National patterns of breakfast consumption: Nutritional and health implications
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The nutritional and health implications of breakfast skipping and type of breakfast consumed were assessed in children (9-13 years, n=4,320), adolescents (14-18 years, n=5,339), and young adults (19-39 years, n=5,316) via three studies. Cross-sectional datasets from the National Health and Nutrition Examination Survey (1999-2006) were used. A 24-hour dietary recall was used to assess self-reported breakfast/brunch consumption, nutrient intakes, nutrient adequacy, and diet quality (i.e., mean adequacy ratio [MAR] and Healthy Eating Index [HEI] scores respectively). Occurrence(s) of overweight/obesity (among all), and the metabolic syndrome (MetS) and its related risk factors (among young adults) were examined using anthropometric and laboratory measurements. Covariate-adjusted sample-weighted means were compared using analysis of variance (with Bonferroni's correction) between breakfast skippers (BS), ready-to-eat cereal (RTEC) breakfast consumers, and other breakfast (OB) consumers. Associations between breakfast consumption, overweight/obesity, and risk factors for MetS were determined using covariate-adjusted multinomial logistic regression. Results revealed that 20.1% children, 31.5% adolescents, and 25.1% young adults were BS; 35.9% children, 25.4% adolescents, and 16.5% young adults were RTEC consumers. Among all ages, compared to BS and OB consumers, the mean percent energy intakes from total fat were lower and carbohydrate were higher among RTEC consumers. Among all ages, compared to BS and OB consumers, RTEC consumers had higher mean intakes of dietary fiber and several micronutrients, and had lower mean intakes of cholesterol. Among all ages, the MAR for micronutrients was highest in RTEC consumers and lowest in BS. In children/adolescents, BS had a higher mean waist circumference (i.e., abdominal obesity) than RTEC and OB consumers. Overall obesity occurrence was higher in BS than RTEC consumers in children/adolescents and was higher in OB than RTEC consumers in adolescents. Among young adults, compared to BS and OB consumers, the mean total HEI score and its several component scores (for the intakes of whole fruits, whole grains, milk, and discretionary calories) were higher among RTEC consumers. Among young adults, compared to BS and OB consumers, the mean values for body mass index, waist circumference (i.e., abdominal obesity), and triceps skinfold measurement were all lower among RTEC consumers. In young adults, compared to BS, RTEC consumers had lower mean serum total and low-density lipoprotein cholesterol concentrations and insulin resistance. Relative to BS and OB consumers, young adults who consumed RTEC had lower odds of being overweight/obese, having abdominal obesity, and hyperhomocysteinemia. Thus, compared to BS and OB consumers, RTEC consumers had better nutrient intakes/adequacy and diet quality, as well as lower adiposity measures and serum/plasma metabolic risk factors.