Meal frequency, breakfast consumption and childhood obesity

Objective. In a recent study meal frequency was inversely related to childhood obesity. To assess an inverse association between meal frequency and childhood obesity with particular focus on breakfast consumption. Methods. Anthropometric data on 4 642 children aged 5 to 6 years were obtained in 5 Bavarian public health offices (Germany) during the obligatory school entry health examination in 2004/2005. An extensive questionnaire on risk factors for childhood obesity was answered by their parents. Obesity was defined according to sex- and age-specific body mass index (BMI) cut-off points, recommended by the International Obesity Task Force. Main exposures were meal frequency and breakfast consumption. Results. The prevalence of obesity decreased by number of daily meals: 3 or less, 5% (95%CI 4 to 6%), 4 meals, 3% (95%CI 2 to 4%) and 5 or more meals 2% (95%CI 2 to 4%) (trend test p < 0.05). After adjustment for sociodemographic and constitutional factors odds ratios (OR) for obesity were 0.71 (95%CI, 0.50 to 1.01) for 4 meals and 0.57 (95%CI 0.37 to 0.88) for 5 or more meals, compared with 3 or less daily meals. The OR was 0.72 (95%CI 0.58 to 0.90) per additional meal. Additional adjustment for regular breakfast only marginally changed the OR of meal frequency on obesity to 0.75 (95%CI 0.60 to 0.95) per additional meal. Conclusions. High meal frequency was inversely associated with childhood obesity. This association was not explained by potential confounders or regular breakfast consumption. These findings support the hypothesis of an independent protective impact of frequent daily meals other than breakfast on childhood obesity.