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Cited by 53Nutrition, Health and Food BehaviorObesity, Physical Activity, DietNutritional Studies and Diet

Irregular eating of meals in adolescence and the metabolic syndrome in adulthood: results from a 27-year prospective cohort

Open access
Wennberg, Maria, Gustafsson, Per E, Wennberg, Patrik, Hammarström, Anne·2016·Public Health Nutrition
DOI 10.1017/s1368980015001445PMC PMC10271199
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Abstract

Objective: The objective was to investigate whether irregular eating of meals in adolescence predicts the metabolic syndrome and its components in adulthood, and if any specific meal is of particular importance. Design: Prospective cohort study with 27 years of follow-up. Information on meals (breakfast, school lunch and dinner with family), lifestyle (alcohol consumption, smoking habits, physical activity, consumption of sweets and pastries) at age 16 years was assessed from questionnaires, and presence or not of the metabolic syndrome and its components were defined at age 43 years in 889 participants (82·1 % of total cohort). Logistic regression was used to calculate odds ratios and confidence intervals. Setting: The Northern Swedish Cohort; all school-leavers of the 9th grade in the town Luleå in 1981. Subjects: Adolescents (age 16 years). Results: Irregular eating of meals at age 16 years was associated with higher prevalence of the metabolic syndrome at age 43 years (OR=1·74; 95 % CI 1·12, 2·71), but this was explained by concurrent unhealthy lifestyle at age 16 years. Poor breakfast at age 16 years was the only meal associated with the metabolic syndrome at age 43 years, independent of other meals, BMI (kg/m 2) and lifestyle at age 16 years (OR=1·67; 95 % CI 1·00, 2·80). Conclusions: Irregular eating of meals in adolescence predicted the metabolic syndrome in adulthood, but not independently of BMI and lifestyle in adolescence. Poor breakfast in adolescence was the only specific meal associated with future metabolic syndrome, even after adjustments. Breakfast eating should be encouraged in adolescence.

AI snapshot

Written from the paper’s full text.

TL;DR

In the Northern Swedish Cohort, irregular eating of meals at age 16 predicted metabolic syndrome at age 43 (OR = 1·74; 95 % CI 1·12, 2·71), but this association was explained by concurrent BMI and lifestyle at age 16. Poor breakfast was the only specific meal habit independently associated with adult metabolic syndrome (OR = 1·67; 95 % CI 1·00, 2·80).

Key findings

  • Eating two or all meals irregularly at age 16 was associated with metabolic syndrome at age 43 in unadjusted analysis (OR = 1·74; 95 % CI 1·12, 2·71) and sex-adjusted analysis (OR = 1·70; 95 % CI 1·09, 2·66), but attenuated after adjustment for BMI (OR = 1·54; 95 % CI 0·97, 2·44) and lifestyle (OR = 1·18; 95 % CI 0·71, 1·95); P for trend was 0·008 unadjusted and 0·476 in the fully adjusted model.
  • Poor breakfast at age 16 was the only specific meal associated with metabolic syndrome at age 43 after adjustment for other meals, sex, BMI and lifestyle (OR = 1·67; 95 % CI 1·00, 2·80); school lunch irregularity (OR = 0·87; 95 % CI 0·61, 1·22) and irregular dinner with family (OR = 1·11; 95 % CI 0·71, 1·74) were not significant in the fully adjusted model.
  • Irregular eating at age 16 was associated with central obesity and high fasting glucose at age 43 in sex-adjusted analysis, but not after BMI/lifestyle adjustment (central obesity model 3: OR = 1·23; 95 % CI 0·76, 2·00; high fasting glucose model 3: OR = 1·30; 95 % CI 0·74, 2·26). Poor breakfast was borderline associated with central obesity in the fully adjusted model (OR = 1·71; 95 % CI 0·99, 2·94).
  • At baseline, those eating all meals regularly had healthier concurrent lifestyle: smoking 13·7 % vs 55·6 %, high alcohol intake 10·8 % vs 43·5 %, physical activity > once/week 58·1 % vs 30·4 %, and daily sweets intake 10·0 % vs 24·3 % across all-regular vs two/all-irregular meal groups.

Methods

  • Prospective cohort study using the Northern Swedish Cohort: all school-leavers of the 9th grade in Luleå in 1981 (n 1083), with 27 years of follow-up; the present sample included 889 participants (82·1 % of total cohort) with data on metabolic syndrome and meal habits.
  • Meal habits at age 16 were assessed by questionnaire for breakfast, school lunch and dinner with family; meal regularity was combined into three categories: all meals regularly (n 439), one meal irregularly (n 332), and two or all meals irregularly (n 115). Metabolic syndrome and its components were defined at age 43 using International Diabetes Federation criteria.
  • Logistic regression calculated odds ratios and confidence intervals; models adjusted for sex, BMI, and lifestyle factors (high alcohol intake, smoking, physical activity, daily sweets/pastries), with additional models adding social class and family history of diabetes; sensitivity analyses replaced dichotomized covariates with continuous ones where possible.

Limitations

  • Stated in the paper: no complete information on meal frequency or in-between meals; breakfast data were from the day of examination only; it is unknown whether school lunch skippers ate lunch elsewhere; free cooked school lunch limits comparability with other countries; it is unknown whether those not eating dinner with family ate alone or with others; key variables were self-reported and may be misclassified; these limitations may have attenuated associations.
  • Evident from the text: the observational design cannot establish causality, and residual confounding by unmeasured or imprecisely measured factors remains possible.
  • Evident from the text: breakfast was measured on a single day, which may not reflect usual breakfast habits, and school lunch/dinner measures were based on single questionnaire items, limiting exposure precision.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1017/s1368980015001445

Cites

29 of 29 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 15 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    All specific meal habits correlated negatively with concurrent smoking and alcohol consumption.

    “All specific meal habits correlated negatively with concurrent smoking and alcohol consumption.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Irregular eating of meals at age 16 years was associated with higher prevalence of the metabolic syndrome at age 43 years (OR = 1•74; 95 % CI 1•12, 2•71) in the Northern Swedish Cohort.

    “Irregular eating of meals at age 16 years was associated with higher prevalence of the metabolic syndrome at age 43 years (OR = 1•74; 95 % CI 1•12, 2•71), but this was explained by concurrent unhealthy lifestyle at age 16 years.”
    • Also stated in: § Results · plain
      “Eating two or all meals irregularly at age 16 years was associated with higher prevalence of the metabolic syndrome at age 43 years in sex-adjusted analysis (model 1), compared with eating all meals regularly.”
    Quote in the paperSubstantial claim
  • Findingown data

    Poor breakfast habits at age 16 years was borderline significantly associated with central obesity at age 43 years in the fully adjusted model (OR = 1•71; 95 % CI 0•99, 2•94).

    “In multivariable analysis for the specific meals, poor breakfast habits at age 16 years was borderline significantly associated with central obesity at age 43 years (model 4: OR = 1•71; 95 % CI 0•99, 2•94; Supplemental Table 2).”
    • Also stated in: § Discussion · hedged
      “Poor breakfast at age 16 years was close to statistically significantly associated with central obesity at age 43 years in the fully adjusted model.”
    Quote in the paperSubstantial claim
  • Findingown data

    Poor breakfast at age 16 years was the only specific meal associated with metabolic syndrome at age 43 years, independent of other meals, BMI and lifestyle at age 16 years (OR = 1•67; 95 % CI 1•00, 2•80).

    “Poor breakfast at age 16 years was the only meal associated with the metabolic syndrome at age 43 years, independent of other meals, BMI (kg/m 2 ) and lifestyle at age 16 years (OR = 1•67; 95 % CI 1•00, 2•80).”
    • Also stated in: § Results · plain
      “Poor breakfast was the only separate meal habit in adolescence associated with significantly higher prevalence of the metabolic syndrome in adulthood, although the results for both lunch and dinner pointed in the same direction but more weakly.This effect of poor breakfast also remained after adjustment for the other two meal habits, sex, BMI and lifestyle habits at age 16 years.”
    • Also stated in: § Conclusions · plain
      “Poor breakfast in adolescence, but not irregular eating of school lunch or dinner with family, was associated with future metabolic syndrome, independent of BMI and lifestyle in adolescence.”
    Quote in the paperSubstantial claim
  • Findingown data

    Higher BMI at age 16 years was associated with eating fewer meals regularly.

    “Higher BMI was associated with eating fewer meals regularly (Table 1).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 13
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    Regularity in all specific meal habits correlated significantly with one another; for school lunch and breakfast Spearman's rank correlation was 0•18 (P < 0•001), but dinner with family correlated only weakly with breakfast and school lunch (R s = 0•09, P = 0•005).

    “Regularity in all specific meal habits correlated significantly with one another; for school lunch and breakfast Spearman's rank correlation (R s ) was 0•18, P < 0•001, but dinner with family correlated only weakly with breakfast and school lunch (R s = 0•09, P = 0•005).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Breakfast and school lunch correlated positively with concurrent physical activity.

    “Breakfast and school lunch correlated positively with concurrent physical activity and school lunch correlated negatively with concurrent consumption of sweets and pastries (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The association between irregular eating of meals at age 16 years and metabolic syndrome at age 43 years was explained by concurrent unhealthy lifestyle at age 16 years; it was not independent of BMI and lifestyle in adolescence.

    “This association was attenuated and no longer statistically significant after adjustment for BMI at age 16 years (model 2) and further attenuated after addition of lifestyle habits at age 16 years (model 3; Table 3).”
    • Also stated in: § Conclusions · plain
      “Irregular eating of meals in adolescence predicted the metabolic syndrome in adulthood, but the association was not independent of BMI and lifestyle in adolescence.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    School lunch correlated negatively with concurrent consumption of sweets and pastries.

    “Breakfast and school lunch correlated positively with concurrent physical activity and school lunch correlated negatively with concurrent consumption of sweets and pastries (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Eating all meals regularly at age 16 years was associated with a healthier concurrent lifestyle: lower proportions of smokers, high alcohol intake and daily intake of sweets and pastries, and a higher proportion physically active more than once per week.

    “Those reporting eating all meals regularly at age 16 years reported concurrent healthier lifestyle; a lower proportion were smokers, had high alcohol intake and daily intake of sweets and pastries, whereas a higher proportion were physically active more than once per week.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    These risk behaviours evidently correlated higher with both breakfast and frequency of school lunch, where also a clear correlation was found with physical activity.

    “However, these risk behaviours evidently correlated higher with both breakfast and frequency of school lunch, where also a clear correlation was found with physical activity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In this study there were significant correlations between frequency of dinner with family and less smoking as well as lower prevalence of high alcohol consumption.

    “In our study there were significant correlations between frequency of dinner with family and less smoking as well as lower prevalence of high alcohol consumption.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    Few countries offer a free, cooked meal for lunch in school, making the findings concerning school lunch difficult to compare with other countries.

    “Few countries offer a free, cooked meal for lunch in school, making the findings concerning school lunch difficult to compare with other countries.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    As for breakfast, we have data on breakfast on the day of examination only.

    “As for breakfast, we have data on breakfast on the day of examination only.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We do not know if those skipping school lunch eat lunch somewhere else (at home, at a restaurant, etc.).

    “We do not know if those skipping school lunch eat lunch somewhere else (at home, at a restaurant, etc.), but the correlation between skipping school lunch and daily consumption of sweets and pastries indicates that school lunch is often replaced with less healthy options.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The correlation between skipping school lunch and daily consumption of sweets and pastries indicates that school lunch is often replaced with less healthy options.

    “We do not know if those skipping school lunch eat lunch somewhere else (at home, at a restaurant, etc.), but the correlation between skipping school lunch and daily consumption of sweets and pastries indicates that school lunch is often replaced with less healthy options.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Randomized crossover trials suggest that irregular meal frequency may cause insulin resistance.

    “Randomized crossover trials suggest that irregular meal frequency may cause insulin resistance (7) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    We do not have complete information on meal frequency; we have information on main meals, but no information on in-between meals.

    “We do not have complete information on meal frequency, which has been the exposure variable in many previous studies; we have information on main meals, but no information on in-between meals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    We do not know if those not eating dinner with family regularly have dinner by themselves or together with someone else.

    “We do not know if those not eating dinner with family regularly have dinner by themselves or together with someone else.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A special protective role of breakfast eating on cardiometabolic risk is supported by previous experimental and observational studies.

    “A special protective role of breakfast eating on cardiometabolic risk is supported by previous experimental and observational studies (8,(21)(22)(23)(24)(25) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (8,(21)(22)(23)(24)(25)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The prevalence of the metabolic syndrome is higher in men than in women in this population (34 % in men v. 19 % in women) and in other European populations, but not consistently so worldwide.

    “in model 1, sex (because the prevalence of the metabolic syndrome differs between men and women; the prevalence is higher in men in this population (34 % in men v. 19 % in women) as well as in other European populations (19) , but not consistently so worldwide (20) );”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] source

      Not checked in the free run.

    • cites [20]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    A reliability test-retest of the alcohol and tobacco questions was conducted at age 16 years, within a 2-month period, showing that similar answers were given by the same pupils to the same questions.

    “A reliability test-retest of the alcohol and tobacco questions was conducted at age 16 years, within a 2-month period, showing that similar answers were given by the same pupils to the same questions (15)(16)(17) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites (15)(16)(17)

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A number of cross-sectional studies suggest that eating irregularly may involve increased risk for cardiometabolic disease.

    “A number of cross-sectional studies suggest that eating irregularly may involve increased risk for cardiometabolic disease.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites (3)(4)(5)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    Key variables were self-reported and there may be some degree of misclassification.

    “Furthermore, key variables were self-reported and there may be some degree of misclassification.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    More frequent daily eating occasions have been associated with a higher diet quality and better appetite control.

    “More frequent daily eating occasions have been associated with a higher diet quality (4) and better appetite control (6) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] source

      Not checked in the free run.

    • cites [6] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Using breakfast data from the day of examination only may decrease measurement precision, but would rather lead to underestimation than overestimation of the association.

    “This may decrease the measurement precision, but would rather lead to underestimation than overestimation of the association (28) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] source

      Not checked in the free run.

21 of 21

  • The paper relies on this without support.

    There is a lack of prospective studies investigating the long-term effect of irregular eating.

    “So, while there is evidence of short-term health risks from irregular eating, there is a lack of prospective studies investigating the long-term effect of irregular eating.”

  • The paper relies on this without support.

    The long-term health effects of deviating from regular eating patterns are largely unknown.

    “A regular meal pattern with breakfast, lunch and dinner as main meals and one to three snacks in between is often recommended as part of a healthy lifestyle (1) , but the longterm health effects of deviating from regular eating patterns are largely unknown.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A study in ninety-six male Swedish industrial workers found that energy intake and quality of food were not affected by shift work, but that the circadian distribution of food changed and coffee consumption increased.

    “A study in ninety-six male Swedish industrial workers found that energy intake and quality of food were not affected by shift work, but that the circadian distribution of food changed and coffee consumption increased (24) .”

    From Meal irregularity and cardiometabolic consequences: results from observational and intervention studies (2016) · cites this paper as [24]

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Nordic Council of Ministers (2005) Nordic Nutrition Recommendations, NNR 2004: Integrating Nutrition and Physical Activity, pp. 85–101. Copenhagen: Nordic Council of Ministers.
  2. Hammarstrom A (1986) Youth unemployment and ill-health: results from a two year follow-up study. Doctoral Thesis, Karolinska Institute (in Swedish, with an English summary).

Cited by

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Related

Authors
Wennberg, M., Gustafsson, P. E., Wennberg, P., & Hammarström, A.
Affiliations
Umeå University (SE)
Corresponding author
Wennberg, Maria
ORCID
Venue
Public Health Nutrition
Publisher
Cambridge University Press (CUP)
Published
2015-05-04
Volume
19
Issue
4
Pages
667-673
ISSN
  • 1368-9800 (ISSN-L)
  • 1475-2727
DOI
10.1017/s1368980015001445
PMC
PMC10271199
OpenAlex
W1956611595
Semantic Scholar
6369cf88f75b21ddf3a7d4befe313d5c819985fb
Cited by
53
References
29
Citations by year
2026: 3 · 2025: 4 · 2024: 5 · 2023: 6 · 2022: 7 · 2021: 4 · 2020: 9 · 2019: 6 · 2018: 3 · 2017: 2 · 2016: 4
FWCI
2.89
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • Public Health Nutrition (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
meal skipping, metabolic syndrome, breakfast skipping, adolescence, childhood obesity, lifestyle factors, body mass index, school meals, family dinner, long-term follow-up, Northern Swedish Cohort
MeSH terms
Adolescent, Adolescent Behavior, Diet, Female, Humans, Life Style, Male, Prospective Studies, Surveys and Questionnaires, Sweden, Health Behavior, Body Mass Index, Prevalence, Logistic Models, Odds Ratio, Metabolic Syndrome, Meals, Breakfast

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