beliefs about healthy eating; body image satisfaction; and positive peer and parental influence were positively associated with daily breakfast consumption, while depression was negatively associated.

Conclusion

Daily breakfast consumption is associated with less overweight and obesity and with healthier dietary- and physical activity-related behaviors among urban Indian students. Although prospective studies should confirm the present results, intervention programs to prevent or treat childhood obesity in India should consider emphasizing regular breakfast consumption.

【 授权许可】

   
2012 Arora et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bhave S, Bavdekar A, Otiv M: IAP national task force for childhood prevention of adult diseases: childhood obesity. Indian Pediatr 2004, 41:559-575.
• [2]Styne DM: Childhood and adolescent obesity. Prevalence and significance. Pediatr Clin North Am 2001, 48:823-854.
• [3]Bhardwaj S, Misra A, Khurana L, Gulati S, Shah P, Vikram NK: Childhood obesity in Asian Indians: a burgeoning cause of insulin resistance, diabetes and sub-clinical inflammation. Asia Pac J Clin Nutr 2008, 17(Suppl 1):172-175.
• [4]Srihari G, Eilander A, Muthayya S, Kurpad AV, Seshadri S: Nutritional status of affluent Indian school children: what and how much do we know? Indian Pediatr 2007, 44:204-213.
• [5]Stigler MH, Arora M, Dhavan P, Shrivastav R, Reddy KS, Perry CL: Weight-related concerns and weight-control behaviors among overweight adolescents in Delhi, India: A cross-sectional study. Int J Behav Nutr Phys Act 2011, 8:9-14. BioMed Central Full Text
• [6]Stigler MH, Arora M, Dhavan P, Tripathy V, Shrivastav R, Reddy KS, Perry CL: Measuring obesity among school-aged youth in india: a comparison of three growth references. Indian Pediatr 2010, 48:105-110.
• [7]UK Prospective Diabetes Study Group: UK prospective diabetes study XII: differences between asian, afro-caribbean and white caucasian type 2 diabetic patients at diagnosis of diabetes. Diabet Med 1994, 1:670-677.
• [8]Misra A: Revisions of cutoffs of body mass index to define overweight and obesity are needed for the Asian-ethnic groups. Int J Obes Relat Metab Disord 2003, 27:1294-1296.
• [9]Skelton JA, Irby MB, Grzywacz JG, Miller G: Etiologies of obesity in children: nature and nurture. Pediatr Clin North Am 2011, 58:1333-1354.
• [10]Stouffer K, Dorman SM: Childhood obesity: a multifaceted etiology. Int Electron J Heal Educ 1999, 2:66-72.
• [11]Philippas NG, Lo CW: Childhood obesity: etiology, prevention, and treatment. Nutr Clin Care 2005, 8:77-88.
• [12]Berkey CS, Rockett HR, Gillman MW, Field AE, Colditz GA: Longitudinal study of skipping breakfast and weight change in adolescents. Int J Obes Relat Metab Disord 2003, 27:1258-1266.
• [13]Vanelli M, Iovane B, Bernardini A, Chiari G, Errico MK, Gelmetti C, Corchia M, Ruggerini A, Volta E, Rossetti S: Breakfast habits of 1,202 northern Italian children admitted to a summer sport school. Breakfast skipping is associated with overweight and obesity. Acta Biomed 2005, 76:79-85.
• [14]Timlin MT, Pereira MA, Story M, Neumark-Sztainer D: Breakfast eating and weight change in a 5-year prospective analysis of adolescents: project EAT (Eating Among Teens). Pediatrics 2008, 121:e638-e645.
• [15]Croezen S, Visscher TL, Ter Bogt NC, Veling ML, Haveman-Nies A: Skipping breakfast, alcohol consumption and physical inactivity as risk factors for overweight and obesity in adolescents: results of the E-MOVO project. Eur J Clin Nutr 2009, 63:405-412.
• [16]Sandercock GR, Voss C, Dye L: Associations between habitual school-day breakfast consumption, body mass index, physical activity and cardiorespiratory fitness in English school children. Eur J Clin Nutr 2010, 64:1086-1092.
• [17]Maddah M, Nikooyeh B: Factors associated with overweight in children in Rasht, Iran: gender, maternal education, skipping breakfast and parental obesity. Public Health Nutr 2010, 13:196-200.
• [18]Szajewska H, Ruszczynski M: Systematic review demonstrating that breakfast consumption influences body weight outcomes in children and adolescents in Europe. Crit Rev Food Sci Nutr 2010, 50:113-119.
• [19]Nicklas TA, Bao W, Webber LS, Berenson GS: Breakfast consumption affects adequacy of total daily intake in children. J Am Diet Assoc 1993, 93:886-891.
• [20]Sampson AE, Dixit S, Meyers AF, Houser R Jr: The nutritional impact of breakfast consumption on the diets of inner-city African-American elementary school children. J Natl Med Assoc 1995, 87:195-202.
• [21]Deshmukh-Taskar PR, Nicklas TA, O’Neil CE, Keast DR, Radcliffe JD, Cho S: The relationship of breakfast skipping and type of breakfast consumption with nutrient intake andweight status in children and adolescents:the national health and nutrition examination survey 1999–2006. J Am Diet Assoc 2010, 110:869-878.
• [22]Mesas AE, Munoz-Pareja M, Lopez-Garcia E, Rodriguez-Artalejo F: Selected eating behaviours and excess body weight: a systematic review. Obes Rev 2012, 13:106-135.
• [23]Corder K, van Sluijs EM, Steele RM, Stephen AM, Dunn V, Bamber D, Goodyer I, Griffin SJ, Ekelund U: Breakfast consumption and physical activity in British adolescents. Br J Nutr 2011, 105:316-321.
• [24]Baranowski T, Perry CL, Parcel GS: How individuals, environments and health behaviour interact: social cognitive theory. In Health behaviour and health education: theory, research and practice. 2nd edition. Edited by Glanz K, Lewis FM, Rimer BK. San Fransisco: Jossey-Bass; 1997:169-188.
• [25]Sands R, Tricker J, Sherman C, Armatas C, Maschette W: Disordered eating patterns, body image, self-esteem, and physical activity in preadolescent school children. Int J Eat Disord 1997, 21:159-166.
• [26]Goodman E, Whitaker RC: A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics 2002, 110:497-504.
• [27]Lytle L, Schmitz KH: Community- level influences and interventions for pediatric obesity. In Handbook of pediatric obesity: etiology, pathophysiology and prevention. Edited by Goran M, Sothern M. Boca Raton: Taylor & Francis Group; 2005:271-290.
• [28]Martens MK, van Assema P, Brug J: Why do adolescents eat what they eat? Personal and social environmental predictors of fruit, snack and breakfast consumption among 12-14-year-old Dutch students. Public Health Nutr 2005, 8:1258-1265.
• [29]DeJong CS, van Lenthe FJ, van der Horst K, Oenema A: Environmental and cognitive correlates of adolescent breakfast consumption. Prev Med 2009, 48:372-377.
• [30]Pearson N, Biddle SJ, Gorely T: Family correlates of breakfast consumption among children and adolescents. A systematic review. Appetite 2009, 52:1-7.
• [31]Kleinman RE, Hall S, Green H, Korzec-Ramirez D, Patton K, Pagano ME, Murphy JM: Diet, breakfast, and academic performance in children. Ann Nutr Metab 2002, 46(Suppl 1):S24-S30.
• [32]Taras H: Nutrition and student performance at school. J Sch Health 2005, 75:199-213.
• [33]Gajre NS, Fernandez S, Balakrishna N, Vazir S: Breakfast eating habit and its influence on attention-concentration, immediate memory and school achievement. Indian Pediatr 2008, 45:824-828.
• [34]Chitra U, Reddy CR: The role of breakfast in nutrient intake of urban school children. Public Health Nutr 2007, 10:55-58.
• [35]Sethi M, Dangwal R: Breakfast eating patterns of school children and their impact on nutritional status. In Nutrition in disease management series 10. Edited by Gopalan S. New Delhi: Centre for Research on Nutrition Support Systems; 2001:8-16.
• [36]Perry CL, Stigler MH, Arora M, Reddy KS: Preventing tobacco Use among young people in India: project MYTRI. Am J Public Health 2009, 99:899-906.
• [37]Reddy KS, Perry CL, Stigler MH, Arora M: Differences in tobacco use among young people in urban India by sex, socioeconomic status, age, and school grade: assessment of baseline survey data. Lancet 2006, 367:589-594.
• [38]Stigler MH, Perry CL, Arora M, Shrivastav R, Mathur C, Reddy KS: Intermediate outcomes from project MYTRI: mobilizing youth for tobacco-related initiatives in india. Cancer Epidemiol Biomarkers Prev 2007, 16:1050-1056.
• [39]Lohman T, Roche A, Martorell R: Anthropometric standardization reference manual. Champaign, IL: Human Kinetics Books; 1988.
• [40]World Health Organization: Physical status: The Use and interpretation of anthropometry –report of a WHO expert committee. Geneva: World Health Organization; 1999. [WHO technical report series 854]
• [41]de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J: Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007, 85:660-667.
• [42]Reddy KS, Arora M, Perry CL, Nair B, Kohli A, Lytle LA, Stigler M, Prabhakaran D: Tobacco and alcohol use outcomes of a school-based intervention in New Delhi. Am J Health Behav 2002, 26:173-181.
• [43]Neumark-Sztainer D, Story M, Hannan PJ, Croll J: Overweight status and eating patterns among adolescents: where do youths stand in comparison with the healthy people 2010 objectives? Am J Public Health 2002, 92:844-851.
• [44]Hoelscher DM, Day RS, Kelder SH, Ward JL: Reproducibility and validity of the secondary level School-Based Nutrition Monitoring student questionnaire. J Am Diet Assoc 2003, 103:186-194.
• [45]Mullan BA, Singh M: A systematic review of the quality, content, and context of breakfast consumption. Nutr Food Sci 2010, 40:81-114.
• [46]Stang J, Kong A, Story M, Eisenberg ME, Neumark-Sztainer D: Food and weight-related patterns and behaviors of Hmong adolescents. J Am Diet Assoc 2007, 107:936-941.
• [47]Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, Goldfield G, Gorber SC: Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 2011, 8:98-119. BioMed Central Full Text
• [48]Strong WB, Malina RM, Blimkie CJR, Daniels SR, Dishman RK, Gutin B, Hergenroeder AC, Must A, Nixon PA, Pivarnik JM, Rowland T, Trost S, Trudeau F: Evidence-based physical activity for school-aged youth. J Pediatr 2005, 146:732-737.
• [49]Raudenbush S, Bryk AS: Hierarchical linear models: applications and data analysis methods. Thousand Oaks: Sage Publications; 2002.
• [50]Murray DM: Design and analysis of group-randomized trials. Monographs in epidemiology and biostatistics. New York: Oxford University Press; 1998. Volume 27
• [51]Wang Y, Chen HJ, Shaikh S, Mathur P: Is obesity becoming a public health problem in India? Examine the shift from under- to overnutrition problems over time. Obes Rev 2009, 10:456-474.
• [52]Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD: Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 2005, 105:743-760.
• [53]Ramachandran A, Snehalatha C, Vinitha R, Thayyil M, Kumar CK, Sheeba L, Joseph S, Vijay V: Prevalence of overweight in urban Indian adolescent school children. Diabetes Res Clin Pract 2002, 57:185-190.
• [54]Marwaha RK, Tandon N, Singh Y, Aggarwal R, Grewal K, Mani K: A study of growth parameters and prevalence of overweight and obesity in school children from Delhi. Indian Pediatr 2006, 43:943-952.
• [55]Boutelle K, Neumark-Sztainer D, Story M, Resnick M: Weight control behaviors among obese, overweight, and nonoverweight adolescents. J Pediatr Psychol 2002, 27:531-540.
• [56]Lattimore PJ, Halford JC: Adolescence and the diet-dieting disparity: healthy food choice or risky health behaviour? Br J Health Psychol 2003, 8:451-463.
• [57]Skinner JD, Salvetti NN, Ezell JM, Penfield MP, Costello CA: Appalachian adolescents’ eating patterns and nutrient intakes. J Am Diet Assoc 1985, 85:1093-1099.
• [58]Evers S, Taylor J, Manske S, Midgett C: Eating and smoking behaviours of school children in southwestern Ontario and Charlottetown, PEI. Can J Public Health 2001, 92:433-436.
• [59]Resnicow K: The relationship between breakfast habits and plasma cholesterol levels in school children. J Sch Health 1991, 61:81-85.
• [60]Sjoberg A, Hallberg L, Hoglund D, Hulthen L: Meal pattern, food choice, nutrient intake and lifestyle factors in The Goteborg Adolescence Study. Eur J Clin Nutr 2003, 57:1569-1578.
• [61]Ajzen I, Fishbein M: Understanding attitudes and predicting social behaviour. Englewood Cliffs: Prentice Hall; 1980.
• [62]Story M, Neumark-Sztainer D, French S: Individual and environmental influences on adolescent eating behaviors. J Am Diet Assoc 2002, 102(Suppl 3):40-51.
• [63]Savage JS, Fisher JO, Birch LL: Parental influence on eating behavior: conception to adolescence. J Law Med Ethics 2007, 35:22-34.
• [64]Fulkerson JA, Sherwood NE, Perry CL, Neumark-Sztainer D, Story M: Depressive symptoms and adolescent eating and health behaviors: a multifaceted view in a population-based sample. Prev Med 2004, 38:865-875.
• [65]O’Dea JA, Wilson R: Socio-cognitive and nutritional factors associated with body mass index in children and adolescents: possibilities for childhood obesity prevention. Health Educ Res 2006, 21:796-805.