title: Meal frequency and childhood obesity.
abstract: OBJECTIVE
  Previous studies have demonstrated an inverse association between meal frequency and the prevalence of obesity in adulthood. The aim of this study was to assess the relationship between meal frequency and childhood obesity.
  
  
  METHODS
  Stature and weight of 4,370 German children ages 5 to 6 years were determined in six Bavarian (Germany) public health offices during the obligatory school entry health examination in 2001/2002. An extensive questionnaire on risk factors for obesity was answered by their parents. Obesity was defined according to sex- and age-specific BMI cut-off points proposed by the International Obesity Task Force. The main exposure was daily meal frequency.
  
  
  RESULTS
  The prevalence of obesity decreased by number of daily meals: three or fewer meals, 4.2% [95% confidence interval (CI), 2.8 to 6.1]; four meals, 2.8% (95% CI, 2.1 to 3.7); and 5 or more meals, 1.7% (95% CI, 1.2 to 2.4). These effects could not be explained by confounding due to a wide range of constitutional, sociodemographic, and lifestyle factors. The adjusted odds ratios for obesity were 0.73 (95% CI, 0.44 to 1.21) for four meals and 0.51 (95% CI, 0.29 to 0.89) for five or more meals. Additional analyses pointed to a higher energy intake in nibblers compared with gorgers.
  
  
  CONCLUSIONS
  A protective effect of an increased daily meal frequency on obesity in children was observed and appeared to be independent of other risk factors for childhood obesity. A modulation of the response of hormones such as insulin might be instrumental.
authors.affiliation: Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Heiglhofstrasse 63, Germany. toschke@biostats.info
authors.forename: André M
authors.initials: AM
authors.lastname: Toschke
authors.forename: Helmut
authors.initials: H
authors.lastname: Küchenhoff
authors.forename: Berthold
authors.initials: B
authors.lastname: Koletzko
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kries
mesh_terms: D000375:Aging; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004435:Eating; D004734:Energy Metabolism; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007328:Insulin / Q000502:physiology; D008019:Life Style; D008297:Male; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016017:Odds Ratio; D050177:Overweight; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D007328:Insulin