Meal patterns and risk of childhood obesity and metabolically unhealthy obesity: a systematic review of the evidence, methodological issues and research gaps
Bibliographic record
Abstract
Childhood overweight/obesity (Ov/Ob) is a major public health problem, of greater concern when accompanied with comorbidities such as hypertension, insulin resistance leading to metabolically unhealthy obesity (MUO). Current evidence suggests a linkage between meal frequency, diet quality and nutritional status(1–3) in children and adolescents, however data regarding associations between meal patterns, Ov/Ob risk and MUO are limited. The aim was to explore associations between meal patterns and the risk of childhood Ov/Ob and MUO. The PRISMA methodology was used to retrieve prospective studies and randomized controlled trials conducted in children/adolescents 2-19 years old in Europe, USA, Canada or Oceania, from 01/2013 to 06/2023. Exposures that were considered under the umbrella “meal patterns” included consumption of a meal, meal skipping, timing, format and context. The quality of the studies was assessed with the ROBINS-E and RoB-2 tools. Of the 3,020 studies initially retrieved, 27 were included. All studies reported on Ov/Ob risk, whilst no studies on MUO were identified. All but one study had a longitudinal study design. Twenty-two studies (81%) had a high/very high risk of bias, mainly due to the methods measures of exposure were assessed. Consumption of/skipping breakfast was the most common exposure, followed by consumption of lunch (n = 5), dinner (n = 5), meal frequency/eating occasion (EO; n = 5) and consumption of fast foods (n = 4). Some studies reported on meal context (eating while watching TV; n = 4). In most studies, frequent breakfast and evening family dinners (i.e. 7 days/week vs <7days/week) were associated with lower odds of childhood Ov/Ob, BMI and %body fat at followup (FU). Four studies also showed that skipping breakfast was associated with increased obesity markers, while three studies showed no associations. There was limited evidence of a positive association between eating while watching TV and weight trajectories (n = 2). No associations were reported in relation to frequency of lunch and fast food intake. Results regarding meal frequency/EO and Ov/Ob at FU are conflicting, with differences attributed to the definition of an EO. Evidence supports that frequent consumption of breakfast and family dinners may be associated with lower Ov/Ob risk in children and adolescents, while eating in front of TV with increasing weight trajectories. No studies were identified in relation to MUO, highlighting a significant research gap. Nevertheless, clear definition on EOs and improved methodological approach in the assessment of meal patterns emerged as a need, according to current review findings.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.049 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.010 |
| Bibliometrics | 0.012 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".