Breakfast is considered as the most important meal of the day. The habit of skipping this meal in adolescence tends to remain until adulthood and has been associated with cardiometabolic risk factors. This study estimated the prevalence of skipping breakfast and its association with cardiometabolic risk factors. This is a cross-sectional study with data from the Study of Cardiovascular Risks in Adolescents (ERICA), with a nationally representative sample of 36,956 Brazilian adolescents, aged 10 to 17 years, enrolled in public and private schools. The outcomes were: excess body weight (body mass index), central obesity (waist circumference and waist/height ratio), lipid profile (total cholesterol, LDLc, HDLc, and triglycerides) and glycidic profile (fasting glycemia, fasting insulin, and glycated hemoglobin). The association between skipping breakfast and each outcome was estimated using multiple logistic regression models (Odds Ratio [OR] and 95% Confidence Interval). Prevalence of skipping breakfast was 68.7% and, after adjustments, it was associated with excess body weight (OR = 1.51), central obesity both by waist circumference (OR = 1.36) and by waist/height ratio (OR = 1.44) and high fasting glucose levels (OR = 1.54), fasting insulin (OR = 1.45), and glycated hemoglobin (OR = 1.23). Thus, skipping breakfast was high among adolescents and those who skip this meal are more likely to have total and central obesity, as well as high levels of total cholesterol, fasting insulin, fasting glycemia and glycated hemoglobin, regardless of factors relative to lifestyle and demographic and socioeconomic characteristics.

OBJECTIVE To systematically review the results of the association between breakfast skipping and cardiometabolic risk factors in adolescents. METHODS The articles were searched in May 2020 from PubMed, Virtual Health Library, Scopus, Web of Science and Scientific Electronic Library Online (SciELO). The review included observational studies conducted with adolescents (10–19 years old), which estimated the association of breakfast skipping with at least one outcome (markers of body adiposity, blood pressure, serum lipid and glucose levels). Regarding the risk of bias, the articles were evaluated using the Research Triangle Institute (RTI) Item Bank on bias risk and accuracy of observational studies. The quality of the evidence was assessed by the Grade rating. RESULTS A total of 43 articles involving 192,262 participants met the inclusion criteria and were considered in this review. The prevalence of breakfast skipping ranged from 0.7% to 94% and 60.5% of studies were classified with low risk of bias. The significant association between breakfast skipping and cardiometabolic risk factors was found in twenty-nine cross-sectional articles (n = 106,031) and four longitudinal articles (n = 5,162) for excess adiposity, in three articles (n = 8,511) for high total cholesterol levels, low-density lipoprotein and triglycerides, and in three studies (n = 6,303) for high blood pressure levels. However, there was no significant association between breakfast skipping and glycemic profile. According to the Grade rating, all the associations had low quality of evidence. CONCLUSION The results of this review suggest that breakfast skipping is associated with cardiometabolic risk factors in adolescents aged 10 to 19 years. However, considering the low quality of the evidence, the present results should be interpreted carefully. In addition, our findings highlight the importance of standardizing the definition of breakfast skipping and that more prospective studies are needed to determine how skipping breakfast can affect cardiometabolic risk factors in the long time.

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The present study identified dietary patterns (DP) and analyze their association with household composition. This is a cross-sectional school-based study, with a nationally representative sample of Brazilian adolescent students, aged 11-19 years-old, with data from National School Health Survey (N= 102,072). The independent variable was household composition. Food consumption was obtained through the weekly frequency of consumption of food markers and the Confirmatory Factor Analysis was applied to examine the latent variables “Healthy” (beans, legumes/vegetables, and fresh fruit/fruit salad) and “Unhealthy” (ultra-processed foods, sweets, soft drinks, and snacks) DP. The association between household composition and DP was estimated using multiple linear regression models, considering lives with both parents as reference category. Among adolescents aged 11-14-years-old, adherence to Healthy DP was lower for boys who lived only with mother (β=-2.1); and boys (β=-4.9) and girls (β=-4.5) who lived without any parents. Adherence to Unhealthy DP was higher among boys (β=7.6) and girls (β=6.0) who lived only with mother, and boys (β=4.6) and girls (β=5.3) who lived only with father. For older adolescents (15-19-years-old), adherence to the Unhealthy DP was higher among boys who lived only with mother (β=3.9) or only with father (β=5.3) and girls who lived only with mother (β=6.3). Adherence to Healthy DP was lower among girls who lived only with father (β=-9.0). Thus, adolescents who lived in single-parent households had lower adherence to healthy DP and greater adherence to unhealthy DP. Among younger adolescents of both sexes, living without any parent contributed to lower adherence to healthy DP.