JIDAM
ORIGINAL ARTICLE
eISSN 2582 - 0559
“An Official Journal of IDA - Madras Branch”©2019.
Available online
ASSESSMENT OF BREAKFAST SKIPPING
AND HEALTH-COMPROMISING BEHAVIOURS
AMONG COLLEGE STUDENTS IN CHENNAI
Dr.Vinita Mary. A, Dr. Kesavan.R , A. Amritha, Dharani Babu, S.Tejasri, S.Uma Maheswari
Department of Public Health Dentistry,
Thai Moogambigai Dental College and Hospital, Chennai, Tamilnadu, India.
To access & cite this article
ABSTRACT
Website: jidam.idamadras.com
BACKGROUND: Breakfast is often considered to be the most
important meal of the day. Skipping breakfast has become more
common among young adults. Its prompting them to adapt an
unhealthy lifestyle and eating habits, which might affect their
health in long term.
MATERIALS AND METHODS: A cross-sectional study
was conducted among 500 college going students from Chennai,
India to assess and compare their demography, socio-economic
status, habits and breakfast eating pattern.
Address for correspondence:
RESULTS: The age of the study subjects ranged from 17 to
Dr. A. Vinita Mary, MDS, Professor,
Dept. of Public Health Dentistry,
28 years,with mean age 19.82+2.035 years. Among them, 360
Thai Moogambigai Dental College
(72%) were females and 140 (28%) were males. Among these
and Hospital
500 students, 47.8% were not having breakfast regularly in the
Chennai
morning and 52.2% were having breakfast regularly. The habit
of skipping breakfast had began predominatly after joining
college among female students (56.2%) and in school among
males students
(54.1%) which was significant statistically
(p-value=0.004). Students from Class Ⅲ socio-economic status
participated in physical activity everyday (24%).
CONCLUSION: The breakfast skipping prevalence was quite
high among the study subjects and it had began in their college
life for the majority of the popupaltion.
Received
: 26.7.2019
KEYWORDS: lifestyle, exercise, over-eating, sleep pattern,
Accepted
: 12.9.2019
socio-economic status
Published
: 27.09.2019
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Vinita et al: Assessment of breakfast skipping and health-compromising behaviours
INTRODUCTION:
MATERIALS AND METHOD:
Breakfast is often considered to be the most
A cross-sectional study was conducted among
important meal of the day.1 Many studies suggest that
college going students in Chennaicity. A pilot study
breakfast contributes to the well-being of an individual
was conducted among 20 randomly selected college
in a number of ways. Mainly, it is a central component
students and based on the findings final sample size
of nutritional well-being by contributing to total daily
was calculated to be 470 which was rounded off to
energy intake and nutritional requirement. Regular
500. Four colleges were randomly selected
(arts
breakfast intake contributes to lower body mass
and science, dental, engineering and allied health
index, higher cognitive performance and improved
sciences - one each) and the concerned authorities
quality of life.2 Breakfast consumption also aids in
were explained about the need for the study and
preventing heart condition, type 2 diabetes, enhances
their permission was obtained. All the students who
the memory and improves the physical and mental
agreed to participate in the study were included. The
performance of an individual.3&4
individuals who were absent on the day of study
and individuals with chronic health problems like
Skipping breakfast has become common
diabetes were excluded. A pretested questionnaire
especially among young adults. This may be due
was used to assess the demography, socio-economic
to various factors that may affect their physical and
status, habits and breakfast eating pattern among the
mental well-being. According to Keski-Rahkonen A
study subjects.The collected data was analysed using
et al., skipping breakfast has deleterious effects upon
SPSS version 21.0.
various aspects of cognitive functioning.5 Skipping
breakfast contributes to slow down of the metabolism
RESULTS:
and increase in appetite and unhealthy cravings
which in turn lead to overeating during other meals
The age of the study subjects ranged from
of the day.6&7 It is a known fact that people often
17 to 28 years, with mean age being 19.82+2.035
skip breakfast to reduce weight but it tends to do
years. Among them, 360 (72%) were females and
the opposite since body compensates by overeating
140 (28%) were males (Figure-1). The distribution
during other meals of the day.8&9 Skipping breakfast
of study subjects according to various departments is
may increase the chances of type -2 diabetes especially
shown in Figure-2.
in women.4 It is believed that skipping breakfast may
The socio-economic status of the study
also contribute to other unhealthy behaviours like
subject is shown in Figure-3. Socioeconomic status
alcohol consumption, smoking, inadequate physical
was divided into Class І, Class Ⅱ, Class Ⅲ and Class
exercise which further can have a negative impact on
Ⅳ using Kuppuswamy’s classification. In the study
a healthy lifestyle.5 A poor socio-economic status can
population, Class Ⅰ people were about 12%, Class Ⅱ
also be a reason for skipping breakfast among people
- 62%, Class Ⅲ - 20% and Class Ⅳ - 6%. No student
with low income.10&11
belonged to classⅤ socioeconomic class. Among the
study subjects, 4.6% of the students had the habit of
In recent times, skipping breakfast has
smoking and 3.8% of them consumed alcohol.
become prevalent in adolescent and young adults
Among these 500 students, 47.8% were not
due to various reasons and factors. Students,
having breakfast regularly in the morning and 52.2%
especially, who are going to university, relocate for
were having breakfast regularly. Almost 13.8% of
the educational purpose and have to stay in a hostel
them, skipped breakfast for no reason and 12.6%
or alone as paying guest, where food practices are
skipped breakfast due to waking up late in the
different from their home environment, they skip
morning. When they were asked about their response
breakfast most of the time due to dislike toward the
how they felt after skipping breakfast; around
food or no time to cook food and irregular sleeping
15.6% answered that they felt hungry and 8% got a
pattern.12&13 With this background, the present study
headache. The habit of skipping breakfast had begun
was conducted to assess the breakfast skipping and
after entering college for 50.2% of students and from
health compromising behavior among college going
school for 37.2% of students. Around half of the
students in Chennai city.
study population i.e. 50.2%, were having breakfast
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Vinita et al: Assessment of breakfast skipping and health-compromising behaviours
every day,
22.8% had breakfast
4-6 days/week,
significant statistically
(p-value=0.070). Students
21.6% had breakfast for
1-2days/week and only
with Class Ⅳ SES significantly (p=0.000) never
5.4% of them never had breakfast in the morning.
overate at other meals (55.2%) when compared to
Around 33.8% agreed that sometimes they overate
the rest of the SES. Students from Class Ⅲ SES
during other meals when they skipped breakfast and
participated in physical activity everyday
(24%)
18% responded that they always overate during other
and students who never participated in any physical
meals when they skipped breakfast. Around 77.4%
activity (79.3%) belonged to Class Ⅳ SES (p=0.016).
of the students had breakfast from home/hostel
It was observed that only 24.2 % of students slept for
and 15.8% had their breakfast at hotels. Regarding
more than 8 hours per night and it was significantly
physical activity, almost half of them i.e. 52.2%,
more among Class Ⅰ SES, p=0.009. It was observed
did not engage in any exercise; 16.6% exercised
that students belonging to Class Ⅰ SES felt tired 5-6
every day; 15.2% exercised 3-5day/week and 16%
times/week (46.7%) when compared to other SES
exercised 1-2 days/week. The lifestyle of the students
and this was significant statistically
(p=.002) (Table
is presented in Figure-4a.
2).
In the present study, the majority of the
students, 64.4%, slept for 6-8 hrs/night and about
one fifth, 21% slept less than 6 hours/night. Among
the students, 21.8% of them never felt tired in the
morning whereas 33% of students felt tired more
than
5-6 days weekly. Around
61.2% of them
described their body weight as normal and 4% of
them described it as obese. More than half of the
student population, 54%, marked good for their self-
health description. Majority of the students (69.8%)
agreed that breakfast indeed helped in prevention of
Fig:1 Distribution of students according to gender
unwanted health problem as it was the most important
meal of the day that was packed with nutrition to help
the person go through everyday work. The lifestyle
of the students is presented in Figure 4b.
Among regular breakfast consumers,
significantly (p=0.001) more male students (19%)
had late breakfast i.e. by around 10-11 am than female
students
(4.9%). The habit of skipping breakfast
began predominatly after joining college among
female students (56.2%) and in school among male
students (54.1%) which was significant statistically
Fig:2 Distribution of students according to the
(p-value=0.004). Also, habit of not excercising
department they were studying
was significantly more among females than among
males
(p-value=0.000). The knowledge about
unwanted health problems occurring due to skipping
breakfast was more among female students (73.7%)
when compared to male students (60%) which was
significant statistically (p-value=0.010) (Table 1).
More number of students belonging to Class
Ⅳ SES had started skipping breakfast from school
(61.2%) when compared to the rest of the classes,
where the habit had started from college and it was
Figure:3 Distribution of students according to socio-
economic statusm
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Vinita et al: Assessment of breakfast skipping and health-compromising behaviours
Fig:4a Response of students about their life style.
Fig:4b Distribution of students about their life style.
Table-1 Comparison of lifestyle of students according to gender
GENDER
Response
Frequency
P-VALUE
Male
Female
Time of having
Before 8 am
29(36.7%)
85(46.7%)
breakfast among
students who were
8-9am
35(44.3%)
88(48.4%)
.001
eating breakfast
10-11am
15(19.0%)
9(4.9%)
regularly
When did
School
33(54.1%)
56(31.4%)
irregularity in
College
20(32.7%)
100(56.2%)
having breakfast
.004
begin from, among
students who
Not sure
8(13.2%)
22(12.4%)
skipped breakfast
Everyday
42(30%)
41(11.3%)
3-5 time/week
29(20.7%)
47(13.1%)
Do you exercise
.000
everyday
1-2 time/week
19(13.5%)
61(16.9%)
never
50(35.8%)
211(58.7%)
Are you aware
Yes
84(60%)
265(73.7%)
that having
breakfast helps in
no
32(22.8%)
50(13.8%)
.010
preventing the risk
of unwanted health
Not sure
24(17.2%)
45(12.5%)
problem
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Vinita et al: Assessment of breakfast skipping and health-compromising behaviours
Table-2 Comparison of lifestyle of students according to their social-economic status
Response
SES
Frequency
Class Ⅰ
Class Ⅱ
Class Ⅲ
Class Ⅳ
When
did
School
12(35.3%)
42(30.8%)
24(47%)
11(61.2%)
.070
irregularity
in
College
16(47.1%)
78(57.5%)
4(22.2%)
having breakfast
begin from, among
Not sure
6(17.6 %)
16(11.7%)
5(9.8%)
3(16.6%)
students
who
skipped breakfast
Do you think
Yes
19(30.7%)
55(17.7%)
12(12%)
4(13.7%)
.000
skipping breakfast
no
14(22.5%)
92(29.7%)
51(51%)
16(55.2%)
leads to overeating
of any other meal
Some times
19(30.7%)
119(38.6%)
24(24%)
7(24.3%)
N e v e r
10(16.1%)
43(14%)
13(13%)
2(6.8%)
noticed
Do you exercise
Everyday
11(17.8%)
43(13.9%)
24(24%)
5(17.3%)
.016
3-5 time/
11(17.8%)
52(16.8%)
12(12%)
1(3.4%)
everyday
week
1-2 time/
11(17.8%)
57(18.5%)
12(12%)
0(0.0%)
week
never
29(46.6%)
157(50.8%)
52(52%)
23(79.3%)
How many hours
< 6hours
10(16.2%)
74(24%)
16(16%)
5(17.3%)
.009
sleep do you get at
6-8hours
37(59.6%)
186(60.1%)
77(77%)
22(75.8%)
night
>8hours
15(24.2%)
49(15.9%)
7(7%)
2(6.9%)
Do you feel tired in
2-4days
/
25(40.4%)
146(47.3%)
40(40%)
15(51.3%)
.002
the morning
week
5-6 days/
29(46.7%)
97(31.3%)
33(33%)
6(20.6%)
week
never
8(12.9%)
66(21.4%)
27(27%)
8(27.6%)
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Vinita et al: Assessment of breakfast skipping and health-compromising behaviours
DISCUSSION:
also people who got less than 6 hours of sleep woke
late in the morning and because of which they may
This study was conducted among 500 students
not had enough time for eating breakfast. This inturn
in Chennai to assess their breakfast eating and
contributed to headache and feeling irritated and tired
skipping habit and also to know about their reasons,
later during class hours. This finding is in consistent
consequences and to know their health-related
with studies by Young JS et al., Smith.C., Allan GA
habits. In the present study population comprising of
et al. 19-21 Ozilgen S reported majority of the students
young adults it was seen that around half of them, did
going to university tend to be less active and females
not have breakfast regularly. Breakfast skipping has
are often less active than male counterparts.22 In our
many negative consequences on health like obesity,
study also, more than half of the study population did
cognitive and mental health detoriation. Skipping
not participate in any physical activity.
breakfast can contribute to obesity.14 According to
Ferrer-Cascales R et al., poor quality of breakfast
According to Moy FM et al., students who
or skipping breakfast has its effect on cognitive and
come from home were less likely to skip breakfast
mental health.15 The similar effects were seen among
compared to those coming fromthe hostel with meals
the present study subjects also as the students who
catered inthe hostel or in rented houses. An equal
were skipping breakfast felt hungry, irritated, and
numberof studentscame from the home/hostel where
were not able to concentrate in the class. Whereas
breakfast is readily available for them to consume
students who had breakfast regularly didn’t feel
and did not have the hassle of cooking breakfast in
hungry and were able to concentrate in the class and
the morning, unlike people who live alone who have
thus had better mental health throughout the day.2
to plan and cook their every day meal [23].When the
participants self-assesed their health, theyclaimed
Studies have pointed out that people often
that they were healthy and maintained a healthy
skip breakfast mainly to reduce weight, not liking the
weight. They also seemed to be satisfied with their
provided food, irregular sleeping pattern and not feel
self-healthassesment.
like eating.16 Furthermore, Deliens et al, also reported
the impact of time scarcity among university students,
The limitation of this study was that BMI
as the students preferred to spend time on activities
(Body Mass Index) was not calculated. The weight
other than cooking, and highlighted the importance
reported by the students were purely self- reported
of short meal preparation times. This finding is
measurement and no height measurement was taken.
consistent with the present study as the students
Another limitation to this study was that measure of
responded that they skipped breakfast because of the
the nutritional intake by the students to estimate the
reasons like they didn’t feel like eating, wanted to
quality of the breakfast was not done.Hence, further
reduce weight, woke up late or did not like the food
studies are needed to include nutritional intake and
prepared for them. Most of the students said skipping
proper BMI measurement to calculate the correlation
breakfast began when they started college. The reason
between the body weight to skipping breakfast and
for this might be that they have to wake around 6-7
also to know the nutrition intake to assess quality
am so that they can reach college on time and they
of the breakfast eaten by the regular breakfast
might not feel hungry at that time leading to breakfast
consumers.
skipping. Also, reducing weight has become one of
the main reasons among young girls to skip breakfast
CONCLUSION:
as more females worry about their body image due
to social expectation than male counterparts which
The breakfast skipping prevalence was quite
lead them to the unhealthy behaviour of skipping not
high among the study subjects and it had began in
only breakfast but also other meals during the day.8
the college life for the majority of the popupaltion.
According to Sato-Mito et al, people who sleep late
Breakfast is one of the most important meal of the
in the night and get less than 5 hours of sleep tend
day which provides essential nutrition and energy
to have the meal later in the day and skip breakfast
required by a person for the day. Even as part ofa
more often.17 Skipping breakfast and irregular meal
diet for reducing weight, skipping breakfast is not
habits often lead to fatigue.18 In the present study
a solution for good health in the long run.Skipping
85
JIDAM/Volume:6/Issue:3/Pages 80 - 87/July-August 2019
Vinita et al: Assessment of breakfast skipping and health-compromising behaviours
breakfast may not directly affect the health of the
Keast DR, Radcliffe JD, Cho S. The relationship
person but it is also one of the factors contributing
of breakfast skipping and type of breakfast
to it.Thus, it is important that students need to
consumption with nutrient intake and weight
status in children and adolescents: the National
be educated of health-related concerns regarding
Health and Nutrition Examination Survey
breakfast skipping.
Association. 2010;110(6):869-878. doi:10.1016/j.
FINANCIAL SUPPORT AND
jada.2010.03.023
SPONSORSHIP:
8. Keim NL, Van Loan MD, Horn WF, Barbieri
TF, Mayclin PL. Weight loss is greater with
Nil
consumption of large morning meals and fat-
free mass is preserved with large evening
CONFLICTS OF INTEREST:
meals in women on a controlled weight
reduction regimen. The Journal of Nutrition
There are no conflicts of interest.
1997;127(1):75-82. doi:10.1093/jn/127.1.75
9. Cho S, Dietrich M, Brown CJP, Clark CA, Block
G. The effect of breakfast type on total daily energy
REFERENCES
intake and Body Mass Index: Results from the
Third National Health and Nutrition Examination
1.
Shaw, E M. Adolescent breakfast skipping:
Survey (NHANES III). Journal of the American
An Australian
Study.
Adolescence.
College of Nutrition 2003;22(4):296-302. doi:10.
2006;33(132):851-861.
1080/07315724.2003.10719307
uq.edu.au/view/uq:7963/ms_ad_33_98.pdf.
10. Affenito
SG.
Breakfast:
a
missed
Accessed July 22, 2019.
opportunity. Journal of the American Dietetic
2.
Smith AP. Breakfast and mental health.
Association. 2007;107(4):565-569. doi:10.1016/j.
International Journal of Food Sciences and
jada.2007.01.011
Nutrition.
11. Utter J, Scragg R, Mhurchu CN, Schaaf D. At-
abs/10.3109/09637489809089415.
Published
home breakfast consumption among New Zealand
2009. Accessed July 22, 2019.
children: associations with body mass index
3.
Blundell JE, Burley VJ. Satiation, satiety and
and related nutrition behaviors. Journal of the
the action of fibre on food intake. International
American Dietetic Association 2007;107(4):570-
Journal of Obesity 1987;11 Suppl 1:9-25. https://
576. doi:10.1016/j.jada.2007.01.010
12. Ruxton CHS, Kirk TR. Breakfast: a review of
4.
Ford ES. Body mass index, diabetes, and
associations with measures of dietary intake,
C-reactive protein among U.S. adults. Diabetes
physiology and biochemistry. British Journal
care
1999;22(12):1971-1977. doi:10.2337/
of Nutrition
1997;78(2):199-213. doi:10.1079/
diacare.22.12.1971
bjn19970140
5.
Keski-Rahkonen A, Kaprio J, Rissanen A,
13. Mullie P, Clarys P, De Ridder D, et al. Breakfast
Virkkunen M, J RR. Breakfast skipping and
frequency and fruit and vegetable consumption
health-compromising behaviors in adolescents
in Belgian adolescents A cross-sectional
and adults. European Journal of Clinical
study. Nutrition & Food Science. 2006;36(5):315-
Nutrition.2015;57(7):842-853.
326. doi:10.1108/00346650610703162
academia.edu/16816093/Breakfast_skipping_
14. Pendergast FJ, Livingstone KM, Worsley A,
and_health-compromising_behaviors_in_
McNaughton SA. Correlates of meal skipping in
adolescents_and_adults. Accessed July 22, 2019.
young adults: a systematic review. International
6.
Rampersaud GC, Pereira MA, Girard BL,
Journal of Behavioral Nutrition and Physical
Adams J, Metzl JD. Breakfast habits, nutritional
Activity.
2016;13(1). doi:10.1186/s12966-016-
status, body weight, and academic performance
0451-1
in children and adolescents. Journal of the
15. Ferrer-Cascales R, Sánchez-SanSegundo M,
American Dietetic Association 2005;105(5):743-
Ruiz-Robledillo N, Albaladejo-Blázquez N,
760. doi:10.1016/j.jada.2005.02.007
Laguna-Pérez A, Zaragoza-Martí A. Eat or
7.
Deshmukh-Taskar PR, Nicklas TA, O’Neil CE,
Skip Breakfast? The important role of breakfast
86
JIDAM/Volume:6/Issue:3/Pages 80 - 87/July-August 2019
Vinita et al: Assessment of breakfast skipping and health-compromising behaviours
quality for health-related quality of life, stress and
depression in Spanish Adolescents. International
Journal of Environmental Research and
Public Health
2018;15(8):1781. doi:10.3390/
ijerph15081781
16. Deliens T, Clarys P, De Bourdeaudhuij I, Deforche
B. Determinants of eating behaviour in university
students: a qualitative study using focus group
discussions. BMC Public Health. 2014;14(1 ).
doi:10.1186/1471-2458-14-53
17. Sato-Mito N, Sasaki S, Murakami K, et al. The
midpoint of sleep is associated with dietary intake
and dietary behavior among young Japanese
women. Sleep medicine
2011;12(3):289-294.
doi:10.1016/j.sleep.2010.09.012
18. Tanaka M, Mizuno K, Fukuda S, Shigihara Y,
Watanabe Y. Relationships between dietary
habits and the prevalence of fatigue in medical
students. Nutrition (Burbank, Los Angeles County,
Calif)
2008;24(10):985-989. doi:10.1016/j.
nut.2008.05.003
19. Young JS, Bourgeois JA, Hilty DM, Hardin
KA. Sleep in hospitalized medical patients, part
1: factors affecting sleep. Journal of hospital
medicine
2008;3(6):473-482.
doi:10.1002/
jhm.372
20. Smith C. Sleep states and memory
processes.
Behavioural Brain Research.
1995;69(1-2):137-145.
doi:10.1016/0166-
4328(95)00024-n
21. Gomes AA, Tavares J, de Azevedo MHP.
Sleep and Academic Performance in
Undergraduates: A multi-measure, multi-
predictor approach. Chronobiology International
2011;28(9):786-801. doi:10.3109/07420528.201
1.606518
22. Ozilgen S. Gender is correlated with body
mass index, eating habits and exercise
frequency in students attending a private
university in western Turkey. Acta alimentaria.
do?recordID=US201700094563.
Published
2017. Accessed July 22, 2019.
23. Moy FM, Johari S, Ismail Y, Mahad R, Tie FH,
Wan Ismail WA. Breakfast Skipping and Its
Associated Factors among Undergraduates in a
Public University in Kuala Lumpur. Malaysian
Journal of Nutrition. 2009;15(2):165-174. https://
Accessed July 22, 2019.
87
JIDAM/Volume:6/Issue:3/Pages 80 - 87/July-August 2019