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A high intake of sugar-sweetened beverages (SSB) has been linked to weight gain, obesity and type 2 diabetes; however, the influence on CVD risk remains unclear. Therefore, our objective was to summarize current evidence for an association between SSB consumption and cardiovascular risk factors and events.
Design
The article search was performed in August 2013. Two independent researchers performed the article search and selection, data extraction and quality assessment. Eligible studies reported the intake of SSB and one of the following outcomes: change in blood pressure, blood lipid or blood sugar, or CVD events such as stroke or myocardial infarction. Only intervention and longitudinal studies were included.
Subjects
Only studies in adults (aged 18+ years old) were considered.
Results
Two of four prospective studies found clear direct associations between SSB consumption and CHD, while two of three studies, including both men and women, found direct associations between SSB consumption and stroke; however, the association was significant among women only. All included studies examining vascular risk factors found direct associations between SSB consumption and change in blood pressure, blood lipid or blood sugar.
Conclusions
The reviewed studies generally showed that SSB intake was related to vascular risk factors, whereas associations with vascular events were less consistent. Due to a limited number of published papers, especially regarding vascular events, the strength of the evidence is still limited and hence more studies are needed before firm conclusions can be made.
To determine the prospective relationship between changes in sugar-sweetened beverage (SSB) intake and central adiposity in older children.
Design
Dietary intakes of children were obtained by 3 d food records at ages 10 and 13 years. Waist circumference (WC) and weight and height to determine BMI were measured at 10 and 13 years and total body fat mass (TBFM) at 13 years by dual-energy X-ray absorptiometry. Analyses were conducted using multivariable linear regression. Reporting errors were measured and participants were categorized as under-, plausible and over-reporters of dietary intakes.
Setting
Community-based British cohort of children participating in the Avon Longitudinal Study of Parents and Children.
Results
Among 2455 older children, increased SSB consumption from ages 10 to 13 years was associated with higher WC (standardized β=0·020, P=0·19), BMI (β=0·028, P=0·03) and TBFM (β=0·017, P=0·20) at 13 years. Effects were strengthened among plausible dietary reporters (n 1059): WC (β=0·097, P<0·001), BMI (β=0·074, P<0·001) and TBFM (β=0·065, P=0·003). The association between change in SSB and WC was weakened, but remained statistically significant after accounting for BMI (β=0·042, P=0·02) and TBFM (β=0·048, P=0·01).
Conclusions
Higher consumption of SSB from ages 10 to 13 years was associated with a larger WC at age 13 years independent of differences in total adiposity. Accounting for dietary reporting errors strengthened associations. Our findings further support recommendations to limit intakes of SSB to reduce excess weight gain in children and suggest that SSB have an additional deleterious effect on central adiposity.
To provide an overview of beverage consumption patterns using the first nationally representative survey of dietary intake in Brazil.
Design
Beverage consumption data were obtained by 1 d food records in an individual dietary survey.
Setting
Nationwide cross-sectional survey, 2008–2009.
Subjects
Nationally representative sample of individuals aged ≥10 years (n 34 003).
Results
Beverages contributed 17·1 % of total energy consumption. Caloric coffee beverages provided the greatest level of energy overall (464 kJ (111 kcal)/d). Individuals aged 10–18 years (243 kJ (58 kcal)/d) and 19–39 years (230 kJ (55 kcal)/d) consumed a higher proportion of energy from sugar-sweetened soft drinks than individuals over this age (142 kJ (34 kcal)/d for those aged 40–59 years and 79 kJ (19 kcal)/d for those aged ≥60 years).
Conclusions
Overall, the contribution of beverages, particularly sugary beverages, to total energy consumption in Brazil represents an important public health challenge and is comparable with those from other countries.
According to the Federal Trade Commission, in 2009, the top food category with teen-directed marketing expenditures was sugar-sweetened beverages (SSB). The present study reports on exposure to SSB advertisements using self-report data from adolescents.
Design
Cross-sectional study design using descriptive statistics to assess self-reported frequency of exposure to SSB advertisements and multivariable logistic regression to examine associations between frequency of SSB advertising exposure and sociodemographic variables.
Setting
Online survey conducted at home.
Subjects
US adolescents aged 12–17 years (n 847).
Results
Among the surveyed adolescents, 42 % to 54 % reported seeing/hearing SSB advertisements ≥1 time/d. Those aged 14–15 years were more likely to report seeing/hearing soda, sports drink and energy drink advertisements ≥1 time/d than 16- to 17-year-olds. Males were more likely to report seeing/hearing sports drink advertising ≥1 time/d than females. Non-Hispanic black adolescents were more likely to report seeing/hearing fruit drink and sports drink advertisements ≥1 time/d than non-Hispanic white adolescents. Adolescents whose parents had high-school education or less were more likely to report seeing/hearing soda, fruit drink and energy drink advertisements ≥1 time/d than adolescents whose parents were college graduates.
Conclusions
Almost half of the adolescents sampled reported daily SSB advertising exposure, with higher exposure among African Americans and adolescents with less educated parents. These data can help inform potential actions that decision makers might take, such as education of adolescents and their caregivers on the potential impact of beverage advertising, especially among groups at higher risk for obesity.
To investigate water contributors in relation to dietary and serum micronutrient profiles.
Design
A cross-sectional study. The main exposures were water contributors. Selected dietary and serum micronutrient levels were outcome measures.
Settings
The US population and its subgroups.
Subjects
US adults (n 2691) aged ≥20 years from the National Health and Nutrition Examination Survey 2005–2006.
Results
The daily mean total water intake was 3·1 (se 0·047) litres, with 68 % of adults consuming below the Adequate Intake level. Total water intake was higher in adults with higher BMI and physical activity, those taking dietary supplements and alcohol consumers (P < 0·05). Plain water intake was positively associated with food moisture and negatively with beverage moisture (P < 0·001). Beverage moisture was negatively associated with food moisture (P < 0·001). In multivariate regression analyses, plain water and food moisture intakes were positively associated with Fe, Ca, vitamins A, B, C, E and K and carotenoid intakes (P < 0·05). However, beverage moisture was unrelated to Ca, niacin and vitamin B6 intakes, and negatively associated with Fe, vitamin A, folate, vitamins C, E and K and carotenoid intakes (P < 0·05). Concentrations of serum vitamins A and C and carotenoids increased with plain water and food moisture intakes (P < 0·05) but decreased (P < 0·01) or were unrelated to beverage moisture intake.
Conclusions
Various contributors of total water intake differed in their associations with dietary and serum micronutrient profiles in US adults. The study provides evidence of plain water benefits on micronutrient adequacy over beverages.
To describe changes in consumption of different types of beverages from pre-pregnancy to early pregnancy, and to examine associations with maternal age, educational level and BMI.
Design
Cross-sectional design. Participants answered an FFQ at inclusion into a randomized controlled trial, the Fit for Delivery (FFD) trial, in median gestational week 15 (range: 9–20), reporting current consumption and in retrospect how often they drank the different beverages pre-pregnancy.
Setting
Eight local antenatal clinics in southern Norway from September 2009 to February 2013.
Subjects
Five hundred and seventy-five healthy pregnant nulliparous women.
Results
Pre-pregnancy, 27 % reported drinking alcohol at least once weekly, compared with none in early pregnancy (P<0·001). The percentage of women drinking coffee (38 % v. 10 %, P<0·001), sugar-sweetened beverages (10 % v. 6 %, P=0·011) and artificially sweetened beverages (12 % v. 9 %, P=0·001) at least daily decreased significantly from pre-pregnancy to early pregnancy, while the percentage of women who reported to drink water (85 % v. 92 %, P<0·001), fruit juice (14 % v. 20 %, P=0·001) and milk (37 % v. 42 %, P=0·001) at least daily increased significantly. From pre-pregnancy to early pregnancy higher educated women reduced their consumption frequency of coffee significantly more than women with lower education. Older women reduced their consumption frequency of coffee and artificially sweetened beverages and increased their consumption frequency of fruit juice and milk significantly more than younger women.
Conclusions
There is a significant change in beverage consumption from pre-pregnancy to early pregnancy among Norwegian nulliparous women.
Knowledge of the types and quantities of foods and drinks available in family homes supports the development of targeted intervention programmes for obesity prevention or management, or for overall diet improvement. In the UK, contemporary data on foods that are available within family homes are lacking. The present study aimed to explore home food and drink availability in UK homes.
Design
An exploratory study using researcher-conducted home food availability inventories, measuring all foods and drinks within the categories of fruits, vegetables, snack foods and beverages.
Setting
Bradford, a town in the north of the UK.
Subjects
Opportunistic sample of mixed ethnicity families with infants approximately 18 months old from the Born in Bradford birth cohort.
Results
All homes had at least one type of fruit, vegetable and snack available. Fresh fruits commonly available were oranges, bananas, apples, satsumas and grapes. Commonly available fresh vegetables included potatoes, cucumber, tomatoes and carrots. The single greatest non-fresh fruit available in homes was raisins. Non-fresh vegetables contributing the most were frozen mixed vegetables, tinned tomatoes and tinned peas. Ethnic differences were found for the availability of fresh fruits and sugar-sweetened beverages, which were both found in higher amounts in Pakistani homes compared with White homes.
Conclusions
These data contribute to international data on availability and provide an insight into food availability within family homes in the UK. They have also supported a needs assessment of the development of a culturally specific obesity prevention intervention in which fruits and vegetables and sugar-sweetened beverages are targeted.
To analyse the Na content and labelling of processed and ultra-processed food products marketed in Brazil.
Design
Cross-sectional study.
Setting
A large supermarket in Florianopolis, southern Brazil.
Subjects
Ingredient lists and Na information on nutrition labels of all processed and ultra-processed pre-prepared meals and prepared ingredients, used in lunch or dinner, available for sale in the supermarket.
Results
The study analysed 1416 products, distributed into seven groups and forty-one subgroups. Five products did not have Na information. Most products (58·8 %; 95 % CI 55·4, 62·2 %) had high Na content (>600 mg/100 g). In 78·0 % of the subgroups, variation in Na content was at least twofold between similar products with high and low Na levels, reaching 634-fold difference in the ‘garnishes and others’ subgroup. More than half of the products (52·0 %; 95 % CI 48·2, 55·6 %) had at least one Na-containing food additive. There was no relationship between the appearance of salt on the ingredients list (first to third position on the list) and a product’s Na content (high, medium or low; P=0·08).
Conclusions
Most food products had high Na content, with great variation between similar products, which presents new evidence for reformulation opportunities. There were inconsistencies in Na labelling, such as lack of nutritional information and incomplete ingredient descriptions. The position of salt on the ingredients list did not facilitate the identification of high-Na foods. We therefore recommend a reduction in Na in these products and a review of Brazilian legislation.
To analyse the dietary intake of Brazilian adolescents and investigate its association with sociodemographic factors as well as health-risk and health-protective behaviours.
Design
Cross-sectional study.
Setting
The study was based on data supplied by the National Survey of Schoolchildren’s Health (2012) on sociodemographic factors, dietary intake and health-risk and health-protective behaviours of schoolchildren in Brazil. A nutritional scale was elaborated combining markers of healthy and unhealthy diets. Poisson regression analysis was applied to investigate the association between the sociodemographic factors and regular intake (≥5 times/week) of selected foods; linear regression analysis was applied to investigate the association of sociodemographic and behavioural factors with nutritional scale score.
Subjects
A total of 109 104 adolescents attending the ninth year of education at 2842 schools in Brazil.
Results
Fewer than 30 % of the adolescents consumed raw or cooked vegetables on a regular basis, whereas more than one-third reported regular intake of sweets, soft drinks and sweet biscuits. Adolescents from the southern area and the oldest ones were those most exposed to inadequate dietary intake. The nutritional scale average score was higher in the students attending public school and exhibited a positive correlation with protective behaviours, such as being physically active, having meals with parents and eating breakfast, and a negative correlation with risk behaviours such as eating while studying or watching television and having smoked, drunk alcohol or used other drugs in the previous 30 d.
Conclusions
The results indicate an association between undesirable nutritional habits and other risk behaviours among Brazilian adolescents.
To identify and critique tools for the assessment of Ca and/or dairy intake in adults, in order to ascertain the most accurate and reliable tools available.
Design
A systematic review of the literature was conducted using defined inclusion and exclusion criteria. Articles reporting on originally developed tools or testing the reliability or validity of existing tools that measure Ca and/or dairy intake in adults were included. Author-defined criteria for reporting reliability and validity properties were applied.
Setting
Studies conducted in Western countries.
Subjects
Adults.
Results
Thirty papers, utilising thirty-six tools assessing intake of dairy, Ca or both, were identified. Reliability testing was conducted on only two dairy and five Ca tools, with results indicating that only one dairy and two Ca tools were reliable. Validity testing was conducted for all but four Ca-only tools. There was high reliance in validity testing on lower-order tests such as correlation and failure to differentiate between statistical and clinically meaningful differences. Results of the validity testing suggest one dairy and five Ca tools are valid. Thus one tool was considered both reliable and valid for the assessment of dairy intake and only two tools proved reliable and valid for the assessment of Ca intake.
Conclusions
While several tools are reliable and valid, their application across adult populations is limited by the populations in which they were tested. These results indicate a need for tools that assess Ca and/or dairy intake in adults to be rigorously tested for reliability and validity.
To assess correlations between cruciferous vegetable intake and urinary isothiocyanate (ITC) level, in addition to glutathione S-transferase (GST) genotypes and other individual factors.
Design
The study included cohort participants whose urinary ITC levels had been previously ascertained. Urinary ITC was assessed using HPLC. Usual dietary intake of cruciferous vegetables was assessed using a validated FFQ and total dietary ITC intake was calculated. Recent cruciferous vegetable intake was determined. GST genotypes were assessed using duplex real-time quantitative PCR assays. Spearman correlations were calculated between the covariates and urinary ITC levels and linear regression analyses were used to calculate the mean urinary ITC excretion according to GST genotype.
Setting
Urban city in China.
Subjects
The study included 3589 women and 1015 men from the Shanghai Women’s and Men’s Health Studies.
Results
Median urinary ITC level was 1·61 nmol/mg creatinine. Self-reported usual cruciferous vegetable intake was weakly correlated with urinary ITC level (rs=0·1149; P<0·0001), while self-reported recent intake was more strongly correlated with urinary ITC (rs=0·2591; P<0·0001). Overall, the GST genotypes were not associated with urinary ITC level, but significant differences according to genotype were observed among current smokers and participants who provided an afternoon urine sample. Other factors, including previous gastrectomy or gastritis, were also related to urinary ITC level.
Conclusions
The study suggests that urinary secretion of ITC may provide additional information on cruciferous vegetable intake and that GST genotypes are related to urinary ITC level only in some subgroups.
Fat mass (FM) and fat-free mass (FFM) are frequently measured to define body composition phenotypes. The load–capacity model integrates the effects of both FM and FFM to improve disease-risk prediction. We aimed to derive age-, gender- and BMI-specific reference curves of load–capacity model indices in an adult population (≥18 years).
Design
Cross-sectional study. Dual-energy X-ray absorptiometry was used to measure FM, FFM, appendicular skeletal muscle mass (ASM) and truncal fat mass (TrFM). Two metabolic load–capacity indices were calculated: ratio of FM (kg) to FFM (kg) and ratio of TrFM (kg) to ASM (kg). Age-standardised reference curves, stratified by gender and BMI (<25·0 kg/m2, 25·0–29·9 kg/m2, ≥30·0 kg/m2), were constructed using an LMS approach. Percentiles of the reference curves were 5th, 15th, 25th, 50th, 75th, 85th and 95th.
Setting
Secondary analysis of data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES).
Subjects
The population included 6580 females and 6656 males.
Results
The unweighted proportions of obesity in males and females were 25·5 % and 34·7 %, respectively. The average values of both FM:FFM and TrFM:ASM were greater in female and obese subjects. Gender and BMI influenced the shape of the association of age with FM:FFM and TrFM:ASM, as a curvilinear relationship was observed in female and obese subjects. Menopause appeared to modify the steepness of the reference curves of both indices.
Conclusions
This is a novel risk-stratification approach integrating the effects of high adiposity and low muscle mass which may be particularly useful to identify cases of sarcopenic obesity and improve disease-risk prediction.
Although the benefits of highly active antiretroviral therapy (HAART) have been documented, it is thought to be associated to disturbances in nutritional status. These disturbances may occur early in life and are poorly understood. The present study aimed to investigate the relationship between anthropometric parameters and body composition of perinatally HIV-infected children and adolescents under HAART, according to use and non-use of protease inhibitors.
Design
Cross-sectional study undertaken between August and December 2007. Demographic, socio-economic, clinical and anthropometric data were collected from the patients. The χ2 test, Wilcoxon rank sum test (Mann–Whitney) and t test were used to compare the following variables between users and non-users of protease inhibitors: age, gender, per capita income, HAART exposure, antiretroviral therapy adopted in the last three years, CD4 count, viral load, pubertal stage, nutritional status (BMI-for-age, height-for-age, waist and neck circumferences, triceps skinfold thickness, body fat percentage, upper-arm fat area and upper-arm muscle area).
Setting
An HIV/AIDS out-patient clinic, São Paulo, Brazil.
Subjects
One hundred and fifteen patients (children and adolescents aged 6–19 years).
Results
Protease inhibitors users had a higher prevalence of stunting (P=0·03), lower BMI (P=0·03) and lower percentage of body fat (P=0·05) compared with non-users. There was no statistically significant difference between the HAART regimens and measurements of fat adiposity.
Conclusions
The findings of the study suggest that children and adolescents under protease inhibitors are at higher risk of growth and development deviations, but not at risk of body fat redistribution.
The present study examines whether rural-to-urban migrant youth consume a greater diversity of high-sugar beverages and fried snacks (HSBFS) compared with their peers who remain in rural areas. It also tests whether the association between migration and HSBFS diversity is moderated by migrant youth’s social engagement with their peers.
Design
Participants were recruited in August and September 2011 following the completion of primary school (6th grade) and shortly before many rural youth migrate to urban areas. Participants were re-interviewed six months later. HSBFS diversity was assessed at follow-up; analyses control for baseline and follow-up characteristics.
Setting
Baseline interviews occurred in rural Southeast Haiti. Follow-up interviews of migrants occurred at urban destinations in Haiti.
Subjects
The sample includes 215 youth (mean age 15·9 years; 43·3 % female; 21·9 % rural-to-urban migrants) who were interviewed at baseline and follow-up.
Results
Rural-to-urban migrant youth consumed a greater diversity of HSBFS products at follow-up than their rural counterparts (b=0·70, P≤0·05). Moreover, we found that this relationship varied by level of peer social engagement. Youth who migrated and had a high degree of peer social engagement consumed 2·2 additional types of HSBFS products daily than their counterparts who remained in rural areas and had low peer social engagement.
Conclusions
Higher HSBFS diversity among migrant youth is consistent with the patterns proposed by the nutrition transition. Interactions with peers may have an important influence as migrant youth adopt new dietary preferences. Emerging dietary patterns among youth migrants have important implications for health trajectories and the development of degenerative diseases.
To examine the effects of lunches with different dietary energy densities on food preferences between genders.
Design
Randomized crossover study. Participants were administered the following packed test meals once weekly on a specified day during six sessions: control (150 g of rice with a sautéed beef entrée containing 40 g of raw beef and 240 g of vegetables), high-meat/low-rice, low-vegetable, medium-fat/low-vegetable, high-fat and high-fat/low-vegetable meals. Subjective levels of sensory properties were assessed over time using visual analogue scales.
Setting
University of Tokushima Graduate School, Tokushima, Japan.
Subjects
Sixty-five men and sixty-five women matched by age and BMI.
Results
Men showed significantly stronger desires for salty and fatty foods after meals (P<0·05). Women showed a significantly stronger desire for sweetness from 2 h after the low-vegetable meal, and increasing fat content under high-vegetable conditions caused a significant stimulated sweetness desire in women more than in men (P<0·05). Moreover, after a high-meat/low-rice meal with 100 g of rice, sweetness desire was stronger in women (P=0·024), whereas no significant differences in sweetness desire were shown between genders after another low-energy-density control meal with 150 g of rice.
Conclusions
Men had significantly stronger desires for salty and fatty foods, whereas women preferred sweet food after meals. The sweetness desire in women was stimulated by increasing fat content, even with a high vegetable intake. Low rice intake in a low-energy-density diet also caused a relative stimulation of sweetness desire in women.
We aimed to use the meta-analysis method to assess the relationship between coffee drinking and all-cause mortality.
Design
Categorical and dose–response meta-analyses were conducted using random-effects models.
Setting
We systematically searched and identified eligible literature in the PubMed and Scopus databases.
Subjects
Seventeen studies including 1 054 571 participants and 131 212 death events from all causes were included in the present study.
Results
Seventeen studies were included and evaluated in the meta-analysis. A U-shaped dose–response relationship was found between coffee consumption and all-cause mortality (P for non-linearity <0·001). Compared with non/occasional coffee drinkers, the relative risks for all-cause mortality were 0·89 (95 % CI 0·85, 0·93) for 1–<3 cups/d, 0·87 (95 % CI 0·83, 0·91) for 3–<5 cups/d and 0·90 (95 % CI 0·87, 0·94) for ≥5 cups/d, and the relationship was more marked in females than in males.
Conclusions
The present meta-analysis of prospective cohort studies indicated that light to moderate coffee intake is associated with a reduced risk of death from all causes, particularly in women.
Adherence to a Mediterranean diet is associated with significant improvements in health status. However, to date no systematic review and meta-analysis has summarized the effects of Mediterranean diet adherence on the risk of type 2 diabetes mellitus.
Design
Electronic searches for randomized controlled trials and cohort studies were performed in MEDLINE, SCOPUS, EMBASE and the Cochrane Trial Register until 2 April 2014. Pooled effects were calculated by an inverse-variance random-effect meta-analysis using the statistical software Review Manager 5·2 by the Cochrane Collaboration.
Setting
Meta-analysis of randomized controlled trials and cohort studies.
Subjects
Eligibility criteria: 19+years of age.
Results
One randomized controlled trial and eight prospective cohort studies (122 810 subjects) published between 2007 and 2014 were included for meta-analysis. For highest v. lowest adherence to the Mediterranean diet score, the pooled risk ratio was 0·81 (95 % CI 0·73, 0·90, P<0·0001, I2=55 %). Sensitivity analysis including only long-term studies confirmed the results of the primary analysis (pooled risk ratio=0·75; 95 % CI 0·68, 0·83, P<0·00001, I2=0 %). The Egger regression test provided no evidence of substantial publication bias (P=0·254).
Conclusions
Greater adherence to a Mediterranean diet is associated with a significant reduction in the risk of diabetes (19 %; moderate quality evidence). These results seem to be clinically relevant for public health, in particular for encouraging a Mediterranean-like dietary pattern for primary prevention of type 2 diabetes mellitus.
To estimate the associations of individual maternal social capital and social capital dimensions (Participation in the Community, Feelings of Safety, Value of Life and Social Agency, Tolerance of Diversity) with adherence to the Mediterranean diet during pregnancy.
Design
This is a cross-sectional analysis of data from a prospective mother–child cohort (Rhea Study). Participants completed a social capital questionnaire and an FFQ in mid-pregnancy. Mediterranean diet adherence was evaluated through an a priori score ranging from 0 to 8 (minimal–maximal adherence). Maternal social capital scores were categorized into three groups: the upper 10 % was the high social capital group, the middle 80 % was the medium and the lowest 10 % was the low social capital group. Multivariable log-binomial and linear regression models adjusted for confounders were performed.
Setting
Heraklion, Crete, Greece.
Subjects
A total of 377 women with singleton pregnancies.
Results
High maternal Total Social Capital was associated with an increase of almost 1 point in Mediterranean diet score (highest v. lowest group: β coefficient=0·95, 95 % CI 0·23, 1·68), after adjustment for confounders. Similar dose–response effects were noted for the scale Tolerance of Diversity (highest v. lowest group: adjusted β coefficient=1·08, 95 % CI 0·39, 1·77).
Conclusions
Individual social capital and tolerance of diversity are associated with adherence to the Mediterranean diet in pregnancy. Women with higher social capital may exhibit a higher sense of obligation to themselves and to others that may lead to proactive nutrition-related activities. Less tolerant women may not provide the opportunity to new healthier, but unfamiliar, nutritional recommendations to become part of their regular diet.
To assess the association of breakfast intake with Mediterranean diet adherence, physical activity levels, obesity, selected cardiovascular risk markers and Fe status.
Design
Cross-sectional study. BMI, body fat percentage and waist circumference were assessed. Physical activity was assessed using a pedometer and diet quality was evaluated by applying the KIDMED index. Blood tests to assess blood lipids, high-sensitivity C-reactive protein, fasting glucose, serum Fe and ferritin, as well as Hb, were performed.
Setting
Primary-school children of the Troodos mountainous area in Cyprus.
Subjects
Eighty-three Cypriot children (mean age 9·2 (sd 1·7) years).
Results
Compared with breakfast skippers, regular breakfast eaters were 40 % more likely to have a KIDMED score higher by one point on average (OR=1·41; 95 % CI 1·08, 1·84) after accounting for obesity levels and other confounders. Breakfast skippers, on the other hand, were by about 14 % more likely to have a body fat percentage value higher by one unit, as well as higher values for both BMI and waist circumference. The relationship was significantly strengthened when combining body fat percentage and waist circumference into a composite variable (OR=0·20; 95 % CI 0·06, 0·69). Fasting glucose was inversely correlated to breakfast intake in descriptive analyses, whereas serum Fe was positively correlated to breakfast intake after considering age, gender and diet quality. The latter relationship disappeared, however, after considering physical activity levels.
Conclusions
Cypriot children who take breakfast regularly exhibit a higher adherence to the Mediterranean diet and have higher serum Fe concentrations and lower BMI, waist circumference, body fat percentage and fasting glucose levels, compared with children who skip breakfast. Public health professionals, educators and parents should prioritize on actions that will motivate children to regularly eat breakfast.