Relationship between Breakfast Skipping and Body Mass Index among School going Children: A Comparative Study in Bengaluru, Karnataka

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1 Available online at Durgannavar and Vijayalakshmi Int. J. Pure App. Biosci. 6 (1): (18) ISSN: 751 DOI: ISSN: 751 Int. J. Pure App. Biosci. 6 (1): (18) Research Article Relationship between Breakfast Skipping and Body Mass Index among School going Children: A Comparative Study in Bengaluru, Karnataka Nataraj A. Durgannavar * and Vijayalakshmi, D. Department of Food Science and Nutrition, University of Agricultural Sciences, GKVK, Bengaluru, India *Corresponding Author natrajdurgannavar@gmail.com Received: Revised: Accepted:.7.17 ABSTRACT Despite the importance of breakfast consumption, breakfast skipping by children was noted consistently across all regions. The study was taken up with the objective to assess the nutritional status of the children in relation to breakfast skipping in government and private schools of Bengaluru city, Karnataka. A total of school children aged 1-1 years were assessed for breakfast consumption pattern using questionnaire for the past one week. BMI for age percentiles were compared with the WHO (7) reference standards and classified according to WHO cut-offs. The breakfast skipping was found more in the children of compared to (7% vs. 7%). In comparison with two schools, the percentage of being underweight was found to be more in children (5.%) compared to children (6.%) irrespective of breakfast skipping frequency. The percentage of children being obese were found more in breakfast skippers who skips 1- times (16.7%) and -4 times (.1%) a week and were from private school. The study highlights the need of regular breakfast consumption during the transition from childhood to adolescence. Key words: School children, Nutritional status, Socio-economic status, Breakfast skipping, WHO standards. INTRODUCTION Children are the wealth of any nation as they constitute one of the important segments of the population. It is recorded that in India one fifth population comprises of children between 5-14 years, the age group covering primary and secondary school age 15. In India, approximately 1 per cent of the growing population comprises children in the age group of -14 years of whom 6.7 per cent currently reside in urban India. A significant and increasing number of these children belong to middle and high socio-economic groups 14. School going children go through remarkable physical changes of all kinds; their food intake becomes a critical aspect for the growth and development. Health of children is of great importance as rapid growth occurs during this period. Good nutrition is a basic requirement for good health and a living organism is a product of nutrition 9. Cite this article: Durgannavar, N.A. and Vijayalakshmi, D. Relationship between Breakfast Skipping and Body Mass Index among School going Children: A Comparative Study in Bengaluru, Karnataka, Int. J. Pure App. Biosci. 6(1): (18). doi: Copyright Jan.-Feb., 18; IJPAB 645

2 Durgannavar and Vijayalakshmi Int. J. Pure App. Biosci. 6 (1): (18) ISSN: 751 Both nutrition and diet are vital determinants of the health and nutritional profile of children. Studies in different countries have method for the current investigation. A total of school children (both gender) were selected from the two schools i.e., Government shown that in general, children s eating Higher Primary School (), patterns have changed over the years with the trends being eating more food away from home, consuming more snacks, drinking more sugar - sweetened beverages, along with a decline in breakfast consumption and less consumption of fruits 1. Bytarayanapura and Oriental English High School (), Vidyaranyapura, Bengaluru city (1 each from two schools). The data was collected with the help of pre-designed and pre-tested interview schedule by paying repeated visits to the study Both systematic reviews of the area and the responses were obtained on literature and statistical investigations on population samples support the notion that the various parameters to meet the requirements of the study. The data was collected during the first meal of the day is the most period of academic year. The underestimated, and often completely interview schedule was used to elicit the neglected 1. information from the participating subjects Despite the recommendations about their age, sex and socio-economic status. encouraging breakfast consumption, breakfast skipping by children was noted consistently across all regions. In only four countries For the present study, updated Kuppuswamy Socio-economic status scale, 1 19 was used. This scale takes into account education, (Netherlands, Portugal, Denmark, and occupation and income of the family to Sweden) 7 per cent or more children reported categorise families into upper, middle and low eating breakfast daily 18. In India, the socioeconomic status. proportion of children skipping breakfast regularly was even higher (over 5%) 4. In children of all ages, the prevalence of skipping breakfast has increased as they grow older 5. This is especially important, not only for the reasons stated above, but since consumption of Breakfast consumption pattern of children was assessed using questionnaire developed for the purpose. The questionnaire consisted of questions on frequency of consumption and skipping of breakfast. The breakfast consumption pattern of the children breakfast has been shown to track into young was assessed for the past one week. adulthood. Consumption of commonly eaten items Many studies undertaken in developed countries and some developing countries like Iran, suggests that the frequency of breakfast consumption is inversely associated with body mass index among school going children and starting from the first food or beverage in the morning until the first proper solid meal was taken into consideration as breakfast. Based on the frequency of breakfast consumption, the children were classified into two groups i.e., adolescents. breakfast consumers and breakfast skippers. Skipping breakfast among school On completion of questionnaires, children is erratic. It is essential to study the anthropometric measurements such as height breakfast consumption pattern of children. To and weight were undertaken and recorded in provide an explanatory view on the effect of their respective questionnaires using standard breakfast skipping on the nutritional status of techniques given by WHO for anthropometric the children, the study was taken up with the parameters 18. objective to assess the nutritional status of the Height was measured accurately to the children in relation to breakfast skipping in nearest.1 cm using a devised vertical rod. government and private schools of Bengaluru The scale was placed on a horizontally flat city, Karnataka surface and the respondent was standing without shoes on horizontal surface against MATERIAL AND METHODS wall with heels chin tucked in and body Study area and subjects stretched upwards to full extent and head in Children in the age group of 1 to 1 years the Frankfurt plane. were selected through random sampling Copyright Jan.-Feb., 18; IJPAB 646

3 Durgannavar and Vijayalakshmi Int. J. Pure App. Biosci. 6 (1): (18) ISSN: 751 Weight (kg) was measured with scale with a compiled on age basis. These measurements precision of.1 kg. The scale was placed on a were used to calculate BMI (Body Mass horizontally flat surface. Children were Index) of children. Age and gender specific weighted barefooted and wearing a minimum BMI centiles were used to classify respondents of clothing and without touching any other as underweight, normal, overweight or obese surface or object and the reading was noted. using the 7 WHO growth reference for The pointer on the balance scale was adjusted school aged children (5-19 years old) 1. This to zero before each weighing. growth reference is well-suited to the Indian Data preparation and analysis context. The WHO AnthroPlus software The various anthropometric measurements of (WHO, Geneva, Switzerland) was used to height and weight were extracted from the calculate BMI z-score and percentile for each administered questionnaires and were then specific age and gender. BMI category Underweight Normal Overweight Obese BMI classification according to WHO WHO cut offs <5 th Percentile 5 th 85 th Percentile 85 th 95 th percentile >95 th percentile Data collected was consolidated and analyzed. Descriptive statistics were performed and expressed as means and standard deviation for continuous variables (BMI) or as number of subjects and percentages for nominal variables (socio-demographic and BMI classification). Independent t-test and Chi-squared test (χ²) were used to evaluate the difference between continuous and categorical variables. All the statistical calculations were carried out through IBM SPSS (Statistical Package for the Social Sciences) for Windows, Version 1.. P values less than.5 were considered as significant. RESULTS AND DISCUSSION Socio-demographic profile of the respondents The investigation was carried out on a total of children representing 1, 11 and 1 year age group (5 th, 6 th and 7 th class) belonging to two different schools viz., (Government Higher Primary School) and (Oriental English High School) represented the sample size of 1 each, respectively. The samples included were both boys and girls. Age wise classification showed that 75 (7.5), 77 (8.5%) and 48 (4%) children belonged to 1, 11 and 1 years respectively; whereas gender wise segregation revealed that 19 were boys (54.5%) and 91 were girls (45.5%). Boys outnumbered the girls in the present study (Table 1). As per the socio-economic classification, nearly half of the families (49. %) from School belonged to lower middle class whereas 65 per cent of the families of School belonged to upper middle class. The percentage of families being in upper class was found to be nil in School and 1 per cent in the School. There was significant difference found between the families of two schools with respect to socio-economic class whereas age and gender showed non-significant difference (Table 1). Breakfast skipping pattern among the school children Breakfast behaviour includes consumption and skipping. Distribution of children according to breakfast skipping pattern is presented in Table. The breakfast skipping was found Copyright Jan.-Feb., 18; IJPAB 647

4 Durgannavar and Vijayalakshmi Int. J. Pure App. Biosci. 6 (1): (18) ISSN: 751 more in the children of compared to cent of BMI for 1, 11 and 1 year age group (7% vs. 7%). Of all the children respectively among. However, mean studied,.5 per cent skipped 1- times a BMI of the children of (government week,.5 per cent skipped -4 times in a school) was found to be significantly lower week, and 8.5 per cent skipped breakfast 5-6 compared to the WHO standards (p<.5, p< times in a week period. Only one child in the.1) (Table ). School skipped breakfast regularly Among children, higher during a week period. When data was analyzed percentage of standards was met by all the for chi-square test, there was no significant children. Boys and girls in the age group of 1 difference found between boys and girls of and 1 years achieved cent per cent standards two schools (Boys: χ = & Girls: χ = as compared with WHO standards (1.1% 1.19). and 1.1% respectively). Significant results The above results were in consistent were found among 1 year (girls), 11 year with the study conducted by Chitra and Reddy 4 (boys and girls) and 1 year (boys) children in who reported that 4.8 per cent did not skip whereas non-significant results found breakfast at all, 11.6 per cent skipped breakfast among children once in two days, 8. per cent skipped The above findings were in line with breakfast once in three days, 5.1 per cent the study conducted by Murugkar et al. 1 who skipped breakfast once a week, 1.8 per cent reported that the BMI of the study population skipped breakfast once in two weeks and 1.7 was found to be significantly lower (P<.5) per cent skipped breakfast every day. Similar than the reference BMI values (ICMR findings were reported in the various studies reference values). In the present study, private (Gajre et al 7., and John and Narasihman 11 ). In school children had higher BMI values contrast to the above results, Arora et al. in compared to government school children. This the study reported that significantly more could be attributed to their socio-economic government school (lower SES) students condition which in turn had effect on the consumed breakfast daily as compared to availability of nutritious food to the children. private school (higher SES) students (7.8% In comparison with two schools, the vs. 66.%, p<.1). percentage of being underweight was found to Government schools generally cater to be more in children (5.%) compared the lower income and lower-middle income to children (6.%) irrespective of class in Indian context. Students belonging to breakfast skipping frequency. In spite of lower income group are more likely to having daily breakfast among children, experience scarcity of good quality food more than 5 per cent of the children found to amounting to a lack of wholesome breakfast as be underweight and it is slightly higher in the well as other meals of the day. Disparities in children who skip breakfast -4 times in a breakfast consumption across regions may be week (55.9%). Among children, more explained by differences in cultural practices, than 6 per cent of children who consume socio-economic factors and availability of breakfast regularly were found to be normal school-meal programs. (6.5%). Equal percentage of children (5.%) Body Mass Index of the children in relation who had breakfast 5-4 times per week was to breakfast skipping found to be underweight and normal in. The BMI is a measure of overall adiposity. The percentage of children being obese were The WHO recommends it as a fatness found more in breakfast skippers who skips 1- measure in children for public health times (16.7%) and -4 times (.1%) a week screening. Comparison of BMI with WHO and were from private school (Table 4). standards showed that boys found to meet the As with the above results, Berkey et standard BMI at 95., 84.5 and 89.4 per cent al. reported that overweight breakfast whereas girls met at 87., 89.1 and 94.4 per skippers had lower BMIs over time when Copyright Jan.-Feb., 18; IJPAB 648

5 Durgannavar and Vijayalakshmi Int. J. Pure App. Biosci. 6 (1): (18) ISSN: 751 compared with overweight breakfast eaters (P The age and socio-economic class <.1), whereas normal-weight breakfast exerted a positive relationship with the BMI skippers had higher BMIs over time when whereas frequency of breakfast skipping compared with normal-weight breakfast eaters. showed to be inversely correlated with the Interestingly, when these same data were BMI (Table 5). analyzed cross-sectionally, results indicated The theoretical framework proposed that, overall, breakfast skippers were heavier. by Zhai et al. acknowledges that economic The results were in concurrent with status may affect the children s access to the findings of Deshmukh-Taskar et al. 5 who resources by lifestyle choices and behaviors, indicated that the prevalence of obesity (BMI area of residence and food affordability which 95th percentile) was higher in breakfast results in higher BMI among children. skippers (.1%) than in RTE cereal As reported by Timlin et al., 16 the consumers (15.%), especially in boys (4.1% frequency of eating breakfast was inversely vs. 14.%). Breakfast skippers had a higher associated with weight gain and BMI in a BMI percentile for age than RTE cereal dose-response manner (P <.1) which is in consumers. agreement with the current study findings. Garg et al. 8 also revealed that more A study conducted by Van Lippevelde numbers of breakfast non-skippers (69.1%) were found to have BMI in normal range than breakfast skippers (5.%) whereas more number of breakfast skippers (1.7%) were found to be overweight than breakfast nonskippers (4.7%). Similar results were observed in the studies conducted by Fayet-Moore et al. 6 and Al-Oboudi 1 who reported lower prevalence of overweight among breakfast consumers compared to skippers. et al., 17 on 1-1 year old children in eight European countries (Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia, Spain, and Switzerland) found that the children s breakfast consumption was negatively related to children s BMI-z-score (all p<.1) which supports the current study findings. Table 1: Socio demographic profile of the respondents Variables Total (n=1) (n=1) (N=) Age (years) (7.5) (8.5) (4.) Gender Male (54.5) Female (45.5) Socio-economic class Upper (I) 1 1 (1.5) Upper middle (II) (4.5) Lower middle (III) (1.5) Upper lower (IV) 9 9 (14.5) χ 1.7 NS.5 NS 9.7 * Government Higher Primary School, Byatarayanapura, Bengaluru Oriental English High School, Vidyaranyapura, Bengaluru *Significant at 5 per cent level NS Non significant Figures in parenthesis includes percentages Copyright Jan.-Feb., 18; IJPAB 649

6 Grand Durgannavar and Vijayalakshmi Int. J. Pure App. Biosci. 6 (1): (18) ISSN: 751 Table : Distribution of the children according to breakfast skipping pattern Breakfast Boys (n=19) Girls (n=91) skipping Total χ Total χ total pattern 1- times / 45 (.5) week (.5) times/week NS 1.19 NS 17 (8.5) times/week Daily (.5) Never (45) Government Higher Primary School, Byatarayanapura, Bengaluru Oriental English High School, Vidyaranyapura, Bengaluru Figures in parenthesis includes percentages NS Non significant Table : Mean BMI of the respondents as compared with WHO standards (N=) BMI WHO % standard t-value Age (Years) Sex Mean±SD standards 1 11 M ±.7 15.± NS -.8 NS F ± ± **.444 NS M ± ± ** NS F ± ± * NS 1 M ± ± * -.65 NS F ± ± NS -.85 NS Government Higher Primary School, Byatarayanapura, Bengaluru Oriental English High School, Vidyaranyapura, Bengaluru **Significant at 1 per cent level *Significant at 5 per cent level NS Non significant Table 4: BMI of the children in relation to the frequency of breakfast skipping (N=) Frequency of breakfast skipping (per week) n n Underweight Normal Overweight Obese 1- times (48.1) -4 times (55.9) 5-6 times (45.5) Daily 1 1 (1.) Never (55.6) (11.1) (15.4) (5.) (.) 19 (.) 14 (51.9) 1 (8.) 6 (54.5) (.) 8 (9.6) 1 (66.7) 8 (61.5) (5.) (.) 4 (6.5) (.) (5.9) (.) (.) (7.4) 1 (5.6) (.) (.) (.) 1 (1.6) No. (%) (.) (.) (.) (.) (7.4) No. (%) (16.7) (.1) (.) (.) (4.8) Government Higher Primary School, Byatarayanapura, Bengaluru Oriental English High School, Vidyaranyapura, Bengaluru Figures in parenthesis includes percentages Copyright Jan.-Feb., 18; IJPAB 65

7 Durgannavar and Vijayalakshmi Int. J. Pure App. Biosci. 6 (1): (18) ISSN: 751 Table 5: Relationship between age, socio-economic class and breakfast skipping with body mass index Variables BMI Correlation Coefficients (r) P-value Age.14.8 Socio-economic class Frequency of breakfast skipping CONCLUSION The study concluded that the breakfast skipping coupled with lower socio-economic status resulted in higher incidences of underweight among whereas unhealthy eating behaviours of children gave rise to overweight incidences among. The study highlights the need of regular breakfast consumption during the transition from childhood to adolescence. Breakfast provision in schools may offer a way to overcome social inequalities in daily breakfast consumption and could serve to yield health benefits associated with breakfast consumption. More research is needed to examine the influence of type of breakfast consumption on the nutritional status over time in larger sample of children. Acknowledgment All participants are gratefully acknowledged. Authors expressed their special thanks to school authorities for their support. The authors were grateful to RGNF-UGC, New Delhi, India for financial assistance. REFERENCES 1. Al-Oboudi, L.M., Impact of breakfast eating pattern on nutritional status, glucose level, iron status in blood and test grades among upper primary school girls in Riyadh city, Saudi Arabia.. Pak. J. Nutr., 9(): (1).. Arora, M., Nazar, G.P., Gupta, V.K., Perry, C. L., Reddy, K.S. and Stigler, M.H., Association of breakfast intake with obesity, dietary and physical activity behavior among urban school-aged adolescents in Delhi, India: results of a cross-sectional study. BMC Pub. Health, 1(1): 1-1 (1).. Berkey, C.S., Rockett, H.R., Gillman, M.W., Field, A.E. and Colditz, G.A., Longitudinal study of skipping breakfast and weight change in adolescents. Int. J. Obesity, 7(1): (). 4. Chitra, U. and Reddy, C.R., The role of breakfast in nutrient intake of urban schoolchildren. Pub. Health Nutr., 1(1): (6). 5. Deshmukh-Taskar, P.R., Nicklas, T.A., O'neil, C.E., Keast, D.R., Radcliffe, J.D. and Cho, S., The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: the National Health and Nutrition Examination Survey J. American Dietet. Association, 11(6): (1). 6. Fayet-Moore, F., Kim, J., Sritharan, N. and Petocz, P., Impact of breakfast skipping and breakfast choice on the nutrient intake and body mass index of Australian children. Nutrients, 8(8): 1-1 (16). 7. Gajre, N.S., Fernandez, S., Balakrishna, N. and Vazir, S., Breakfast eating habit and its influence on attention-concentration, immediate memory and school achievement. Indian Pediatrics, 45(1): (8). 8. Garg, M., Rajesh, V. and Kumar, P., Effect of breakfast skipping on nutritional status and school performance of 1-16 years old children of udupi district. Health and Population-Perspectives and Issues, 7(): (14). 9. Hasan, I., Zulkifle, M. and Ansari, A.H., An assessment of nutritional status of the children of government Urdu higher primary schools of Azad Nagar and its surrounding areas of Bangalore. Arch Appl Sci Res., (): (11). Copyright Jan.-Feb., 18; IJPAB 651

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