Prospective association between breakfast consumption frequency and BMI z-score among European school-aged children. The Feel4Diabetes Study.

Background The long-term effects of breakfast on childhood z-BMI remain inconclusive. Objective To prospectively assess the impact of stable and altered breakfast consumption habits on z-BMI change over two years, in school-aged children across six European countries. Methods Data of 6,528 children (8.2 ± 1.0 years, 48.9% male) from the Feel4Diabetes study were used. Children's lifestyle behaviors, including breakfast frequency, were assessed through parent-reported questionnaires. Weight and height were objectively measured and converted to z-BMI. Participants were categorized into trajectories combining breakfast consumption habit (i.e. regular consumption, irregular consumption or omission) at baseline and follow up. Logistic regression analyzed the prospective association between breakfast trajectories and z-BMI increase, with adjustment for demographic and lifestyle variables. Results A statistically signidficant effect of breakfast trajectories was observed in z-BMI, both at baseline and follow up. Stable skippers was the only trajectory that showed a significant increase in BMI z-score from baseline to follow up (0.891 ± 1.058 vs. 1.034 ± 1.072 respectively, p < 0.05). BMI z-score at follow up of regular eaters (0.615 ± 0.967) was significantly lower, compared to both irregular eaters (1.229 ± 0.890) and stable skippers (both p < 0.05).Stable regular consumption and transition from omission to regular consumption were independently associated with significantly lower risk of z-BMI gain, compared to stable omission [OR,95%CI: 0.55 (0.31,0.97), p = 0.039 and 0.43 (0.21, 0.88), p = 0.021 respectively]. Conclusion Stable regular breakfast consumption or transition from omission to regular consumption seem to contribute to superior weight regulation in children and to independently protect against z-BMI gain, compared to stable omission. Further studies are warranted to extend the evidence on the breakfast habit-BMI association among children.