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Clinical nutrition

Healthy breakfast habits and changes in obesity-related cardiometabolic markers in children: a longitudinal analysis



Data on the association of breakfast habits and changes in cardiometabolic markers in children are limited.


In total, 6964 children aged 6–13 years from Beijing, Shanghai, Chongqing, Jinan, Harbin, and Guangzhou were included in the final analysis. Daily consumption, consumption of ≥3 food groups, and at-home consumption were defined as healthy breakfast habits. Blood pressure, % fat mass, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, glucose, and 50-m × 8 shuttle run were measured at baseline (May 2009) and follow-up (May 2010). Clustered cardiometabolic risk score (CCRS) was computed by summing Z scores of five components: % fat mass, systolic blood pressure, glucose, TC to HDL-C ratio, and triglyceride.


Children who ate breakfast daily had a higher decrease in TC to HDL-C ratio and a higher increase in HDL-C compared with breakfast skippers (both P values < 0.05). There was an inverse association of the number of food groups consumed at breakfast with the change in CCRS (P trend = 0.005). At-home breakfast consumption was associated with a lower increase in BMI, LDL-C, TC to HDL-C ratio, fasting glucose, and 50-m × 8 shuttle run and a higher increase in HDL-C (all P values < 0.05). Children with two or three healthy breakfast habits had a lower increase in CCRS, LDL-C, TC to HDL-C ratio, glucose, and a higher increase in HDL-C compared with those with none or one (all P values < 0.05).


Healthy breakfast habits might help minimize the cardiometabolic risk factors in children.

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Fig. 1: Flowchart of population selection.


  1. 1.

    GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1659–724.

    Article  Google Scholar 

  2. 2.

    Laitinen TT, Pahkala K, Magnussen CG, Viikari JS, Oikonen M, Taittonen L, et al. Ideal cardiovascular health in childhood and cardiometabolic outcomes in adulthood: the Cardiovascular Risk in Young Finns Study. Circulation. 2012;125:1971–8.

    Article  PubMed  Google Scholar 

  3. 3.

    Bao W, Srinivasan SR, Wattigney WA, Berenson GS. Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood. The Bogalusa Heart Study. Arch Intern Med. 1994;154:1842–7.

    CAS  Article  Google Scholar 

  4. 4.

    Berenson GS. Childhood risk factors predict adult risk associated with subclinical cardiovascular disease. The Bogalusa Heart Study. Am J Cardiol. 2002;90:3l–7l.

    Article  Google Scholar 

  5. 5.

    Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. 2011;35:891–8.

    CAS  Article  Google Scholar 

  6. 6.

    Park MH, Falconer C, Viner RM, Kinra S. The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obes Rev. 2012;13:985–1000.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Ezzati M, Riboli E. Behavioral and dietary risk factors for noncommunicable diseases. N Engl J Med. 2013;369:954–64.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Lachat C, Otchere S, Roberfroid D, Abdulai A, Seret FM, Milesevic J, et al. Diet and physical activity for the prevention of noncommunicable diseases in low- and middle-income countries: a systematic policy review. PLoS Med. 2013;10:e1001465

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Hu FB, Liu Y, Willett WC. Preventing chronic diseases by promoting healthy diet and lifestyle: public policy implications for China. Obes Rev. 2011;12:552–9.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Affenito SG. Breakfast: a missed opportunity. J Am Diet Assoc. 2007;107:565–9.

    Article  PubMed  Google Scholar 

  12. 12.

    O’Neil CE, Byrd-Bredbenner C, Hayes D, Jana L, Klinger SE, Stephenson-Martin S. The role of breakfast in health: definition and criteria for a quality breakfast. J Acad Nutr Diet. 2014;114:S8–26.

    Article  PubMed  Google Scholar 

  13. 13.

    Odegaard AO, Jacobs DR Jr, Steffen LM, Van Horn L, Ludwig DS, Pereira MA. Breakfast frequency and development of metabolic risk. Diabetes Care. 2013;36:3100–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Hallstrom L, Labayen I, Ruiz JR, Patterson E, Vereecken CA, Breidenassel C, et al. Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 2013;16:1296–305.

    Article  PubMed  Google Scholar 

  15. 15.

    Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study. Am J Clin Nutr. 2010;92:1316–25.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Papoutsou S, Briassoulis G, Wolters M, Peplies J, Iacoviello L, Eiben G, et al. No breakfast at home: association with cardiovascular disease risk factors in childhood. Eur J Clin Nutr. 2014;68:829–34.

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Utter J, Scragg R, Mhurchu CN, Schaaf D. At-home breakfast consumption among New Zealand children: associations with body mass index and related nutrition behaviors. J Am Diet Assoc. 2007;107:570–6.

    Article  PubMed  Google Scholar 

  18. 18.

    Williams PG. The benefits of breakfast cereal consumption: a systematic review of the evidence base. Adv Nutr. 2014;5:636s–73s.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Deshmukh-Taskar PR, Nicklas TA, O’Neil CE, Keast DR, Radcliffe JD, Cho S. The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: the National Health and Nutrition Examination Survey 1999-2006. J Am Diet Assoc. 2010;110:869–78.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Fayet-Moore F, Kim J, Sritharan N, Petocz P. Impact of breakfast skipping and breakfast choice on the nutrient intake and body mass index of Australian Children. Nutrients. 2016;8.

  21. 21.

    The Chinese Nutrition Society. Dietary guidelines for chinese residents. Beijing: People’s Medical Publishing House; 2016.

  22. 22.

    Li Y, Hu X, Zhang Q, Liu A, Fang H, Hao L, et al. The nutrition-based comprehensive intervention study on childhood obesity in China (NISCOC): a randomised cluster controlled trial. BMC Public Health. 2010;10:229.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Xu H, Li Y, Zhang Q, Hu XL, Liu A, Du S, et al. Comprehensive school-based intervention to control overweight and obesity in China: a cluster randomized controlled trial. Asia Pac J Clin Nutr. 2017;26:1139–51.

    Article  PubMed  Google Scholar 

  24. 24.

    Liu AL, Ma GS, Zhang Q, Ma WJ. Reliability and validity of a 7-day physical activity questionnaire for elementary students. Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi. 2003;24:901–4.

    PubMed  Google Scholar 

  25. 25.

    Deurenberg P, van der Kooy K, Leenen R, Weststrate JA, Seidell JC. Sex and age specific prediction formulas for estimating body composition from bioelectrical impedance: a cross-validation study. Int J Obes. 1991;15:17–25.

    CAS  PubMed  Google Scholar 

  26. 26.

    Yang Y, Lau PW, Wang J, Dong B, Wu L, Quach B, et al. Associations among cardiorespiratory endurance, body mass index and blood pressure in Han Chinese children: results from the 2010 Chinese National Survey On Students’ Constitution and Health. Hypertens Res. 2016;39:799–804.

    Article  PubMed  Google Scholar 

  27. 27.

    Shang X, Liu A, Li Y, Hu X, Du L, Ma J, et al. The Association of Weight Status with Physical Fitness among Chinese Children. Int J Pediatr. 2010;2010:515414.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Eisenmann JC. On the use of a continuous metabolic syndrome score in pediatric research. Cardiovasc Diabetol. 2008;7:17.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser. 1995;57:289–300.

    Google Scholar 

  30. 30.

    Tin SP, Ho SY, Mak KH, Wan KL, Lam TH. Breakfast skipping and change in body mass index in young children. Int J Obes. 2011;35:899–906.

    CAS  Article  Google Scholar 

  31. 31.

    Yoo KB, Suh HJ, Lee M, Kim JH, Kwon JA, Park EC. Breakfast eating patterns and the metabolic syndrome: the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-9. Asia Pac J Clin Nutr. 2014;23:128–37.

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Tin SP, Ho SY, Mak KH, Wan KL, Lam TH. Location of breakfast consumption predicts body mass index change in young Hong Kong children. Int J Obes. 2012;36:925–30.

    CAS  Article  Google Scholar 

  33. 33.

    Altman M, Cahill Holland J, Lundeen D, Kolko RP, Stein RI, Saelens BE, et al. Reduction in food away from home is associated with improved child relative weight and body composition outcomes and this relation is mediated by changes in diet quality. J Acad Nutr Diet. 2015;115:1400–7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Wang M, Zhong JM, Wang H, Zhao M, Gong WW, Pan J, et al. Breakfast consumption and its associations with health-related behaviors among school-aged adolescents: a Cross-Sectional Study in Zhejiang Province, China. Int J Environ Res Public Health. 2016; 13.

  35. 35.

    Chen J, Cheng J, Liu Y, Tang Y, Sun X, Wang T, et al. Associations between breakfast eating habits and health-promoting lifestyle, suboptimal health status in Southern China: a population based, cross sectional study. J Transl Med. 2014;12:348.

    Article  PubMed  PubMed Central  Google Scholar 

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The authors would like to acknowledge the support of other team members and the participated students, teachers, parents, and local education and health staff members.


This project was funded by the China Ministry of Science & Technology as Key Projects in the National Science & Technology Pillar Program during the Eleventh Five-Year Plan Period (2008BAI58B05).

Author information




GM conceived and designed the research. GM, YiL, JM, GX, HG, TL, and SD performed the experiments. XS and YaL performed data analysis and interpretation. XS wrote the initial draft of the paper. XS, YaL, HX, and GM revised the paper. All authors read and approved the final paper.

Corresponding author

Correspondence to Guansheng Ma.

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The authors declare that they have no conflict of interest.


The study protocol was approved by the Ethical Review Committee of the National Institute for Nutrition and Food Safety, Chinese Centre for Disease Control and Prevention.

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Written informed consent was obtained from parents, the next of kin, carers, or guardians of all the participants.

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Shang, X., Li, Y., Xu, H. et al. Healthy breakfast habits and changes in obesity-related cardiometabolic markers in children: a longitudinal analysis. Eur J Clin Nutr 74, 1685–1697 (2020).

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