Breakfast Skipping and overweight/obesity among European adolescents, a cross-sectional analysis of the HELENA dataset: a DEDIPAC study.

Background: The aim was to examine demographic and dietary factors associated with breakfast skipping, and the relationship of breakfast skipping with overweight/obesity among adolescents across Europe. Methods: Cross-sectional data from the Healthy Lifestyle in Europe by Nutrition in Adolescence study (n=3528) conducted in ten European cities: Athens (Greece), Dortmund (Germany), Ghent (Belgium), Herkalion (Greece), Lille (France), Pecs (Hungary), Rome (Italy), Vienna (Austria), Stockholm (Sweden) and Zaragoza (Spain) were used.  Analysis was carried out using a sub-sample of adolescents (n=1894) aged 12.5-17.49 years with data on breakfast skipping and two days of 24-Hour Diet Recall data. As 24-Hour Recall data was not available from Pecs (Hungary) this city was excluded. Using responses from the Food Choices and Preferences Questionnaire adolescents were classified as breakfast skippers or non-breakfast skippers. All analyses were stratified by sex. Differences in the intake of macronutrients, both overall and when breakfast was excluded, and key foods were compared between skippers and non-skippers using Wilcoxen Rank Sum test. Multivariate logistic regression was used to examine the relationship between breakfast skipping and overweight/obesity. Results: Overall, 44% of females were skippers compared to 36% of males. Among both male and female estimated mean fibre intake and median fruit intake were significantly lower among skippers compared to non-skippers. Male skippers were significantly more likely than non-skippers to be overweight/obese [AOR = 2.34, 95% CI, 1.40-3.90] but this was not observed among females [AOR = 0.89, 95% CI 0.59-1.34]. Conclusions: Different patterns of daily macronutrient intake were observed among adolescents who skip and do not skip breakfast.  In males, breakfast skipping was associated with increased odds of being overweight/obese. Gender may play a key part in breakfast skipping behaviours. These results present an opportunity to identify and target adolescents who may be at risk of a poorer nutritional profile or overweight/obesity.