Relationship between breakfast consumption, BMI status and physical fitness of Ghanaian school-aged children

Background: Good nutrition and physical activity of school-aged children are important for ensuring optimum growth and reducing obesity. This present study assessed associations between breakfast consumption, BMI-for-Age (BMI) and physical fitness in a cross-section of school-aged children attending government-owned primary schools in Kumasi, Ghana. Method: The sample consisted of 438 pupils (boys=213; girls=225; mean age 11.1 +/- 1.1), attending 10 randomly selected schools. Weight (kg), height (cm) and Mid Upper Arm Circumference (MUAC) were measured for each participant, and BMI-for-age z-scores determined using the World Health Organisation (WHO) anthroplus software. Participants were stratified into thinness, normal weight, overweight/obese using WHO cut offs. Physical fitness was assessed using forward jump, left and right handgrips, flexibility, sit-ups and 50metre run following standard procedures and converted to scores of 1 to 10 following Japanese standards, based on which percentiles were derived. Total fitness score for each pupil was computed by adding all scores. A questionnaire was used to assess meal intake patterns. Results: The mean BMI-for-age z-score for participants was -0.24 +/- 0.99. Thinness, normal weight and overweight/obesity were 2.7, 86.5, and 10.5% respectively among the pupils. Overweight was higher in girls (14.2%) compared to boys (4.2%), p=0.003. Similarly, mean MUAC was significantly (p=0.021) higher in the girls (22.0 +/- 3.2cm) than the boys (20.7 +/- 7.3cm). For physical fitness, the girls scored higher in forward jump (p<0.0001), 50-m run (p=0.002) and overall fitness score than the boys (21.0 +/- 6.2 versus 19.2 +/- 8.3, p=0.012). However, a larger proportion of boys performed excellently and poorly than girls (p=0.019). A positive correlation was observed between BMI z-score and hand grip (r =0.21, p<0.001), while sit up (r =-0.11, p=0.018) showed a negative correlation with BMI z-score. No other fitness test varied by BMI. Overweight children performed best in handgrip. Majority of children said they engaged in exercise (89.9%) and consumed breakfast (78.9%). Breakfast consumption was not associated with BMI z-score (x(2) 0.0359, p=0.549) but non-breakfast consumers performed better in 50m run compared to consumers (7.0 seconds +/- 2.3 vrs 6.3 seconds +/- 2.5, p=0.022). Children who reported to exercise were physically fitter than those who did not. Conclusion: Underweight levels were low while overweight was over 10% in these children. Girls were more than 3 times affected by overweight than boys, and were also physically fitter than boys. Breakfast consumption was not related to weight or fitness.