Breakfast skipping and cardiometabolic risk factors in adolescents: Systematic review

Marielly Rodrigues Souza Morgana Egle Alves Neves Bartira Mendes Gorgulho Amanda Moura Souza Patrícia Simone Nogueira Márcia Gonçalves Ferreira Paulo Rogério Melo Rodrigues About the authors

ABSTRACT

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.

Adolescent; Breakfast; Food Deprivation; Metabolic Syndrome; Cardiometabolic Risk Factors; Review

INTRODUCTION

In recent decades, the meal consumption pattern has been associated with adolescents’ physical growth and various health outcomes11. St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2017;135(9):e96-121. https://doi.org/10.1161/CIR.0000000000000476
https://doi.org/10.1161/CIR.000000000000...
. Among behaviors related to that, we highlight the unfavorable effect of skipping meals, especially breakfast11. St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2017;135(9):e96-121. https://doi.org/10.1161/CIR.0000000000000476
https://doi.org/10.1161/CIR.000000000000...
.

Breakfast is the first and most important meal22. O’Neil CE, Byrd-Bredbenner C, Hayes D, Jana L, Klinger SE, Stephenson-Martin S. The role of breakfast in health: definition and criteria for a quality breakfast. J Acad Nutr Diet. 2014;114(12 Suppl):S8-26. https://doi.org/10.1016/j.jand.2014.08.022
https://doi.org/10.1016/j.jand.2014.08.0...
of the day, and contributes to maintaining adolescents’ overall health and diet quality33. Monteiro LS, Souza AM, Hassan BK, Estima CCP, Sichieri R, Pereira RA. Breakfast eating among Brazilian adolescents: analysis of the National Dietary Survey 2008-2009. Rev Nutr. 2017;30(4):463-76. https://doi.org/10.1590/1678-98652017000400006
https://doi.org/10.1590/1678-98652017000...
. This meal usually occurs before the start of daily activities, after a period of rest (sleep) of approximately 8 to 10 hours without any food consumption44. Timlin MT, Pereira MA. Breakfast frequency and quality in the etiology of adult obesity and chronic discases. Nutr Rev. 2007;65(6 Pt 1):268-81. https://doi.org/10.1301/nr.2007.jun.268-281
https://doi.org/10.1301/nr.2007.jun.268-...
.

Regular consumption of breakfast has been considered as a marker of healthy eating habits33. Monteiro LS, Souza AM, Hassan BK, Estima CCP, Sichieri R, Pereira RA. Breakfast eating among Brazilian adolescents: analysis of the National Dietary Survey 2008-2009. Rev Nutr. 2017;30(4):463-76. https://doi.org/10.1590/1678-98652017000400006
https://doi.org/10.1590/1678-98652017000...
,55. Hallström L, Labayen I, Ruiz JR, Petterson E, Vereecken CA, Breidenassel C, et al. Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 2013;16(7):1296-305. https://doi.org/10.1017/S1368980012000973
https://doi.org/10.1017/S136898001200097...
, and plays an important role in nutritional adequacy, bone and cardiovascular health66. Sandercock GRH, Voss C, Dye L. Association between habitual school-day breakfast consumption, body mass index, physical activity, and cardiorespiratory fitness in English schoolchildren. Eur J Clin Nutr. 2010;64(10):1086-92. https://doi.org/10.1038/ejcn.2010.145
https://doi.org/10.1038/ejcn.2010.145...
,77. Hunty A, Gibson S, Ashwell M. Does regular breakfast cereal consumption help children and adolescents stay slimmer? A systematic review and meta-analysis. Obes Facts. 2013;6(1):70-85. https://doi.org/10.1159/000348878
https://doi.org/10.1159/000348878...
, school performance, cognitive performance88. Sampasa-Kanyinga H, Hamilton HA. Eating breakfast regularly is related to higher school connectedness and academic performance in Canadian middle- and high-school students. Public Health. 2017;145:120-3. https://doi.org/10.1016/j.puhe.2016.12.027
https://doi.org/10.1016/j.puhe.2016.12.0...
, and improved attention and mood99. Ptomey LT, Steger FL, Schubert MM, Lee J, Willis EA, Sullivan DK, et al. Breakfast intake and composition is associated with superior academic achievement in elementary schoolchildren. J Am Coll Nutr. 2015;35(4):326-33. https://doi.org/10.1080/07315724.2015.1048381
https://doi.org/10.1080/07315724.2015.10...
.

In adolescence, unhealthy eating habits, such as skipping breakfast, can compromise growth, development, and long-term health1010. Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study. Am J Clin Nutr. 2010;92(6):1316-25. https://doi.org/10.3945/ajcn.2010.30101
https://doi.org/10.3945/ajcn.2010.30101...
. Skipping this meal is also associated with cardiometabolic risk factors in adolescents, such as increased central and total adiposity, insulin resistance, and dyslipidemia55. Hallström L, Labayen I, Ruiz JR, Petterson E, Vereecken CA, Breidenassel C, et al. Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 2013;16(7):1296-305. https://doi.org/10.1017/S1368980012000973
https://doi.org/10.1017/S136898001200097...
,1010. Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study. Am J Clin Nutr. 2010;92(6):1316-25. https://doi.org/10.3945/ajcn.2010.30101
https://doi.org/10.3945/ajcn.2010.30101...
.

The term cardiometabolic risk was proposed by the American Diabetes Association and the American Heart Association, and it is used to describe a set of clinical signs, such as: dyslipidemia, insulin resistance, obesity, and high blood pressure1313. Eckel RH, Kahn R, Robertson RM, Rizza RA. Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes. Association and the American Heart Association. Circulation. 2006;29(7):1697-9. https://doi.org/10.2337/dc06-9911
https://doi.org/10.2337/dc06-9911...
,1414. Moschonis G, Tsoutsoulopoulou K, Efstathopoulou E, Tsirigoti L, Lambrinou CP, Georgiou A. Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood. Expert Rev Cardiovasc Ther. 2015;13(6):673-92. https://doi.org/10.1586/14779072.2015.1039992
https://doi.org/10.1586/14779072.2015.10...
.

Some physiological and metabolic mechanisms may explain how breakfast skipping may be associated with cardiometabolic risk factors, including its contribution to an unfavorable energy balance causing weight gain and changes in serum lipid levels1515. Szajewska H, Ruszczyński M. Systematic review demonstrating that breakfast consumption influences body weight outcomes in children and adolescents in Europe. Crit Rev Food Sci Nutr. 2010;50(2):113-9. https://doi.org.10.1080/10408390903467514
https://doi.org.10.1080/1040839090346751...
. Another explanation is that breakfast skipping increases hunger and leads to excessive consumption throughout the day, resulting in increased body weight1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
. Prolonged fasting time alters glucose homeostasis, resulting in decreased insulin secretion and intact glucagon-like peptide-1 (iGLP-1) responses and increased post meal plasma glucose1717. Jakubowicz D, Wainstein J, Ahren B, Landau Z, Bar-Dayan Y, Froy O. Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: a randomized clinical trial. Diabetes Care. 2015;38(10):1820-6. https://doi.org/10.2337/dc15-0761
https://doi.org/10.2337/dc15-0761...
.

Therefore, this study sought to systematically review the association between breakfast skipping and cardiometabolic risk factors in adolescents.

METHODS

This is a systematic review of the literature, aiming to answer the questions: “Is breakfast skipping associated with serum lipid and glucose levels in adolescents?”; “Is breakfast skipping associated with blood pressure in adolescents?”; “Is breakfast skipping associated with markers of body adiposity in adolescents?” This review was developed and structured according to the acronym PECO components (Population: adolescents; Exposure: breakfast skipping; Control: without control; Outcome: Lipid and glycemic profile, high blood pressure, systemic arterial hypertension, and markers of body adiposity). The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), National Institute for Health Research, under the registration number: CRD42018105003.

The records were searched independently by two researchers in the following databases: MEDLINE via PubMed, Web of Science (WoS), Scopus, Virtual Health Library (VHL) and SciELO. The searches were carried out in May 2020. No country restrictions have been established. Descriptors were used for skipping breakfast, blood pressure, lipid and glycemic profile, and adolescents, combining the terms through the Boolean operators OR and AND, as shown in Supplementary Table 1.

Table 1
General characteristics of the studies included in the systematic review, main results, and scores in the risk of bias assessment.

Inclusion and Exclusion Criteria of the Studies

This review included cross-sectional and longitudinal observational studies published between 2008 and 2019 in English, Spanish, or Portuguese, conducted with adolescents (10–19 years old, as defined by the World Health Organization)1818. World Health Organization. Physical status: the use of and interpretation of anthropometry: report of a WHO expert committee. Geneva (CH): WHO; 1995 [cited 2020 Aug 22]. (WHO Technical Report Series; nº 854). Available from: https://apps.who.int/iris/handle/10665/37003
https://apps.who.int/iris/handle/10665/3...
, which have estimated the association of breakfast skipping with at least one of the cardiometabolic risk factors (markers of body adiposity, blood pressure, systemic arterial hypertension, serum lipid, and glucose levels).

The articles including adolescents with mental disorders, kidney disease, HIV, cancer, Down syndrome, and others were excluded from the review; those including other age groups, in addition to individuals aged between 10 and 19 years, and articles that did not present separate results for this age group; non-empirical records, opinions and editorials, case studies, summaries of scientific events that were not published as full papers, intervention studies and animal studies were also excluded.

Review Process

The articles were selected by two independent researchers and disagreements were discussed and analyzed at subsequent meetings. After the search, the Mendeley reference management tool was used to exclude duplicate records, and an initial screening was performed to reject records whose title and/or abstract information failed the inclusion criteria. If abstracts were unavailable or provided insufficient results, the article was selected for full reading. After analyzing the articles previously selected for full reading, reviewers included studies with results on the association of breakfast skipping with cardiometabolic risk factors (Figure).

Figure
PRISMA flow diagram of study selection process.

The studies were presented according to the following characteristics: (1) identification data with citation of the author(s), year of publication and place of study; (2) number of individuals evaluated, age and sex of the sample studied; (3) study outcome(s); (4) breakfast skipping assessment; (5) control of confounding factors and (6) main results (prevalence of breakfast skipping, association of breakfast skipping with markers of body adiposity, serum lipid levels, glucose metabolism (insulin resistance, fasting glucose and glucose intolerance) and blood pressure). Table 1 shows this information in chronological order.

Evaluation of Study Quality

The studies included in this systematic review underwent independent quality and risk of bias review by two reviewers. The instrument used was the Research Triangle Institute (RTI) Item Bank on Bias Risk and Accuracy of Observational Studies proposed and validated by Viswanathan & Berkman1919. Viswanathan M, Berkman ND. Development of the RTI item bank on risk of bias and precision of observational studies. J Clin Epidemiol 2012;65(2):163-78. https://doi.org/10.1016/j.jclinepi.2011.05.008
https://doi.org/10.1016/j.jclinepi.2011....
to assess risk of bias and accuracy of observational studies.

The RTI Item Bank includes several study designs, and the authors provided instructions on which items to use depending on the studies being evaluated. Considering the authors’ recommendations and the types of study included in this review, ten items were used to evaluate cross-sectional studies (sample definition and selection, consistency of information, outcomes, comparability of analysis, analysis results, interpretation of results, and funding) and thirteen items for cohort studies (three additional questions on follow-up time and impact of losses). Thus, a cross-sectional study with three or more key items classified as negative or unclear or a cohort study with four or more negative or unclear items were classified as at risk of bias (Table 1).

Evaluation of the Quality of Evidence

This evaluation aims to provide greater reliability to the critical analysis of the findings. In this study, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) System was used for each analyzed outcome2020. Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Ciência e Tecnologia. Diretrizes metodológicas: Sistema GRADE – Manual de graduação da qualidade da evidência e força de recomendação para tomada de decisão em saúde. Brasília, DF; 2014 [cited 2020 Aug 22]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_sistema_grade.pdf.
https://bvsms.saude.gov.br/bvs/publicaco...
. The following criteria were used to evaluate the studies: design (randomized clinical trial starts with high quality and observational study with low); factors responsible for reducing evidence level (methodological limitations, indirect evidence, imprecision, and publication bias) and factors that contribute to raising the evidence (large magnitude of effect, dose-response gradient, and residual confounding factors). After evaluation according to the GRADE rating, the studies were classified into four quality of evidence levels: High (A) – There is strong confidence that the true effect/association is close to that estimated; Moderate (B) – There is moderate confidence in the estimated effect/association; Low (C) – Confidence in the effect/association is limited; and, Very low (D) – Confidence in the effect/association estimate is very limited2020. Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Ciência e Tecnologia. Diretrizes metodológicas: Sistema GRADE – Manual de graduação da qualidade da evidência e força de recomendação para tomada de decisão em saúde. Brasília, DF; 2014 [cited 2020 Aug 22]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_sistema_grade.pdf.
https://bvsms.saude.gov.br/bvs/publicaco...
(Table 2).

Table 2
Relationship between breakfast skipping and cardiometabolic risk factors with classification of the quality of evidence according to the GRADE system.

RESULTS

In the databases searched, 4,660 records were identified and 3,910 remained after deletion of duplicates. Then, the titles and abstracts were read, and 134 articles were selected for full reading, of which 91 did not meet the inclusion criteria; therefore, a total of 43 articles were included in this systematic review (Figure).

Table 1 shows the summary of the main characteristics of the 43 studies involving 192,262 participants from 10 to 19 years old. Six studies are longitudinal (cohort)1111. Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013
https://doi.org/10.1016/j.appet.2018.10....
,1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
and thirty-seven are cross-sectional studies1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,2424. Hassan BK, Cunha DB, Veiga GV, Pereira RA, Hoffman DJ, Sichieri R. Breakfast consumption, family breakfast, and adiposity trajectory in adolescence: The Adolescent Nutritional Assessment Longitudinal Cohort Study. J Acad Nutr Diet. 2019;119(6):944-56. https://doi.org/10.1016/j.jand.2018.11.014
https://doi.org/10.1016/j.jand.2018.11.0...
. In twenty-two articles, the population was predominantly female1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
,2525. Harding S, Teyhan A, Maynard MJ, Cruickshank KJ. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 2008;37(1):162-72. https://doi.org/10.1093/ije/dym252
https://doi.org/10.1093/ije/dym252...
,2626. Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046
https://doi.org/10.1016/j.ijcard.2008.04...
,2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
,3232. Maddah M, Rashidi A, Mohammadpour B, Vafa R, Karandish M. In-school Snacking, Breakfast Consumption, and Sleeping Patterns of Normal and Overweight Iranian High School Girls: a study in urban and rural areas in Guilan, Iran. J Nutr Educ Behav. 2009;41(1):27-31. https://doi.org/10.1016/j.jneb.2008.03.115
https://doi.org/10.1016/j.jneb.2008.03.1...
,3434. Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002. J Am Coll Nutr. 2010;29(4):407-18. https://doi.org/10.1080/07315724.2010.10719858
https://doi.org/10.1080/07315724.2010.10...
and four of them studied only adolescent girls2525. Harding S, Teyhan A, Maynard MJ, Cruickshank KJ. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 2008;37(1):162-72. https://doi.org/10.1093/ije/dym252
https://doi.org/10.1093/ije/dym252...
,3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
,3535. Kapantais E, Chala E, Kaklamanou D, Lanaras L, Kaklamanou M, Tzotzas T. Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents. Public Health Nutr. 2010;14(1):101-8. https://doi.org/10.1017/S1368980010000765
https://doi.org/10.1017/S136898001000076...
,3636. Maddah M, Nikooyeh B. Obesity among Iranian adolescent girls: location of residence and parental obesity. J Health Popul Nutr. 2010;28(1):61-6. https://doi.org/10.3329/jhpn.v28i1.4524
https://doi.org/10.3329/jhpn.v28i1.4524...
. Three articles did not describe the frequency of each sex2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
,2424. Hassan BK, Cunha DB, Veiga GV, Pereira RA, Hoffman DJ, Sichieri R. Breakfast consumption, family breakfast, and adiposity trajectory in adolescence: The Adolescent Nutritional Assessment Longitudinal Cohort Study. J Acad Nutr Diet. 2019;119(6):944-56. https://doi.org/10.1016/j.jand.2018.11.014
https://doi.org/10.1016/j.jand.2018.11.0...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
.

The selected studies were conducted in 22 countries. Seventeen studies were conducted in Asian countries1111. Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013
https://doi.org/10.1016/j.appet.2018.10....
,1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,2626. Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046
https://doi.org/10.1016/j.ijcard.2008.04...
,3232. Maddah M, Rashidi A, Mohammadpour B, Vafa R, Karandish M. In-school Snacking, Breakfast Consumption, and Sleeping Patterns of Normal and Overweight Iranian High School Girls: a study in urban and rural areas in Guilan, Iran. J Nutr Educ Behav. 2009;41(1):27-31. https://doi.org/10.1016/j.jneb.2008.03.115
https://doi.org/10.1016/j.jneb.2008.03.1...
,3333. Sun Y, Sekine M, Sadanobu K. Lifestyle and overweight among Japanese adolescents: The Toyama Birth Cohort Study. J Epidemiol. 2009;19(6):303-10. https://doi.org/10.2188/jea.je20080095
https://doi.org/10.2188/jea.je20080095...
,3636. Maddah M, Nikooyeh B. Obesity among Iranian adolescent girls: location of residence and parental obesity. J Health Popul Nutr. 2010;28(1):61-6. https://doi.org/10.3329/jhpn.v28i1.4524
https://doi.org/10.3329/jhpn.v28i1.4524...
,3838. Kim JH, So WY. Association between frequency of breakfast eating and obesity in Korean adolescents. Iran J Public Health. 2012;41(6):50-7.,3939. Kuriyan R, Thomas T, Sumithra S, Lokesh DP, Sheth NR, Joy R, et al. Potential factors related to waist circumference in urban South Indian children. Indian Pediatr. 2012;49(2):124-8. https://doi.org/10.1007/s13312-012-0027-3
https://doi.org/10.1007/s13312-012-0027-...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4444. Faizi N, Khan IM, Amir A, Azmi SA, Ahmad A, Khalique N. Breakfast skipping and proposed effects of breakfast on obesity: a school-based study in adolescents in Aligarh, India. Ann Trop Med Public Health. 2014;7(1):43-7.,4646. Garg M, Rajesh V, Kumar P. Effect of breakfast skipping on nutritional status and school performance of 10-16 years old children of Udupi district. Health Popul Perspect Issues. 2014;37(3-4):98-117., twelve in European countries2525. Harding S, Teyhan A, Maynard MJ, Cruickshank KJ. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 2008;37(1):162-72. https://doi.org/10.1093/ije/dym252
https://doi.org/10.1093/ije/dym252...
,2727. Mota J, Fidalgo F, Silva R, Ribeiro JC, Santos R, Carvalho J, et al. Relationships between physical activity, obesity and meal frequency in adolescents. Ann Hum Biol. 2008;35(1):1-10. https://doi.org/10.1080/03014460701779617
https://doi.org/10.1080/0301446070177961...
,2828. Henríquez Sánchez P, Doroeste Alonso J, Laínez Sevillano P, Estévez Gonzáles MD, Iglesias Valle M, López Martin G, et al. Prevalencia de obesidad y sobrepeso en adolescentes canarios. Relación con el desayuno y la actividad física. Med Clin (Barc). 2008;130(16):606-10. https://doi.org/10.1157/13120339
https://doi.org/10.1157/13120339...
,3030. Croezen S, Visscher TLS, Bogt NCW, 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(3):405-12. https://doi.org/10.1038/sj.ejcn.1602950
https://doi.org/10.1038/sj.ejcn.1602950...
,3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
,3535. Kapantais E, Chala E, Kaklamanou D, Lanaras L, Kaklamanou M, Tzotzas T. Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents. Public Health Nutr. 2010;14(1):101-8. https://doi.org/10.1017/S1368980010000765
https://doi.org/10.1017/S136898001000076...
,4040. Vaezghasemi M, Lindkvist M, Ivarsson A, Eurenius E. Overweight and lifestyle among 13-15 year olds: a cross-sectional study in northern Sweden. Scand J Public Health. 2012;40(3):221-8. https://doi.org/10.1177/1403494812443603
https://doi.org/10.1177/1403494812443603...
,4242. Boričić K, Simić S, Vasiljević N, Marinković J. Risk factors associated with overweight among adolescents in Serbia. Zdr Varst. 2014;53(4):283-93. https://doi.org/10.2478/sjph-2014-0031
https://doi.org/10.2478/sjph-2014-0031...
,4343. Díez-Navarro A, Martín-Camargo A, Solé-Llussà A, Marrodán MD, Gónzales-Montero de Espinoza M. [Influence of breakfast on overweight and obesity in child and adolescent population from Madrid]. Nutr Clin Diet Hosp. 2014;34(2):9-17. Spanish.,4545. Garcia-Continente X, Allue N, Pérez-Giménez A, Ariza A, Sánchez-Martínez F, López MJ et al. [Eating habits, sedentary behaviors and overweight and obesity among adolescents in Barcelona (Spain)]. An Pediatr (Barc). 2015;83(1):3-10. Spanish. https://doi.org/10.1016/j.anpede.2015.05.017
https://doi.org/10.1016/j.anpede.2015.05...
,5353. Zalewska M, Maciorkowska E. Selected nutritional habits of teenagers associated with overweight and obesity. PeerJ. 2017;5:e3681. https://doi.org/10.7717/peerj.3681
https://doi.org/10.7717/peerj.3681...
,5959. Forkert ECO, Moraes ACF, Carvalho HB, Manios Y, Whidhalm K, González-Gross M, et al. Skipping breakfast is associated with adiposity markers especially when sleep time is adequate in adolescents. Sci Rep. 2019;9:6380. https://doi.org/10.1038/s41598-019-42859-7
https://doi.org/10.1038/s41598-019-42859...
, twelve in countries of the American continent1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
and two in Oceanian countries3737. Thompson-McCormick JJ, Thomas JJ, Bainivualiku A, Khan AN, Becker AE. Breakfast skipping as a risk correlate of overweight and obesity in school-going ethnic Fijian adolescent girls. Asia Pac J Clin Nutr. 2010;19(3):372-82.,5252. Frayon S, Cherrier S, Cavaloc Y, Touitou A, Zongo P, Wattelez G, et al. Nutrition behaviors and sociodemographic factors associated with overweight in the multi-ethnic adolescents of New Caledonia. Ethn Health. 2019;24(2):194-210. https://doi.org/10.1080/13557858.2017.1315530
https://doi.org/10.1080/13557858.2017.13...
. The countries with the highest number of studies were Brazil2222. Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081
https://doi.org/10.1097/MPG.000000000000...
, United States1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
,2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,3434. Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002. J Am Coll Nutr. 2010;29(4):407-18. https://doi.org/10.1080/07315724.2010.10719858
https://doi.org/10.1080/07315724.2010.10...
, and Iran2626. Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046
https://doi.org/10.1016/j.ijcard.2008.04...
,3232. Maddah M, Rashidi A, Mohammadpour B, Vafa R, Karandish M. In-school Snacking, Breakfast Consumption, and Sleeping Patterns of Normal and Overweight Iranian High School Girls: a study in urban and rural areas in Guilan, Iran. J Nutr Educ Behav. 2009;41(1):27-31. https://doi.org/10.1016/j.jneb.2008.03.115
https://doi.org/10.1016/j.jneb.2008.03.1...
,3636. Maddah M, Nikooyeh B. Obesity among Iranian adolescent girls: location of residence and parental obesity. J Health Popul Nutr. 2010;28(1):61-6. https://doi.org/10.3329/jhpn.v28i1.4524
https://doi.org/10.3329/jhpn.v28i1.4524...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
(Table 1).

Three studies evaluated markers of body adiposity, blood pressure, and glycemic and lipid profile4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
, one evaluated markers of body adiposity, lipid profile, and blood pressure4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
; two assessed markers of body adiposity and glycemic profile2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
; one article evaluated only lipid profile1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
; one only blood pressure3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
and thirty-five articles evaluated only markers of body adiposity (body mass index (BMI), waist circumference (WC), body fat %, and waist-height ratio (WHR))1111. Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013
https://doi.org/10.1016/j.appet.2018.10....
,1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
.

The definition of breakfast skipping presented many variations; twenty-three articles assessed skipping by frequency of breakfast consumption; twelve studies considered the number of days per week (0 days/week6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
, 0–2 days/week3535. Kapantais E, Chala E, Kaklamanou D, Lanaras L, Kaklamanou M, Tzotzas T. Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents. Public Health Nutr. 2010;14(1):101-8. https://doi.org/10.1017/S1368980010000765
https://doi.org/10.1017/S136898001000076...
,5757. Tee ES, Nurliyana AR, Norimah AK, Mohamed HJBJ, Tan SY, Appukutty M, et al. Breakfast consumption among Malaysian primary and secondary school children and relationship with body weight status: findings from the MyBreakfast Study. Asia Pac J Clin Nutr. 2018;27(2):421-32. https://doi.org/10.6133/apjcn.062017.12
https://doi.org/10.6133/apjcn.062017.12...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
, 0–3 times/week1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,4040. Vaezghasemi M, Lindkvist M, Ivarsson A, Eurenius E. Overweight and lifestyle among 13-15 year olds: a cross-sectional study in northern Sweden. Scand J Public Health. 2012;40(3):221-8. https://doi.org/10.1177/1403494812443603
https://doi.org/10.1177/1403494812443603...
, 0–4 days/week1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,5555. Khan A, Khan SR, Burton NW. Missing breakfast is associated with overweight and obesity in Bangladeshi adolescents. Acta Paediatr. 2018;108(1):178-9. https://doi.org/10.1111/apa.14553
https://doi.org/10.1111/apa.14553...
, 0–5 days/week2222. Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081
https://doi.org/10.1097/MPG.000000000000...
, < 2 times/week4444. Faizi N, Khan IM, Amir A, Azmi SA, Ahmad A, Khalique N. Breakfast skipping and proposed effects of breakfast on obesity: a school-based study in adolescents in Aligarh, India. Ann Trop Med Public Health. 2014;7(1):43-7., ≤ 6 times/week4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
); one study considered breakfast skipping when frequency of consumption was reported as rarely3333. Sun Y, Sekine M, Sadanobu K. Lifestyle and overweight among Japanese adolescents: The Toyama Birth Cohort Study. J Epidemiol. 2009;19(6):303-10. https://doi.org/10.2188/jea.je20080095
https://doi.org/10.2188/jea.je20080095...
; two considered skipping as never or almost never2323. Hassan BK, Cunha DB, Veiga GV, Pereira RA, Sichieri R. Changes in breakfast frequency and composition during adolescence: The Adolescent Nutritional Assessment Longitudinal Study, a cohort from Brazil. PLoS One. 2018;13(7):e0200587. https://doi.org/10.1371/journal.pone.0200587
https://doi.org/10.1371/journal.pone.020...
,2424. Hassan BK, Cunha DB, Veiga GV, Pereira RA, Hoffman DJ, Sichieri R. Breakfast consumption, family breakfast, and adiposity trajectory in adolescence: The Adolescent Nutritional Assessment Longitudinal Cohort Study. J Acad Nutr Diet. 2019;119(6):944-56. https://doi.org/10.1016/j.jand.2018.11.014
https://doi.org/10.1016/j.jand.2018.11.0...
; and eight studies considered skipping as never before2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
,2626. Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046
https://doi.org/10.1016/j.ijcard.2008.04...
,3232. Maddah M, Rashidi A, Mohammadpour B, Vafa R, Karandish M. In-school Snacking, Breakfast Consumption, and Sleeping Patterns of Normal and Overweight Iranian High School Girls: a study in urban and rural areas in Guilan, Iran. J Nutr Educ Behav. 2009;41(1):27-31. https://doi.org/10.1016/j.jneb.2008.03.115
https://doi.org/10.1016/j.jneb.2008.03.1...
,3838. Kim JH, So WY. Association between frequency of breakfast eating and obesity in Korean adolescents. Iran J Public Health. 2012;41(6):50-7.,4242. Boričić K, Simić S, Vasiljević N, Marinković J. Risk factors associated with overweight among adolescents in Serbia. Zdr Varst. 2014;53(4):283-93. https://doi.org/10.2478/sjph-2014-0031
https://doi.org/10.2478/sjph-2014-0031...
,4545. Garcia-Continente X, Allue N, Pérez-Giménez A, Ariza A, Sánchez-Martínez F, López MJ et al. [Eating habits, sedentary behaviors and overweight and obesity among adolescents in Barcelona (Spain)]. An Pediatr (Barc). 2015;83(1):3-10. Spanish. https://doi.org/10.1016/j.anpede.2015.05.017
https://doi.org/10.1016/j.anpede.2015.05...
,4848. Talat MA, El Shahat E. Prevalence of overweight and obesity among preparatory school adolescents in Urban Sharkia Governorate, Egypt. Egypt Pediatr Assoc Gaz. 2016;64(1):20-5. https://doi.org/10.1016/j.epag.2015.11.004
https://doi.org/10.1016/j.epag.2015.11.0...
,5151. Badr HE, Lakha SF, Pennefather P. Differences in physical activity, eating habits and risk of obesity among Kuwaiti adolescent boys and girls: a population-based study. Int J Adolesc Med Health. 2017;31(1):20160138. https://doi.org/10.1515/ijamh-2016-0138
https://doi.org/10.1515/ijamh-2016-0138...
. Four articles evaluated skipping by the frequency of breakfast skipping (sometimes or always vs. rarely2525. Harding S, Teyhan A, Maynard MJ, Cruickshank KJ. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 2008;37(1):162-72. https://doi.org/10.1093/ije/dym252
https://doi.org/10.1093/ije/dym252...
, 0 to 7 days3030. Croezen S, Visscher TLS, Bogt NCW, 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(3):405-12. https://doi.org/10.1038/sj.ejcn.1602950
https://doi.org/10.1038/sj.ejcn.1602950...
,3737. Thompson-McCormick JJ, Thomas JJ, Bainivualiku A, Khan AN, Becker AE. Breakfast skipping as a risk correlate of overweight and obesity in school-going ethnic Fijian adolescent girls. Asia Pac J Clin Nutr. 2010;19(3):372-82. and 5, 6, and 7 times/week5050. Morales A, Montilva M. Hábitos alimentarios no saludables, actividad física y obesidad en adolescentes entre 15 y 19 años. An Venez Nutr. 2016;29(1):4-10.). Seven articles used the “skip yes/no” option1111. Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013
https://doi.org/10.1016/j.appet.2018.10....
,2727. Mota J, Fidalgo F, Silva R, Ribeiro JC, Santos R, Carvalho J, et al. Relationships between physical activity, obesity and meal frequency in adolescents. Ann Hum Biol. 2008;35(1):1-10. https://doi.org/10.1080/03014460701779617
https://doi.org/10.1080/0301446070177961...
,3939. Kuriyan R, Thomas T, Sumithra S, Lokesh DP, Sheth NR, Joy R, et al. Potential factors related to waist circumference in urban South Indian children. Indian Pediatr. 2012;49(2):124-8. https://doi.org/10.1007/s13312-012-0027-3
https://doi.org/10.1007/s13312-012-0027-...
,4646. Garg M, Rajesh V, Kumar P. Effect of breakfast skipping on nutritional status and school performance of 10-16 years old children of Udupi district. Health Popul Perspect Issues. 2014;37(3-4):98-117.,5252. Frayon S, Cherrier S, Cavaloc Y, Touitou A, Zongo P, Wattelez G, et al. Nutrition behaviors and sociodemographic factors associated with overweight in the multi-ethnic adolescents of New Caledonia. Ethn Health. 2019;24(2):194-210. https://doi.org/10.1080/13557858.2017.1315530
https://doi.org/10.1080/13557858.2017.13...
,5353. Zalewska M, Maciorkowska E. Selected nutritional habits of teenagers associated with overweight and obesity. PeerJ. 2017;5:e3681. https://doi.org/10.7717/peerj.3681
https://doi.org/10.7717/peerj.3681...
,5959. Forkert ECO, Moraes ACF, Carvalho HB, Manios Y, Whidhalm K, González-Gross M, et al. Skipping breakfast is associated with adiposity markers especially when sleep time is adequate in adolescents. Sci Rep. 2019;9:6380. https://doi.org/10.1038/s41598-019-42859-7
https://doi.org/10.1038/s41598-019-42859...
and nine defined skipping according to breakfast consumption: yes/no2828. Henríquez Sánchez P, Doroeste Alonso J, Laínez Sevillano P, Estévez Gonzáles MD, Iglesias Valle M, López Martin G, et al. Prevalencia de obesidad y sobrepeso en adolescentes canarios. Relación con el desayuno y la actividad física. Med Clin (Barc). 2008;130(16):606-10. https://doi.org/10.1157/13120339
https://doi.org/10.1157/13120339...
,3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
, regular/non-regular3636. Maddah M, Nikooyeh B. Obesity among Iranian adolescent girls: location of residence and parental obesity. J Health Popul Nutr. 2010;28(1):61-6. https://doi.org/10.3329/jhpn.v28i1.4524
https://doi.org/10.3329/jhpn.v28i1.4524...
,5454. De Cnop ML, Monteiro LS, Rodrigues PRM, Estima CCP, Veiga GV, Pereira RA. Meal habits and anthropometric indicators in adolescents from public and private schools of the metropolitan region of Rio de Janeiro. Rev Nutr. 2018;31(1):35-47. https://doi.org/10.1590/1678-98652018000100004
https://doi.org/10.1590/1678-98652018000...
, presence/absence4343. Díez-Navarro A, Martín-Camargo A, Solé-Llussà A, Marrodán MD, Gónzales-Montero de Espinoza M. [Influence of breakfast on overweight and obesity in child and adolescent population from Madrid]. Nutr Clin Diet Hosp. 2014;34(2):9-17. Spanish.,4747. Gökler ME, Buğrul N, Metintaş S, Kalyoncu C. Adolescent obesity and associated cardiovascular risk factors of rural and urban life (Eskisehir, Turkey). Cent Eur J Public Health. 2015;23(1):20-5. https://doi.org/10.21101/cejph.a3958
https://doi.org/10.21101/cejph.a3958...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
and whether study participants did not report food or drink consumption in the R24h2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,3434. Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002. J Am Coll Nutr. 2010;29(4):407-18. https://doi.org/10.1080/07315724.2010.10719858
https://doi.org/10.1080/07315724.2010.10...
(Table 1).

The prevalence of breakfast skipping ranged from 0.7%3333. Sun Y, Sekine M, Sadanobu K. Lifestyle and overweight among Japanese adolescents: The Toyama Birth Cohort Study. J Epidemiol. 2009;19(6):303-10. https://doi.org/10.2188/jea.je20080095
https://doi.org/10.2188/jea.je20080095...
to 94%2727. Mota J, Fidalgo F, Silva R, Ribeiro JC, Santos R, Carvalho J, et al. Relationships between physical activity, obesity and meal frequency in adolescents. Ann Hum Biol. 2008;35(1):1-10. https://doi.org/10.1080/03014460701779617
https://doi.org/10.1080/0301446070177961...
, according to the different definitions of breakfast skipping used in the articles. Twelve studies did not report the prevalence of skipping breakfast1111. Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013
https://doi.org/10.1016/j.appet.2018.10....
,2222. Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081
https://doi.org/10.1097/MPG.000000000000...
,2525. Harding S, Teyhan A, Maynard MJ, Cruickshank KJ. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 2008;37(1):162-72. https://doi.org/10.1093/ije/dym252
https://doi.org/10.1093/ije/dym252...
,2626. Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046
https://doi.org/10.1016/j.ijcard.2008.04...
,3030. Croezen S, Visscher TLS, Bogt NCW, 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(3):405-12. https://doi.org/10.1038/sj.ejcn.1602950
https://doi.org/10.1038/sj.ejcn.1602950...
,3232. Maddah M, Rashidi A, Mohammadpour B, Vafa R, Karandish M. In-school Snacking, Breakfast Consumption, and Sleeping Patterns of Normal and Overweight Iranian High School Girls: a study in urban and rural areas in Guilan, Iran. J Nutr Educ Behav. 2009;41(1):27-31. https://doi.org/10.1016/j.jneb.2008.03.115
https://doi.org/10.1016/j.jneb.2008.03.1...
,3636. Maddah M, Nikooyeh B. Obesity among Iranian adolescent girls: location of residence and parental obesity. J Health Popul Nutr. 2010;28(1):61-6. https://doi.org/10.3329/jhpn.v28i1.4524
https://doi.org/10.3329/jhpn.v28i1.4524...
,3939. Kuriyan R, Thomas T, Sumithra S, Lokesh DP, Sheth NR, Joy R, et al. Potential factors related to waist circumference in urban South Indian children. Indian Pediatr. 2012;49(2):124-8. https://doi.org/10.1007/s13312-012-0027-3
https://doi.org/10.1007/s13312-012-0027-...
,4040. Vaezghasemi M, Lindkvist M, Ivarsson A, Eurenius E. Overweight and lifestyle among 13-15 year olds: a cross-sectional study in northern Sweden. Scand J Public Health. 2012;40(3):221-8. https://doi.org/10.1177/1403494812443603
https://doi.org/10.1177/1403494812443603...
,4242. Boričić K, Simić S, Vasiljević N, Marinković J. Risk factors associated with overweight among adolescents in Serbia. Zdr Varst. 2014;53(4):283-93. https://doi.org/10.2478/sjph-2014-0031
https://doi.org/10.2478/sjph-2014-0031...
,5050. Morales A, Montilva M. Hábitos alimentarios no saludables, actividad física y obesidad en adolescentes entre 15 y 19 años. An Venez Nutr. 2016;29(1):4-10.,5454. De Cnop ML, Monteiro LS, Rodrigues PRM, Estima CCP, Veiga GV, Pereira RA. Meal habits and anthropometric indicators in adolescents from public and private schools of the metropolitan region of Rio de Janeiro. Rev Nutr. 2018;31(1):35-47. https://doi.org/10.1590/1678-98652018000100004
https://doi.org/10.1590/1678-98652018000...
. Twenty-six1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,2222. Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081
https://doi.org/10.1097/MPG.000000000000...
(60.5%) studies were classified with low risk of bias (Table 1).

The six longitudinal studies (cohort) evaluated only the markers of body adiposity1111. Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013
https://doi.org/10.1016/j.appet.2018.10....
,1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
. Four studies found significant association between breakfast skipping and markers of body adiposity1111. Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013
https://doi.org/10.1016/j.appet.2018.10....
,1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
,2222. Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081
https://doi.org/10.1097/MPG.000000000000...
, that is, adolescents who skipped breakfast showed an increase in BMI, and body and abdominal fat over time. The analyzes were adjusted for potential confounding factors related to sociodemographic, economic, lifestyle and sexual maturation characteristics (Table 1).

In relation to cross-sectional studies, breakfast skipping was associated with higher prevalence of body adiposity. Twenty-nine articles (78.4%) found a significant association between breakfast skipping and excess adiposity2525. Harding S, Teyhan A, Maynard MJ, Cruickshank KJ. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 2008;37(1):162-72. https://doi.org/10.1093/ije/dym252
https://doi.org/10.1093/ije/dym252...
,2626. Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046
https://doi.org/10.1016/j.ijcard.2008.04...
,2828. Henríquez Sánchez P, Doroeste Alonso J, Laínez Sevillano P, Estévez Gonzáles MD, Iglesias Valle M, López Martin G, et al. Prevalencia de obesidad y sobrepeso en adolescentes canarios. Relación con el desayuno y la actividad física. Med Clin (Barc). 2008;130(16):606-10. https://doi.org/10.1157/13120339
https://doi.org/10.1157/13120339...
. However, Alexander et al.2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
found association only for Intra-Abdominal Adipose Tissue, Gokler et al.4747. Gökler ME, Buğrul N, Metintaş S, Kalyoncu C. Adolescent obesity and associated cardiovascular risk factors of rural and urban life (Eskisehir, Turkey). Cent Eur J Public Health. 2015;23(1):20-5. https://doi.org/10.21101/cejph.a3958
https://doi.org/10.21101/cejph.a3958...
found association only in adolescents living in urban areas, Garcia-Continente et al.4545. Garcia-Continente X, Allue N, Pérez-Giménez A, Ariza A, Sánchez-Martínez F, López MJ et al. [Eating habits, sedentary behaviors and overweight and obesity among adolescents in Barcelona (Spain)]. An Pediatr (Barc). 2015;83(1):3-10. Spanish. https://doi.org/10.1016/j.anpede.2015.05.017
https://doi.org/10.1016/j.anpede.2015.05...
, Tee et al.5757. Tee ES, Nurliyana AR, Norimah AK, Mohamed HJBJ, Tan SY, Appukutty M, et al. Breakfast consumption among Malaysian primary and secondary school children and relationship with body weight status: findings from the MyBreakfast Study. Asia Pac J Clin Nutr. 2018;27(2):421-32. https://doi.org/10.6133/apjcn.062017.12
https://doi.org/10.6133/apjcn.062017.12...
found association only for female adolescents and Frayon et al.5252. Frayon S, Cherrier S, Cavaloc Y, Touitou A, Zongo P, Wattelez G, et al. Nutrition behaviors and sociodemographic factors associated with overweight in the multi-ethnic adolescents of New Caledonia. Ethn Health. 2019;24(2):194-210. https://doi.org/10.1080/13557858.2017.1315530
https://doi.org/10.1080/13557858.2017.13...
found association only for males.

Of these thirty articles that found breakfast skipping associated with excess adiposity, twenty-one performed adjusted analysis for potential confounders, such as: age, sex, race/ethnicity, socioeconomic status, total energy consumption, pubertal stage and physical activity2525. Harding S, Teyhan A, Maynard MJ, Cruickshank KJ. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 2008;37(1):162-72. https://doi.org/10.1093/ije/dym252
https://doi.org/10.1093/ije/dym252...
,2626. Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046
https://doi.org/10.1016/j.ijcard.2008.04...
,2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,3030. Croezen S, Visscher TLS, Bogt NCW, 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(3):405-12. https://doi.org/10.1038/sj.ejcn.1602950
https://doi.org/10.1038/sj.ejcn.1602950...
,3333. Sun Y, Sekine M, Sadanobu K. Lifestyle and overweight among Japanese adolescents: The Toyama Birth Cohort Study. J Epidemiol. 2009;19(6):303-10. https://doi.org/10.2188/jea.je20080095
https://doi.org/10.2188/jea.je20080095...
,3434. Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002. J Am Coll Nutr. 2010;29(4):407-18. https://doi.org/10.1080/07315724.2010.10719858
https://doi.org/10.1080/07315724.2010.10...
,3636. Maddah M, Nikooyeh B. Obesity among Iranian adolescent girls: location of residence and parental obesity. J Health Popul Nutr. 2010;28(1):61-6. https://doi.org/10.3329/jhpn.v28i1.4524
https://doi.org/10.3329/jhpn.v28i1.4524...
,3737. Thompson-McCormick JJ, Thomas JJ, Bainivualiku A, Khan AN, Becker AE. Breakfast skipping as a risk correlate of overweight and obesity in school-going ethnic Fijian adolescent girls. Asia Pac J Clin Nutr. 2010;19(3):372-82.,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4242. Boričić K, Simić S, Vasiljević N, Marinković J. Risk factors associated with overweight among adolescents in Serbia. Zdr Varst. 2014;53(4):283-93. https://doi.org/10.2478/sjph-2014-0031
https://doi.org/10.2478/sjph-2014-0031...
,4545. Garcia-Continente X, Allue N, Pérez-Giménez A, Ariza A, Sánchez-Martínez F, López MJ et al. [Eating habits, sedentary behaviors and overweight and obesity among adolescents in Barcelona (Spain)]. An Pediatr (Barc). 2015;83(1):3-10. Spanish. https://doi.org/10.1016/j.anpede.2015.05.017
https://doi.org/10.1016/j.anpede.2015.05...
,4747. Gökler ME, Buğrul N, Metintaş S, Kalyoncu C. Adolescent obesity and associated cardiovascular risk factors of rural and urban life (Eskisehir, Turkey). Cent Eur J Public Health. 2015;23(1):20-5. https://doi.org/10.21101/cejph.a3958
https://doi.org/10.21101/cejph.a3958...
,4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
,5151. Badr HE, Lakha SF, Pennefather P. Differences in physical activity, eating habits and risk of obesity among Kuwaiti adolescent boys and girls: a population-based study. Int J Adolesc Med Health. 2017;31(1):20160138. https://doi.org/10.1515/ijamh-2016-0138
https://doi.org/10.1515/ijamh-2016-0138...
,5252. Frayon S, Cherrier S, Cavaloc Y, Touitou A, Zongo P, Wattelez G, et al. Nutrition behaviors and sociodemographic factors associated with overweight in the multi-ethnic adolescents of New Caledonia. Ethn Health. 2019;24(2):194-210. https://doi.org/10.1080/13557858.2017.1315530
https://doi.org/10.1080/13557858.2017.13...
,5454. De Cnop ML, Monteiro LS, Rodrigues PRM, Estima CCP, Veiga GV, Pereira RA. Meal habits and anthropometric indicators in adolescents from public and private schools of the metropolitan region of Rio de Janeiro. Rev Nutr. 2018;31(1):35-47. https://doi.org/10.1590/1678-98652018000100004
https://doi.org/10.1590/1678-98652018000...
,5555. Khan A, Khan SR, Burton NW. Missing breakfast is associated with overweight and obesity in Bangladeshi adolescents. Acta Paediatr. 2018;108(1):178-9. https://doi.org/10.1111/apa.14553
https://doi.org/10.1111/apa.14553...
,5757. Tee ES, Nurliyana AR, Norimah AK, Mohamed HJBJ, Tan SY, Appukutty M, et al. Breakfast consumption among Malaysian primary and secondary school children and relationship with body weight status: findings from the MyBreakfast Study. Asia Pac J Clin Nutr. 2018;27(2):421-32. https://doi.org/10.6133/apjcn.062017.12
https://doi.org/10.6133/apjcn.062017.12...
. On the other hand, five studies found no association between breakfast skipping and body adiposity3838. Kim JH, So WY. Association between frequency of breakfast eating and obesity in Korean adolescents. Iran J Public Health. 2012;41(6):50-7.,4646. Garg M, Rajesh V, Kumar P. Effect of breakfast skipping on nutritional status and school performance of 10-16 years old children of Udupi district. Health Popul Perspect Issues. 2014;37(3-4):98-117.,5050. Morales A, Montilva M. Hábitos alimentarios no saludables, actividad física y obesidad en adolescentes entre 15 y 19 años. An Venez Nutr. 2016;29(1):4-10.,5353. Zalewska M, Maciorkowska E. Selected nutritional habits of teenagers associated with overweight and obesity. PeerJ. 2017;5:e3681. https://doi.org/10.7717/peerj.3681
https://doi.org/10.7717/peerj.3681...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
, of which two made no adjustments for potential confounding factors4646. Garg M, Rajesh V, Kumar P. Effect of breakfast skipping on nutritional status and school performance of 10-16 years old children of Udupi district. Health Popul Perspect Issues. 2014;37(3-4):98-117.,5353. Zalewska M, Maciorkowska E. Selected nutritional habits of teenagers associated with overweight and obesity. PeerJ. 2017;5:e3681. https://doi.org/10.7717/peerj.3681
https://doi.org/10.7717/peerj.3681...
. In summary a significant positive association between the breakfast skipping and excess adiposity is evidenced with a GRADE C classification (Table 2).

Among the articles included in this review, eight evaluated the association of breakfast skipping with cardiometabolic risk factors (glucose metabolism, blood pressure, and serum lipid levels), all of which are cross-sectional1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
.

Of these studies, five investigated the association between breakfast skipping and lipid profile1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
, and three found a statistically significant association; therefore, adolescents who omitted breakfast had higher levels of total cholesterol (TC), low density lipoprotein (LDL) and triglyceride (TG)1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
. Five of the eight articles investigated the association between breakfast skipping and glycemic profile (fasting glucose, Homeostatic Insulin Resistance Assessment Model (HOMA-IR), acute insulin response, and insulin sensitivity), but none of them found a significant association2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
.

Regarding blood pressure, five articles evaluated the association between breakfast skipping and high blood pressure3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
; and three found a significant association, i.e., adolescents who skipped breakfast had higher levels of systolic blood pressure (SBP)3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
.

In summary a significant positive association for lipid profile and blood pressure was found, whereas for glycemic profile there was no association, all risk factors were rated GRADE C.

All studies investigating the association of breakfast skipping with cardiometabolic risk factors considered the potential confounders: age1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
, sex2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
, ethnicity4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
, socioeconomic status4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
, BMI1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
, pubertal stage2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
, energy intake1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
, abdominal adiposity4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
, total adiposity2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
, physical activity5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
, and smoking and alcoholic beverage6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
.

DISCUSSION

This systematic review included 43 studies that evaluated the association between breakfast skipping and cardiometabolic risk factors in adolescents. The prevalence of breakfast skipping varied widely between studies. Adolescents who skipped breakfast were more likely to have cardiometabolic risk factors, e.g., excess adiposity, higher levels of total cholesterol, low density lipoprotein, triglycerides, and blood pressure. However, the association between breakfast skipping and glycemic profile is unclear, since only five studies were included, and none found a significant association. The impact of the content of macronutrients present at breakfast2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
and adjustment for body adiposity2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
, and quality of diet6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
can explain those associations.

Of the studies, 78.4% found that breakfast skipping is associated with excess body fat in adolescents. Intiful and Lartey6161. Intiful FD, Lartey A. Breakfast habits among school children in selected communities in the eastern region of Ghana. Ghana Med J. 2014;48(2):71-7. https://doi.org/10.4314/gmj.v48i2.3
https://doi.org/10.4314/gmj.v48i2.3...
attribute this association to adolescents who omit breakfast being more likely to eat other meals, such as lunch and dinner, irregularly and to eat unhealthy food between meals, such as non-nutritious snacks and fast foods. Thus, adolescents who skip breakfast consume more fat and less fiber, vitamins, and minerals44. Timlin MT, Pereira MA. Breakfast frequency and quality in the etiology of adult obesity and chronic discases. Nutr Rev. 2007;65(6 Pt 1):268-81. https://doi.org/10.1301/nr.2007.jun.268-281
https://doi.org/10.1301/nr.2007.jun.268-...
and are less physically active, leading to an imbalance between energy consumption and expenditure6262. Vissers PAJ, Jones AP, Corder K, Jennings A, Sluijs EMF, Welch A, et al. Breakfast consumption and daily physical activity in 9-10 year old British children. Public Health Nutr. 2013;16(7):1281-90. https://doi.org/10.1017/S1368980011002175
https://doi.org/10.1017/S136898001100217...
.

Wang et al.1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
and Cayres et al.2222. Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081
https://doi.org/10.1097/MPG.000000000000...
showed that breakfast skipping is associated with weight gain, since adolescents who skipped this meal spent a longer period fasting (night and morning), with increased ghrelin release6363. Depoortere I. Targeting the ghrelin receptor to regulate food intake. Regul Pept. 2009;156(1-3):13-23. https://doi.org/10.1016/j.regpep.2009.04.002
https://doi.org/10.1016/j.regpep.2009.04...
, consequently, increased appetite, increasing the probability of hyperphagia and body fat accumulation6464. Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. https://doi.org/10.1371/journal.pmed.0010062
https://doi.org/10.1371/journal.pmed.001...
.

A potential confounding factor in assessing the association between breakfast skipping and body adiposity is energy intake, since individuals who skip breakfast tend to consume high energy density foods, or they may consume more energy from other meals throughout the day1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
. Four studies in this review evaluated the association of breakfast skipping with body adiposity, adjusting for total energy consumption; in three of them, the association remained even after adjustment2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
,2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,3434. Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002. J Am Coll Nutr. 2010;29(4):407-18. https://doi.org/10.1080/07315724.2010.10719858
https://doi.org/10.1080/07315724.2010.10...
.

Three articles found an association between breakfast skipping and abnormal lipid profile1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
in addition to the observed propensity for excess body adiposity. The main factors that may explain this association are related to increased appetite and high energy intake after fasting1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
. Breakfast skipping also induces insulin resistance and may play an important role in the development of dyslipidemia6565. Deshmukh-Taskar P, Nicklas TA, Radcliffe JD, O’Neil CE, Liu Y. The relationship of breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome in young adults. The National Health and Nutrition Examination Survey (NHANES): 1999-2006. Public Health Nutr. 2013;16(11):2073-82. https://doi.org/10.1017/S1368980012004296
https://doi.org/10.1017/S136898001200429...
. Hyperinsulinemia may increase apolipoprotein B-48 secretion by stimulating chylomicrons formation in the small intestine and inducing postprandial hyperlipidemia. Next, lipoprotein lipase, which hydrolyzes the central chylomicrons triglycerides6666. Ginsberg HN, Zhang YL, Hernandez-Ono A. Regulation of plasma triglycerides in insulin resistance and diabetes. Arch Med Res. 2005;36(3):232-40. https://doi.org/10.1016/j.arcmed.2005.01.005
https://doi.org/10.1016/j.arcmed.2005.01...
, is inhibited, leading to increased hepatic lipase activity, which hydrolyzes LDL-cholesterol and HDL-cholesterol, triggering the decrease in HDL-cholesterol and the increase of small and dense LDL-cholesterol arterial particles6767. Perret B, Mabile L, Martinez L, Tercé F, Barbaras R, Collet X. Hepatic lipase: structure/function relationship, synthesis, and regulation. J Lipid Res. 2002;43(8):1163-9. https://doi.org/10.1194/jlr.R100020-JLR200
https://doi.org/10.1194/jlr.R100020-JLR2...
.

Regarding blood pressure increase in adolescents who omit breakfast, three articles in this review found a significant association3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
. The mechanisms that explain this association are still unclear, but they seem to be related to body adiposity, which may be the result of skipping breakfast, as mentioned above. Vanderlei et al.6868. Vanderlei LCM, Pastre CM, Freitas Júnior IF, Godoy MF. Analysis of cardiac autonomic modulation in obese and eutrophic children. Clinics. 2010;65(8):789-92. https://doi.org/10.1590/S1807-59322010000800008
https://doi.org/10.1590/S1807-5932201000...
argue that increased body fat is related to higher sympathetic activity, because adiposity is associated with increased oxidative stress, increasing stimulation in specific brain regions that control sympathetic activity6969. Hirooka Y, Sagara Y, Kishi T, Sunagawa K. Oxidative stress and central cardiovascular regulation. Pathogenesis of hypertension and therapeutic aspects. Circ J. 2010;74(5):827-35. https://doi.org/10.1253/circj.cj-10-0153
https://doi.org/10.1253/circj.cj-10-0153...
. However, the associations found by Kollias et al.3131. Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
https://doi.org/10.1038/jhh.2008.166...
, Shafiee et al.4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
, and Cayres et al.4949. Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
https://doi.org/10.1017/S104795111500005...
remained significant for SBP, even after adjustment for indicators of body adiposity.

The five articles that evaluated breakfast skipping and glucose metabolism-related variables found no significant association2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,5656. Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
https://doi.org/10.1111/apa.14363...
,5858. Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
https://doi.org/10.3390/medicina54060096...
,6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
. Alexander et al.2929. Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
https://doi.org/10.1038/oby.2009.127...
reported that this association was not supposed to be found by the impact of the macronutrient content in breakfast on metabolic parameters, but the study did not evaluate the type of breakfast, therefore, its influence in the results cannot be stated. According to Tolfrey and Zakrzewski7070. Tolfrey K, Zakrzewski J. Breakfast, glycaemic index and health in young people. J Sport Health Sci. 2012;1(3):149-59. https://doi.org/10.1016/j.jshs.2012.09.001
https://doi.org/10.1016/j.jshs.2012.09.0...
, breakfast with high-fiber, low-glycemic cereals is associated with increased glycemic control and satiety.

The metabolic effects of breakfast can also be explained by their impact on the circadian cycle, a period in which the environment influences the transcription of some genes, mainly by light variations and by the time of feeding, which helps synchronize this system7171. Oosterman JE, Kalsbeek A, La Fleur SE, Belsham DD. Impact of nutrients on circadian rhythmicity. Am J Physiol Regul Integr Comp Physiol. 2015;308(5):R337-50. https://doi.org/10.1152/ajpregu.00322.2014
https://doi.org/10.1152/ajpregu.00322.20...
. When food is restricted during a period, such as breakfast skipping, i.e., the fasting period after the sleeping period increases, circadian cycles may be out of sync, causing changes in certain genes that regulate lipid and glucose metabolism11. St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2017;135(9):e96-121. https://doi.org/10.1161/CIR.0000000000000476
https://doi.org/10.1161/CIR.000000000000...
.

The variation in the results found in the articles may have been influenced by the different ways of collecting information on breakfast consumption and the definition of skipping breakfast. The definition most used by the studies considered the frequency of breakfast consumption (“rarely”, “never” and number of days/week).

Dialektakou et al.7272. Dialektakou KD, Vranas PBM. Breakfast skipping and body mass index among adolescents in Greece: whether an association exists depends on how breakfast skipping is defined. J Am Diet Assoc. 2008;108(9):1517-25. https://doi.org/10.1016/j.jada.2008.06.435
https://doi.org/10.1016/j.jada.2008.06.4...
stressed that breakfast skipping is associated with BMI, but this association depends on how skipping is defined. Among Greek adolescents, the authors found that all variables corresponding to breakfast consumption on the day of data collection were associated with both BMI and overweight or obesity. However, few associations remained significant when considering breakfast consumption in the previous week; which may have been because adolescents’ recollections of omitting breakfast in the previous week were less accurate than information reported on the day of data collection.

Among Brazilian adolescents, Hassan et al.2323. Hassan BK, Cunha DB, Veiga GV, Pereira RA, Sichieri R. Changes in breakfast frequency and composition during adolescence: The Adolescent Nutritional Assessment Longitudinal Study, a cohort from Brazil. PLoS One. 2018;13(7):e0200587. https://doi.org/10.1371/journal.pone.0200587
https://doi.org/10.1371/journal.pone.020...
also found that the results depend on how breakfast skipping defined and on how the variable was categorized; they noted that the prevalence of breakfast skipping ranged from 3.6 % when the baseline was last week to 39.0% when we asked the teenagers if they had eaten any solid food in the morning of the interview.

In this systematic review, we observed that, in general, studies that considered breakfast skipping 5 or more times or every day showed a higher frequency of positive association between skipping this meal and the respective outcomes: lipid profile1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,4040. Vaezghasemi M, Lindkvist M, Ivarsson A, Eurenius E. Overweight and lifestyle among 13-15 year olds: a cross-sectional study in northern Sweden. Scand J Public Health. 2012;40(3):221-8. https://doi.org/10.1177/1403494812443603
https://doi.org/10.1177/1403494812443603...
,5959. Forkert ECO, Moraes ACF, Carvalho HB, Manios Y, Whidhalm K, González-Gross M, et al. Skipping breakfast is associated with adiposity markers especially when sleep time is adequate in adolescents. Sci Rep. 2019;9:6380. https://doi.org/10.1038/s41598-019-42859-7
https://doi.org/10.1038/s41598-019-42859...
, blood pressure4040. Vaezghasemi M, Lindkvist M, Ivarsson A, Eurenius E. Overweight and lifestyle among 13-15 year olds: a cross-sectional study in northern Sweden. Scand J Public Health. 2012;40(3):221-8. https://doi.org/10.1177/1403494812443603
https://doi.org/10.1177/1403494812443603...
,4848. Talat MA, El Shahat E. Prevalence of overweight and obesity among preparatory school adolescents in Urban Sharkia Governorate, Egypt. Egypt Pediatr Assoc Gaz. 2016;64(1):20-5. https://doi.org/10.1016/j.epag.2015.11.004
https://doi.org/10.1016/j.epag.2015.11.0...
and body adiposity markers1111. Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013
https://doi.org/10.1016/j.appet.2018.10....
,1212. Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
https://doi.org/10.3345/kjp.2016.59.2.65...
,2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
,2222. Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081
https://doi.org/10.1097/MPG.000000000000...
,2626. Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046
https://doi.org/10.1016/j.ijcard.2008.04...
,3030. Croezen S, Visscher TLS, Bogt NCW, 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(3):405-12. https://doi.org/10.1038/sj.ejcn.1602950
https://doi.org/10.1038/sj.ejcn.1602950...
,3232. Maddah M, Rashidi A, Mohammadpour B, Vafa R, Karandish M. In-school Snacking, Breakfast Consumption, and Sleeping Patterns of Normal and Overweight Iranian High School Girls: a study in urban and rural areas in Guilan, Iran. J Nutr Educ Behav. 2009;41(1):27-31. https://doi.org/10.1016/j.jneb.2008.03.115
https://doi.org/10.1016/j.jneb.2008.03.1...
,3535. Kapantais E, Chala E, Kaklamanou D, Lanaras L, Kaklamanou M, Tzotzas T. Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents. Public Health Nutr. 2010;14(1):101-8. https://doi.org/10.1017/S1368980010000765
https://doi.org/10.1017/S136898001000076...
,3737. Thompson-McCormick JJ, Thomas JJ, Bainivualiku A, Khan AN, Becker AE. Breakfast skipping as a risk correlate of overweight and obesity in school-going ethnic Fijian adolescent girls. Asia Pac J Clin Nutr. 2010;19(3):372-82.. Thus, a cutoff point of breakfast skipping almost every and every day possibly allows a better assessment of the association between this behavior and cardiometabolic risk factors, because adolescents who report breakfast skipping every day probably have this habit over months and years, resulting in metabolic and body composition changes.

In the cohort study conducted by Timlin et al.2121. 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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
https://doi.org/10.1542/peds.2007-1035...
with a 5-year follow-up, they considered a cutoff point of breakfast skipping every day and observed that adolescents who omitted breakfast had a greater increase in the mean BMI. Cayres et al.2222. Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081
https://doi.org/10.1097/MPG.000000000000...
observed similar results, which also considered the cutoff point of skipping in 5 days, follow-up was 12 months and abdominal fat and total body fat of the adolescents who skipped breakfast increased more than those who ate regularly.

Thus, the definition and standardization of the category defining breakfast skipping may influence the results and their interpretation. This systematic review found a wide variation in the definitions of breakfast skipping, hindering the comparison between the results. According to Hassan et al.2323. Hassan BK, Cunha DB, Veiga GV, Pereira RA, Sichieri R. Changes in breakfast frequency and composition during adolescence: The Adolescent Nutritional Assessment Longitudinal Study, a cohort from Brazil. PLoS One. 2018;13(7):e0200587. https://doi.org/10.1371/journal.pone.0200587
https://doi.org/10.1371/journal.pone.020...
, a standard definition of breakfast skipping in the scientific literature is essential to improve comparisons among studies and results interpretation.

The American Heart Association recently proposed definitions to improve and standardize the assessment of consumption and skipping of meals11. St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2017;135(9):e96-121. https://doi.org/10.1161/CIR.0000000000000476
https://doi.org/10.1161/CIR.000000000000...
: breakfast as the first meal of the day that breaks the fast after the longest period of sleep, eaten within 2 to 3 hours of waking, consisting of food or drink from at least one food group and consumed in any location. Other meals were defined as consumption occasions that provide ≥ 15% of the total energy intake and snacks as consumption occasions that provide < 15% of the total energy intake11. St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2017;135(9):e96-121. https://doi.org/10.1161/CIR.0000000000000476
https://doi.org/10.1161/CIR.000000000000...
.

In addition, Food Guide for the Brazilian population7373. Ministério da Saúde (BR), Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Guia alimentar para a população brasileira. 2. ed. Brasília, DF; 2014 [cited 2020 Aug 22]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf
https://bvsms.saude.gov.br/bvs/publicaco...
recommends the consumption of fresh or minimally processed foods for breakfast, such as milk, coffee, eggs, fruits, and preparations based on cereals or tubers, since the nutritional composition of this meal is important and the consumption of certain foods for breakfast can have a protective effect against cardiometabolic risk factors, such as BMI, total cholesterol, and LDL6060. Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
https://doi.org/10.3390/nu11050973...
.

Standardizing the definition of breakfast skipping is necessary to enable the aggregation of results and the summarization of effects, and to better evaluation and understanding of scientific evidence in the association between breakfast skipping and cardiometabolic risk factors in adolescents. This can subsidize public policies and technical advice directed to schools aiming at instructing on the effects and risks of skipping breakfast on the cardiometabolic health of adolescents and promoting the daily consumption of this meal.

The studies included in this systematic review showed a significant association with excess adiposity, lipid profile, and blood pressure. In summary, the positive association remained for these outcomes with quality, according to the GRADE rating, C – low. As for the glycidic profile, no association was observed, and the quality of evidence was also C – low. Despite the low quality of the evidence of this study’s findings, we observed that they agree with what other studies with adolescents verified, thus, breakfast skipping was associated with cardiometabolic risk factors55. Hallström L, Labayen I, Ruiz JR, Petterson E, Vereecken CA, Breidenassel C, et al. Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 2013;16(7):1296-305. https://doi.org/10.1017/S1368980012000973
https://doi.org/10.1017/S136898001200097...
,1010. Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study. Am J Clin Nutr. 2010;92(6):1316-25. https://doi.org/10.3945/ajcn.2010.30101
https://doi.org/10.3945/ajcn.2010.30101...
,1515. Szajewska H, Ruszczyński M. Systematic review demonstrating that breakfast consumption influences body weight outcomes in children and adolescents in Europe. Crit Rev Food Sci Nutr. 2010;50(2):113-9. https://doi.org.10.1080/10408390903467514
https://doi.org.10.1080/1040839090346751...
. The low quality of the evidence from the studies was also mainly due to the observational design and inconsistency.

The conflicts of interest towards the financing of studies by the food industry is also important to point out. Some studies1616. Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
https://doi.org/10.1111/ijpo.12127...
,4141. Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
https://doi.org/10.1016/j.jped.2013.03.0...
,4444. Faizi N, Khan IM, Amir A, Azmi SA, Ahmad A, Khalique N. Breakfast skipping and proposed effects of breakfast on obesity: a school-based study in adolescents in Aligarh, India. Ann Trop Med Public Health. 2014;7(1):43-7. were financed by the food industries that manufacture breakfast cereals and despite the researchers reporting no conflict of interest, the food industry has an interest in promoting the habit of having breakfast, because the consumption of breakfast cereals generally occurs in this meal. Breakfast cereals are also classified as ultra-processed food products, that is, they contain high levels of added sugars, salt, and unhealthy fats, thus being unhealthy. Pagliai et al.7474. Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2021;125(3):308-18. https://doi:10.1017/S0007114520002688
https://doi:10.1017/S0007114520002688...
systematic review and meta-analysis, which analyzed ultra-processed and chronic diseases, showed a relation between the consumption of ultra-processed products and increased risk of obesity, metabolic syndrome, and cardiovascular diseases.

The strengths of this review include the search in various databases, the selection and evaluation of articles by peers, the evaluation of the quality of the included studies and the focus only on adolescents aged 10 to 19 years old. Among the limitations is the inclusion of longitudinal studies that evaluated only the markers of body adiposity and the impossibility of performing statistical synthesis through meta-analysis, due to the different definitions of breakfast skipping and statistical analysis methodologies adopted by the studies.

CONCLUSION

The results 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, they should be interpreted carefully. We emphasize the importance of standardizing the breakfast skipping definition for better use as an exposure factor in assessing cardiometabolic risk factors and we recommend carrying out studies with longitudinal designs to raise the level of evidence and ensure temporality and consistency of results in different confusion scenarios.

REFERENCES

  • 1
    St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2017;135(9):e96-121. https://doi.org/10.1161/CIR.0000000000000476
    » https://doi.org/10.1161/CIR.0000000000000476
  • 2
    O’Neil CE, Byrd-Bredbenner C, Hayes D, Jana L, Klinger SE, Stephenson-Martin S. The role of breakfast in health: definition and criteria for a quality breakfast. J Acad Nutr Diet. 2014;114(12 Suppl):S8-26. https://doi.org/10.1016/j.jand.2014.08.022
    » https://doi.org/10.1016/j.jand.2014.08.022
  • 3
    Monteiro LS, Souza AM, Hassan BK, Estima CCP, Sichieri R, Pereira RA. Breakfast eating among Brazilian adolescents: analysis of the National Dietary Survey 2008-2009. Rev Nutr. 2017;30(4):463-76. https://doi.org/10.1590/1678-98652017000400006
    » https://doi.org/10.1590/1678-98652017000400006
  • 4
    Timlin MT, Pereira MA. Breakfast frequency and quality in the etiology of adult obesity and chronic discases. Nutr Rev. 2007;65(6 Pt 1):268-81. https://doi.org/10.1301/nr.2007.jun.268-281
    » https://doi.org/10.1301/nr.2007.jun.268-281
  • 5
    Hallström L, Labayen I, Ruiz JR, Petterson E, Vereecken CA, Breidenassel C, et al. Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 2013;16(7):1296-305. https://doi.org/10.1017/S1368980012000973
    » https://doi.org/10.1017/S1368980012000973
  • 6
    Sandercock GRH, Voss C, Dye L. Association between habitual school-day breakfast consumption, body mass index, physical activity, and cardiorespiratory fitness in English schoolchildren. Eur J Clin Nutr. 2010;64(10):1086-92. https://doi.org/10.1038/ejcn.2010.145
    » https://doi.org/10.1038/ejcn.2010.145
  • 7
    Hunty A, Gibson S, Ashwell M. Does regular breakfast cereal consumption help children and adolescents stay slimmer? A systematic review and meta-analysis. Obes Facts. 2013;6(1):70-85. https://doi.org/10.1159/000348878
    » https://doi.org/10.1159/000348878
  • 8
    Sampasa-Kanyinga H, Hamilton HA. Eating breakfast regularly is related to higher school connectedness and academic performance in Canadian middle- and high-school students. Public Health. 2017;145:120-3. https://doi.org/10.1016/j.puhe.2016.12.027
    » https://doi.org/10.1016/j.puhe.2016.12.027
  • 9
    Ptomey LT, Steger FL, Schubert MM, Lee J, Willis EA, Sullivan DK, et al. Breakfast intake and composition is associated with superior academic achievement in elementary schoolchildren. J Am Coll Nutr. 2015;35(4):326-33. https://doi.org/10.1080/07315724.2015.1048381
    » https://doi.org/10.1080/07315724.2015.1048381
  • 10
    Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study. Am J Clin Nutr. 2010;92(6):1316-25. https://doi.org/10.3945/ajcn.2010.30101
    » https://doi.org/10.3945/ajcn.2010.30101
  • 11
    Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013
    » https://doi.org/10.1016/j.appet.2018.10.013
  • 12
    Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65
    » https://doi.org/10.3345/kjp.2016.59.2.65
  • 13
    Eckel RH, Kahn R, Robertson RM, Rizza RA. Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes. Association and the American Heart Association. Circulation. 2006;29(7):1697-9. https://doi.org/10.2337/dc06-9911
    » https://doi.org/10.2337/dc06-9911
  • 14
    Moschonis G, Tsoutsoulopoulou K, Efstathopoulou E, Tsirigoti L, Lambrinou CP, Georgiou A. Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood. Expert Rev Cardiovasc Ther. 2015;13(6):673-92. https://doi.org/10.1586/14779072.2015.1039992
    » https://doi.org/10.1586/14779072.2015.1039992
  • 15
    Szajewska H, Ruszczyński M. Systematic review demonstrating that breakfast consumption influences body weight outcomes in children and adolescents in Europe. Crit Rev Food Sci Nutr. 2010;50(2):113-9. https://doi.org.10.1080/10408390903467514
    » https://doi.org.10.1080/10408390903467514
  • 16
    Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127
    » https://doi.org/10.1111/ijpo.12127
  • 17
    Jakubowicz D, Wainstein J, Ahren B, Landau Z, Bar-Dayan Y, Froy O. Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: a randomized clinical trial. Diabetes Care. 2015;38(10):1820-6. https://doi.org/10.2337/dc15-0761
    » https://doi.org/10.2337/dc15-0761
  • 18
    World Health Organization. Physical status: the use of and interpretation of anthropometry: report of a WHO expert committee. Geneva (CH): WHO; 1995 [cited 2020 Aug 22]. (WHO Technical Report Series; nº 854). Available from: https://apps.who.int/iris/handle/10665/37003
    » https://apps.who.int/iris/handle/10665/37003
  • 19
    Viswanathan M, Berkman ND. Development of the RTI item bank on risk of bias and precision of observational studies. J Clin Epidemiol 2012;65(2):163-78. https://doi.org/10.1016/j.jclinepi.2011.05.008
    » https://doi.org/10.1016/j.jclinepi.2011.05.008
  • 20
    Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Ciência e Tecnologia. Diretrizes metodológicas: Sistema GRADE – Manual de graduação da qualidade da evidência e força de recomendação para tomada de decisão em saúde. Brasília, DF; 2014 [cited 2020 Aug 22]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_sistema_grade.pdf
    » https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_sistema_grade.pdf
  • 21
    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(3):e638-45. https://doi.org/10.1542/peds.2007-1035
    » https://doi.org/10.1542/peds.2007-1035
  • 22
    Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081
    » https://doi.org/10.1097/MPG.0000000000002081
  • 23
    Hassan BK, Cunha DB, Veiga GV, Pereira RA, Sichieri R. Changes in breakfast frequency and composition during adolescence: The Adolescent Nutritional Assessment Longitudinal Study, a cohort from Brazil. PLoS One. 2018;13(7):e0200587. https://doi.org/10.1371/journal.pone.0200587
    » https://doi.org/10.1371/journal.pone.0200587
  • 24
    Hassan BK, Cunha DB, Veiga GV, Pereira RA, Hoffman DJ, Sichieri R. Breakfast consumption, family breakfast, and adiposity trajectory in adolescence: The Adolescent Nutritional Assessment Longitudinal Cohort Study. J Acad Nutr Diet. 2019;119(6):944-56. https://doi.org/10.1016/j.jand.2018.11.014
    » https://doi.org/10.1016/j.jand.2018.11.014
  • 25
    Harding S, Teyhan A, Maynard MJ, Cruickshank KJ. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 2008;37(1):162-72. https://doi.org/10.1093/ije/dym252
    » https://doi.org/10.1093/ije/dym252
  • 26
    Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046
    » https://doi.org/10.1016/j.ijcard.2008.04.046
  • 27
    Mota J, Fidalgo F, Silva R, Ribeiro JC, Santos R, Carvalho J, et al. Relationships between physical activity, obesity and meal frequency in adolescents. Ann Hum Biol. 2008;35(1):1-10. https://doi.org/10.1080/03014460701779617
    » https://doi.org/10.1080/03014460701779617
  • 28
    Henríquez Sánchez P, Doroeste Alonso J, Laínez Sevillano P, Estévez Gonzáles MD, Iglesias Valle M, López Martin G, et al. Prevalencia de obesidad y sobrepeso en adolescentes canarios. Relación con el desayuno y la actividad física. Med Clin (Barc). 2008;130(16):606-10. https://doi.org/10.1157/13120339
    » https://doi.org/10.1157/13120339
  • 29
    Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127
    » https://doi.org/10.1038/oby.2009.127
  • 30
    Croezen S, Visscher TLS, Bogt NCW, 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(3):405-12. https://doi.org/10.1038/sj.ejcn.1602950
    » https://doi.org/10.1038/sj.ejcn.1602950
  • 31
    Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166
    » https://doi.org/10.1038/jhh.2008.166
  • 32
    Maddah M, Rashidi A, Mohammadpour B, Vafa R, Karandish M. In-school Snacking, Breakfast Consumption, and Sleeping Patterns of Normal and Overweight Iranian High School Girls: a study in urban and rural areas in Guilan, Iran. J Nutr Educ Behav. 2009;41(1):27-31. https://doi.org/10.1016/j.jneb.2008.03.115
    » https://doi.org/10.1016/j.jneb.2008.03.115
  • 33
    Sun Y, Sekine M, Sadanobu K. Lifestyle and overweight among Japanese adolescents: The Toyama Birth Cohort Study. J Epidemiol. 2009;19(6):303-10. https://doi.org/10.2188/jea.je20080095
    » https://doi.org/10.2188/jea.je20080095
  • 34
    Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002. J Am Coll Nutr. 2010;29(4):407-18. https://doi.org/10.1080/07315724.2010.10719858
    » https://doi.org/10.1080/07315724.2010.10719858
  • 35
    Kapantais E, Chala E, Kaklamanou D, Lanaras L, Kaklamanou M, Tzotzas T. Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents. Public Health Nutr. 2010;14(1):101-8. https://doi.org/10.1017/S1368980010000765
    » https://doi.org/10.1017/S1368980010000765
  • 36
    Maddah M, Nikooyeh B. Obesity among Iranian adolescent girls: location of residence and parental obesity. J Health Popul Nutr. 2010;28(1):61-6. https://doi.org/10.3329/jhpn.v28i1.4524
    » https://doi.org/10.3329/jhpn.v28i1.4524
  • 37
    Thompson-McCormick JJ, Thomas JJ, Bainivualiku A, Khan AN, Becker AE. Breakfast skipping as a risk correlate of overweight and obesity in school-going ethnic Fijian adolescent girls. Asia Pac J Clin Nutr. 2010;19(3):372-82.
  • 38
    Kim JH, So WY. Association between frequency of breakfast eating and obesity in Korean adolescents. Iran J Public Health. 2012;41(6):50-7.
  • 39
    Kuriyan R, Thomas T, Sumithra S, Lokesh DP, Sheth NR, Joy R, et al. Potential factors related to waist circumference in urban South Indian children. Indian Pediatr. 2012;49(2):124-8. https://doi.org/10.1007/s13312-012-0027-3
    » https://doi.org/10.1007/s13312-012-0027-3
  • 40
    Vaezghasemi M, Lindkvist M, Ivarsson A, Eurenius E. Overweight and lifestyle among 13-15 year olds: a cross-sectional study in northern Sweden. Scand J Public Health. 2012;40(3):221-8. https://doi.org/10.1177/1403494812443603
    » https://doi.org/10.1177/1403494812443603
  • 41
    Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020
    » https://doi.org/10.1016/j.jped.2013.03.020
  • 42
    Boričić K, Simić S, Vasiljević N, Marinković J. Risk factors associated with overweight among adolescents in Serbia. Zdr Varst. 2014;53(4):283-93. https://doi.org/10.2478/sjph-2014-0031
    » https://doi.org/10.2478/sjph-2014-0031
  • 43
    Díez-Navarro A, Martín-Camargo A, Solé-Llussà A, Marrodán MD, Gónzales-Montero de Espinoza M. [Influence of breakfast on overweight and obesity in child and adolescent population from Madrid]. Nutr Clin Diet Hosp. 2014;34(2):9-17. Spanish.
  • 44
    Faizi N, Khan IM, Amir A, Azmi SA, Ahmad A, Khalique N. Breakfast skipping and proposed effects of breakfast on obesity: a school-based study in adolescents in Aligarh, India. Ann Trop Med Public Health. 2014;7(1):43-7.
  • 45
    Garcia-Continente X, Allue N, Pérez-Giménez A, Ariza A, Sánchez-Martínez F, López MJ et al. [Eating habits, sedentary behaviors and overweight and obesity among adolescents in Barcelona (Spain)]. An Pediatr (Barc). 2015;83(1):3-10. Spanish. https://doi.org/10.1016/j.anpede.2015.05.017
    » https://doi.org/10.1016/j.anpede.2015.05.017
  • 46
    Garg M, Rajesh V, Kumar P. Effect of breakfast skipping on nutritional status and school performance of 10-16 years old children of Udupi district. Health Popul Perspect Issues. 2014;37(3-4):98-117.
  • 47
    Gökler ME, Buğrul N, Metintaş S, Kalyoncu C. Adolescent obesity and associated cardiovascular risk factors of rural and urban life (Eskisehir, Turkey). Cent Eur J Public Health. 2015;23(1):20-5. https://doi.org/10.21101/cejph.a3958
    » https://doi.org/10.21101/cejph.a3958
  • 48
    Talat MA, El Shahat E. Prevalence of overweight and obesity among preparatory school adolescents in Urban Sharkia Governorate, Egypt. Egypt Pediatr Assoc Gaz. 2016;64(1):20-5. https://doi.org/10.1016/j.epag.2015.11.004
    » https://doi.org/10.1016/j.epag.2015.11.004
  • 49
    Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050
    » https://doi.org/10.1017/S1047951115000050
  • 50
    Morales A, Montilva M. Hábitos alimentarios no saludables, actividad física y obesidad en adolescentes entre 15 y 19 años. An Venez Nutr. 2016;29(1):4-10.
  • 51
    Badr HE, Lakha SF, Pennefather P. Differences in physical activity, eating habits and risk of obesity among Kuwaiti adolescent boys and girls: a population-based study. Int J Adolesc Med Health. 2017;31(1):20160138. https://doi.org/10.1515/ijamh-2016-0138
    » https://doi.org/10.1515/ijamh-2016-0138
  • 52
    Frayon S, Cherrier S, Cavaloc Y, Touitou A, Zongo P, Wattelez G, et al. Nutrition behaviors and sociodemographic factors associated with overweight in the multi-ethnic adolescents of New Caledonia. Ethn Health. 2019;24(2):194-210. https://doi.org/10.1080/13557858.2017.1315530
    » https://doi.org/10.1080/13557858.2017.1315530
  • 53
    Zalewska M, Maciorkowska E. Selected nutritional habits of teenagers associated with overweight and obesity. PeerJ. 2017;5:e3681. https://doi.org/10.7717/peerj.3681
    » https://doi.org/10.7717/peerj.3681
  • 54
    De Cnop ML, Monteiro LS, Rodrigues PRM, Estima CCP, Veiga GV, Pereira RA. Meal habits and anthropometric indicators in adolescents from public and private schools of the metropolitan region of Rio de Janeiro. Rev Nutr. 2018;31(1):35-47. https://doi.org/10.1590/1678-98652018000100004
    » https://doi.org/10.1590/1678-98652018000100004
  • 55
    Khan A, Khan SR, Burton NW. Missing breakfast is associated with overweight and obesity in Bangladeshi adolescents. Acta Paediatr. 2018;108(1):178-9. https://doi.org/10.1111/apa.14553
    » https://doi.org/10.1111/apa.14553
  • 56
    Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363
    » https://doi.org/10.1111/apa.14363
  • 57
    Tee ES, Nurliyana AR, Norimah AK, Mohamed HJBJ, Tan SY, Appukutty M, et al. Breakfast consumption among Malaysian primary and secondary school children and relationship with body weight status: findings from the MyBreakfast Study. Asia Pac J Clin Nutr. 2018;27(2):421-32. https://doi.org/10.6133/apjcn.062017.12
    » https://doi.org/10.6133/apjcn.062017.12
  • 58
    Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096
    » https://doi.org/10.3390/medicina54060096
  • 59
    Forkert ECO, Moraes ACF, Carvalho HB, Manios Y, Whidhalm K, González-Gross M, et al. Skipping breakfast is associated with adiposity markers especially when sleep time is adequate in adolescents. Sci Rep. 2019;9:6380. https://doi.org/10.1038/s41598-019-42859-7
    » https://doi.org/10.1038/s41598-019-42859-7
  • 60
    Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973
    » https://doi.org/10.3390/nu11050973
  • 61
    Intiful FD, Lartey A. Breakfast habits among school children in selected communities in the eastern region of Ghana. Ghana Med J. 2014;48(2):71-7. https://doi.org/10.4314/gmj.v48i2.3
    » https://doi.org/10.4314/gmj.v48i2.3
  • 62
    Vissers PAJ, Jones AP, Corder K, Jennings A, Sluijs EMF, Welch A, et al. Breakfast consumption and daily physical activity in 9-10 year old British children. Public Health Nutr. 2013;16(7):1281-90. https://doi.org/10.1017/S1368980011002175
    » https://doi.org/10.1017/S1368980011002175
  • 63
    Depoortere I. Targeting the ghrelin receptor to regulate food intake. Regul Pept. 2009;156(1-3):13-23. https://doi.org/10.1016/j.regpep.2009.04.002
    » https://doi.org/10.1016/j.regpep.2009.04.002
  • 64
    Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. https://doi.org/10.1371/journal.pmed.0010062
    » https://doi.org/10.1371/journal.pmed.0010062
  • 65
    Deshmukh-Taskar P, Nicklas TA, Radcliffe JD, O’Neil CE, Liu Y. The relationship of breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome in young adults. The National Health and Nutrition Examination Survey (NHANES): 1999-2006. Public Health Nutr. 2013;16(11):2073-82. https://doi.org/10.1017/S1368980012004296
    » https://doi.org/10.1017/S1368980012004296
  • 66
    Ginsberg HN, Zhang YL, Hernandez-Ono A. Regulation of plasma triglycerides in insulin resistance and diabetes. Arch Med Res. 2005;36(3):232-40. https://doi.org/10.1016/j.arcmed.2005.01.005
    » https://doi.org/10.1016/j.arcmed.2005.01.005
  • 67
    Perret B, Mabile L, Martinez L, Tercé F, Barbaras R, Collet X. Hepatic lipase: structure/function relationship, synthesis, and regulation. J Lipid Res. 2002;43(8):1163-9. https://doi.org/10.1194/jlr.R100020-JLR200
    » https://doi.org/10.1194/jlr.R100020-JLR200
  • 68
    Vanderlei LCM, Pastre CM, Freitas Júnior IF, Godoy MF. Analysis of cardiac autonomic modulation in obese and eutrophic children. Clinics. 2010;65(8):789-92. https://doi.org/10.1590/S1807-59322010000800008
    » https://doi.org/10.1590/S1807-59322010000800008
  • 69
    Hirooka Y, Sagara Y, Kishi T, Sunagawa K. Oxidative stress and central cardiovascular regulation. Pathogenesis of hypertension and therapeutic aspects. Circ J. 2010;74(5):827-35. https://doi.org/10.1253/circj.cj-10-0153
    » https://doi.org/10.1253/circj.cj-10-0153
  • 70
    Tolfrey K, Zakrzewski J. Breakfast, glycaemic index and health in young people. J Sport Health Sci. 2012;1(3):149-59. https://doi.org/10.1016/j.jshs.2012.09.001
    » https://doi.org/10.1016/j.jshs.2012.09.001
  • 71
    Oosterman JE, Kalsbeek A, La Fleur SE, Belsham DD. Impact of nutrients on circadian rhythmicity. Am J Physiol Regul Integr Comp Physiol. 2015;308(5):R337-50. https://doi.org/10.1152/ajpregu.00322.2014
    » https://doi.org/10.1152/ajpregu.00322.2014
  • 72
    Dialektakou KD, Vranas PBM. Breakfast skipping and body mass index among adolescents in Greece: whether an association exists depends on how breakfast skipping is defined. J Am Diet Assoc. 2008;108(9):1517-25. https://doi.org/10.1016/j.jada.2008.06.435
    » https://doi.org/10.1016/j.jada.2008.06.435
  • 73
    Ministério da Saúde (BR), Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Guia alimentar para a população brasileira. 2. ed. Brasília, DF; 2014 [cited 2020 Aug 22]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf
    » https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf
  • 74
    Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2021;125(3):308-18. https://doi:10.1017/S0007114520002688
    » https://doi:10.1017/S0007114520002688

  • Funding:Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes), Brazil, through a Master grant (MRS. and MEAN.; Finance Code 001). Pró-Reitora de Pesquisa/Pró-Reitora de Ensino de Pós-Graduação – Universidade Federal de Mato Grosso (UFMT). Capes and UFMT had no role in the design, analysis or writing of this manuscript and the authors have no conflicts of interest to be reported.

Publication Dates

  • Publication in this collection
    17 Dec 2021
  • Date of issue
    2021

History

  • Received
    22 Aug 2020
  • Accepted
    9 Apr 2021
Faculdade de Saúde Pública da Universidade de São Paulo São Paulo - SP - Brazil
E-mail: revsp@org.usp.br