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Breakfast Skipping and Its Associated Factors among

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Mal J Nutr 15(2): 165 - 174, 2009

Breakfast Skipping and Its Associated Factors among

Undergraduates in a Public University in Kuala Lumpur
Moy FM 1, Johari S2, Ismail Y3, Mahad R 4, Tie FH 5& Wan Ismail WMA 4

1
Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya
2
Department of Parasitology, Faculty of Medicine, University of Malaya
3
Department of Geology, Faculty of Science, University of Malaya
4
Department of Physics, Faculty of Science, University of Malaya
5
Department of Principality Study, Faculty of Education, University of Malaya

ABSTRACT

An analytical cross-sectional study was conducted in a public university in Kuala

Lumpur among a random sample of 2665 undergraduates. The objective was to
study the prevalence of breakfast skipping and its associated factors. Data
collection was conducted via a self-administered pre-tested questionnaire. There
were 43.5% male respondents, with Malays being the majority (58.3%). The
prevalence of breakfast skipping was 29.2 (95% CI: 27.3 – 30.3) %. The factors
significantly associated with breakfast skipping (p<0.05) were age, race,
accommodation, faculty and skipping dinner. As the respondents’ age increased,
their risk of breakfast skipping was lower (OR: 0.95; 0.89 – 0.99). Malays (OR:
1.94; 1.48 – 2.54), Indians (OR: 1.70; 1.08 – 2.66), and students from the Sabah and
Sarawak indigenous communities (OR: 2.13; 1.37 – 3.33) were more likely to skip
breakfast compared to their Chinese counterparts. Respondents who stayed in
their own houses were also less likely to skip breakfast compared to those
staying in hostel with meals catered (OR: 2.32; 1.39 – 3.84), hostel with cafeteria
(OR: 2.92; 1.74 – 4.91) or in rented houses (OR: 2.08; 1.25 – 3.46). Respondents
majoring in Arts & Economics had 1.40 (1.07 – 1.82) times risk of breakfast
skipping compared to those majoring in Life Sciences. Those who skipped dinner
too had twice the odds (1.47 – 2.77) of breakfast skipping. In conclusion the
prevalence of breakfast skipping among the undergraduates of this university
was moderately high. Health awareness campaigns or introduction of healthy
eating guidelines should be initiated for the undergraduates as well as food
caterers in campus. The policy and pricing of catered food in campus should also
be reviewed.

Keywords: Breakfast skipping, undergraduates

INTRODUCTION adults leave home and adjust to independent

living, good dietary habits gained from home
Young adults in the age group of 18 – 25 decline (Harris et al., 2006). Studies show
years are often the neglected group in any that many young adults have the habits of
health or nutrition education as compared skipping meals especially breakfast (Keski-
to children and adults. When these young Rahkonen et al., 2003; Osako, Takayama &

Correspondence author: Dr Moy FM; Email: moyfm@um.edu.my

166 Moy FM, Johari S, Ismail Y, Mahad R, Tie FH & Wan Ismail WMA

Kira, 2005; Song et al., 2005), snacking MATERIALS AND METHODS

(Samuelson, 2000; Song et al., 2005) and
consumption of fastfood (Niemeier et al., An analytical cross-sectional study was
2006). They appear to be at higher risk for conducted from March to May 2003 in a
weight gain through these unhealthy eating public university in Kuala Lumpur. Using
habits. Increased snacking, lunch skipping, the sample size calculator (Statscalc) from
a sedentary lifestyle and obesity have been the EPI INFO software, the university
found to be more common among those who undergraduate population of 20,000 and the
skip breakfast than the breakfast eater (Keski- expected frequency of breakfast skipping of
Rahkonen et al., 2003). Breakfast skipping 10% (Siega-Riz Popkin & Carson, 2000) with
has also been found to be associated with the worst accepted frequency of 8.5%, a total
dysmenorrhea among the females (Fujiwara, sample of 1,427 undergraduates would give
2003). On the other hand, breakfast taking the power of 80% with 95% confidence
has also been found to be a contributing interval. The study protocol was approved
factor in main-taining weight loss (Wyatt et by the Faculty of Medicine as well as the
al., 2002). Unit of Students’ Affairs of the university.
During these transitional years of young Informed consent was also given by all
adulthood, establishment of a healthy respondents. Five thousand pre-tested and
lifestyle behaviour can have a long lasting self-administered questionnaires were
impact on their health and the health of their distributed to all faculties of the university.
future family. It is important that these The sampling ratio was 1 out of four
young adults are educated and reinforced undergraduates based on the number of
in healthy eating behaviour and are able to undergraduates of each faculty. Within each
select a healthy choice of food in the future. faculty, proportionate sampling was used
Hopefully these healthy eating food habits to sample undergraduates of various years.
can be sustained into the future so that The return of the questionnaire was 53%
problems of chronic diseases such as giving a total of 2665 questionnaires. The
diabetes mellitus, hypertension and questionnaires enquired on socio-
coronary heart disease could be delayed or demographic characteristics, knowledge on
prevented. All these diseases are lifestyle- nutrition, dietary habits, pattern of
related where diet plays an important role expenditure and accommodation of the
(Hu et al., 2001; Sobngwi et al., 2002; Key et undergraduates. However, this paper will
al., 2004; Lakka & Bouchard, 2005; only describe the socio-demographic
Lindstrom, Peltonen & Tuomilehto, 2005). characteristics and factors associated with
The university and college arenas breakfast skipping (such as skipping of
represent the final opportunity for health lunch and dinner, consumption of fastfood
and nutritional education of a large number and nutritional supplements, consumption
of young adults from the educator’s of vegetables and fruits, smoking, accom-
perspective (Sakamaki et al., 2005). modation and academic performance among
Therefore, a study was initiated in a public the undergraduates).
university in Kuala Lumpur, Malaysia with The operational definitions of some of
the intention of identifying their dietary the terms used in this study are as follows:
habits and associated factors contributing Breakfast was defined as the first meal of the
to breakfast skipping among the day, eaten before or at the start of daily
undergraduates. However, this paper will activities, within 2 hours of waking, typically
only report the pattern of breakfast skipping no later than 10:00 am as defined by
and its associated factors. Giovannini et al (2008). Skipping of breakfast
meant consuming breakfast fewer than 7
 Breakfast Skipping among Undergraduates in Kuala Lumpur 167

days per week while fastfood was defined bivariate analysis was used to study the
as convenience foods that can be prepared association of two variables and when there
and served very quickly, including salty was significant association, multivariate
french fries, hamburgers, fried chicken, and analysis (Logistic Regression) was
pizzas which are usually served in fastfood conducted to control for confounders.
restaurants. Nutritional supplements are Significance level was pre-set at 0.05. Odds
preparations to be taken orally intended to ratio (OR) and 95% confidence interval are
supply nutrients such as vitamins and reported where applicable. Receiver
minerals. Consumption of fruits and Operating Curve (ROC) was drawn for the
vegetables was measured by asking if the final Logistic Regression model.
respondents consumed fruits or vegetables
during lunch or dinner. A positive response RESULTS
was given a score of 1 and the fruits and
vegetables consumption score ranged from The total number of respondents in the
0 to 4. Academic performance was self- survey was 2665 which represented 13% of
reported Cumulated Grade Point Average all undergraduates in the university. As
(CGPA) points which is commonly used in shown in Table 1, there were slightly more
universities in Malaysia. females than males in the sample. The racial
Data was entered and analysed using distribution reflected the country’s racial
the SPSS for windows 15.0. Univariate distribution with Malays being the largest
analysis was used to describe the variables, group, followed by Chinese, Indian and the

Table 1. Socio-demographic characteristics of the respondents (n=2665)

n (%)

Sex Male 1160 (43.5)

Female 1505 (56.5)
Race Malay 1551 (58.3)
Chinese 785 (29.5)
Indian 160 (6.0)
Sabahan & Sarawakian 164 (6.2)
Age groups Less than 20 years 382 (10.7)
20 – 22 years 1762 (66.8)
23 – 24 years 412 (15.7)
> 25 years 179 (6.8)
Age (mean + s.d.) 21.7 + 2.8 years

Faculty Life & Health Sciences 763 (29.5)

Engineering & Physical Sciences 813 (31.4)
Arts, Social Sciences & Economy 1011 (39.1)
Academic year Year 1 1040 (39.1)
Year 2 755 (28.4)
Year 3 638 (24.0)
Year 4 & 5 226 (9.2)
Accommodation Hostel with food catered 1023 (39.2)
Hostel with cafeteria 535 (20.5)
Rented house 866 (33.2)
Own House 185 (7.1)
168 Moy FM, Johari S, Ismail Y, Mahad R, Tie FH & Wan Ismail WMA

Table 2. Prevalence of meal skipping and associated factors

n (%)

Prevalence of meal skipping Breakfast 778 (29.2)

Lunch 300 (11.3)
Dinner 236 (8.9)
Consumption of nutritional
supplements Yes 594 (22.3)
No 2071 (77.7)
Fast food consumption Yes
No or 941 ( 35.3)
less frequent 1724 (64.7)
Fruits & vegetable consumption
score (mean + s.d.) 1.47 + 1.16
Smoking Yes 158 (5.9 )
No 2507 (94.1)

indigenous communities of Sabah and so that they could familiarise themselves

Sarawak. with the campus environment.
About 67% of the undergraduates were Table 2 shows that the prevalence of
in the age group of 20 to 22 years (mean age: breakfast skipping was 29.2% (95% C.I.: 27.3
21.7 + 2.8 years) and they came from a variety – 30.3 %). Reasons for skipping breakfast
of backgrounds as shown by the distribution were no time to eat (n = 341 or 43.8%), did
of students from various faculties. There not like to eat early (n=145 or 18.6%), no
were more Year 1 undergraduates who appetite (n=74 or 9.5%) and overslept (n=74
responded to the questionnaire followed by or 9.5%). Only 11.3 (95% CI: 9.8 – 12.2) %
Year 2 and Year 3 undergraduates, while skipped lunch and 8.9 (95% CI: 7.9 – 10.1) %
only a small proportion comprised Years 4 skipped dinner. Reasons for skipping lunch
and 5 undergraduates who were from the were no time to eat (n=118 or 39.3%), no
professional courses such as Medicine, appetite to eat (n=61 or 20.3%) or food not
Dentistry, Engineering and Architecture. palatable (n=22 or 7.3%). Reasons for
About 60% of the undergraduates stayed in skipping dinner were quite similar to reasons
the university’s hostels which could be for skipping lunch (no appetite, do not like
divided into hostels with food catered and to eat at dinner time, no time to eat) except
hostels with cafeteria. Those who stayed in that dieting emerged as one of the reasons
hostels with food catered had included for skipping dinner.
meals in their payment with accommodation About 22% of the undergraduates took
and they were expected to take their meals nutritional supplements on a regular basis
in the hostel. Those who stayed in hostels (daily) while about one -third (35.3%) of them
with cafeterias needed to pay when they took fast food at least once a week. The
purchased food from the cafeterias. Most of consumption of fruits and vegetables was
the undergraduates who stayed in the unsatisfactory as the mean score was only
hostels were the first-year undergraduates. 1.46 + 1.15 (minimum = 0 and maximum
It was the university’s policy to allow all score =4). Only about 6% of the under-
first year undergraduates to stay in campus graduates reported to be current smokers.
 Breakfast Skipping among Undergraduates in Kuala Lumpur 169

Factors found to be significantly those with poorer academic performance and

associated (p<0.05) with breakfast skipping younger undergraduates had significantly
were race, faculty, accommodation, academic higher proportions of breakfast skipping
performance, age, skipping of dinner, compared to their counterparts. Respond-
consumption of fastfood, consumption of ents who skipped breakfast, consumed
vegetables and fruits; and smoking (Table fastfood at least once a week, consumed less
3). Malays, students from non-Life Sciences’ vegetables and fruits daily (with lower
majors, staying in hostels or rented houses, scores) were also found to be more likely to

Table 3. Association of variables with breakfast skipping

Breakfast skipping (n= 778) p-value

Yes No
n (%) n (%)

Gender Male 350 (30.2) 810 (69.8) 0.33

Female 428 (28.4) 1077 (71.6)
Race Malays 532 (34.3) 1019 (65.7) < 0.01
Chinese 144 (18.3) 641 (81.7)
Indians 48 (30.0) 112 (70.0)
Sabahan & Sarawakian 54 (32.9) 110 (67.1)
Faculty Arts & Economics 311 (30.8) 700 (69.2) 0.01
Engineering 252 (31.0) 561 (69.0)
Life Sciences 191 (25.0) 572 (75.0)
Accommodation Hostel (meals catered) 305 (29.8) 718 (70.2) < 0.01
Hostel (cafeteria) 198 (37.0) 337 (63.0)
Own house 24 (13.0) 161 (87.0)
Rented house 242 (27.9) 624 (72.1)
AcademicPerformance <2.5 118 (36.8) 203 (63.2) <0.01
(CGPA) 2.5 -3.5 438 (29.3) 1059 (70.7)
> 3.5 92 (25.1) 274 (74.9)
BMI Underweight 182 (28.4) 459 (71.6) 0.78
Normal weight 513 (29.9) 1204 (70.1)
Overweight 58 (29.1) 141 (70.9)
Age in years (mean + s.d.) 21.33 + 2.13 21.90 + 3.03 <0.01
Skipping lunch Yes 100 (33.3) 200 (66.7) 0.094
No 678 (28.7) 1687 (71.3)
Skipping dinner Yes 112 (47.5) 124 (52.5) <0.001
No 666 (27.4) 1763 (72.6)
Nutritional supplements Yes 157 (30.0) 437 (70.0) 0.093
No 621 (26.4) 1450 (73.6)
Fast food consumption Yes 301 (32.0) 640 (68.0) 0.019
No 477 (27.7) 1247 (72.3)
Vege & fruits score 1.37 + 1.10 1.51 + 1.18 0.003
Smoking Yes 57 (36.1) 101 (63.9) 0.050
No 721 (28.8) 1786 (71.2)
170 Moy FM, Johari S, Ismail Y, Mahad R, Tie FH & Wan Ismail WMA

Table 4. Crude and adjusted odds ratio (O.R) for confounders on breakfast skipping

Crude O.R. Adjusted O.R.

Race Chinese* 1.00 1.00

Malay 2.32 (1.89 – 2.86) 1.94 (1.48 – 2.54)
Indian 1.91 (1.30 – 2.80) 1.70 (1.08 – 2.66)
Sabahan & Sarawakian 2.19 (1.51 – 3.17) 2.13 (1.37 – 3.33)
Accommodation Own house* 1.00 1.00
Hostel (food catered) 2.85 (1.82 – 4.46) 2.32 (1.39 – 3.84)
Hostel (cafeteria) 3.94 (2.48 – 6.26) 2.92 (1.74 – 4.91)
Rented house 2.60 (1.65 – 4.09) 2.08 (1.25 – 3.46)
Academic performance > 3.5* 1.00 1.00
(CGPA) < 2.5 1.73 (1.25 – 2.40) 1.23 (0.85 – 1.78)
2.5 – 3.5 1.23 (0.95 – 1.60) 0.97 (0.72- 1.29)
Faculty Life Sciences* 1.00 1.00
Arts & Economics 1.33 (1.08 – 1.64) 1.40 (1.07 – 1.82)
Engineering 1.35 (1.08 – 1.69) 1.20 (0.92 – 1.58)
Skipping lunch No* 1.00 1.00
Yes 1.24 (0.96 – 1.61) 1.06 (0.79 – 1.42)
Skipping dinner No* 1.00 1.00
Yes 2.39 (1.82 – 3.13) 2.02 (1.47 – 2.77)
Nutritional supplement Yes* 1.00 1.00
No 1.19 (0.97 – 1.46) 1.03 (0.81 – 1.31)
Fastfood consumption No* 1.00 1.00
Yes 1.23 (1.03 – 1.46) 1.21 (0.99 – 1.49)
Smoking No 1.00 1.00
Yes 1.40 (1.00 – 1.96) 1.20 (0.82 – 1.76)
Fruits & vege score 0.90 (0.84 – 0.97) 0.93 (0.85 – 1.01)
Age (years) 0.92 ( 0.88-0.95) 0.95 (0.89 – 0.99)

*reference group (ROC area under the curve = 0.654)

skipp breakfast. Smoking was marginally 0.95; 95% CI: 0.89 – 0.99). Malays (OR: 1.94;
significant (p=0.05) with breakfast skipping. 1.48 – 2.54), Indians (OR: 1.70; 1.08 – 2.66);
Gender, skipping lunch and taking and undergraduates from Sabah and
nutritional supplements were not Sarawak indigenous communities (OR: 2.13;
significantly associated with breakfast 1.37 – 3.33) were more likely to skip breakfast
skipping. compared to their Chinese counterparts.
After adjusting for all the above Respondents who stayed in their own
confounders using Multiple Logistic houses were also less likely to skip breakfast
Regression, age, race, accommodation, compared to those staying in hostels with
faculty and skipping dinner were found to meals catered (OR: 2.32; 1.39 – 3.84), hostels
be significant (p<0.05) as shown in Table 4. with cafeteria (OR: 2.92; 1.74 – 4.91) or rented
As the respondents’ age increased, their houses (OR: 2.08; 1.25 – 3.46). Respondents
risks of breakfast skipping was lower (OR: majoring in Arts & Economics had 1.40 (1.07
 Breakfast Skipping among Undergraduates in Kuala Lumpur 171

– 1.82) times risk of breakfast skipping appetite or overslept. Similar findings have
compared to those majoring in Life Sciences. been reported elsewhere (Chitra & Reddy,
Those who skipped dinner too had the odds 2007). The younger undergraduates were
of 2.02 (1.47 – 2.77) times of breakfast more likely to skip breakfast perhaps due to
skipping. The area under the Receiver ignorance or inability to adapt to campus
Operating Curve (ROC) was 0.654, meaning life. Non-Chinese had a higher tendency to
that the above variables were able to explain skip breakfast compared to Chinese perhaps
65.4% of breakfast skipping. due to the fact that the Chinese culture
considers food as an important component
DISCUSSION of their life (Chang, 1977) and these
undergraduates might have been educated
The university and college arenas represent from young about the importance of food.
the final opportunity for health and Non-Life Science majors might not have
nutritional education of a large number of been reinforced on the importance of a
students from the educator’s perspective healthy eating behaviour (including not
(Sakamaki et al., 2005). It is important that skipping meals) as the Life Science majors
the undergraduates are educated and in their current curriculum. Increased
reinforced in healthy eating behaviours and knowledge of dietary guidelines appeared
are able to select a healthy choice of foods in to be positively related to more healthful
the future. eating patterns (Kolodinsky et al., 2007).
Skipping of breakfast was found to be Undergraduates who stayed in their
quite high (29%) among this group of own houses were least likely to skip
respondents. Studies show that the breakfast possibly due to their family
prevalence of breakfast skipping is common members preparing breakfast for them. Study
among young adults in colleges and by Yokoyama et al (2002) showed that
universities (Samuelson, 2000; Keski- students who were not supplied with meals
Rahkonen et al., 2003; Osako et al., 2005; Song from their mothers or dormitory food service
et al., 2005). People who did not take had more irregular meal times and skipped
breakfast were much more likely to have breakfast more than the students supplied
inadequate nutrient intakes. Regular with meals. A study by Keski-Rahkonen et
breakfast consumption is associated with al. (2003) found that those who skipped
better diets for adults overall (Williams, breakfast were more prone to skipping lunch
2005). A study by Ma et al. (2003) found that or dinner, consumed more fastfood and
adults and adolescents who skipped snacked. However, the current study found
breakfast tend to eat more for the rest of the that only respondents who skipped
day. Breakfast skipping was also associated breakfast were more likely to skip dinner.
with increased prevalence of obesity (O.R. Studies show that consumption of
4.5; 1.57 – 12.90) and dysmenorrhea among vegetables and fruits is unsatisfactory among
the females (Fujiwara, 2003). college or university students (Debate,
After adjusting for confounding factors Topping & Sargent, 2001; Osako et al., 2005).
in the Multiple Logistic Regression model, Among our respondents, vegetables were
respondents who were younger, non- found to be consumed by only about half
Chinese, non-Life Science majors, staying while fruits were only consumed by less than
out of own house and skipping dinner were one-third of them (results not shown).
significantly at higher risk of breakfast Therefore the score of vegetables and fruits
skipping (p<0.05). Reasons for breakfast consumption obtained for the whole group
skipping were more of personal choice such was generally low. Reasons for this could
as no time to eat, did not like to eat early, no be due to the ignorance of students about
172 Moy FM, Johari S, Ismail Y, Mahad R, Tie FH & Wan Ismail WMA

the importance of vegetables and fruits in mentioned as one of the reasons for skipping
the diet; inaccessiblilty of fruits and meals. The management of the university
vegetables or unaffordable prices at the should also monitor the choices of food
cafeteria. Respondents who skipped offered by the cafeterias in the campus.
breakfast were also found to have even lower Glanz & Holscher (2004) found that a
consumption of vegetables and fruits. changing environment, policy and pricing
Similar results were shown by Chung & did manage to result in moderate
Hoerr (2005) where a positive association improvement on the consumption of fruits
between breakfast taking with vegetable and and vegetables.
fruit consumption existed among their
participants. However, the association was CONCLUSION
not statistically significant in this study.
Breakfast skipping is associated with The prevalence of skipping breakfast among
health-compromising behaviours in adults the undergraduates of this university was
and adolescents such as smoking (Keski- 29%. Factors influencing breakfast skipping
Rahkonen et al., 2003). However, this study were age, race, accommodation, faculties and
did not show significant results possibly due skipping dinner. Health awareness
to the small numbers of smokers. campaigns or the introduction of healthy
Therefore as observed above, some of the eating guidelines should be implemented to
predictors for breakfast skipping were more the undergraduates as well as to the caterers
related to knowledge and information in campus. The policy and pricing of catered
available to the undergraduates. The non food in campus should also be reviewed.
Life Science undergraduates especially those
from the Arts and Economics faculty urgently REFERENCES
need more information or knowledge in
healthier choices of food and healthy eating Chang KC (ed.) (1977). Food in Chinese
behaviours. This could be achieved through Culture: Anthropological and Historical
awareness campaigns in campus or Perspectives. Yale University Press,
introduction of related courses in all New Haven.
faculties of the university. The younger
undergraduates should be given more Chitra U & Reddy CR (2007). The role of
attention by the management of the breakfast in nutrient intake of urban
university where they should be briefed on schoolchildren. Public Health Nutr 10(1):
life in campus and possibly how to adapt to 55-58.
campus life; as well as the importance of a
healthy lifestyle especially a healthy diet. The Chung SJ & Hoerr SL (2005). Predictors of
Malaysian Dietary Guidelines should be fruit and vegetable intakes in young
introduced to these undergraduates with adults by gender. Nutr Res 25(5): 453-
effective awareness campaigns within the 463.
campus. This may be a useful mechanism
for promoting change in what they choose Debate RD, Topping M & Sargent RG (2001).
to eat. Racial and gender differences in weight
Caterers of the cafeterias in the campus status and dietary practices among
should be educated on the importance of college students. Adolescence 36(144):
providing a healthy choice in their menu, 819-833.
making vegetables and fruits more available
and affordable. The menu and cooking
methods of meals catered by the cafeterias
should be improved as inpalatibility was
 Breakfast Skipping among Undergraduates in Kuala Lumpur 173

Fujiwara T (2003). Skipping breakfast is Lakka TA & Bouchard C (2005). Physical

associated with dysmenorrhea in young activity, obesity and cardiovascular
women in Japan. Int J Food Sci Nutr 54(6): diseases. Handb Exp Pharmacol(170):
505-509. 137-163.

Giovannini M, Verduci E, Scaglioni S, Lindstrom J, Peltonen M & Tuomilehto J

Salvatici E, Bonza M, Riva E & Agostoni (2005). Lifestyle strategies for weight
C (2008). Breakfast: a good habit, not a control: experience from the Finnish
repetitive custom. J Int Med Res 36: 613- Diabetes Prevention Study. Proc Nutr Soc
624. 64(1): 81-88.

Glanz K & Hoelscher D (2004). Increasing Ma YS, Bertone ER, Stanek EJ, Reed GW,
fruit and vegetable intake by changing Herbert JR, Cohen NL, Merriam PA &
environments, policy and pricing: Ockene IS (2003). Association between
restaurant-based research, strategies, eating patterns and obesity in a free
and recommendations. Prev Med living US adult population. Am J
39(Suppl 2): S88-93. Epidemiol 158: 85-92.

Harris KM, Gordon-Larsen P, Chantala K & Niemeier HM, Raynor HA, Lloyd-
Udry JR (2006). Longitudinal trends in Richardson EE, Rogers ML & Wing RR
race/ethnic disparities in leading (2006). Fast food consumption and
health indicators from adolescence to breakfast skipping: predictors of weight
young adulthood. Arch Pediatr Adolesc gain from adolescence to adulthood in a
Med 160(1): 74-81. nationally representative sample. J
Adolescent Health 39(6): 842-849.
Hu FB, Manson JE, Stampfer MJ, Colditz G,
Liu S, Solomon CG & Willett WC (2001). Osako M, Takayama T & Kira S (2005).
Diet, lifestyle, and the risk of type 2 Dietary habits, attitudes toward weight
diabetes mellitus in women. N Engl J Med control, and subjective symptoms of
345(11): 790-797. fatigue in young women in Japan.
Nippon Koshu Eisei Zasshi 52(5): 387-398.
Keski-Rahkonen A, Kaprio J, Rissanen A,
Virkkunen M & Rose RJ (2003). Breakfast Sakamaki R, Toyama K, Amamoto R, Liu CJ
skipping and health-compromising & Shinfuku N (2005). Nutritional
behaviors in adolescents and adults. Eur knowledge, food habits and health
J Clin Nutr 57(7): 842-853. attitude of Chinese university
students—a cross sectional study. Nutr
Key TJ, Schatzkin A, Willett WC, Allen NE, J 4: 4.
Spencer EA & Travis RC (2004). Diet,
nutrition and the prevention of cancer. Samuelson G (2000). Dietary habits and
Public Health Nutr 7(1A): 187-200. nutritional status in adolescents over
Europe. An overview of current studies
Kolodinsky J, Harvey-Berino JR, Berlin L, in the Nordic countries. Eur J Clin Nutr
Johnson RK & Reynolds TW (2007). 54 Suppl 1: S21-28.
Knowledge of current dietary guidelines
and food choice by college students:
better eaters have higher knowledge of
dietary guidance. J Am Diet Assoc 107(8):
1409-1413.
 174 Moy FM, Johari S, Ismail Y, Mahad R, Tie FH & Wan Ismail WMA

Siega-Riz AM, Popkin BM & Carson T Williams P (2005). Breakfast and the diets of
(2000). Differences in food patterns at Australian adults: an analysis of data
breakfast by socio-demographic charac- from the 1995 National Nutrition
teristics among a nationally represen- Survey. Int J Food Sci Nutr 56(1): 65-79.
tative sample of adults in the United
States. Prev Med 30: 415-424. Wyatt HR, Grunwald GK, Mosca CL, Klem
ML, Wing RR & Hill JO (2002). Long-
Sobngwi E, Mbanya JC, Unwin NC, Kengne term weight loss and breakfast in
AP, Fezeu L, Minkoulou EM, Aspray TJ subjects in the National Weight Control
& Alberti KG (2002). Physical activity Registry. Obes Res 10(2): 78-82.
and its relationship with obesity,
hypertension and diabetes in urban and Yokoyama H, Miyazaki M, Mizuta Y,
rural Cameroon. Int J Obes Relat Metab Matsuki H & Okazaki I (2002). Analysis
Disord 26(7): 1009-1016. of factors affecting breakfast skipping by
male students undergoing hard training
Song Y, Joung H, Engelhardt K, Yoo SY & for sports. Nippon Koshu Eisei Zasshi
Paik HY (2005). Traditional v. modified 49(9): 902-910.
dietary patterns and their influence on
adolescents’ nutritional profile. Br J Nutr
93(6): 943-949.

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