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1.  Regular Breakfast Consumption and Type 2 Diabetes Risk Markers in 9- to 10-Year-Old Children in the Child Heart and Health Study in England (CHASE): A Cross-Sectional Analysis 
PLoS Medicine  2014;11(9):e1001703.
Angela Donin and colleagues evaluated the association between breakfast consumption and composition and risk markers for diabetes and cardiovascular disease in 9- and 10-year-olds.
Please see later in the article for the Editors' Summary
Regular breakfast consumption may protect against type 2 diabetes risk in adults but little is known about its influence on type 2 diabetes risk markers in children. We investigated the associations between breakfast consumption (frequency and content) and risk markers for type 2 diabetes (particularly insulin resistance and glycaemia) and cardiovascular disease in children.
Methods and Findings
We conducted a cross-sectional study of 4,116 UK primary school children aged 9–10 years. Participants provided information on breakfast frequency, had measurements of body composition, and gave fasting blood samples for measurements of blood lipids, insulin, glucose, and glycated haemoglobin (HbA1c). A subgroup of 2,004 children also completed a 24-hour dietary recall. Among 4,116 children studied, 3,056 (74%) ate breakfast daily, 450 (11%) most days, 372 (9%) some days, and 238 (6%) not usually. Graded associations between breakfast frequency and risk markers were observed; children who reported not usually having breakfast had higher fasting insulin (percent difference 26.4%, 95% CI 16.6%–37.0%), insulin resistance (percent difference 26.7%, 95% CI 17.0%–37.2%), HbA1c (percent difference 1.2%, 95% CI 0.4%–2.0%), glucose (percent difference 1.0%, 95% CI 0.0%–2.0%), and urate (percent difference 6%, 95% CI 3%–10%) than those who reported having breakfast daily; these differences were little affected by adjustment for adiposity, socioeconomic status, and physical activity levels. When the higher levels of triglyceride, systolic blood pressure, and C-reactive protein for those who usually did not eat breakfast relative to those who ate breakfast daily were adjusted for adiposity, the differences were no longer significant. Children eating a high fibre cereal breakfast had lower insulin resistance than those eating other breakfast types (p for heterogeneity <0.01). Differences in nutrient intakes between breakfast frequency groups did not account for the differences in type 2 diabetes markers.
Children who ate breakfast daily, particularly a high fibre cereal breakfast, had a more favourable type 2 diabetes risk profile. Trials are needed to quantify the protective effect of breakfast on emerging type 2 diabetes risk.
Please see later in the article for the Editors' Summary
Editors' Summary
Worldwide, more than 380 million people have diabetes, a disorder that is characterized by high levels of glucose (sugar) in the blood. Blood sugar levels are usually controlled by insulin, a hormone released by the pancreas after meals (digestion of food produces glucose). In people with type 2 diabetes (the commonest type of diabetes) blood sugar control fails because the fat and muscle cells that normally respond to insulin become insulin resistant. Type 2 diabetes can often be controlled initially with diet and exercise and with drugs such as metformin and sulfonylureas. However, many patients eventually need insulin injections to control their blood sugar levels. Long-term complications of diabetes, which include an increased risk of heart disease and stroke (cardiovascular disease), reduce the life expectancy of people with diabetes by about 10 years compared to people without diabetes. Risk factors for the condition include being over 40 years old and being overweight or obese.
Why Was This Study Done?
Experts predict that by 2035 nearly 600 million people will have diabetes so better strategies to prevent diabetes are urgently needed. Eating breakfast regularly—particularly a high fiber, cereal-based breakfast—has been associated with a reduced risk of type 2 diabetes (and a reduced risk of being overweight or obese) in adults. However, little is known about whether breakfast eating habits affect markers of type 2 diabetes risk in children. In this cross-sectional study (an observational investigation that studies a group of individuals at a single time point), the researchers examine the associations between breakfast consumption (both frequency and content) and risk markers for type 2 diabetes, particularly insulin resistance and glycemia (the presence of sugar in the blood), in an ethnically mixed population of children; insulin resistance and glycemia measurements in children provide important information about diabetes development later in life.
What Did the Researchers Do and Find?
The researchers invited 9–10 year old children attending 200 schools in London, Birmingham, and Leicester to participate in the Child Heart and Health Study in England (CHASE), a study examining risk factors for cardiovascular disease and type 2 diabetes in children of South Asian, black African-Caribbean, and white European origin. The researchers measured the body composition of the study participants and the levels of insulin, glucose, and other markers of diabetes risk in fasting blood samples (blood taken from the children 8–10 hours after their last meal or drink). All the participants (4,116 children) reported how often they ate breakfast; 2,004 children also completed a 24-hour dietary recall questionnaire. Seventy-four percent of the children reported that they ate breakfast every day, 11% and 9% reported that they ate breakfast most days and some days, respectively, whereas 6% reported that they rarely ate breakfast. Children who ate breakfast infrequently had higher fasting insulin levels and higher insulin resistance than children who ate breakfast every day. Moreover, the children who ate a high fiber, cereal-based breakfast had lower insulin resistance than children who ate other types of breakfast such as low fiber or toast-based breakfasts.
What Do These Findings Mean?
These findings indicate that children who ate breakfast every day, particularly those who ate a high fiber breakfast, had lower levels of risk markers for type 2 diabetes than children who rarely ate breakfast. Importantly, the association between eating breakfast and having a favorable type 2 diabetes risk profile remained after allowing for differences in socioeconomic status, physical activity levels, and amount of body fat (adiposity); in observational studies, it is important to allow for the possibility that individuals who share a measured characteristic and a health outcome also share another characteristic (a confounder) that is actually responsible for the outcome. Although trials are needed to establish whether altering the breakfast habits of children can alter their risk of developing type 2 diabetes, these findings are encouraging. Specifically, they suggest that if all the children in England who do not eat breakfast daily could be encouraged to do so, it might reduce population-wide fasting insulin levels by about 4%. Moreover, encouraging children to eat a high fiber breakfast instead of a low fiber breakfast might reduce population-wide fasting insulin levels by 11%–12%. Thus, persuading children to eat a high fiber breakfast regularly could be an important component in diabetes preventative strategies in England and potentially worldwide.
Additional Information
Please access these websites via the online version of this summary at
The US National Diabetes Information Clearinghouse provides information about diabetes for patients, health-care professionals, and the general public, including detailed information on diabetes prevention (in English and Spanish)
The UK National Health Service Choices website provides information for patients and carers about type 2 diabetes and about living with diabetes; it also provides people's stories about diabetes; Change4Life, a UK campaign that provides tips for healthy living, has a webpage about the importance of a healthy breakfast
The charity Diabetes UK provides detailed information for patients and carers in several languages, including information on healthy lifestyles for people with diabetes
The UK-based non-profit organization Healthtalkonline has interviews with people about their experiences of diabetes
MedlinePlus provides links to further resources and advice about diabetes and diabetes prevention (in English and Spanish)
Kidshealth, a US-based not-for-profit organization provides information for parents about the importance of breakfast and information for children
More information about the Child Heart and Health Study in England (CHASE) is available
PMCID: PMC4151989  PMID: 25181492
2.  Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: results of a cross-sectional study 
BMC Public Health  2012;12:881.
In developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors.
Design: Cross-sectional study. Setting: Eight schools (Private and Government) of Delhi in the year 2006. Participants: 1814 students from 8th and 10th grades; response rate was 87.2%; 55% were 8th graders, 60% were boys and 52% attended Private schools. Main outcome measures: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors. Data analysis: Mixed effects regression models were employed, adjusting for age, gender, grade level and school type (SES).
Significantly more Government school (lower SES) students consumed breakfast daily as compared to Private school (higher SES) students (73.8% vs. 66.3%; p<0.01). More 8th graders consumed breakfast daily vs.10th graders (72.3% vs. 67.0%; p<0.05). A dose–response relationship was observed such that overall prevalence of overweight and obesity among adolescents who consumed breakfast daily (14.6%) was significantly lower vs. those who only sometimes (15.2%) or never (22.9%) consumed breakfast (p<0.05 for trend). This relationship was statistically significant for boys (15.4 % vs. 16.5% vs. 26.0; p<0.05 for trend) but not for girls. Intake of dairy products, fruits and vegetables was 5.5 (95% CI 2.4-12.5), 1.7 (95% CI 1.1-2.5) and 2.2 (95% CI 1.3-3.5) times higher among those who consumed breakfast daily vs. those who never consumed breakfast. Breakfast consumption was associated with greater physical activity vs. those who never consumed breakfast. Positive values and beliefs about healthy eating; body image satisfaction; and positive peer and parental influence were positively associated with daily breakfast consumption, while depression was negatively associated.
Daily breakfast consumption is associated with less overweight and obesity and with healthier dietary- and physical activity-related behaviors among urban Indian students. Although prospective studies should confirm the present results, intervention programs to prevent or treat childhood obesity in India should consider emphasizing regular breakfast consumption.
PMCID: PMC3549919  PMID: 23075030
Breakfast; Obesity; Adolescent; Diet; Physical activity; Behavior
3.  Effects of a free school breakfast programme on school attendance, achievement, psychosocial function, and nutrition: a stepped wedge cluster randomised trial 
BMC Public Health  2010;10:738.
Approximately 55,000 children in New Zealand do not eat breakfast on any given day. Regular breakfast skipping has been associated with poor diets, higher body mass index, and adverse effects on children's behaviour and academic performance. Research suggests that regular breakfast consumption can improve academic performance, nutrition and behaviour. This paper describes the protocol for a stepped wedge cluster randomised trial of a free school breakfast programme. The aim of the trial is to determine the effects of the breakfast intervention on school attendance, achievement, psychosocial function, dietary habits and food security.
Sixteen primary schools in the North Island of New Zealand will be randomised in a sequential stepped wedge design to a free before-school breakfast programme consisting of non-sugar coated breakfast cereal, milk products, and/or toast and spreads. Four hundred children aged 5-13 years (approximately 25 per school) will be recruited. Data collection will be undertaken once each school term over the 2010 school year (February to December). The primary trial outcome is school attendance, defined as the proportion of students achieving an attendance rate of 95% or higher. Secondary outcomes are academic achievement (literacy, numeracy, self-reported grades), sense of belonging at school, psychosocial function, dietary habits, and food security. A concurrent process evaluation seeks information on parents', schools' and providers' perspectives of the breakfast programme.
This randomised controlled trial will provide robust evidence of the effects of a school breakfast programme on students' attendance, achievement and nutrition. Furthermore the study provides an excellent example of the feasibility and value of the stepped wedge trial design in evaluating pragmatic public health intervention programmes.
Trial Registration Number
Australian New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12609000854235
PMCID: PMC3009648  PMID: 21114862
4.  The nutritional impact of breakfast consumption on the diets of inner-city African-American elementary school children. 
To determine the contribution of breakfast-eating behavior to dietary adequacy among low-income African-American children, 1151 children attending grades two through five at four elementary schools in East Orange, New Jersey were studied. Results of a 4-day eating behavior survey and a 24-hour dietary recall reveal that on any given day, 12% to 26% of children attend school without having eaten anything. Thirty-six percent of the children were obese, which did not vary with breakfast-eating behavior. A significantly greater proportion of the children who skipped breakfast compared to those who ate breakfast failed to achieve dietary adequacy for nearly every nutrient studied. More than one third of breakfast skippers consumed < 50% of the recommended dietary allowance for vitamins A, E, B6, and folacin, and nearly one fourth consumed < 50% of the recommended dietary allowance for calories, vitamin C, calcium, and iron. Not eating breakfast results in substantial deficits in dietary intake of a variety of essential nutrients among low-income African-American school children. Efforts to improve the nutritional status of children should include nutrition education to promote breakfast.
PMCID: PMC2607827  PMID: 7731069
5.  Changes in dietary pattern in 15 year old adolescents following a 4 month dietary intervention with school breakfast – a pilot study 
Nutrition Journal  2006;5:33.
Few studies on impact of meals served in school have been published. However, implications of school meals are an actual issue of both public and political concern in several countries. The objective of this study was to evaluate if breakfast served in a lower secondary school could improve dietary habits and school performance among the students.
All students in 10th grade in a lower secondary school, consisting of two school classes, were invited to participate in a controlled study. The students in one class were offered a free breakfast at the beginning of each school day for 4 months, while the students in the second class were controls. Both classes were educated in the importance of healthy eating, and a data program enabling them to evaluate dietary intake was introduced. The students answered two questionnaires, one on school performance and one short food frequency questionnaire, four weeks before study start and one week after. Body weight and height were measured by the school nurse at the beginning and end of the study. Because of few students in each group, non-parametrical statistic analyses were used.
All students in the intervention group had breakfast at school during the intervention. One week after the intervention the students in the class who received breakfast had returned to their normal breakfast pattern. In the control group the frequency of a lunch intake had increase, as compared to before study start (p < 0.01). An improved food pattern was seen among the male students in the intervention group, as measured by a healthy eating index after the intervention (p < 0.01). Body Mass Index increased statistically significant in both males and females in the control group (p < 0,01 for males and p < 0.05 for females), but not in the intervention group. Improvement in school performance following school breakfast was not found, but the males in the intervention group reported a significant increase in school contentment (p < 0.05).
In a lower secondary school class served breakfast for 4 months, dietary intake changed to a more healthy profile and weight gain was reduced.
PMCID: PMC1713247  PMID: 17150115
6.  Breakfast Habits Among School Children in Selected Communities in the Eastern Region of Ghana 
Ghana Medical Journal  2014;48(2):71-77.
Breakfast is considered the most important meal of the day, yet many people skip breakfast. Studies indicate that school age children who regularly skip breakfast are not likely to concentrate in class, thus affecting school performance. This study determined the breakfast habits and nutrient contributions of the breakfast meal to the days' nutrient intake.
A cross sectional study was conducted among school children (n=359) between the ages of 6–19 years in Manya Krobo in the Eastern Region of Ghana. Questionnaires were used to collect information on background characteristics and breakfast consumption habits. The 24-hour dietary recall method was used to obtain information on the children's food intake. T-test was used to compare differences between means of variables of breakfast consumers and skippers.
About 85.5% of the children had breakfast on the day of interview. More boys (87.8%) consumed breakfast compared to the girls (83.1%). For those who skipped breakfast, lack of food at home or lack of no money (36.5%) was the main reason. Breakfast consumers had significantly higher energy and nutrient intakes than those who skipped breakfast (energy 2259 verses 1360 kcal, p-0.039; vitamin A 1534 verses 662 ug/RE, p=0.001; iron 22.9 verses 13.9 mg, p=0.017, zinc 9.9 verses 5.6 mg, p=0.034). The breakfast meal contributed between 32–41% of the day's energy intake, and between 30–47% of micronutrient intake.
Encouraging breakfast consumption among school children is a way to ensure that they meet their daily nutrient and energy intakes.
PMCID: PMC4310337  PMID: 25667553
Breakfast; School children; Energy; Nutrients; Ghana
7.  Eating breakfast and dinner together as a family: Associations with sociodemographic characteristics and implications for diet quality and weight status 
Journal of the Academy of Nutrition and Dietetics  2013;113(12):10.1016/j.jand.2013.08.011.
Research has shown that adolescents who frequently share evening meals with their families experience more positive health outcomes, including diets of higher nutritional quality. However, little is known about families eating together at breakfast.
This study examined sociodemographic differences in family meal frequencies in a population-based adolescent sample. Additionally, this study examined associations of family breakfast meal frequency with dietary quality and weight status.
Cross-sectional data from EAT 2010 (Eating and Activity in Teens) included anthropometric assessments and classroom-administered surveys completed in 2009-2010.
Participants included 2,793 middle and high school students (53.2% girls, mean age=14.4 years) from Minneapolis/St. Paul, MN, public schools.
Main outcome measures
Usual dietary intake was self-reported on a food frequency questionnaire. Height and weight were measured.
Statistical analyses performed
Regression models adjusted for sociodemographic characteristics, family dinner frequency, family functioning, and family cohesion were used to examine associations of family breakfast frequency with dietary quality and weight status.
On average, adolescents reported having family breakfast meals 1.5 times (SD=2.1) and family dinner meals 4.1 times (SD=2.6) in the past week. There were racial/ethnic differences in family breakfast frequency, with the highest frequencies reported by adolescents of Black, Hispanic, Native American, and mixed race/ethnicity. Family breakfast frequency was also positively associated with male sex; younger age; and living in a two-parent household. Family breakfast frequency was associated with several markers of better diet quality (such as higher intake of fruit, whole grains, and fiber) and lower risk for overweight/obesity. For example, adolescents who reported seven family breakfasts in the past week consumed an average of 0.37 additional daily fruit servings compared to adolescents who never had a family breakfast meal.
Results suggest that eating breakfast together as a family may have benefits for adolescents’ dietary intake and weight status.
PMCID: PMC3833880  PMID: 24139290
Adolescents; Family meals; Breakfast; Dietary intake; Overweight
8.  Children's body mass index, participation in school meals, and observed energy intake at school meals 
Data from a dietary-reporting validation study with fourth-grade children were analyzed to investigate a possible relationship of body mass index (BMI) with daily participation in school meals and observed energy intake at school meals, and whether the relationships differed by breakfast location (classroom; cafeteria).
Data were collected in 17, 17, and 8 schools during three school years. For the three years, six, six, and seven of the schools had breakfast in the classroom; all other schools had breakfast in the cafeteria. Information about 180 days of school breakfast and school lunch participation during fourth grade for each of 1,571 children (90% Black; 53% girls) was available in electronic administrative records from the school district. Children were weighed and measured, and BMI was calculated. Each of a subset of 465 children (95% Black; 49% girls) was observed eating school breakfast and school lunch on the same day. Mixed-effects regression was conducted with BMI as the dependent variable and school as the random effect; independent variables were breakfast participation, lunch participation, combined participation (breakfast and lunch on the same day), average observed energy intake for breakfast, average observed energy intake for lunch, sex, age, breakfast location, and school year. Analyses were repeated for BMI category (underweight/healthy weight; overweight; obese; severely obese) using pooled ordered logistic regression models that excluded sex and age.
Breakfast participation, lunch participation, and combined participation were not significantly associated with BMI or BMI category irrespective of whether the model included observed energy intake at school meals. Observed energy intake at school meals was significantly and positively associated with BMI and BMI category. For the total sample and subset, breakfast location was significantly associated with BMI; average BMI was larger for children with breakfast in the classroom than in the cafeteria. Significantly more kilocalories were observed eaten at breakfast in the classroom than in the cafeteria.
For fourth-grade children, results provide evidence of a positive relationship between BMI and observed energy intake at school meals, and between BMI and school breakfast in the classroom; however, BMI and participation in school meals were not significantly associated.
PMCID: PMC2859739  PMID: 20334667
9.  Effects of a free school breakfast programme on children's attendance, academic achievement and short-term hunger: results from a stepped-wedge, cluster randomised controlled trial 
Free school breakfast programmes (SBPs) exist in a number of high-income countries, but their effects on educational outcomes have rarely been evaluated in randomised controlled trials.
A 1-year stepped-wedge, cluster randomised controlled trial was undertaken in 14 New Zealand schools in low socioeconomic resource areas. Participants were 424 children, mean age 9±2 years, 53% female. The intervention was a free daily SBP. The primary outcome was children's school attendance. Secondary outcomes were academic achievement, self-reported grades, sense of belonging at school, behaviour, short-term hunger, breakfast habits and food security.
There was no statistically significant effect of the breakfast programme on children's school attendance. The odds of children achieving an attendance rate <95% was 0.76 (95% CI 0.56 to 1.02) during the intervention phase and 0.93 (95% CI 0.67 to 1.31) during the control phase, giving an OR of 0.81 (95% CI 0.59 to 1.11), p=0.19. There was a significant decrease in children's self-reported short-term hunger during the intervention phase compared with the control phase, demonstrated by an increase of 8.6 units on the Freddy satiety scale (95% CI 3.4 to 13.7, p=0.001). There were no effects of the intervention on any other outcome.
A free SBP did not have a significant effect on children's school attendance or academic achievement but had significant positive effects on children's short-term satiety ratings. More frequent programme attendance may be required to influence school attendance and academic achievement.
Trial registration
Australian New Zealand Clinical Trials Registry (ANZCTR)—ACTRN12609000854235.
PMCID: PMC3582067  PMID: 23043203
Breakfast; intervention; randomised controlled trial; schools; education; child health; diet; public health; randomised trials; exercise
10.  The effects of breakfast on behavior and academic performance in children and adolescents 
Breakfast consumption is associated with positive outcomes for diet quality, micronutrient intake, weight status and lifestyle factors. Breakfast has been suggested to positively affect learning in children in terms of behavior, cognitive, and school performance. However, these assertions are largely based on evidence which demonstrates acute effects of breakfast on cognitive performance. Less research which examines the effects of breakfast on the ecologically valid outcomes of academic performance or in-class behavior is available. The literature was searched for articles published between 1950–2013 indexed in Ovid MEDLINE, Pubmed, Web of Science, the Cochrane Library, EMBASE databases, and PsychINFO. Thirty-six articles examining the effects of breakfast on in-class behavior and academic performance in children and adolescents were included. The effects of breakfast in different populations were considered, including undernourished or well-nourished children and adolescents from differing socio-economic status (SES) backgrounds. The habitual and acute effects of breakfast and the effects of school breakfast programs (SBPs) were considered. The evidence indicated a mainly positive effect of breakfast on on-task behavior in the classroom. There was suggestive evidence that habitual breakfast (frequency and quality) and SBPs have a positive effect on children's academic performance with clearest effects on mathematic and arithmetic grades in undernourished children. Increased frequency of habitual breakfast was consistently positively associated with academic performance. Some evidence suggested that quality of habitual breakfast, in terms of providing a greater variety of food groups and adequate energy, was positively related to school performance. However, these associations can be attributed, in part, to confounders such as SES and to methodological weaknesses such as the subjective nature of the observations of behavior in class.
PMCID: PMC3737458  PMID: 23964220
breakfast; behavior; academic performance; children; adolescents; learning
11.  Breakfast consumption is positively associated with nutrient adequacy in Canadian children and adolescents 
The British Journal of Nutrition  2014;112(8):1373-1383.
Although breakfast is associated with more favourable nutrient intake profiles in children, limited data exist on the impact of breakfast on nutrient adequacy and the potential risk of excessive intakes. Accordingly, we assessed differences in nutrient intake and adequacy among breakfast non-consumers, consumers of breakfasts with ready-to-eat cereal (RTEC) and consumers of other types of breakfasts. We used cross-sectional data from 12 281 children and adolescents aged 4–18 years who took part in the nationally representative Canadian Community Health Survey, 2004. Mean nutrient intakes (obtained using a multiple-pass 24 h recall method) were compared among the breakfast groups using covariate-adjusted regression analysis. Usual nutrient intake distributions, generated using the National Cancer Institute method, were used to determine the prevalence of nutrient inadequacy or the potential risk of excessive intakes from food sources alone and from the combination of food plus supplements. Of these Canadian children, 10 % were breakfast non-consumers, 33 % were consumers of RTEC breakfasts and 57 % were consumers of other types of breakfasts. Non-consumption of breakfast increased with age (4–8 years: 2 %; 9–13 years: 9 %; 14–18 years: 18 %). Breakfast consumers had higher covariate-adjusted intakes of energy, many nutrients and fibre, and lower fat intakes. The prevalence of nutrient inadequacy for vitamin D, Ca, Fe and Mg (from food alone or from the combination of food plus supplements) was highest in breakfast non-consumers, intermediate in consumers of other types of breakfasts and lowest in consumers of RTEC breakfast. For vitamin A, P and Zn, breakfast non-consumers had a higher prevalence of nutrient inadequacy than both breakfast groups. The potential risk of excessive nutrient intakes was low in all groups. Efforts to encourage and maintain breakfast consumption in children and adolescents are warranted.
PMCID: PMC4197762  PMID: 25196844
Dietary surveys; Nutrition assessment; Breakfast; Population studies
12.  P25 - Growing Strong and Healthy with Mister Bone: An Educational Programme to Ensure Strong Bones Later in Life 
Bone mass increases steadily until the age of 20–30 years and most bone mass is acquired during the first two decades of life. Nutrition plays a critical role in the achievement of one’s optimal genetically programmed peak bone mass (PBM), reducing the risk of osteoporosis later in life. PBM is the amount of bony tissue present in the skeleton at the end of skeletal maturation. Even though 90% of PBM is acquired by the end of second decade of life, skeletal mass continues to increase for up to 10–15 years after that, through the process of bone consolidation, with maximal PBM occurring at around 30 years of age. As a 10% increase in PBM corresponds to a gain of one standard deviation in bone mineral density in adulthood, osteoporotic fracture risk may be reduced by up to 50% by interventions aimed at maximising PBM in a sustainable manner in childhood and adolescence. Although genetic factors are the strongest predictors of bone mass, accounting for 50–80% of its variance, nutritional and lifestyle factors can explain an additional 20–30% of bone mass variance.
Bone is living tissue like any other, and its cells have the same kinds of nutrient needs as those of the rest of the body; it does not require only an energy supply, but also protein and micronutrients, calcium and vitamin D in primis. In a balanced western-style diet, about 60% of dietary calcium should come from milk and dairy products, 20% from fresh vegetables and dried fruits, and the rest from drinking water or other discrete sources.
Current research indicates that calcium intake in school-age children is below the recommended adequate level.The recommended adequate intake of calcium for children between the ages of 9 and 11 years is about 1100–1200 mg.
In response to this critical health issue it is essential to monitor children’s intake of dairy products and nutrients important for bone health, such as calcium and vitamin D, in order to ensure that their nutritional needs are met and that they are receiving the nutritional intakes needed to safeguard their health later in life. The aim of our study was to monitor and promote the intake of dairy products, calcium and vitamin D in children, in order to help them achieve their optimal PBM and to safeguard their bone health later in life. Modifications in schoolchildren’s nutritional behaviour were evaluated through a nutritional programme designed to increase calcium intake. The project was conducted with the support of novel instruments specifically created for this educational programme.
Our study sample comprised 180 children (48% males and 52% females) aged 9–11 years from a primary school in Florence. We evaluated the children’s eating habits through a questionnaire designed to assess intake of calcium, dairy products, and total caloric energy intake at baseline and at follow up. Data were processed using nutrition software (Win-Food 2.7-MediMatica) and analysed using Student’s paired T-test to determine pre- versus post-intervention differences. The results showed that total caloric intakes rose from 1690±290 before the educational intervention to 1700±330 kcal/day after the educational intervention in boys and from 1620±256 to 1640±260 kcal/day in girls. Statistical analysis of the data did not show any significant variation in pre- versus post-educational assessments (p<0.05), although the protein percentage increased by two points, from 14.5 to 16.5%, while both carbohydrate and lipid intake decreased by one percentage point. Student’s T-test analysis of dietary intakes evaluated, through the questionnaire, before and after the educational intervention revealed a significant increase (p<0.05) in calcium intake, which rose from 860±190 to 1060±200 mg/day in the girls and from 890±200 to 1100±210 mg/day in the boys, and in vitamin D intake, which rose from 3.6±1.53 μg/day to 4.1±2 μg/day, without significant differences emerging between the boys and girls. Although sub-optimal, the calcium intake obtained after the educational programme was sufficient to attain the target RDI of 1100–1200 mg/day. During the educational programme the percentage of children who drank milk rose from 92 to 96%. A change in the quantity of milk intake was also detected: the results showed a significant increase from 200±35 to about 270±65 ml/day in boys and girls (p<0.05). The observations on hard cheese intake revealed an increase in cheese consumers, from 84% to 91% at the end of the educational period. Similarly, a positive change was recorded in the percentage of children eating fresh vegetables: an increase from 89% to 96%.
Our educational programme appears to be significantly effective in modifying calcium intake in children. Analysis of the questionnaire data, which showed significantly increased consumption of dairy products and vegetables, without significant changes in total caloric intakes, revealed an important change in these children’s dietary habits. These behavioural modifications are the result of progressive nutritional education imparted through lessons, brochures, calendars, games, and crosswords. These findings may prompt school policy-makers to introduce educational strategies to promote students’ skeletal health.
PMCID: PMC3213834
13.  Effect of Nutrition Changes on Foods Selected by Students in a Middle School-based Diabetes Prevention Intervention Program; the HEALTHY Experience 
The Journal of School Health  2012;82(2):82-90.
The HEALTHY primary prevention trial developed an integrated multi-component intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program (NSLP), and a la carte venues are compared to the experience of control schools.
The intervention was implemented in 21 middle schools from winter 2007 through spring 2009 (following a cohort of students from sixth through eighth grades); 21 schools acted as observed controls. The nutrition component targeted school food service environmental change. Data identifying foods and nutrients served (selected by students for consumption) were collected over a 20-day period at baseline and end of study. Analysis compared end of study values for intervention versus control schools.
Intervention schools more successfully limited dessert and snack food portion size in NSLP and a la carte and lowered fat content of foods served. Servings of high fiber grain-based foods and/or legumes were improved in SBP but not NSLP. Intervention and control schools eliminated >1% fat milk and sugar added beverages in SBP, but intervention schools were more successful in NSLP and a la carte.
The HEALTHY program demonstrated significant changes in the nutritional quality of foods and beverages served in the SBP, NSLP, and a la carte venues, as part of an effort to decrease childhood obesity and support beneficial effects in some secondary HEALTHY study outcomes.
PMCID: PMC3261591  PMID: 22239133
School Food Services; Nutrition and Diet; Child and Adolescent Health
14.  Breakfast habits among adolescents and their association with daily energy and fish, vegetable, and fruit intake: a community-based cross-sectional study 
To investigate breakfast eating habits on daily energy and fish, vegetable, and fruit intake in Japanese adolescents.
This study was completed as part of the Shunan Child Health Cohort Study. Two types of questionnaires, one on lifestyle habits and the other a brief-type, self-administered questionnaire on diet history, were administered to second-year junior high school students (1,876 boys and 1,759 girls) in Shunan City, Yamaguchi, Japan. The different breakfast habits were compared using the general linear model and the estimated means and P value for trend were calculated, with energy-adjusted food intake as the dependent variable and body mass index, gender, age, residential areas, and living status as covariates.
In both males and females, the proportion of those who ate breakfast irregularly was about 10%. The daily intake of fish, vegetables, and fruit was significantly higher in those who ate breakfast with their guardians than in those who ate breakfast alone (P for trend <0.01). The daily intake of fish, seafood, and vegetables was significantly higher in those who less frequently ate cooked foods for breakfast (P for trend <0.01). Those who ate rice more frequently than bread at breakfast had a higher daily intake of fish, seafood, and vegetables (P for trend <0.01).
Eating breakfast with the family, reducing the intake of cooked foods at breakfast, and eating breakfast with rice as a main staple food are suggested to contribute to an improved quality of diet in adolescents.
PMCID: PMC3437357  PMID: 22351508
Breakfast styles; Daily energy/food intake; Japanese adolescents; Cross-sectional study; Dietary education
15.  Differences in Fourth-Graders' Participation Rates Across Four School-Based Nutrition Studies 
Federal policy has encouraged researchers to include children in research studies; thus, it is important to report experiences recruiting children to participate in studies. This article compares fourth-graders' participation rates across four school-based nutrition studies conducted in one school district in a southeastern state. For each study, children were observed eating school meals (breakfast and lunch); interviewed regarding dietary intake; and weighed and measured. For Study 1, children from 11 schools received $10 per interview for up to two interviews conducted in the morning at school. For Study 2, children from 10 schools received $25 if interviewed once in the evening, either by telephone or in a van parked outside the child's home. For Study 3, children from three schools received $10 per interview for up to three interviews held in the evening by telephone. For Study 4, children from six schools received $15 per interview for up to two interviews conducted either in the morning or afternoon at school, or in the evening by telephone. Recruitment procedures were similar for all studies.
Participation rates were 73% (n=635) for Study 1, 57% (n=432) for Study 2, 66% (n=158) for Study 3, and 71% (n=296) for Study 4. Logistic regression was used to determine whether study (1, 2, 3, 4), race (black, white), or gender (male, female) were significant predictors of participation (agreed, denied). The results indicated that study (p<0.0001), race (p=0.0198), and gender (p=0.0188) were significant predictors, however, no two-factor interactions among these effects were significant. Post hoc pairwise comparisons with Bonferroni adjustment indicated that agreement to participate for Study 2 was lower (p<0.0001) than that for Studies 1, 3, and 4, which did not differ. Agreement to participate across all four studies was higher for black (69%) than white (63%; p=0.0054) children and for females (69%) than males (64%; p=0.0209). Schools provide a natural environment for nutrition research because school foodservice programs feed millions of children one or two meals (breakfast and/or lunch) each school day. Observations of children eating school meals provide a convenient and relatively unobtrusive means of validating children's dietary recalls. Thus, at some point, most child nutrition professionals are likely to be involved in research either directly (i.e. by conducting studies themselves) or indirectly (i.e. by allowing others access to their school cafeterias to collect data).
This paper references the following data: Table 1. Similarities and Differences in the Designs for Each of the Four Studies. Table 2. Number and Percent of Fourth-Grade Children Who Agreed or Denied to Participate by Race and Gender Across all Four Studies Combined. Table 3. Number and Percent of Fourth-Grade Children Who Agreed or Denied to Participate by Gender and Race for Each of the Four Studies Separately.
PMCID: PMC1945013  PMID: 17694161
16.  Examining variations in fourth-grade children’s participation in school-breakfast and school-lunch programs by student and program demographics 
Analyses were conducted to examine variations in fourth-grade children’s participation in school-breakfast and school-lunch programs by weekday, month, socioeconomic status, absenteeism, sex, and school-breakfast location.
Fourth-grade children were participants in a dietary-reporting validation study during the 2005–2006 or 2006–2007 school years in 17 or 8 schools, respectively, in one South Carolina school district. For the two respective school years, school-breakfast location was the classroom for six and seven schools, and for the remaining schools, the cafeteria. District administrative records provided information about 180 possible days of participation in the school-breakfast and school-lunch programs for each of 1,060 children (91% Black, 52% girls). The state’s Office of Research and Statistics linked data on school-meal participation with information about individual children’s socioeconomic status (eligibility for free or reduced-price school meals) and annual absenteeism from school.
For school-provided breakfast, logistic regression showed participation rate differences by weekday (smallest for Monday [56.1%], largest for Wednesday [57.8%], p<0.0001), month (smallest for April [53.5%], largest for September [60.8%], p<0.0001), socioeconomic status (smallest for full-price status [27.5%], largest for free-meal status [63.4%], p<0.0001), school-breakfast location (smaller for breakfast located in the cafeteria [38%] than classroom [71%], p<0.0001), and absenteeism (p<0.0001). For school-provided lunch, logistic regression showed participation rate differences by weekday (smallest for Friday [81.9%], largest for Thursday [83.3%], p<0.0001), month (smallest for May [78.7%], largest for August [86.0%], p<0.0001), socioeconomic status (smallest for full-price status [72.1%], largest for free-meal status [84.9%], p<0.0001), and absenteeism (p<0.0001). There were no differences in participation rate by sex.
Applications for Child Nutrition Professionals
Administrative participation records are used for forecasting purchasing and production. Using such records in research studies may provide insight into aspects of children’s participation in school-provided meals. Districts and managers are encouraged to share administrative records of children’s participation in school-provided meals with researchers.
PMCID: PMC3972127  PMID: 24701197
17.  Children's very low food security is associated with increased dietary intakes in energy, fat, and added sugar among Mexican-origin children (6-11 y) in Texas border Colonias 
BMC Pediatrics  2012;12:16.
Food insecurity among Mexican-origin and Hispanic households is a critical nutritional health issue of national importance. At the same time, nutrition-related health conditions, such as obesity and type 2 diabetes, are increasing in Mexican-origin youth. Risk factors for obesity and type 2 diabetes are more common in Mexican-origin children and include increased intakes of energy-dense and nutrient-poor foods. This study assessed the relationship between children's experience of food insecurity and nutrient intake from food and beverages among Mexican-origin children (age 6-11 y) who resided in Texas border colonias.
Baseline data from 50 Mexican-origin children were collected in the home by trained promotora-researchers. All survey (demographics and nine-item child food security measure) and 24-hour dietary recall data were collected in Spanish. Dietary data were collected in person on three occasions using a multiple-pass approach; nutrient intakes were calculated with NDS-R software. Separate multiple regression models were individually fitted for total energy, protein, dietary fiber, calcium, vitamin D, potassium, sodium, Vitamin C, and percentage of calories from fat and added sugars.
Thirty-two children (64%) reported low or very low food security. Few children met the recommendations for calcium, dietary fiber, and sodium; and none for potassium or vitamin D. Weekend intake was lower than weekday for calcium, vitamin D, potassium, and vitamin C; and higher for percent of calories from fat. Three-day average dietary intakes of total calories, protein, and percent of calories from added sugars increased with declining food security status. Very low food security was associated with greater intakes of total energy, calcium, and percentage of calories from fat and added sugar.
This paper not only emphasizes the alarming rates of food insecurity for this Hispanic subgroup, but describes the associations for food insecurity and diet among this sample of Mexican-origin children. Child-reported food insecurity situations could serve as a screen for nutrition problems in children. Further, the National School Lunch and School Breakfast Programs, which play a major beneficial role in children's weekday intakes, may not be enough to keep pace with the nutritional needs of low and very low food secure Mexican-origin children.
PMCID: PMC3298490  PMID: 22348599
18.  Accuracy of children's school-breakfast reports and school-lunch reports (in 24-hour dietary recalls) differs by retention interval 
European journal of clinical nutrition  2009;63(12):1394-1403.
Validation-study data were analyzed to investigate the effect of retention interval (time between the to-be-reported meal and interview) on accuracy of children's school-breakfast reports and school-lunch reports in 24-hour recalls, and to compare accuracy of children's school-breakfast reports for two breakfast locations (classroom; cafeteria).
Each of 374 fourth-grade children was interviewed to obtain a 24-hour recall using one of six conditions from crossing two target periods (prior 24 hours; previous day) with three interview times (morning; afternoon; evening). Each condition had 62 or 64 children (half boys). A recall's target period included one school breakfast and one school lunch, for which the child had been observed. Food-item variables (observed number; reported number; omission rate; intrusion rate) and energy variables (observed; reported; report rate; correspondence rate; inflation ratio) were calculated for each child for school breakfast and school lunch separately.
Accuracy for school-breakfast reports and school-lunch reports was inversely related to retention interval. Specifically, as indicated by smaller omission rates, smaller intrusion rates, larger correspondence rates, and smaller inflation ratios, accuracy for school-breakfast reports was best for prior-24-hour recalls in the morning, and accuracy for school-lunch reports was best for prior-24-hour recalls in the afternoon. For neither school meal was a significant sex effect found for any variable. For school-breakfast reports, there was no significant school-breakfast location effect for any variable.
By shortening the retention interval, accuracy can be improved for school-breakfast reports and school-lunch reports in children's 24-hour recalls.
PMCID: PMC2788046  PMID: 19756033
validation study; school meals; retention interval
19.  Breakfast Eating Habits Among Medical Students 
Ghana Medical Journal  2014;48(2):66-70.
Breakfast is often thought to be the most important meal of the day as it is known to provide energy for the brain and improve learning. It is also known to contribute significantly to the total daily energy and nutrient intake. Skipping breakfast may affect performance during the rest of the day.
To determine the level of breakfast skipping among medical students and its effect on their attention span and level of fatigue during clinical sessions.
A descriptive cross-sectional study of breakfast eating habits among medical students at the University of Ghana Medical School, Korle Bu-Accra.
The University of Ghana Medical School, Korle Bu-Accra.
Questionnaires were distributed to second year (pre-clinical) medical students studying the basic sciences and clinical students in ophthalmology to be self-administered. Interview data was captured and analyzed using SPSS version 17.0.
The total number of pre-clinical students recruited was 154 and clinical students 163 bringing to a total of 317 students made up of 203 males and 114 females (M: F=1.8:1). The overall breakfast skipping among the students was 71.92%. The prevalence among the pre-clinical students was 76.62% and clinical students 67.48%. Generally, breakfast skipping was significantly related to fatigue and poor attention during clinical sessions.
This study suggests that the medical students, both pre-clinical and clinical, skip breakfast and this may affect their studies adversely
PMCID: PMC4310332  PMID: 25667552
breakfast skipping; medical students; fatigue; attention span; breakfast habits
20.  Association between fruits and vegetables intake and frequency of breakfast and snacks consumption: a cross-sectional study 
Nutrition Journal  2013;12:123.
There are very few studies on the frequency of breakfast and snack consumption and its relation to fruit and vegetable intake. This study aims to fill that gap by exploring the relation between irregular breakfast habits and snack consumption and fruit and vegetable intake in Tuscan adolescents. Separate analyses were conducted with an emphasis on the potentially modifying factors of sex and age.
Data was obtained from the 2010 Tuscan sample of the Health Behaviour in School-aged Children (HBSC) study. The HBSC study is a cross-sectional survey of 11-, 13- and 15-year-old students (n = 3291), selected from a random sample of schools. Multivariate logistic regression was used for analyzing the food-frequency questionnaire.
A significant relation was found between low fruit and vegetable intake and irregular breakfast habits. Similarly, low fruit intake was associated with irregular snack consumption, whereas vegetable intake did not prove to be directly related to irregular snack consumption. Different patterns emerged when gender and age were considered as modifying factors in the analyses. A statistically significant relation emerged only among female students for irregular breakfast habits and fruit and vegetable intake. Generally, older female participants with irregular breakfast habits demonstrated a higher risk of low fruit and vegetable intake. Age pattern varied between genders, and between fruit and vegetable consumption.
Results suggest that for those adolescents who have an irregular consumption of breakfast and snacks, fruit intake occurs with a lower frequency. Lower vegetable consumption was associated with irregular breakfast consumption. Gender and age were shown to be moderators and this indicated the importance of analyzing fruit and vegetable intake and meal types separately.
This study also confirmed that health-promotion campaigns that aim to promote regular meal consumption and consumption of fruits and vegetables need to take into account gender and age differences in designing promotional strategies. Future research should identify evidence-based interventions to facilitate the achievement of the Italian guidelines for a healthy diet for fruit, vegetables and meals intake.
PMCID: PMC3765730  PMID: 23981379
21.  Psychosocial, behavioural, pedagogical, and nutritional proposals about how to encourage eating a healthy breakfast 
Even if more and more evidences have highlighted the importance of breakfast in the growth and development of children, from 10 to 30% of US and European children and adolescents regularly skip breakfast. Thus, there is still a lot to be done before breakfast becomes a daily habit. The aim of this paper is to try and understand how it is possible to overcome the real or imaginary difficulties associated with skipping breakfast by psychosocial, behavioural, pedagogical and nutritional proposals.
Schools are the best context where perform healthy interventions because it is here that children learn about the importance of good health at an age when the school still plays a major role in their education. Some school interventions, based on solid theories as the Self Determination Theory and the Behaviour Analysis, have been implemented in the last years to promote health behaviour such as intake of fruit and vegetables and physical activities. Cognitive behaviour therapy is the most closely monitored type of treatment/cure for obesity in randomised controlled trials. Moreover some associations such as the National Association of Food Science Specialists have drawn an own method to encourage food education at school and promote the importance of prevention. These projects could be used as starting point to perform interventions focus on breakfast.
Increase the consumption of breakfast between children is very important. Efforts should be done to drawn new school projects based on scientific-evidences.
PMCID: PMC4237809  PMID: 25125024
Breakfast; School; Children; Behaviour analysis; Nudging; Cognitive strategies; Games
22.  The Benefits of Breakfast Cereal Consumption: A Systematic Review of the Evidence Base1234 
Advances in Nutrition  2014;5(5):636S-673S.
There have been no comprehensive reviews of the relation of breakfast cereal consumption to nutrition and health. This systematic review of all articles on breakfast cereals to October 2013 in the Scopus and Medline databases identified 232 articles with outcomes related to nutrient intake, weight, diabetes, cardiovascular disease, hypertension, digestive health, dental and mental health, and cognition. Sufficient evidence was available to develop 21 summary evidence statements, ranked from A (can be trusted to guide practice) to D (weak and must be applied with caution). Breakfast cereal consumption is associated with diets higher in vitamins and minerals and lower in fat (grade B) but is not associated with increased intakes of total energy or sodium (grade C) or risk of dental caries (grade B). Most studies on the nutritional impact are cross-sectional, with very few intervention studies, so breakfast cereal consumption may be a marker of an overall healthy lifestyle. Oat-, barley-, or psyllium-based cereals can help lower cholesterol concentrations (grade A), and high-fiber, wheat-based cereals can improve bowel function (grade A). Regular breakfast cereal consumption is associated with a lower body mass index and less risk of being overweight or obese (grade B). Presweetened breakfast cereals do not increase the risk of overweight and obesity in children (grade C). Whole-grain or high-fiber breakfast cereals are associated with a lower risk of diabetes (grade B) and cardiovascular disease (grade C). There is emerging evidence of associations with feelings of greater well-being and a lower risk of hypertension (grade D), but more research is required.
PMCID: PMC4188247  PMID: 25225349
23.  Regular breakfast consumption is associated with increased IQ in kindergarten children 
Early human development  2013;89(4):257-262.
Studies have documented a positive relationship between regular breakfast consumption and cognitive outcomes in youth. However, most of these studies have emphasized specific measures of cognition rather than cognitive performance as a broad construct (e.g., IQ test scores) and been limited to Western samples of school-age children and adolescents. This study aims to extend the literature on breakfast consumption and cognition by examining these constructs in a sample of Chinese kindergarten-age children.
This cross-sectional study consisted of a sample of 1,269 children (697 boys and 572 girls) aged 6 from the Chinese city of Jintan. Cognition was assessed with the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence – Revised. Breakfast habits were assessed through parental questionnaire. Analyses of variance and linear regression models were used to analyze the association between breakfast habits and IQ. Socioeconomic and parental psychosocial variables related to intelligence were controlled for.
Findings showed that children who regularly have breakfast on a near-daily basis had significantly higher full scale, verbal, and performance IQ test scores (all p <0.001) compared to children who “sometimes” have breakfast. This relationship persisted for VIQ (verbal IQ) and FIQ (full IQ) even after adjusting for gender, current living location, parental education, parental occupation, and primary child caregiver.
Findings may reflect nutritional as well as social benefits of regular breakfast consumption on cognition, and regular breakfast consumption should be encouraged among young children.
PMCID: PMC3606659  PMID: 23395328
24.  Data from a Validation Study of Reporting Accuracy over Multiple Recalls, and School Foodservice Production Records Provide Insight into the Origins of Intrusions (Reports of Uneaten Food Items) in Children’s Dietary Recalls 
Intrusions in dietary recalls may originate in confusion of episodic memories manifested as temporal dating errors.
Data from a validation study (concerning reporting accuracy over multiple recalls) and school foodservice production records were used to investigate origins of intrusions in school meals in children’s 24-hour recalls.
During the 1999–2000 school year, 104 fourth-grade children were observed eating school meals on one to three non-consecutive days separated by ≥25 days, and interviewed about the previous day’s intake in the morning on the day after each observation day.
Statistical analyses performed
For breakfast and lunch separately, logistic regression was used to investigate the effect of time (i.e., days) before the interview day on the probability that intrusions referred to items available in the school foodservice environment. Exploratory analyses were conducted for breakfast options observed and/or reported eaten.
For interviews in which reported meals met criteria to be considered school meals and that contained intrusions, of 634 and 699 items reported eaten at breakfast and lunch, respectively, 394 and 331 were intrusions. Availability in the school foodservice environment of items referred to by intrusions in reports of lunch, but not breakfast, decreased as days increased before the interview day (P values=0.031 and 0.285, respectively). Concerning breakfast, children observed eating a cold option (i.e., ready-to-eat [RTE] cereal, milk, juice, crackers [graham; animal]) almost always reported a cold option, whereas children observed eating a hot option (i.e., non-RTE-cereal entrée [e.g., sausage biscuit], milk, fruit or juice) reported a cold option in approximately 50% of interviews.
In children’s 24-hour recalls, confusion of episodic memories contributes to intrusions in school lunch, and generic dietary information (e.g., cold option items available daily) or confusion of episodic memories may contribute to intrusions in school breakfast. Understanding the origins of intrusions may help in developing interview methods to decrease the occurrence of intrusions.
PMCID: PMC2625290  PMID: 18656570
Children; dietary recalls; intrusions
25.  Child hunger and the protective effects of supplemental nutrition assistance program (SNAP) and alternative food sources among Mexican-origin families in Texas border colonias 
BMC Pediatrics  2013;13:143.
Nutritional health is essential for children’s growth and development. Many Mexican-origin children who reside in limited-resource colonias along the Texas-Mexico border are at increased risk for poor nutrition as a result of household food insecurity. However, little is known about the prevalence of child hunger or its associated factors among children of Mexican immigrants. This study determines the prevalence of child hunger and identifies protective and risk factors associated with it in two Texas border areas.
This study uses 2009 Colonia Household and Community Food Resource Assessment (C-HCFRA) data from 470 mothers who were randomly recruited by promotora-researchers. Participants from colonias near two small towns in two South Texas counties participated in an in-home community and household assessment. Interviewer-administered surveys collected data in Spanish on sociodemographics, federal food assistance program participation, and food security status. Frequencies and bivariate correlations were examined while a random-effects logistic regression model with backward elimination was used to determine correlates of childhood hunger.
Hunger among children was reported in 51% (n = 239) of households in this C-HCFRA sample. Bivariate analyses revealed that hunger status was associated with select maternal characteristics, such as lower educational attainment and Mexican nativity, and household characteristics, including household composition, reliance on friend or neighbor for transportation, food purchase at dollar stores and from neighbors, and participation in school-based nutrition programs. A smaller percentage of households with child hunger participated in school-based nutrition programs (51%) or used alternative food sources, while 131 households were unable to give their child or children a balanced meal during the school year and 145 households during summer months. In the random effects model (RE = small town), increased household composition, full-time unemployment, and participation in the National School Lunch Program were significantly associated with increased odds for child hunger, while participation in Supplemental Nutrition Assistance Program (SNAP) and purchasing food from a neighbor were significantly associated with decreased odds for child hunger.
This study not only emphasizes the alarming rates of child hunger among this sample of Mexican-origin families, but also identifies economic and family factors that increased the odds for child hunger as well as community strategies that reduced the odds. It is unsettling that so many children did not participate in school-based nutrition programs, and that many who participated in federal nutrition assistance programs remained hungry. This study underscores the importance of identifying the presence of child hunger among low-income Mexican-origin children in Texas border colonias and increasing access to nutrition-related resources. Hunger-associated health inequities at younger ages among colonia residents are likely to persist across the life span and into old age.
PMCID: PMC3847461  PMID: 24034599
Childhood hunger; Food assistance programs; Alternative food sources; Immigrant

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