A Systematic Review of the Association of Skipping Breakfast with Weight and Cardiometabolic Risk Factors in Children and Adolescents. What Should We Better Investigate in the Future?
Plain language summary
Childhood obesity is a major public health issue across the world. The incidence of skipping breakfast among children and adolescent is rising. Numerous studies have shown a positive relationship between skipping breakfast and overweight or obesity. The aim of the study was to analyse the association of skipping breakfast with body weight and metabolic outcomes in the paediatric population. The study is a systemic review focusing on studies published in the last ten years. 39 articles were included for analysis and data from a total of 286,804 children and adolescents were reported. The systemic review demonstrates that children and adolescents who skip breakfast are at higher risk to be or become overweight or obese. Authors conclude that skipping breakfast may be a potential marker of lifestyle behaviours in children and adolescents that promote overweight or obesity and metabolic diseases.
The incidence of skipping breakfast in pediatric subjects is rising, and a relationship with overweight (OW) and obesity (OB) has been shown. Associations with cardiovascular outcomes and skipping breakfast in adults have been reported. The purpose of this systematic review was to summarize the association of skipping breakfast with body weight and metabolic outcomes in the pediatric population. We searched relevant databases (2008⁻2018) and identified 56 articles, of which 39 were suitable to be included, basing on inclusion criteria (observational; defined breakfast skipping; weight and/or metabolic outcomes). Overall, 286,804 children and adolescents living in 33 countries were included. The definitions of OW/OB, skipping breakfast, and the nutrient assessment were highly heterogeneous. Confounding factors were reported infrequently. The prevalence of skipping breakfast ranged 10⁻30%, with an increasing trend in adolescents, mainly in girls. Skipping breakfast was associated with OW/OB in the 94.7% of the subjects. The lack of association was shown mainly in infants. Moreover, 16,130 subjects were investigated for cardiometabolic outcomes. Skipping breakfast was associated with a worse lipid profile, blood pressure levels, insulin-resistance, and metabolic syndrome. Five studies reported a lower quality dietary intake in breakfast skippers. This review supports skipping breakfast as an easy marker of the risk of OW/OB and metabolic diseases, whether or not it is directly involved in causality. We encourage intervention studies using standardized and generalizable indicators. Data on confounders, time of fasting, chronotypes, and nutrition quality are needed to establish the best practice for using it as a tool for assessing obesity risk.
Exploring Associations between Interindividual Differences in Taste Perception, Oral Microbiota Composition, and Reported Food Intake.
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There are many known drivers of food choice and habits, however, taste is considered one of the main predictors. Each taste quality is associated with diﬀerent nutritional or physiological requirements or indicates a potential dietary risk. The main aim of this study was to explore whether variation in gustatory functions among individuals could be related to diﬀerent dietary patterns and intake. A secondary aim was to examine the relationship between gustatory functions and dietary patterns in relation to oral microbiota composition. The study recruited 59 (27 male and 32 female) healthy, normal-weight volunteers aged between 18 and 30 years of age. Seven concentrations for each taste stimulus were prepared to determine the recognition thresholds. Results indicate that: (i) recognition thresholds for the basic tastes were associated with each other, even though in diﬀerent ways, (ii) interindividual diﬀerences in taste perception may inﬂuence habitual food consumption and intake, and (iii) there are gender-related diﬀerences in food consumption frequency and intake. Authors conclude that nongenetic factors, such as the oral bacteria lining the tongue, should be adequately considered in order to gain new insights into taste-related eating habits that may inﬂuence long-term health outcomes.
The role of taste perception, its relationship with oral microbiota composition, and their putative link with eating habits and food intake were the focus of the present study. A sample of 59 reportedly healthy adults (27 male, 32 female; age: 23.3 ± 2.6 years) were recruited for the study and taste thresholds for basic tastes, food intake, and oral microbiota composition were evaluated. Differences in taste perception were associated with different habitual food consumption (i.e., frequency) and actual intake. Subjects who were orally hyposensitive to salty taste reported consuming more bakery and salty baked products, saturated-fat-rich products, and soft drinks than hypersensitive subjects. Subjects hyposensitive to sweet taste reported consuming more frequently sweets and desserts than the hypersensitive group. Moreover, subjects hypersensitive to bitter taste showed higher total energy and carbohydrate intakes compared to those who perceived the solution as less bitter. Some bacterial taxa on tongue dorsum were associated with gustatory functions and with vegetable-rich (e.g., Prevotella) or protein/fat-rich diets (e.g., Clostridia). Future studies will be pivotal to confirm the hypothesis and the potential exploitation of oral microbiome as biomarker of long-term consumption of healthy or unhealthy diets.
Altered metabolic homeostasis is associated with appetite regulation during and following 48-h of severe energy deprivation in adults.
Metabolism: clinical and experimental. 2016;65(4):416-27
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Intermittent periods of substantial energy deficit, common among military personnel, result in multiple endocrine and metabolic signals. To date, the association between metabolic and endocrine markers with appetite regulation remain controversial. Using a novel model, the aim of this crossover study was to determine the effects of severe energy deprivation on cognitive function, and explore the metabolic response and its impact on appetite regulation in 23 young adults. Following prescribed exercise, participants were randomised to consume an energy balanced or energy deficit diet. The findings of this study showed that during energy deprivation, metabolic homeostasis modulates appetite independent of diet volume. Though further studies are required, these results suggest that metabolic and endocrine signals are associated with adipose and lean tissue loss to restore energy balance.
BACKGROUND Military personnel frequently endure intermittent periods of severe energy deficit which can compromise health and performance. Physiologic factors contributing to underconsumption, and the subsequent drive to overeat, are not fully characterized. This study aimed to identify associations between appetite, metabolic homeostasis and endocrine responses during and following severe, short-term energy deprivation. METHODS Twenty-three young adults (17M/6F, 21±3years, BMI 25±3kg/m(2)) participated in a randomized, controlled, crossover trial. During separate 48-h periods, participants increased habitual energy expenditure by 1647±345kcal/d (mean±SD) through prescribed exercise at 40-65% VO2peak, and consumed provided isovolumetric diets designed to maintain energy balance at the elevated energy expenditure (EB; 36±93kcal/d energy deficit) or to produce a severe energy deficit (ED; 3681±716kcal/d energy deficit). Appetite, markers of metabolic homeostasis and endocrine mediators of appetite and substrate availability were periodically measured. Ad libitum energy intake was measured over 36h following both experimental periods. RESULTS Appetite increased during ED and was greater than during EB despite maintenance of diet volume (P=0.004). Ad libitum energy intake was 907kcal/36h [95% CI: 321, 1493kcal/36h, P=0.004] higher following ED compared to following EB. Serum beta-hydroxybutyrate, free fatty acids, branched-chain amino acids, dehydroepiandrosterone-sulfate (DHEA-S) and cortisol concentrations were higher (P<0.001 for all), whereas whole-body protein balance was more negative (P<0.001), and serum glucose, insulin, and leptin concentrations were lower (P<0.001 for all) during ED relative to during EB. Cortisol concentrations, but not any other hormone or metabolic substrate, were inversely associated with satiety during EB (R(2)=0.23, P=0.04). In contrast, serum glucose and DHEA-S concentrations were inversely associated with satiety during ED (R(2)=0.68, P<0.001). No associations between physiologic variables measured during EB and ad libitum energy intake following EB were observed. However, serum leptin and net protein balance measured during ED were inversely associated with ad libitum energy intake following ED (R(2)=0.48, P=0.01). CONCLUSION These findings suggest that changes in metabolic homeostasis during energy deprivation modulate appetite independent of reductions in diet volume. Following energy deprivation, physiologic signals of adipose and lean tissue loss may drive restoration of energy balance. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov #NCT01603550.
[Type 2 Diabetes Mellitus, Depression and Eating Disorders in Patients Submitted to Bariatric Surgery].
Acta medica portuguesa. 2016;29(3):176-81
Plain language summary
Bariatric surgery has become the most efficient way to obtain satisfying results in terms of weight loss, comorbidity improvement and survival amongst people with morbid obesity. The aim of the study is to assess the progression of type 2 diabetes and psychopathological variables before and after bariatric surgery. A secondary aim is to analyse the importance of the different variables in weight loss outcomes. The retrospective observational and cross-sectional study involves clinical data of 75 patients, aged between 23 and 64, before and after bariatric surgery. Results indicate that type 2 diabetes improved through bariatric surgery, and that type 2 diabetes, depression and eating disorders have an influence on weight loss postoperatively. Authors conclude that it is important to provide continuous psychiatric follow-up of patients who undergo bariatric surgery.
INTRODUCTION Obesity is associated with a great number of complications, including type 2 diabetes mellitus and psychiatric pathology. Bariatric surgery is the best solution to weight loss and improvement of complications in morbid obese patients. This study aims to analyze the evolution of type 2 diabetes mellitus and psychopathologic variables before and after bariatric surgery and assess the importance of different variables in weight loss. MATERIAL AND METHODS This is a longitudinal study, which evaluates 75 patients before and after bariatric surgery (47 - LAGB - laparoscopic adjustable gastric band; 19 - RYGB - Roux-en-Y gastric bypass; 9 - sleeve) with a follow-up time between 18 and 46 months. A clinical interview and self report questionnaires were applied - Eating Disorder Examination questionnaire - EDE-Q and Beck Depression Inventory - BDI. RESULTS Results show an improvement in type 2 diabetes mellitus after surgery (X2 (1) = 26.132, p < 0.001). There was not a significant improvement among psychiatric pathology when we controlled the analysis for the type of surgery. It was verified that type 2 diabetes mellitus, depression and eating disorders in post-operative period are associated with less weight loss. This model explains 27% of weight variance after surgery (R2 = 0.265) and it is significant F (3.33) = 2.981, p = 0.038. DISCUSSION Type 2 diabetes mellitus, psychiatric pathology and eating disorders after surgery influenced weight loss. It was not clear in what way this relation was verified, neither the relation that these metabolic and psychological variables may have during the postoperative period. CONCLUSION Type 2 diabetes mellitus improved after surgery. Type 2 diabetes mellitus, depression and eating disorders influenced weight loss in the postoperative period. These variables did not influence weight loss in the preoperative period.
Effects of exercise on gut peptides, energy intake and appetite.
The Journal of endocrinology. 2007;193(2):251-8
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The impact of physical activity on weight loss is difficult to quantify as it involves both long-term and short-term mechanisms. It has been suggested that the deficit created by exercise may be partially compensated for by an increase in energy intake, resulting in no weight loss. The aim of this crossover study was to investigate the acute effects of exercise on energy intake, appetite, satiety and postprandial hormone levels in 12 healthy volunteers. This study indicates that while exercise increases subsequent energy intake, it produces a significant decrease in overall energy balance. The authors conclude that moderate-intensity exercise temporarily decreases hunger sensations and is able to produce a short-term negative energy balance.
This study investigated the acute effects of exercise on the postprandial levels of appetite-related hormones and metabolites, energy intake (EI) and subjective measures of appetite. Ghrelin, polypeptide YY (PYY), glucagon-like peptide-1 (GLP-1) and pancreatic polypeptide (PP) were measured in the fasting state and postprandially in 12 healthy, normal-weight volunteers (six males and six females) using a randomised crossover design. One hour after a standardised breakfast, subjects either cycled for 60 min at 65% of their maximal heart rate or rested. Subjective appetite was assessed throughout the study using visual analogue scales and subsequent EI at a buffet meal was measured at the end (3-h post-breakfast and 1-h post-exercise). Exercise significantly increased mean PYY, GLP-1 and PP levels, and this effect was maintained during the post-exercise period for GLP-1 and PP. No significant effect of exercise was observed on postprandial levels of ghrelin. During the exercise period, hunger scores were significantly decreased; however, this effect disappeared in the post-exercise period. Exercise significantly increased subsequent absolute EI, but produced a significant decrease in relative EI after accounting for the energy expended during exercise. Hunger scores and PYY, GLP-1 and PP levels showed an inverse temporal pattern during the 1-h exercise/control intervention. In conclusion, acute exercise, of moderate intensity, temporarily decreased hunger sensations and was able to produce a short-term negative energy balance. This impact on appetite and subsequent energy homeostasis was not explained by changes in postprandial levels of ghrelin; however, 'exercise-induced anorexia' may potentially be linked to increased PYY, GLP-1 and PP levels.