DO WEIGHT STATUS AND SELF- PERCEPTION OF WEIGHT IN THE U.S. ADULT POPULATION DIFFER BETWEEN BREAKFAST CONSUMERS AND BREAKFAST SKIPPERS? Results from NHANES 2009-2010 Freida Pan! NHANES Research Project! NTR 555 Nutrition in Epidemiology! December 8 th, 2014!
BACKGROUND & RATIONALE Observational evidence: breakfast consumption may be inversely associated with obesity 1-3! Breakfast consumption is associated with! total daily energy 4, "physical activity 5 and! impulsive snacking 6!! However, evidence remain controversial and evolving 7-9! The current studies supporting the proposed effect of breakfast consumption on obesity are beyond the strength of scientific evidence! Self-perception of weight: Important determinant in dietary behavior and weight management 10! No recent study has been done to associate self-perception of weight, actual weight and breakfast consumption!
OBJECTIVES 1. To examine the difference in weight status between breakfast consumers and breakfast skippers in the U.S. adult population in NHANES 2009-2010.!! 2. To examine the difference in self-perception of weight between breakfast consumers (BC) and breakfast skippers (BS) in the U.S. adult population in NHANES 2009-2010.!
Sample Size Flowchart Total Sample: NHANES 2009-2010! (n=10,537)! Adults 20 yrs old! (n=6218)! Measured weight, waist circumference, calculated BMI, Responses to the three Weight History Questions Non-pregnant subjects who named Individual Food Consumed with Eating Occasion! (n=5663)! Subjects with available data for the study outcomes! (n=4678)! Breakfast Consumer! (n=4014)! Breakfast Skipper! (n=664)!
DEFINE BREAKFAST CONSUMER, ABDOMINAL OBESITY AND BMI CATEGORIES Breakfast consumer (BC):! Respondent who named consumption of any food/ beverage as a meal occasion as breakfast or desayuno/ almuerzo (Spanish) 3, 15! Body Mass Index (BMI, kg/m 2 ):! Underweight: <18.5; normal: 18.50-24.99; overweight: 25.00; obese: 30.00 11! Abdominal obesity was defined as 12 :! WC> 40 for men, >35 for non-pregnant women!
ASSESS SELF-PERCEPTION OF WEIGHT 1.Difference between measured weight & selfreported weight (kg) 2. Subject s responses to the following weight history related questions: How do you consider your weight? (Overweight, underweight, or about the right weight) Would you like to weigh more, less, or stay about the same? During the past 12 months, have you tried to lose weight?
OUTCOME VARIABLES Demographics:! Categorical: Gender, race and education levels! Continuous: Age and PIR! Weight status:! Categorical: BMI & WC categories (Central obesity/ normal)! Continuous: BMI (kg/m 2 ) and WC (cm)! Self-perception of weight! Categorical: Responses to three weight history questions! Continuous: Difference between self-reported weight and measured weight (cm)! Total daily energy intake (kcal): continuous variable!
DATA ANALYSIS Normality: Measurements of skew and histogram distribution! Statistical significance: Traditional cutoff of p < 0.05! Chi-square: Gender, race, education levels, BMI categories, central obesity vs. normal and weight attitude! Mann-Whitney U: Age, PIR, BMI, WC, self-reported weight minus actual weight and total daily energy intake! Spearman s rho: Correlation between BMI, WC and total daily energy intake in male participants!
Table 1. Demographic characteristics and total daily energy intake Demographics Breakfast Consumer (BC) (n=4014) Breakfast Skipper (BS) (n=664) P-value (BC vs. BS) Age (y) mdn (25 th, 75 th ) 51 (37, 65) 40 (28, 53) * <0.001 Gender n(%) Males Females 1944 (48.4) 2070 (51.6) 361 (54.4) 303 (45.6) * 0.005 Ethnicity n(%) Non-Hispanic whites Non-Hispanic blacks Mexican Americans Other Hispanics Other Race/Multi-racial PIR a mdn (25 th, 75 th ) 1995 (49.7) 611 (15.2) 765 (19.1) 425 (10.6) 218 (5.4) 2.18 (1.11, 4.12) 311 (46.8) 186 (28.0) 89 (13.4) 37 (5.6) 41 (6.2) 1.38 (0.91, 3.23) *<0.001 *<0.001 * Statistically significant P value! n=3671 n=604
Demographics Education level b n(%) < 9 th grade 9-11 th grade High school grad/ged or Equivalent Some college or AA degree College Graduate or above Breakfast Consumer (BC) (n=4014) n=4006 511 (12.8) 599 (15.0) 921 (23.0) 1067 (26.6) 908 (22.7) Energy (kcal) mdn(25 th, 75 th ) 1950.0 (1459.8, 2586.3) Breakfast Skipper (BS) (n=664) n=663 57 (8.6) 130 (19.6) 184 (27.8) 203 (30.6) 89 (13.4) 1868.0 (1349.8, 2557.0) P-value (BC vs. BS) *<0.001 *0.017 a PIR: Poverty income ratio category, data missing from 403 subjects! b 9 subjects reported refused (n=4, 3 from BC) or don t know (n=5, all from BC), coded to system missing when running X 2! * Statistically significant P value!!
BC consumed more total daily energy compared to BS. (p= 0.017) Figure 1. Total energy intake between breakfast consumers (BC) and breakfast skippers (BS) (BC vs. BS: mdn 1950.0, IQR: 1459.8-2586.3 vs. mdn 1868.0, IQR: 1349.8, 2557.0)
* Statistically significant P value! Table 2. Body mass index (BMI) and waist circumference of adults ( 20 y) by BC vs. BS Weight status Breakfast Consumer (BC) (n=4014) Breakfast Skipper (BS) (n=664) BMI (kg/m 2 ) mdn (25 th, 75 th ) Total Male n=2305 Female n=2373 BMI category n(%) Underweight (<18.5) Normal (18.50-24.99) Overweight ( 25.00) Obese ( 30.00) 27.8 (24.2, 32.0) 27.7 (24.7, 31.3) n=1944 27.9 (23.8, 32.6) n=2070 64 (1.6) 1128 (28.1) 1400 (34.9) 1422 (35.4) Waist circumference (cm) mdh (25 th, 75 th ) Male n=2305 Female n=2373 99.85 (91.20, 109.58) n=1944 94.60 (84.80, 106.00) n=2070 27.3 (23.4, 32.4) 27.2 (23.3, 31.5) n=361 27.6 (23.3, 31.3) n=303 13 (2.0) 230 (34.6) 188 (28.3) 233 (35.1) 96.20 (84.95, 107.65) n=361 92.80 (83.40, 108.50) n=303 P-value (BC vs. BS) 0.119 *0.023 0.909 *0.001 *<0.001 0.786
Table 2. Body mass index (BMI) and waist circumference of adults ( 20 y) by BC vs. BS cont Weight status Waist circumference (cm) mdn (25 th, 75 th ) Male (n=2305) Female (n=2373) Waist circumference category n(%) Central obesity Normal! * Statistically significant P value! Breakfast Consumer (BC) (n=4014) 99.85 (91.20, 109.58) n=1944 94.60 (84.80, 106.00) n=2070 2160 (53.8) 1854 (46.2) Breakfast Skipper (BS) (n=664) 96.20 (84.95, 107.65) n=361 92.80 (83.40, 108.50) n=303 306 (46.1) 358 (53.9) P-value (BC vs. BS) *<0.001 0.786 * <0.001
A Mann-Whitney U test revealed a significant difference in BMI between males from BC and BS. (p=0.023) Figure 2. Body Mass Index (BMI) in male by breakfast groups BC male had a " BMI than the BS male (BC vs. BS mdn 27.7, IQR: 24.7-31.3 vs. 27.2, IQR: 23.3-31.5)
A Mann-Whitney U test revealed a significant difference in WC between males from BC and BS. (p< 0.001) Figure 3. Waist circumference (cm) in male by breakfast groups BC male had a " WC than the BS male (mdn 99.85, IQR: 91.20-109.58 vs. mdn 96.20, IQR: 84.95-107.65)
Table 3. Self-perception of weight by type of adults ( 20 y) by BC vs. BS Self-perception of weight Breakfast Consumer Breakfast Skipper (BS) (BC) (n=664) (n=4014) Difference between selfreported weight and measured weight mdn(25 th, 75 th ) Total Male Female a P value (Male vs. Female) Response to How do you consider your weight? n(%) Overweight Underweight About the right weight 0.1 (-1.7, 1.8) 0.60 (-1.40, 2.50) n=1944-0.30 (-2.00, 1.10) n=2070 a *<0.001 2170 (54.1) 203 (5.1) 1641 (40.9) 0.2 (-2.1, 2.0) 0.60 (-1.80, 2.95) n=361-0.30 (-2.30, 1.10) n=303 a *<0.001 317 (47.7) 41 (6.2) 306 (46.1) *Statistically significant P value! a Women reported a lower weight than their actual weight in both groups (p< 0.001)! P-value (BC vs. BS) 0.966 0.790 0.338 NA *0.009
Figure 4. Difference between self-reported weight (kg) and actual wt (kg) by breakfast group (consumer vs. skipper) Mann-Whitney U tests revealed no significant difference between selfreported Wt and measured Wt across the breakfast groups. (all p> 0.05)
Table 3. Self-perception of weight by type of adults ( 20 y) by BC vs. BS cont Self-perception of weight Response to Would you like to weigh more, less, or stay about the same? n(%) More Less Stay about the same Response to During the past 12 months, have you tried to lose weight? n(%) Yes No * Statistically significant P value! Breakfast Consumer (BC) (n=4014) 284 (7.1) 2454 (61.1) 1276 (31.8) 1314 (32.7) 2700 (67.3) Breakfast Consumer (BC) (n=4014) 67 (10.1) 385 (58.0) 212 (31.9) 213 (32.1) 451 (67.9) P-value (BC vs. BS) *0.02 0.738
Figure 5. Weight attitude to the question of "How do you consider your weight?" between groups Chi-square tests revealed significant differences in the participants response to the questions How do you consider your weight? between groups. (p= 0.009)
Figure 6. Weight attitude to the question of "Do you like to weigh more, less or stay about the same?" between groups Chi-square tests revealed significant differences in the participants response to the questions Would you like to weigh more, less, or stay about the same? between groups. (p= 0.02)
DISCUSSION Breakfast consumption has no favorable effects on total energy intakes throughout the day.! Consistent with previous studies 1, 13,14 : Total daily kcal breakfast > Total daily kcal no-breakfast! Only male BC had "BMI and waist circumference than BS, and the difference might not be clinical significant (Δ BMI : 0.5, Δ WC : 1.4 ).! Contrary to previous observational evidences 1,2!! Significant differences in BMI categories, central obesity ( p< 0.001) and weight attitude (p< 0.05).! Chi-square provides only suggestive evidence to support that breakfast consumers might have been more likely to be overweight/ obese and abdominal obese, and more likely to consider themselves as overweight and wanting to weigh less.!
LIMITATION Did not analyze the component of the breakfast.! Previous studies have shown that types of food consumed for breakfast have an impact on weight status and adiposity index 1-3!! Did not determine the calorie consumed at breakfast, whole body composition (e.g. lean body mass vs. fat mass) and physical activity.! A single 24-hour dietary recall may not capture the usual breakfast habits of the participants.!! Statistical: Chi-square tests are lacking power to detect directions of the differences between the groups. Did not adjust covariates such as age, gender, poverty level and total energy intakes.!
CONCLUSION Breakfast consumption has no favorable effects on total energy intakes throughout the day. Male breakfast consumers had greater BMI and waist circumference in comparison to breakfast skippers, but the results might lacking clinical significance.!! Our findings only provide suggestive evidence to support that breakfast consumers may have been more likely to be overweight/ obese and abdominal obese, and more likely to consider themselves as overweight and wanting to weigh less.!! Future research needs to examine and compare the influence of:! Types of food consumed at breakfast! Change in habitual breakfast behavior on weight status! Self-perception of weight in both male and female!
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