The path between breakfast eating habit, sleep duration and physical activity on obesity status: An epidemiological study in schoolchildren

Abstract

<b>Background:</b> Although the literature suggests that skipping breakfast, insufficient sleep, and reduced physical activity are associated with childhood obesity their co-influence and their in-between interactions on weight status have rarely been studied. <b>Aim:</b> To examine the co-influence of breakfast eating habits, sleep duration, and physical activity on the weight status of children 10-12 years old from several schools of Greece. <b>Methods:</b> A cross-sectional study was conducted on 1688 students in Greece, during 2014-2016. Children's Body Mass Index (BMI) was calculated and classified according to the International Obesity Task Force (IOTF) classification. Logistic regression models and path analysis were used. <b>Results:</b> Overweight/obesity prevalence was higher in boys (32.5% vs. 20.4%; <i>p</i> < 0.001). Average sleep duration decreased the odds of overweight/obesity [OR (95% CI): 0.86 (0.76, 0.97)] independently of the frequency of breakfast habit. Interaction between sleep duration with breakfast habit (<i>p</i> = 0.002) and physical activity (<i>p</i> < 0.001) was observed. Path analysis showed a negative association of BMI with sleep duration (standardized beta = -0.095, <i>p</i> < 0.001). A third-order interaction between breakfast habit, sleep duration, and physical activity revealed that daily breakfast eating along with adequate sleep and moderate/adequate physical activity levels, decreased the odds of over-weight/obesity by 55% [OR 0.45, 95% CI (0.27, 0.72)]. <b>Conclusion:</b> Although sleep duration is inversely associated with weight status independently of breakfast habit, the co-influence of adequate sleep duration with frequent breakfast eating and moderate/adequate physical activity seems to be a profoundly higher associated as a result of synergy against childhood obesity.