Skipping breakfast and nutrient density: Influence on obesity, blood pressure, glucose, and cholesterol in elementary school students

Background: Skipping breakfast is a public health issue affecting childhood obesity worldwide. However, how skipping breakfast adversely affects metabolic health in children has not been investigated comprehensively. This study investigated the associations between breakfast skipping, obesity, and cardiometabolic risk in elementary school students and identified its association with nutritional patterns. Methods: Data on 3590 elementary school students were obtained from the Korea National Health and Nutrition Examination Survey (2013–2020). Participants self-reported weekly breakfast frequency, and dietary nutrient intake was assessed using a 24-h recall survey. The associations of breakfast frequency with obesity, cardiometabolic risk factors, and nutrient density were analyzed using a survey multivariate linear regression analysis. Results: The lowest breakfast frequency group (0–2 times/week) had a higher mean body mass index (estimated mean differences; 0.80 kg/m², 95 % confidence interval (CI) 0.30–1.31) and waist circumference (2.20 cm, 0.83–3.57) than the highest frequency group (5–7 times/week). Additionally, they had higher systolic blood pressure (1.68 mmHg, 0.12–3.24), diastolic blood pressure (2.24 mmHg, 1.09–3.39), fasting glucose (1.58 mg/dL, 0.40–2.75) than the highest breakfast group. Furthermore, this group had higher percentages of energy from fat (1.96 %, 0.90–3.02), sodium density (10.29 mg/100 kcal, 0.75–19.82) and Na/K ratio (0.25 mmol/mmol, 0.11–0.40) than the highest frequency group, despite lower caloric intake. Conclusions: Elementary school students who skipped breakfast had higher obesity and cardiometabolic risk factors. These associations might be assumed from dietary nutrient patterns characterized by higher fat and sodium density despite lower daily caloric consumption.