Dose-Dependent Association of Adolescent Breakfast Consumption with Mental Health and Changes Over Time: an International Observational Study

Objective We aimed to examine the dose-dependent association between breakfast consumption and mental health, and how this relationship has changed over time. Methods Data were obtained from five rounds (2002, 2006, 2010, 2014, and 2018) of a multi-country cross-national survey of school students: Health Behavior in School-aged Children (HBSC). Mental health was measured using a list of eight items for psychosomatic health complaints, combined into a composite score from 0 to 32. Breakfast consumption frequency was measured by the days per week. A multilevel generalized additive model was applied to evaluate the dose-dependent association of adolescent breakfast consumption with mental health. Results This study included 918,564 adolescents, with a mean (SD) age of 13.59 (1.64) years, of whom 473,633 (51.6%) were girls. In the final multivariate-adjusted model, breakfast consumption frequency was negatively associated with mental health, compared with daily breakfast consumption, adolescents with breakfast skipping had significantly higher psychosomatic complaints (β: 2.93, 95% CI: 2.84–3.02, P  < 0.001). This significant non-linear association was consistent across different survey years ( P  < 0.001), gender ( P  < 0.001), and school grade ( P  < 0.001), indicating a broad relevance to adolescent mental health. The association of breakfast consumption on mental health was more pronounced in females ( P for interaction < 0.001) and in higher school grade ( P for interaction < 0.001). Conclusions Breakfast consumption frequency was negatively associated with mental health, and this dose-dependent association exhibited a non-linear pattern. Over time, the association of breakfast consumption on mental health was more pronounced, and this trend particularly was pronounced in recent years. Furthermore, girls and adolescents in higher grades are more likely to experience worse mental health.