(P24-019-24) Breakfast Habits and Body Mass Index in Adolescents From Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Objectives: This systematic review and meta-analysis aimed to examine the scientific evidence available from low- and middle-income countries (LMIC) on the relationship between breakfast consumption habits and anthropometry- and nutrition-related outcomes in adolescents aged 10-19 years.

Methods: The databases MEDLINE, EMBASE, CINAHL, CENTRAL and Web of Science were searched until June 2023. Studies comparing the habit of breakfast skipping and consumption among adolescents in LMIC were included. Primary outcomes included body mass index (BMI), and anemia. Random-effects meta-analysis models were used to pool data for each outcome measure from the included studies and odds ratios (OR) with 95% Confidence Interval (CI) were reported. The risk of bias was assessed using the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: Our search identified 3604 records and 41 observational studies met our inclusion criteria. The odds of having OV/OB were twice as high in adolescents who infrequently (0-2 days/week) ate breakfast compared to regular (5-7 d/w) breakfast consumers (OR 2.05, 95% CI 1.61–2.61; P< 0.01, n=15, I² 85%). Irregular (3-4 d/w) breakfast consumers were 32% more likely to have OV/OB (OR 1.32 95% CI 1.16–1.50; P < 0.01, n=9, I² 59%) compared to regular consumers. The odds of non-daily consumers having OV/OB were 38% higher compared to daily consumers (OR 1.38, 95% CI 1.19–1.59; P=0.02, n=10, I² 54%). There was no statistically significant difference in the odds of anemia between adolescent irregular and regular eaters (OR 2.85 95% CI 1.71, 4.76; P=0.59; n=2, I² 0%), and was limited by a small number of studies (n=2).

Conclusions: The current evidence is suggestive that breakfast skipping is associated with greater odds of having OV/OB among adolescents in LMIC. More rigorous study designs with standardized exposure definitions are needed to elucidate the relationship between breakfast skipping and the risk of OV/OB and other anthropometric measurements in this population. Limited evidence exists on breakfast habits and nutrition outcomes, emphasizing the need for further research on the health impacts of this common practice in their daily diets worldwide.

Funding Sources: Sight and Life Foundation