title: Associations between family-related factors, breakfast consumption and BMI among 10- to 12-year-old European children: the cross-sectional ENERGY-study.
abstract: OBJECTIVE
  To investigate associations of family-related factors with children's breakfast consumption and BMI-z-score and to examine whether children's breakfast consumption mediates associations between family-related factors and children's BMI-z-score.
  
  
  METHODS
  Ten- to twelve-year-old children (n = 6374; mean age = 11.6 ± 0.7 years, 53.2% girls, mean BMI-z-score = 0.4 ± 1.2) and one of their parents (n = 6374; mean age = 41.4 ± 5.3 years, 82.7% female, mean BMI = 24.5 ± 4.2 kg/m(2)) were recruited from schools in eight European countries (Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia, Spain, and Switzerland). The children self-reported their breakfast frequency per week. The body weight and height of the children were objectively measured. The parents responded to items on family factors related to breakfast (automaticity, availability, encouragement, paying attention, permissiveness, negotiating, communicating health beliefs, parental self-efficacy to address children's nagging, praising, and family breakfast frequency). Mediation analyses were performed using multi-level regression analyses (child-school-country).
  
  
  RESULTS
  Three of the eleven family-related variables were significantly associated with children's BMI-z-score. The family breakfast frequency was negatively associated with the BMI-z-score; permissiveness concerning skipping breakfast and negotiating about breakfast were positively associated with the BMI-z-score. Children's breakfast consumption was found to be a mediator of the two associations. All family-related variables except for negotiating, praising and communicating health beliefs, were significantly associated with children's breakfast consumption.
  
  
  CONCLUSIONS
  Future breakfast promotion and obesity prevention interventions should focus on family-related factors including the physical home environment and parenting practices. Nevertheless, more longitudinal research and intervention studies to support these findings between family-related factors and both children's breakfast consumption and BMI-z-score are needed.
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Wendy
authors.initials: W
authors.lastname: Van Lippevelde
authors.forename: Saskia J
authors.initials: SJ
authors.lastname: Te Velde
authors.forename: Maïté
authors.initials: M
authors.lastname: Verloigne
authors.forename: Maartje M
authors.initials: MM
authors.lastname: Van Stralen
authors.forename: Ilse
authors.initials: I
authors.lastname: De Bourdeaudhuij
authors.forename: Yannis
authors.initials: Y
authors.lastname: Manios
authors.forename: Elling
authors.initials: E
authors.lastname: Bere
authors.forename: Froydis N
authors.initials: FN
authors.lastname: Vik
authors.forename: Nataša
authors.initials: N
authors.lastname: Jan
authors.forename: Juan M
authors.initials: JM
authors.lastname: Fernández Alvira
authors.forename: Mai J M
authors.initials: MJ
authors.lastname: Chinapaw
authors.forename: Bettina
authors.initials: B
authors.lastname: Bringolf-Isler
authors.forename: Eva
authors.initials: E
authors.lastname: Kovacs
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
authors.forename: Lea
authors.initials: L
authors.lastname: Maes
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D062408:Breakfast; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003430:Cross-Sectional Studies; D004435:Eating; D005060:Europe; D005195:Family Relations; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000209:etiology* / Q000517:prevention & control; D016487:Parenting