Breakfast habits, dairy product consumption, physical activity,
and their associations with body mass index in children aged 6–18
Received: 21 November 2016 /Revised: 30 April 2017 /Accepted: 27 July 2017 /Published online: 11 August 2017
Springer-Verlag GmbH Germany 2017
Abstract The purpose of this study was to determine breakfast
habits, dairy product consumption, and physical activity and
their relations with body mass index (BMI) in schoolchildren
and adolescents. This cross-sectional, school-based study was
performed with children aged 6–18 years. Height and weight
were measured, and a BMI z-score was calculated for each
child. Breakfast consumption frequency, intake of milk and oth-
er dairy products, physical activity habits, and mothers’ employ-
ment status were assessed via a self-report questionnaire.
Multiple linear regression analysis was used to estimate the as-
sociation between these habits and BMI z-scores. Seven thou-
sand one hundred sixteen children were included, 3445 (48.4%)
female, with a mean age of 11.7 ± 2.7 years (5.8–18.9). Of these,
62.6% had breakfast every day. Boys ate breakfast daily signif-
icantly more often than girls (64.5 and 60.7%, respectively;
p < 0.001). The percentage of children eating breakfast daily
decreased with age (79.1% at 6–11 vs. 52.1% at 12–18 years,
p < 0.001). Sixty-four (0.9%) children consumed no dairy prod-
ucts. Milk intake was negatively and significantly associated
with BMI z-score (β = − 0.103, p < 0.001). Cheese consumption
and the mother being employed were positively and significant-
ly associated with BMI z-score (β = 0.517, p < 0.001, and
β =0.172,p < 0.001, respectively). Children engaging in phys-
ical activity had higher BMI z-score values than others
(0.22 ± 0.01 vs. 0.12 ± 0.02, p < 0.001). Prevalence of
overweight/obese was higher among children of working
mothers compared to those of unemployed mothers (respective-
ly, 29.3, 23.3%, p <0.001).
Conclusions: Skipping breakfast was associated with
overweight/obesity in schoolchildren and adolescents, while
milk consumption exhibited a protective effect.
What is known?
• Dietary interventions should be incorporated into a multidisciplinary
strategy for obesity prevention.
• Most studies of habitual physical activity in children suggest that the
overweight and obese children are less active.
What is new?
• Milk consumption seems to have a protective effect against
overweight/obesity, irrespective of yogurt or cheese consumption.
• Children engaging in greater physical activity had higher body mass
index values than others.
Body mass index
products, obesity, physical activity
BMI body mass index
FFQ food frequency questionnaire
WHO World Health Organization
Genetic factors, inappropriate eating habits in the early years
of life , and insufficient physical activity have been shown
Communicated by Mario Bianchetti
* Mustafa Akcam
Department of Pediatrics, Division of Pediatric Gastroenterology,
Hepatology and Nutrition, Faculty of Medicine, Suleyman Demirel
University, Isparta, Turkey
Department of Pediatrics, Faculty of Medicine, Suleyman Demirel
University, Isparta, Turkey
Eur J Pediatr (2017) 176:1251–1257