The Association of Breakfast Frequency and Cardiovascular Disease (CVD) Risk Factors among Adolescents in Malaysia

Abstract

Breakfast frequency is associated with cardiovascular disease (CVD) risk in Western populations, possibly via the types of food eaten or the timing of food consumption, but associations in Malaysian adolescents are unknown. While the timing of breakfast is similar, the type of food consumed at breakfast in Malaysia differs from Western diets, which allows novel insight into the mechanisms underlying breakfast–CVD risk associations. We investigated foods eaten for breakfast and associations between breakfast frequency and CVD risk factors in the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). Breakfast (frequency of any food/drink reported as breakfast in 7-day diet history interviews) and CVD risk factors (body mass index (BMI), waist circumference, fasting blood glucose, triacylglycerol, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and systolic and diastolic blood pressure) were cross-sectionally associated using linear regression adjusting for potential confounders (n = 795, age 13 years). Twelve percent of adolescents never ate breakfast and 50% ate breakfast daily, containing mean (SD) 400 (±127) kilocalories. Commonly consumed breakfast foods were cereal-based dishes (primarily rice), confectionery (primarily sugar), hot/powdered drinks (primarily Milo), and high-fat milk (primarily sweetened condensed milk). After adjustment, each extra day of breakfast consumption per week was associated with a lower BMI (−0.34 kg/m2, 95% confidence interval (CI) −0.02, −0.66), and serum total (−0.07 mmol/L 95% CI −0.02, −0.13) and LDL (−0.07 mmol/L 95% CI −0.02, −0.12) cholesterol concentrations. Eating daily breakfast in Malaysia was associated with slightly lower BMI and total and LDL cholesterol concentrations among adolescents. Longitudinal studies and randomized trials could further establish causality.

Dietary Behavior and Physical Activity in Children and Adolescents

“…Results from the WHO Health Behavior in School-Aged Children survey in Belgium are in line with previous findings which showed that eating culture plays a role in inequalities of eating habits among immigrants when socioeconomic conditions are considered [26]. Mustafa N. et al [27] further highlighted that the type of foods consumed at breakfast are highly dependent on culture. Malaysian adolescents consume breakfast that is of low nutrient quality, such as cereal-based and often primarily rice dishes, chocolate and confectionary, hot and powered drinks, and noodles.…”

Nutritional Quality of Breakfast Consumed by the Low-Income Population in Brazil: A Nationwide Cross-Sectional Survey

“…Marchioni et al [21] evaluated 795 adolescents in São Paulo/Brazil and found that 38% skipped breakfast. Eating breakfast is hypothesized to reduce subsequent snack consumption, resulting in lower overall daily energy intake, thus maintaining energy balance and a lower body weight, if it is not associated with higher energy product intake [38]. For low-income people, household food insecurity can limit access to adequate foods, which may lead to problems such as insufficient nutrients and food intake, leading to health issues such as chronic diseases, mental health problems, and poor quality of life [39].…”

“…The existence of economic restrictions on the value of food leads to diets with low participation of fruits and vegetables and with high energy density [57,58]. breakfast composition can impact the body mass index and the risk of developing noncommunicable diseases [4,38]. The combination of whole cereals with dairy products plays a protecting role, while high-fat and processed foods, such as processed meat, cheese, and margarine, are associated with a higher risk of developing noncommunicable diseases [4].…”

The Quality of Breakfast and Healthy Diet in School-aged Adolescents and Their Association with BMI, Weight Loss Diets and the Practice of Physical Activity

“…Thus, the percentage of high school boys going to class without having had any breakfast at all increases from 8.2% at 11–12 years of age to 24.6% at 17–18 years of age [ 15 ]. Numerous studies point out that regular consumption of breakfast has also been associated with lower BMI [ 40 , 41 , 42 , 43 ]. Adherence to a weight loss diet can lead to skipping breakfast altogether or having an unhealthy breakfast, mainly as a result of wanting to stay in shape or lose weight, with this habit being more frequent amongst girls [ 44 ].…”