Associations of breakfast skipping with obesity and health-related quality of life: evidence from a national survey in Taiwan

Objective: This study investigated the associations of breakfast skipping with obesity and health-related quality of life (QOL). We also tested the hypothesis that there is a dose-dependent relationship between frequency of breakfast consumption and prevalence of obesity. Subjects and Design: This cross-section study used a national representative sample (n = 15 340) from the 2005 Taiwan National Health Interview Survey. Breakfast skippers were defined as those who ate breakfast about once a week or less often and those who never ate breakfast. Individuals were classified as 'obese' if their body mass index was >= 27. Health-related QOL was assessed using the Medical Outcome Studies 36-Item Short-Form (SF-36) Health Survey. Logistic regression was used to examine the odds ratio of obesity and associated 95% confidence intervals (CIs) in breakfast skippers compared with breakfast eaters. Multivariable logistic regression modeling was used to adjust all risk estimates for covariates. Results: The unadjusted odds ratio of obesity in breakfast skippers was 1.23 (95% CI: 1.06, 1.43). The odds of developing obesity for breakfast skippers was 1.34 (95% CI: 1.15, 1.56) controlling for age, sex, marital status, educational level, monthly income, smoking, alcohol, betel nut chewing and exercise habit. The Cochran-Armitage trend test revealed that the prevalence rate of obesity decreased as the frequency of breakfast consumption increased (P=0.005). Breakfast skippers had significantly worse health-related QOL than breakfast eaters (P<0.001). Moreover, breakfast skippers had significantly lower scores in 5 out of 8 domain scores of the SF-36, namely general health perceptions (P<0.001), vitality (P<0.001), social functioning (P = 0.036), emotional role (P<0.001) and mental health (P<0.001). Conclusion: The findings from this study add support to the potential role of breakfast eating in obesity prevention. International Journal of Obesity (2010) 34, 720-725; doi: 10.1038/ijo.2009.285; published online 12 January 2010