Song WO, Chun OK, Obayashi S, Cho S, Chung CE. Is consumption of breakfast associated with body mass index in US adults? J Am Diet Assoc 2005;105:1373-82.
To test the hypothesis that breakfast consumption is associated with weight status measure by body mass index in US Adults.
Participants in NHANES 1999-2000 > 19 years of age.
- Pregnant or lactating women.
- Participants with unreliable dietary recall records (reference was made to an NCHS reference but details were not included).
Recruitment That used in NHANES 1999-2000, not detailed
Design Cross-sectional comparison between breakfast consumers and non-conumers and among breakfast consumers, RTEC breakfast consumers and non-RTEC breakfast consumers and the effect of breakfast habits on BMI.
Blinding used NA
Statistical Analysis T-tests and linear regressional analyses were performed to develop multiple logistic models. The reference groups (OR=1.0) were breakfast non-consumers and non-RTEC breakfast consumers with the logistic regressions assessing the predictability of breakfast consumption on BMI > 25, and the predictability of RTEC consumption on BMI > 25, respectively.
Timing of Measurements cross-sectional
Dependent Variables BMI
- breakfast consumption
- RTEC breakfast consumption
- smoking habit
- energy intake
- weight control
Initial N: gg65
Attrition (final N): 4,218 (2,097 men and 2,121 women)
- 19-29 years old 825
- 30-39 years old 644
- 40-49 years old 684
- 50-59 years old 528
- 60-69 years old 735
- 70+ years old 802
- White 1,841
- African American 827
- Hispanic 1,170
- Others 380
Other relevant demographics: None
Anthropometrics Sample was divided on BMI ranging between BMI < 18.5 to BMI >30.
- Mean daily energy intake was higher for breakfast consumers than for breakfast nonconsumers among women (1871 vs 1657 kcal/d; P=.0009), but not among men.
- Compared with female breakfast nonconsumers, women who consumed breakfast were less likely to have BMI > 25 (OR=0.76, 95% CI=0.56 to 1.01l P=0.57) after adjusting for age, ethnicity, smoking, energy intake, exercise, and weight control.
- A lower prevalence of BMI > 25 was consistently observed among women RTEC breakfast consumers (OR=0.70, 95% CI=0.52 to 0.94; P<.05) after adjustment for age, ethnicity, smoking, and energy intake.
- When RTEC breakfast consumption was added as a covariate, the OR for BMI >25 among breakfast consumers no longer differed significantly from that among breakfast nonconsumers.
- There was an inverse association between RTEC breakfast consumption and BMI in women (regression coefficient = -1.37; P<.01), but not in men.
- Breakfast consumption was highest among whites (80.4%), compared with 68.6% for African Americans, and 71.7% for Hispanics.
- RTEC breakfast consumption was highest among white (24.7%), compared with 16.1% among African Americans and 11.1% among Hispanics.
- Breakfast consumers, compared to nonconsumers, were more likely to be trying to control their weight (10.8% vs. 6.3%, P<.01).
- Energy intake from fat was not significantly different between breakfast consumers and non-consumers (33% vs. 32%). Among men and women, breakfast consumers had significantly higher dietary fiber intake than breakfast non-consumers (17+0.3g vs. 12+0.4g) and RTEC breakfast consumers also had significantly higher dietary fiber intake than non-RTEC breakfast consumers (P<0.001 for both comparisons).
Research Design and Implementation Criteria Checklist: Primary Research
|1.||Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)|
|2.||Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?|
|3.||Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to nutrition or dietetics practice?|
|4.||Is the intervention or procedure feasible? (NA for some epidemiological studies)|
|1.||Was the research question clearly stated?|
|1.1.||Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?|
|1.2.||Was (were) the outcome(s) [dependent variable(s)] clearly indicated?|
|1.3.||Were the target population and setting specified?|
|2.||Was the selection of study subjects/patients free from bias?|
|2.1.||Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?|
|2.2.||Were criteria applied equally to all study groups?|
|2.3.||Were health, demographics, and other characteristics of subjects described?|
|2.4.||Were the subjects/patients a representative sample of the relevant population?|
|3.||Were study groups comparable?|
|3.1.||Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)|
|3.2.||Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?|
|3.3.||Were concurrent controls used? (Concurrent preferred over historical controls.)|
|3.4.||If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?|
|3.5.||If case control or cross-sectional study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable. Criterion may not be applicable in some cross-sectional studies.)|
|3.6.||If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?|
|4.||Was method of handling withdrawals described?|
|4.1.||Were follow-up methods described and the same for all groups?|
|4.2.||Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)|
|4.3.||Were all enrolled subjects/patients (in the original sample) accounted for?|
|4.4.||Were reasons for withdrawals similar across groups?|
|4.5.||If diagnostic test, was decision to perform reference test not dependent on results of test under study?|
|5.||Was blinding used to prevent introduction of bias?|
|5.1.||In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?|
|5.2.||Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)|
|5.3.||In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?|
|5.4.||In case control study, was case definition explicit and case ascertainment not influenced by exposure status?|
|5.5.||In diagnostic study, were test results blinded to patient history and other test results?|
|6.||Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?|
|6.1.||In RCT or other intervention trial, were protocols described for all regimens studied?|
|6.2.||In observational study, were interventions, study settings, and clinicians/provider described?|
|6.3.||Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?|
|6.4.||Was the amount of exposure and, if relevant, subject/patient compliance measured?|
|6.5.||Were co-interventions (e.g., ancillary treatments, other therapies) described?|
|6.6.||Were extra or unplanned treatments described?|
|6.7.||Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?|
|6.8.||In diagnostic study, were details of test administration and replication sufficient?|
|7.||Were outcomes clearly defined and the measurements valid and reliable?|
|7.1.||Were primary and secondary endpoints described and relevant to the question?|
|7.2.||Were nutrition measures appropriate to question and outcomes of concern?|
|7.3.||Was the period of follow-up long enough for important outcome(s) to occur?|
|7.4.||Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?|
|7.5.||Was the measurement of effect at an appropriate level of precision?|
|7.6.||Were other factors accounted for (measured) that could affect outcomes?|
|7.7.||Were the measurements conducted consistently across groups?|
|8.||Was the statistical analysis appropriate for the study design and type of outcome indicators?|
|8.1.||Were statistical analyses adequately described and the results reported appropriately?|
|8.2.||Were correct statistical tests used and assumptions of test not violated?|
|8.3.||Were statistics reported with levels of significance and/or confidence intervals?|
|8.4.||Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?|
|8.5.||Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?|
|8.6.||Was clinical significance as well as statistical significance reported?|
|8.7.||If negative findings, was a power calculation reported to address type 2 error?|
|9.||Are conclusions supported by results with biases and limitations taken into consideration?|
|9.1.||Is there a discussion of findings?|
|9.2.||Are biases and study limitations identified and discussed?|
|10.||Is bias due to study’s funding or sponsorship unlikely?|
|10.1.||Were sources of funding and investigators’ affiliations described?|
|10.2.||Was the study free from apparent conflict of interest?|
Copyright American Dietetic Association (ADA).