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. 2025 May;79(5):427-434.
doi: 10.1038/s41430-025-01570-9. Epub 2025 Jan 25.

Prospective association between breakfast consumption frequency and BMI z-score among European school-aged children. The Feel4Diabetes Study

Panayiota Kostarellou  1 , Costas A Anastasiou  1 , Eva Karaglani  1 , Violeta Iotova  2 , Natalya Usheva  3 , Tsvetalina Tankova  4 , Imre Rurik  5 , Stavros Liatis  6 , Natalia Giménez Legarre  7 , Luis A Moreno  7 , Jaana Lindstrom  8 , Katja Wikström  8 , Greet Cardon  9 , Konstantinos Makrilakis  6 , Yannis Manios  10   11 ; Feel4Diabetes-study group
Collaborators, Affiliations

Prospective association between breakfast consumption frequency and BMI z-score among European school-aged children. The Feel4Diabetes Study

Panayiota Kostarellou et al. Eur J Clin Nutr. 2025 May.

Abstract

Background: The long-term effects of breakfast on childhood z-BMI remain inconclusive.

Objective: To prospectively assess the impact of stable and altered breakfast consumption habits on z-BMI change over two years, in school-aged children across six European countries.

Methods: Data of 6,528 children (8.2 ± 1.0 years, 48.9% male) from the Feel4Diabetes study were used. Children's lifestyle behaviors, including breakfast frequency, were assessed through parent-reported questionnaires. Weight and height were objectively measured and converted to z-BMI. Participants were categorized into trajectories combining breakfast consumption habit (i.e., regular consumption, irregular consumption or omission) at baseline and follow up. Logistic regression analyzed the prospective association between breakfast trajectories and z-BMI increase, with adjustment for demographic and lifestyle variables.

Results: A statistically significant effect of breakfast trajectories was observed in z-BMI, both at baseline and follow up. Stable skippers was the only trajectory that showed a significant increase in BMI z-score from baseline to follow up (0.891 ± 1.058 vs. 1.034 ± 1.072 respectively, p < 0.05). BMI z-score at follow up of regular eaters (0.615 ± 0.967) was significantly lower, compared to both irregular eaters (1.229 ± 0.890) and stable skippers (both p < 0.05). Stable regular consumption and transition from omission to regular consumption were independently associated with significantly lower risk of z-BMI gain, compared to stable omission [OR, 95% CI: 0.55 (0.31, 0.97), p = 0.039 and 0.43 (0.21, 0.88), p = 0.021 respectively].

Conclusion: Stable regular breakfast consumption or transition from omission to regular consumption seem to contribute to superior weight regulation in children and to independently protect against z-BMI gain, compared to stable omission. Further studies are warranted to extend the evidence on the breakfast habit-BMI association among children.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethical approval: This study was conducted conforming to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were granted approval by the human bioethics committees of all of the participating tertiary institutions [Medical Ethics Committee of the Ghent University Hospital, Belgium (Ethical Approval (EA) No.: B670201524237; 21/04/15); Ethics Committee of the Medical University of Varna, Bulgaria (EA No.: 52/10-3-2016; 10/03/16) and the Municipalities of Sofia and Varna, as well as the Ministry of Education and Science local representatives; Hospital district of Southwest Finland ethical committee (EA: No.: 174/1801/2015; 13/03/15); Bioethics Committee of Harokopio University, Greece and the Greek Ministry of Education; (EA No.: 46/3-4-2015; 03/04/15); National Committee for Scientific Research in Medicine, Hungary (EA No.: 20095/2016/EKU; 29/03/16); Clinical Research Ethics Committee and the Department of Consumers´ Health of the Government of Aragón, Spain (EA No.: CP03/2016; 08/04/15)]. All participants gave signed informed consent before inclusion into the study.

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