Skipping Breakfast and Its Association with Health Risk Behaviour and Mental Health Among University Students in 28 Countries

Figures & data

Table 1 Sample and Breakfast Intake Characteristics

Variables	Sample	Breakfast Intake
		Rarely or Never	Sometimes	Almost Always
	N (%)	N (%)	N (%)	N (%)
All	21,972	3026 (13.8)	7517 (34.2)	11,431 (52.0)
Sex
Female	12,789 (58.4)	1737 (13.6)	4586 (35.9)	6463 (50.5)
Male	9120 (41.6)	1282 (14.1)	2904 (31.9)	4921 (54.0)
Age
17–19	6952 (31.6)	869 (12.5)	2399 (34.5)	3678 (53.0)
20–21	8608 (39.2)	1220 (14.2)	2916 (33.9)	4466 (51.9)
22–30	6412 (29.2)	937 (14.6)	2202 (34.4)	3269 (51.0)
Subjective economic status
Low	10,705 (48.8)	1737 (13.6)	4586 (35.9)	6463 (50.5)
High	11,211 (51.2)	1282 (14.1)	2904 (31.9)	4921 (54.0)
Country income
Low/lower	11,843 (53.9)	1572 (13.3)	3669 (33.5)	6298 (53.2)
Upper/high	10,129 (46.1)	1454 (14.4)	3548 (35.1)	5115 (50.6)
Residence status
Live with parents/guardians	10,073 (46.1)	1330 (13.2)	2790 (27.7)	5951 (59.1)
Live away from parents	11,782 (53.9)	1679 (14.3)	4686 (39.8)	5403 (45.9)
Social support
Low	7715 (36.2)	1136 (14.7)	2875 (37.3)	3698 (48.0)
High	13,620 (63.8)	1791 (13.2)	4443 (32.6)	7376 (54.2)
Organized religiosity
Low	5081 (23.8)	813 (16.0)	1530 (30.1)	2739 (53.9)
Medium	7784 (36.4)	1098 (14.1)	2857 (36.7)	3838 (49.3)
High	8518 (39.8)	1022 (12.0)	2964 (34.8)	4540 (53.3)
Intrinsic religiosity
Low	7717 (36.2)	1132 (15.2)	2596 (34.8)	3723 (50.0)
Medium	6566 (30.8)	837 (13.2)	2097 (33.1)	3403 (53.7)
High	7035 (33.0)	920 (13.6)	2223 (32.8)	3644 (53.7)

Table 2 Breakfast Consumption and Its Associations with Body Weight and Health Risk Behaviours

Variables	Breakfast Intake	UOR (95% CI)	AOR (95% CI)^A
Body weight and health risk behaviour
Overweight or obese (29.3%)	Almost daily Sometimes Rarely/never	1 (Reference) 0.96 (0.90, 1.03) 1.12 (1.01, 1.48)*	(Reference) 0.99 (0.86, 1.13) 1.11 (0.92, 1.33)
Inadequate fruit and vegetables intake (80.5%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.16 (0.95, 1.43) 1.29 (1.09, 1.54)**	1 (Reference) 1.24 (1.05, 1.46)* 1.33 (1.10, 1.60)**
Soft drink intake (≥2/day) (9.6%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.49 (0.89, 2.47) 2.16 (1.54, 3.04)**	1 (Reference) 1.37 (0.80, 2.35) 1.96 (1.01, 3.84)*
Not avoid fat and cholesterol (60.8%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.21 (1.04, 1.40)* 1.37 (1.17, 1.59)***	1 (Reference) 1.24 (1.09, 1.40)*** 1.40 (1.20, 1.63)***
Usually salt with every meal (39.6%)	Almost daily Sometimes Rarely/never	1 (Reference) 0.91 (0.74, 1.13) 0.90 (0.74, 1.10)	1 (Reference) 0.92 (0.79, 1.08) 0.91 (0.78, 1.07)
Red meat daily (48.0%)	Almost daily Sometimes Rarely/never	1 (Reference) 0.87 (0.73, 1.04) 0.94 (0.80, 1.10)	1 (Reference) 0.87 (0.74, 1.03) 0.93 (0.79, 1.10)
Binge drinking (past month) (10.5%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.37 (1.23, 1.52)*** 1.73 (1.51, 1.99)***	1 (Reference) 1.37 (1.15, 1.62)*** 1.65 (1.25, 2.18)***
Current tobacco use (11.8%)	Almost daily Sometimes Rarely/never	1 (Reference) 0.97 (0.89, 1.06) 1.55 (1.39, 1.73)***	1 (Reference) 1.14 (0.97, 1.29) 1.73 (1.38, 2.17)***
Gambling (any 5/week) (7.2%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.06 (0.87, 1.28) 1.27 (1.08, 1.48)**	1 (Reference) 1.09 (0.92, 1.28) 1.25 (1.08, 1.45)**
Not always wearing a seatbelt (61.1%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.22 (1.02, 1.45)* 1.20 (1.01, 1.43)*	1 (Reference) 1.18 (1.02, 1.37)* 1.24 (1.04, 1.48)*
Inadequate physical activity (38.2%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.26 (1.10, 1.44)*** 1.31 (1.12, 1.53)***	1 (Reference) 1.20 (1.06, 1.35)** 1.31 (1.12, 1.53)***
Sedentary behaviour (8 or more hours) (33.5%)	Almost daily Sometimes Rarely/never	1 (Reference) 0.90 (0.75, 1.08) 1.04 (0.83, 1.30)	1 (Reference) 0.93 (0.78, 1.10) 1.08 (0.86, 1.37)
Tooth brushing <2 times/day (31.0%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.03 (0.82, 1.30) 1.51 (1.25, 1.81)***	1 (Reference) 1.08 (0.90, 1.29) 1.56 (1.35, 1.79)***
Saw dentist less than past 12 months (58.2%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.20 (0.96, 1.50) 1.39 (1.13, 1.70)**	1 (Reference) 1.14 (0.98, 1.34) 1.37 (1.20, 1.56)***
Physical fight past 12 month (12.0%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.06 (0.97, 1.16) 1.39 (1.24, 1.56)***	1 (Reference) 1.35 (0.30, 6.08) 3.25 (1.51, 6.98)**

Notes: ***P<0.001; **P<0.01; *P<0.05; ^AAdjusted for age, sex, subjective economic status, residence status, country, social support, and religiosity.

Abbreviations: UOR, unadjusted odds ratio; AOR, adjusted odds ratio; CI, confidence interval.

Table 3 Breakfast Consumption and Its Associations with Mental Health and Academic Performance

Variables	Breakfast Intake	UOR (95% CI)	AOR (95% CI)^A
Mental health
Depression (severe) (12.9%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.25 (1.06, 1.49)* 1.82 (1.65, 2.00)***	1 (Reference) 1.10 (0.95, 1.26) 2.13 (1.84, 2.45)***
Posttraumatic Stress Disorder (PTSD) (21.8%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.23 (1.05, 1.43)* 1.57 (1.29, 1.91)***	1 (Reference) 1.14 (0.96, 1.35) 1.61 (1.32, 1.97)***
Loneliness (9.9%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.19 (1.03, 1.37)* 1.58 (1.34, 1.87)***	1 (Reference) 1.17 (1.01, 1.35)* 1.56 (1.33, 1.84)***
Happiness (61.3%)	Almost daily Sometimes Rarely/never	1 (Reference) 0.93 (0.87, 0.99)* 0.82 (0.75, 0.89)***	1 (Reference) 0.98 (0.90, 1.07) 0.84 (0.75, 0.93)***
Short sleep (46.8%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.35 (1.20, 1.53)*** 1.58 (1.36, 1.82)***	1 (Reference) 1.38 (1.23, 1.56)*** 1.58 (1.32, 1.89)***
Long sleep (12.9%)	Almost daily Sometimes Rarely/never	1 (Reference) 0.98 (0.81, 1.17) 1.39 (1.15, 1.69)***	1 (Reference) 0.98 (0.82, 1.18) 1.39 (1.15, 1.68)***
Sleep problem (severe) (9.3%)	Almost daily Sometimes Rarely/never	1.49 (1.16, 1.92)** 2.32 (1.87, 2.87)*** 1 (Reference)	1 (Reference) 1.55 (1.25, 1.92)*** 2.41 (1.99, 2.92)***
Restless sleep (much or most of the time) (19.9%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.18 (1.03, 1.35)* 1.79 (1.64, 1.97)***	1 (Reference) 1.14 (0.99, 1.32) 1.89 (1.59, 2.24)***
Sleep problem (traumatic event) (26.6%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.19 (1.04, 1.37)* 1.56 (1.51, 2.13)***	1 (Reference) 1.20 (1.05, 1.36)** 1.66 (1.38, 2.00)***
Academic performance (poor) (7.7%)	Almost daily Sometimes Rarely/never	1 (Reference) 1.14 (0.97, 1.35) 1.49 (1.19, 1.85)***	1 (Reference) 0.98 (0.83, 1.16) 1.40 (1.11, 1.78)**

Notes: ***P<0.001; **P<0.01; *P<0.05; ^AAdjusted for age, sex, subjective economic status, residence status, country, social support, and religiosity.

Abbreviations: UOR, unadjusted odds ratio; AOR, adjusted odds ratio; CI, confidence interval.