Association of Breakfast Quality and Energy Density with Cardiometabolic Risk Factors in Overweight/Obese Children: Role of Physical Activity

Abstract

There is a general belief that having breakfast is an important healthy lifestyle factor; however, there is scarce evidence on the influence of breakfast quality and energy density on cardiometabolic risk in children, as well as on the role of physical activity in this association. The aims of this paper were (i) to examine the associations of breakfast quality and energy density from both solids and beverages with cardiometabolic risk factors, and (ii) to explore whether physical activity levels may attenuate these relationships in children with overweight/obesity from two projects carried out in the north and south of Spain. Breakfast consumption, breakfast quality index (BQI) score, BEDs/BEDb (24 h-recalls and the KIDMED questionnaire), and physical activity (PA; accelerometry) were assessed, in 203 children aged 8–12 years who were overweight or obese. We measured body composition (Dual X-ray Absorptiometry), uric acid, blood pressure, lipid profile, gamma-glutamyl-transferase (GGT), glucose, and insulin, and calculated the HOMA and metabolic syndrome z-score. The BQI score was inversely associated with serum uric acid independently of a set of relevant confounders (β = −0.172, p = 0.028), but the relationship was attenuated after further controlling for total PA (p < 0.07). BEDs was positively associated with total and HDL cholesterol, and systolic blood pressure regardless of confounders (all p < 0.05), while BEDb was positively associated with HOMA in either active/inactive children (all p < 0.03). In conclusion, higher breakfast quality and lower breakfast energy density should be promoted in overweight/obesity children to improve their cardiometabolic health.

Prevention of Obesity and Metabolic Syndrome in Children

“…A tendency to eat in the absence of hunger leads to a >4-fold risk of being overweight (54). Missing breakfast has been associated with an increased adverse metabolic risk (55) and there is evidence to suggest that consumption of a high quality breakfast with low energy density is associated with a number of improved markers of cardiometabolic health (serum uric acid, cholesterol, and measures on insulin resistance) in a cohort of 8–12 year olds who were overweight or obese (56).…”

Breakfast Habits of a Representative Sample of the Spanish Child and Adolescent Population (The ENALIA Study): Association with Diet Quality

“…Breakfast is part of a healthy diet and lifestyle and can have a positive impact on the health and well–being of children and adolescents [ 1 , 2 , 3 , 4 , 5 ]. This meal is considered by many as one of the most important of the day [ 6 , 7 ], as it breaks the fast maintained since the last intake of the previous day and modifies metabolic processes [ 8 ]: during fasting, glycogen reserves decrease and lipolysis increases, while with breakfast the use of glucose as an energy substrate increases and lipogenesis is also promoted.…”

“…One of the benefits that has been associated with the habit of eating breakfast in children and adolescents is its protective effect against overweight and obesity [ 1 , 2 , 3 , 6 , 7 , 12 , 13 , 14 , 15 ] and its beneficial effect on cardiometabolic health indicators [ 7 , 14 , 15 , 16 ]. It has also been described that breakfast is associated with functional, cognitive and mood benefits [ 3 , 5 , 7 , 17 ].…”

Breakfast Food Advertisements in Mediterranean Countries: Products’ Sugar Content in the Adverts from 2015 to 2019

“…A traditional Mediterranean breakfast should contain about 30% of the day’s energy and should include whole-grain cereals or bread, milk-based products, and vegetables or fruits. Based on previous research [ 25 , 26 , 27 ], up to 30% of children and adolescents do not have a qualitatively balanced meal for breakfast or they even skip having breakfast altogether; this trend is especially found in Mediterranean countries, where the rate of obesity in children is higher. Although breakfast intake in these countries seems to be quite balanced for adults [ 28 ], children and adolescents have shown poorer adherence to a MD [ 6 ], despite the evidence on the association between following a MD and having a healthier life.…”