Breakfast Skipping Is an Independent Predictor of Obesity but not Overweight Among Children in a Southeastern European Population

Aim: To assess the association of breakfast skipping with overweight and obesity among children in Albania, a post-communist country in the Western Balkans, which is undergoing a long and difficult political and socioeconomic transition towards a market-oriented economy. Methods: A nationwide cross-sectional study was carried out in Albania in 2013 including a representative sample of 5810 children aged 7.0-9.9 years (49.5 % girls aged 8.4 +/- 0.6 years and 51.5 % boys aged 8.5 +/- 0.6 years; overall response rate: 97 %). Children were measured for height and weight, and body mass index (BMI) calculated. Cut-off BMI values of the World Health Organization (WHO) and the International Obesity Task Force (IOTF) were used to define overweight and obesity in children. Demographic data were also collected. Results: Upon adjustment for age, sex, and place of residence, breakfast skipping was positively related to obesity (WHO criteria: OR = 1.5, 95 % CI = 1.3-1.9; IOTF criteria: OR = 1.9, 95 % CI = 1.4-2.5), but not overweight (OR = 1.1, 95 % CI = 0.9-1.3 and OR = 1.1, 95 % CI = 0.9-1.4, respectively). Furthermore, breakfast skipping was associated with a higher BMI (multivariable-adjusted OR = 1.05, 95 % CI = 1.02-1.07). Conclusions: Our findings point to a strong and consistent positive relationship between breakfast skipping and obesity, but not overweight, among children in this transitional southeastern European population. Future studies in Albania and other transitional settings should prospectively examine the causal role of breakfast skipping in the development of overweight and obesity.