title: Associations between breakfast frequency and adiposity indicators in children from 12 countries.
abstract: OBJECTIVE
  Reports of inverse associations between breakfast frequency and indices of obesity are predominantly based on samples of children from high-income countries with limited socioeconomic diversity. Using data from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), the present study examined associations between breakfast frequency and adiposity in a sample of 9-11-year-old children from 12 countries representing a wide range of geographic and socio-cultural variability.
  
  
  METHODS
  Multilevel statistical models were used to examine associations between breakfast frequency (independent variable) and adiposity indicators (dependent variables: body mass index (BMI) z-score and body fat percentage (BF%)), adjusting for age, sex, and parental education in 6941 children from 12 ISCOLE study sites. Associations were also adjusted for moderate-to-vigorous physical activity, healthy and unhealthy dietary patterns and sleep time in a sub-sample (n=5710). Where interactions with site were significant, results were stratified by site.
  
  
  RESULTS
  Adjusted mean BMI z-score and BF% for frequent breakfast consumers were 0.45 and 20.5%, respectively. Frequent breakfast consumption was associated with lower BMI z-scores compared with occasional (P<0.0001, 95% confidence intervals (CI): 0.10-0.29) and rare (P<0.0001, 95% CI: 0.18-0.46) consumption, as well as lower BF% compared with occasional (P<0.0001, 95% CI: 0.86-1.99) and rare (P<0.0001, 95% CI: 1.07-2.76). Associations with BMI z-score varied by site (breakfast by site interaction; P=0.033): associations were non-significant in three sites (Australia, Finland and Kenya), and occasional (not rare) consumption was associated with higher BMI z-scores compared with frequent consumption in three sites (Canada, Portugal and South Africa). Sub-sample analyses adjusting for additional covariates showed similar associations between breakfast and adiposity indicators, but lacked site interactions.
  
  
  CONCLUSIONS
  In a multinational sample of children, more frequent breakfast consumption was associated with lower BMI z-scores and BF% compared with occasional and rare consumption. Associations were not consistent across all 12 countries. Further research is required to understand global differences in the observed associations.
authors.affiliation: Department of Sport Science and Physical Activity, University of Bedfordshire , Bedford, UK.
authors.forename: J K
authors.initials: JK
authors.lastname: Zakrzewski
authors.affiliation: Department for Health, University of Bath , Bath, UK.
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authors.initials: FB
authors.lastname: Gillison
authors.affiliation: Department for Health, University of Bath , Bath, UK.
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authors.lastname: Cumming
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
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authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
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authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
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authors.lastname: Broyles
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
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authors.lastname: Champagne
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute , Ottawa, Ontario, Canada.
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authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
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authors.affiliation: Department of Food and Environmental Sciences, University of Helsinki , Helsinki, Finland.
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authors.lastname: Fogelholm
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
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authors.lastname: Hu
authors.affiliation: St Johns Research Institute , Bangalore, India.
authors.forename: R
authors.initials: R
authors.lastname: Kuriyan
authors.affiliation: St Johns Research Institute , Bangalore, India.
authors.forename: A
authors.initials: A
authors.lastname: Kurpad
authors.affiliation: Department of Human Biology, Faculty of Health Sciences, Division of Exercise Science and Sports Medicine, University of Cape Town , Cape Town, South Africa.
authors.forename: E V
authors.initials: EV
authors.lastname: Lambert
authors.affiliation: Alliance for Research In Exercise Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia , Adelaide, South Australia, Australia.
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authors.lastname: Maher
authors.affiliation: CIFI2D, Faculdade de Desporto, University of Porto , Porto, Portugal.
authors.forename: J
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authors.lastname: Maia
authors.affiliation: Centro de Estudos do Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS) , Sao Paulo, Brazil.
authors.forename: V
authors.initials: V
authors.lastname: Matsudo
authors.affiliation: Pennington Biomedical Research Center , Baton Rouge, LA, USA.
authors.forename: E F
authors.initials: EF
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authors.affiliation: Alliance for Research In Exercise Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia , Adelaide, South Australia, Australia.
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authors.initials: T
authors.lastname: Olds
authors.affiliation: Department of Recreation Management and Exercise Science, Kenyatta University , Nairobi, Kenya.
authors.forename: V
authors.initials: V
authors.lastname: Onywera
authors.affiliation: School of Medicine Universidad de los Andes , Bogota, Colombia.
authors.forename: O L
authors.initials: OL
authors.lastname: Sarmiento
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute , Ottawa, Ontario, Canada.
authors.forename: M S
authors.initials: MS
authors.lastname: Tremblay
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA, USA; Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Tudor-Locke
authors.affiliation: Tianjin Women's and Children's Health Center , Tianjin, China.
authors.forename: P
authors.initials: P
authors.lastname: Zhao
authors.affiliation: Department for Health, University of Bath , Bath, UK.
authors.forename: M
authors.initials: M
authors.lastname: Standage