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

European Journal of Clinical Nutrition volume 79, pages 427–434 (2025)Cite this article

Subjects

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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Data availability

The original data of this work are available upon reasonable request to the corresponding author.

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Funding

The Feel4Diabetes study has received funding from the European Union’s Horizon 2020 research and innovation program [Grant Agreement: n° 643708]. The content of this article reflects only the authors’ views and the European Community is not liable for any use that may be made of the information contained therein. The funding body had no role in the design of this study and collection, analysis, and interpretation of the data, and in writing this manuscript.

Author information

Authors and Affiliations

  1. Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, Kallithea, Athens, Attica, Greece

    Panayiota Kostarellou, Costas A. Anastasiou, Eva Karaglani, Yannis Manios, Kalliopi Karatzi, Odysseas Androutsos, George Moschonis, Spyridon Kanellakis, Christina Mavrogianni, Konstantina Tsoutsoulopoulou, Christina Katsarou, Irini Qira, Efstathios Skoufas, Konstantina Maragkopoulou, Antigone Tsiafitsa, Irini Sotiropoulou, Michalis Tsolakos, Effie Argyri, Mary Nikolaou, Eleni-Anna Vampouli, Christina Filippou, Kyriaki Apergi, Amalia Filippou, Gatsiou Katerina & Efstratios Dimitriadis

  2. Department of Pediatrics, Medical University Varna, Varna, Bulgaria

    Violeta Iotova, Kaloyan Tsochev, Nevena Chakarova, Sonya Galcheva, Rumyana Dimova, Yana Bocheva, Zhaneta Radkova, Vanya Marinova, Yuliya Bazdarska & Tanya Stefanova

  3. Department of Social Medicine and Health Care Organization, Medical University of Varna, Varna, Bulgaria

    Natalya Usheva

  4. Department of Diabetology, Clinical Center of Endocrinology, Medical University of Sofia, Sofia, Bulgaria

    Tsvetalina Tankova

  5. Department of Family Medicine, Semmelweis University, Budapest, Hungary

    Imre Rurik, Timea Ungvari, Zoltán Jancsó, Anna Nánási, László Kolozsvári, Csilla Semánova, Éva Bíró, Emese Antal & Sándorné Radó

  6. First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Stavros Liatis, Konstantinos Makrilakis, George Dafoulas, Christina-Paulina Lambrinou & Angeliki Giannopoulou

  7. Growth, Exercise, NUtrition and Development (GENUD), Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Spain

    Natalia Giménez Legarre, Luis A. Moreno, Fernando Civeira, Gloria Bueno, Pilar De Miguel-Etayo, Esther Mª Gonzalez-Gil, María L. Miguel-Berges, Natalia Giménez-Legarre, Paloma Flores-Barrantes, Alelí M. Ayala-Marín, Miguel Seral-Cortés, Lucia Baila-Rueda, Ana Cenarro, Estíbaliz Jarauta & Rocío Mateo-Gallego

  8. Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland

    Jaana Lindstrom, Katja Wikström, Tiina Laatikainen, Jemina Kivelä, Päivi Valve, Esko Levälahti, Eeva Virtanen, Tiina Pennanen, Seija Olli & Karoliina Nelimarkka

  9. Greet Cardon Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium

    Greet Cardon, Lieven Annemans, Vicky Van Stappen, Nele Huys & Samyah Shadid

  10. Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece

    Yannis Manios

  11. Dresden University of Technology (Technische Universität Dresden), Dresden, Germany

    Peter Schwarz & Patrick Timpel

  12. International Diabetes Federation European Region, Antwerp, Belgium

    Winne Ko & Ernest Karuranga

  13. Extensive Life Oy, Tampere, Finland

    Remberto Martinez & Marcos Tong

Authors
  1. Panayiota Kostarellou
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  2. Costas A. Anastasiou
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  3. Eva Karaglani
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  4. Violeta Iotova
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  5. Natalya Usheva
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  6. Tsvetalina Tankova
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  7. Imre Rurik
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  8. Stavros Liatis
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  9. Natalia Giménez Legarre
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  10. Luis A. Moreno
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  14. Konstantinos Makrilakis
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  15. Yannis Manios
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Consortia

Feel4Diabetes-study group

  • Yannis Manios
  • , Greet Cardon
  • , Jaana Lindstrom
  • , Peter Schwarz
  • , Konstantinos Makrilakis
  • , Lieven Annemans
  • , Winne Ko
  • , Kalliopi Karatzi
  • , Odysseas Androutsos
  • , George Moschonis
  • , Spyridon Kanellakis
  • , Christina Mavrogianni
  • , Konstantina Tsoutsoulopoulou
  • , Christina Katsarou
  • , Eva Karaglani
  • , Irini Qira
  • , Efstathios Skoufas
  • , Konstantina Maragkopoulou
  • , Antigone Tsiafitsa
  • , Irini Sotiropoulou
  • , Michalis Tsolakos
  • , Effie Argyri
  • , Mary Nikolaou
  • , Eleni-Anna Vampouli
  • , Christina Filippou
  • , Kyriaki Apergi
  • , Amalia Filippou
  • , Gatsiou Katerina
  • , Efstratios Dimitriadis
  • , Tiina Laatikainen
  • , Katja Wikström
  • , Jemina Kivelä
  • , Päivi Valve
  • , Esko Levälahti
  • , Eeva Virtanen
  • , Tiina Pennanen
  • , Seija Olli
  • , Karoliina Nelimarkka
  • , Vicky Van Stappen
  • , Nele Huys
  • , Ruben Willems
  • , Samyah Shadid
  • , Patrick Timpel
  • , George Dafoulas
  • , Christina-Paulina Lambrinou
  • , Angeliki Giannopoulou
  • , Ernest Karuranga
  • , Fernando Civeira
  • , Gloria Bueno
  • , Pilar De Miguel-Etayo
  • , Esther Mª Gonzalez-Gil
  • , María L. Miguel-Berges
  • , Natalia Giménez-Legarre
  • , Paloma Flores-Barrantes
  • , Alelí M. Ayala-Marín
  • , Miguel Seral-Cortés
  • , Lucia Baila-Rueda
  • , Ana Cenarro
  • , Estíbaliz Jarauta
  • , Rocío Mateo-Gallego
  • , Kaloyan Tsochev
  • , Nevena Chakarova
  • , Sonya Galcheva
  • , Rumyana Dimova
  • , Yana Bocheva
  • , Zhaneta Radkova
  • , Vanya Marinova
  • , Yuliya Bazdarska
  • , Tanya Stefanova
  • , Timea Ungvari
  • , Zoltán Jancsó
  • , Anna Nánási
  • , László Kolozsvári
  • , Csilla Semánova
  • , Éva Bíró
  • , Emese Antal
  • , Sándorné Radó
  • , Remberto Martinez
  •  & Marcos Tong

Contributions

PK acquired data and drafted the manuscript. CAA contributed in the design of the work and in the interpretation of the results, acquired data and drafted the manuscript. EK contributed in the design and in the interpretation of the results and revised the manuscript. VI, IR, SL, LAM, JL, KW, GC, KM and YM conceived the work and revised the manuscript. NU, TT and NGL acquired data and revised the manuscript. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Yannis Manios.

Ethics declarations

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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Kostarellou, P., Anastasiou, C.A., Karaglani, E. et al. Prospective association between breakfast consumption frequency and BMI z-score among European school-aged children. The Feel4Diabetes Study. Eur J Clin Nutr 79, 427–434 (2025). https://doi.org/10.1038/s41430-025-01570-9

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