The main findings of this study indicated that breakfast skipping or infrequent breakfast consumption amongst adolescents was significantly associated with higher DXA-determined total body adiposity, abdominal obesity, assessed by WC and body weight, compared to those who habitually ate breakfast, after taking into account other potential confounding factors. This finding is in line with studies in children and adolescents in Hong Kong and in the United States 
. An analysis of cross-sectional data in 693 Minnesota adolescents at the end of a 2-year follow-up study showed that adolescents who consumed breakfast more frequently tended to have lower BMI and%BF than those consuming breakfast less frequently 
. In addition, a recent cross-sectional study in Hong Kong also found that Chinese children and adolescents aged from 9- to 18 years, who were breakfast skippers or only ate breakfast twice or less in a week had higher BMI levels compared to those who were non-breakfast skippers 
. Furthermore, infrequent breakfast consumption during childhood is associated with higher obesity risk in adulthood as shown in previous studies 
. The National Longitudinal Study of Adolescent Health carried-out by Niemeier and his co-workers showed that adolescents who skipped breakfast each day during adolescence had a significantly greater risk of developing obesity during the transition into adulthood 
. Similarly, a recent longitudinal study of children aged 9 to 15 years at the start of the study, when followed over 24 years also found that breakfast skipping in both childhood and current adulthood life were significantly associated with higher levels of BMI, waist circumference and blood markers of insulin and low-density lipoprotein-cholesterol compared to those who were taking breakfast at both time points, suggesting that infrequent breakfast consumption over a long period may have detrimental effects on body weight and cardio-metabolic health 
In contrast, several studies with Australian, Portuguese and Saudi Arabian children and adolescents found that there was no significant association between daily breakfast eaters and body weight levels in male and female adolescents 
. These discrepancies may be partly due to differences in definitions of breakfast skipping and confounding variables used in the final analysis model 
. However, in the present study, a significant inverse association was found between infrequent breakfast eaters and body composition and body adiposity and this remained statistically significant, even after adjustment for potential dietary and lifestyle confounding factors. The lack of a universal definition for breakfast skipping practices and assessment of the breakfast meal may further complicate the interpretation of the influence of breakfast consumption on health-related outcomes. The definition of breakfast skipping may have a direct impact on the responses given by the participants. For instance, in the previous study, breakfast skipping status was defined as ‘seldom' or ‘never' eating breakfast in a week 
, whereas in the present study it was defined as taking breakfast less than 5 times a week. The use of quantitative classifications, as in the present study, seems to be more helpful in determining the association between breakfast consumption and body composition because self- perception assessment of patterns of eating breakfast in qualitative terms may not be as accurate in reporting actual meal consumption frequency.
Although the mechanisms that explain the influence of infrequent breakfast consumption on body composition are still unknown, there are several plausible theories that could explain such phenomena in adolescents. The habitual skipping of breakfast was associated with poor food choices and unfavorable nutrient intakes 
. Several studies have shown that children who frequently consumed breakfast tended to consume more fruits and vegetables 
. Furthermore, breakfast skippers tend to have diets that are high in energy-dense foods and have an increased tendency of overeating at other meals during the day 
. Several studies have also reported that breakfast skipping was closely associated with dieting practices in girls, because of concerns about body weight and dissatisfaction with their body shape 
. In the present study, almost half of the adolescent girls reported skipping breakfast because of concerns about becoming fat (data not shown). A similar observation was reported in school-aged adolescent girls in the United Kingdom 
. It was generally found that adolescents, especially girls, believed that skipping breakfast was an effective method of dieting to lose weight and reduced daily energy intakes 
. However, our findings show that infrequent breakfast eating was significantly associated with higher body adiposity levels compared regular breakfast consumption.
As the trend towards breakfast skipping has been increasing in children and adolescents, the detrimental effects of breakfast skipping on their health have become increasingly recognised 
. Therefore, more effort should be made to encourage healthy daily breakfast consumption practices in growing children and adolescents, when behavioural patterns are becoming established during this critical stage of life. One approach could be to introduce healthy breakfast intervention programs at school, as most growing children and adolescents spend much of their time at school. Therefore, active involvement of school authorities, food providers and health personnel would be important to ensure that a successful school breakfast intervention program could be implemented. Continuous monitoring and evaluation would also be needed to ensure that such a program was successful. Healthy eating campaigns at school would not only benefit the students, but may also help their parents in choosing healthy dietary habits at home. Nutrition education by teachers is important for encouraging regular and healthful food choices during breakfast among schoolchildren. Thus, more effort should be directed towards increasing the opportunities for children and adolescents to consume a nutritious breakfast by providing a greater variety of healthy foods for breakfast at school. The government should consider subsidizing the provision of healthy breakfast meals for students from socioeconomically disadvantaged groups.
Some limitations of the present study need to be acknowledged. Due to the cross-sectional design of this study, causality for the positive association between infrequent breakfast consumption and body adiposity and abdominal obesity in adolescents cannot be established. Secondly, for this particular study, we did not look at the nutritional quality of the breakfasts consumed. For instance, the nutrients from breakfast consumption could not be calculated as portion sizes of breakfast foods were not recorded. This finding in apparently healthy adolescents should serve as the basis for future longitudinal studies with large populations to investigate the interaction between infrequent breakfast consumption and obesity and risks of metabolic disorders in growing children. However, a particular strength of this study was to determine body composition and body adiposity accurately by dual energy X-ray absorptiometry (DXA), which is now regarded as the reference method to assess the total body soft tissue composition in children and adolescents. It exposes subjects to only low level of ionizing radiation, is easy to operate and is less expensive compared to CT and MRI procedures 
. In addition, the inclusion of important biological, dietary and lifestyle confounders such as pubertal growth status, energy intake, snacking and total PA levels in the multivariate analysis model are strengths of this study. Lastly, it is important to note that there is little published information on the breakfast habits of Malaysian adolescents. The large sample size with a power of >70% for detecting differences in body composition status between the habitual and infrequent breakfast eaters over a wide age range, therefore gives confidence for the conclusion that breakfast skipping in this population is a significant influence on health.