Consistent with other reports of breakfast skipping in both adults and adolescents (8
), 21.5% of our participants regularly skipped breakfast. In this study, individuals who skipped breakfast had higher IAAT compared with both breakfast eaters and occasional breakfast eaters independent of covariates. To our knowledge, this is the first study to show a relationship between breakfast consumption and visceral adiposity. These results suggest that even occasional consumption of breakfast is associated with lower visceral adiposity in overweight Latino adolescents.
The importance of breakfast consumption in youth has recently received a lot of attention. Breakfast has been identified as the most commonly missed meal for adolescents (6
). The National Longitudinal Study of Adolescent Health found that 20% of adolescents skipped breakfast the previous day (19
). Adolescents who habitually eat breakfast have been shown to have a lower BMI compared with adolescents who frequently skip breakfast (6
). Cross-sectional research has shown that adolescents who consume breakfast regularly have a lower BMI compared with those who frequently skip breakfast (20
). A recent review of literature also found that adolescents and children who ate breakfast generally consumed more daily calories yet were less likely to be overweight (21
). A high BMI was also significantly associated with breakfast skipping in a study of 16-year-old girls and boys in Finland (8
). In addition, a study of 6- to 19-year-old children and adolescents found that overweight females were more likely to omit breakfast (22
Conflicting data exist on adolescent breakfast consumption and ethnicity. One study found that African-Americans and Hispanics, compared with their white peers, were less likely to omit breakfast (9
). In contrast, Dwyer et al. showed that Hispanic youth were more likely to skip breakfast than their white counterparts (7
). The level of acculturation also seems to play a role in adolescent breakfast consumption. In a study on the behavior of Hispanic immigrants to the United States, the frequency of daily breakfast intake was higher among foreign-born adolescents as compared with US-born adolescents (23
). In a cross-sectional survey of 39,000 youth, minorities were more likely to have a BMI above 85th percentile, and the frequency of eating breakfast was inversely associated with being at or above the 85th percentile (24
). To our knowledge, there have been no studies that show an association of breakfast skipping with distribution of adiposity in minority populations.
Visceral fat accumulation is an important indicator of disease risk including dyslipidemia and glucose intolerance (25
). Although BMI provides a general assessment of overweight, it does not account for variations in the distribution of adiposity. The distribution of body fat is known to be important in the development of metabolic disorders associated with obesity (27
). Of particular interest is the relationship of visceral fat to the development of insulin resistance in both adults and children. We have previously shown that IAAT was positively associated with higher fasting insulin (4
), insulin area under the curve after OGTT (29
), and insulin resistance (4
). However, in the present analysis, the association between breakfast consumption and IAAT remains significant even after adjusting for fasting insulin and insulin sensitivity. These results suggest that breakfast skipping is associated with IAAT independent of insulin action.
One possible explanation is that that regularly omitting breakfast may have resulted in a decreased number of total eating episodes by the breakfast skippers, as compared with the other groups. Although we did not examine meal frequency in this study, this is one hypothesis to support our breakfast findings. Several studies have been conducted examining this relationship of meal frequency to adiposity in pediatric populations. Two pediatric studies found an association between eating frequency and prevalence of overweight (30
), whereas two found no association (32
). However, these studies used BMI or weight to height proportions to assess adiposity and no assessment of precise measures of adiposity or metabolic factors, i.e., thermic effect of food or glucose or insulin dynamics, was reported. For this particular study, we were interested in examining the effects of breakfast consumption rather than total meal frequency on fat distribution and insulin dynamics. In this study, breakfast consumption was inversely related to visceral adiposity, whereas no association to insulin dynamics was found, and these results were independent of energy intake. Given that there were no differences in daily energy intake and insulin dynamics between the breakfast groups, our findings may be more related to the differences in the thermic effect of food, although not measured in this study. For future analyses and papers, we intend to explore the relationship of meal patterns and frequency with adiposity and metabolic parameters.
Another explanation to consider is the impact of the macro-nutrient content of the breakfast on adiposity and metabolic parameters. Several studies have shown that the type of breakfast consumed, specifically high fiber or whole grain cereals, is associated with reduced BMI (19
) and insulin values (36
). In the current analyses, there were no significant differences in daily total macronutrient intake between breakfast groups. In addition, breakfast consumption was inversely related to IAAT independent of macronutrient intake. Thus, the macronutrient intake of the breakfast meal did not appear to influence our findings. However, the purpose of this study was to compare the effects of regular breakfast consumption, regardless of type, to irregular and skipping breakfast on adiposity parameters.
There are several limitations in this study. There may be a bias of dietary reporting and possibly underreporting of overweight subjects. However, because our entire cohort was overweight, we would expect similar underreporting across the whole sample. Also, two dietary recalls may not adequately represent participants’ usual dietary intake patterns. In addition, there is no clear definition of breakfast consumption. A recent study found that the percentage of breakfast skippers varied greatly by how breakfast was categorized (37
). However, our definition is similar to one used in past studies (6
). Our small sample size and lack of adjustment for physical activity may also be limiting factors. Furthermore, because the current study is cross-sectional, no firm conclusions can be drawn about the causative relationship of breakfast consumption and IAAT over time. Finally, for this particular study, we did not look at the food composition of the breakfast consumed, and intend to examine this in later studies.
In summary, we have found that breakfast skipping was related to increased visceral fat independent of age, gender, total fat, total lean tissue, and total energy intake. These findings suggest that interventions promoting breakfast consumption may reduce the risk for visceral adiposity and subsequently diseases associated with visceral adiposity in overweight Latino youth. More pediatric studies should be conducted investigating the role of meal patterns, specifically breakfast consumption, in adiposity, using precise methodology.