Breakfast skipping and cardiometabolic risk factors in adolescents: Systematic review

Authors

  • Marielly Rodrigues Souza Universidade Federal de Mato Grosso. Faculdade de Nutrição. Programa de Pós-Graduação em Nutrição, Alimentos e Metabolismo. Cuiabá, MT, Brasil https://orcid.org/0000-0003-4127-4780
  • Morgana Egle Alves Neves Universidade Federal de Mato Grosso. Faculdade de Nutrição. Programa de Pós-Graduação em Nutrição, Alimentos e Metabolismo. Cuiabá, MT, Brasil https://orcid.org/0000-0001-5806-1939
  • Bartira Mendes Gorgulho Universidade Federal de Mato Grosso. Faculdade de Nutrição. Departamento de Alimentos e Nutrição. Cuiabá, MT, Brasil https://orcid.org/0000-0002-1714-3548
  • Amanda Moura Souza Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Departamento de Epidemiologia e Bioestatística. Rio de Janeiro, RJ, Brasil https://orcid.org/0000-0002-8962-798X
  • Patrícia Simone Nogueira Universidade Federal de Mato Grosso. Faculdade de Nutrição. Departamento de Alimentos e Nutrição. Cuiabá, MT, Brasil https://orcid.org/0000-0002-2984-9302
  • Márcia Gonçalves Ferreira Universidade Federal de Mato Grosso. Faculdade de Nutrição. Departamento de Alimentos e Nutrição. Cuiabá, MT, Brasil https://orcid.org/0000-0001-8362-0819
  • Paulo Rogério Melo Rodrigues Universidade Federal de Mato Grosso. Faculdade de Nutrição. Departamento de Alimentos e Nutrição. Cuiabá, MT, Brasil https://orcid.org/0000-0002-4213-0685

DOI:

https://doi.org/10.11606/s1518-8787.2021055003077

Keywords:

Adolescent, Breakfast, Food Deprivation, Metabolic Syndrome, Cardiometabolic Risk Factors, Review

Abstract

OBJECTIVE To systematically review the results of the association between breakfast skipping and cardiometabolic risk factors in adolescents. METHODS The articles were searched in May 2020 from PubMed, Virtual Health Library, Scopus, Web of Science and Scientific Electronic Library Online (SciELO). The review included observational studies conducted with adolescents (10–19 years old), which estimated the association of breakfast skipping with at least one outcome (markers of body adiposity, blood pressure, serum lipid and glucose levels). Regarding the risk of bias, the articles were evaluated using the Research Triangle Institute (RTI) Item Bank on bias risk and accuracy of observational studies. The quality of the evidence was assessed by the Grade rating. RESULTS A total of 43 articles involving 192,262 participants met the inclusion criteria and were considered in this review. The prevalence of breakfast skipping ranged from 0.7% to 94% and 60.5% of studies were classified with low risk of bias. The significant association between breakfast skipping and cardiometabolic risk factors was found in twenty-nine cross-sectional articles (n = 106,031) and four longitudinal articles (n = 5,162) for excess adiposity, in three articles (n = 8,511) for high total cholesterol levels, low-density lipoprotein and triglycerides, and in three studies (n = 6,303) for high blood pressure levels. However, there was no significant association between breakfast skipping and glycemic profile. According to the Grade rating, all the associations had low quality of evidence. CONCLUSION The results of this review suggest that breakfast skipping is associated with cardiometabolic risk factors in adolescents aged 10 to 19 years. However, considering the low quality of the evidence, the present results should be interpreted carefully. In addition, our findings highlight the importance of standardizing the definition of breakfast skipping and that more prospective studies are needed to determine how skipping breakfast can affect cardiometabolic risk factors in the long time.

References

St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2017;135(9):e96-121. https://doi.org/10.1161/CIR.0000000000000476

O’Neil CE, Byrd-Bredbenner C, Hayes D, Jana L, Klinger SE, Stephenson-Martin S. The role of breakfast in health: definition and criteria for a quality breakfast. J Acad Nutr Diet. 2014;114(12 Suppl):S8-26. https://doi.org/10.1016/j.jand.2014.08.022

Monteiro LS, Souza AM, Hassan BK, Estima CCP, Sichieri R, Pereira RA. Breakfast eating among Brazilian adolescents: analysis of the National Dietary Survey 2008-2009. Rev Nutr. 2017;30(4):463-76. https://doi.org/10.1590/1678-98652017000400006

Timlin MT, Pereira MA. Breakfast frequency and quality in the etiology of adult obesity and chronic discases. Nutr Rev. 2007;65(6 Pt 1):268-81. https://doi.org/10.1301/nr.2007.jun.268-281

Hallström L, Labayen I, Ruiz JR, Petterson E, Vereecken CA, Breidenassel C, et al. Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 2013;16(7):1296-305. https://doi.org/10.1017/S1368980012000973

Sandercock GRH, Voss C, Dye L. Association between habitual school-day breakfast consumption, body mass index, physical activity, and cardiorespiratory fitness in English schoolchildren. Eur J Clin Nutr. 2010;64(10):1086-92. https://doi.org/10.1038/ejcn.2010.145

Hunty A, Gibson S, Ashwell M. Does regular breakfast cereal consumption help children and adolescents stay slimmer? A systematic review and meta-analysis. Obes Facts. 2013;6(1):70-85. https://doi.org/10.1159/000348878

Sampasa-Kanyinga H, Hamilton HA. Eating breakfast regularly is related to higher school connectedness and academic performance in Canadian middle- and high-school students. Public Health. 2017;145:120-3. https://doi.org/10.1016/j.puhe.2016.12.027

Ptomey LT, Steger FL, Schubert MM, Lee J, Willis EA, Sullivan DK, et al. Breakfast intake and composition is associated with superior academic achievement in elementary schoolchildren. J Am Coll Nutr. 2015;35(4):326-33. https://doi.org/10.1080/07315724.2015.1048381

Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study. Am J Clin Nutr. 2010;92(6):1316-25. https://doi.org/10.3945/ajcn.2010.30101

Wu CH, Lin CY, Hsieh YP, Strong C, Meshki C, Lin YC, et al. Dietary behaviors mediate the association between food insecurity and obesity among socioeconomically disadvantaged youth. Appetite. 2019;132:275-81. https://doi.org/10.1016/j.appet.2018.10.013

Kim SH, Song YH, Park S, Park MJ. Impact of lifestyle factors on trends in lipid profiles among Korean adolescents: the Korea National Health and Nutrition Examination Surveys study, 1998 and 2010. Korean J Pediatr. 2016;59(2):65-73. https://doi.org/10.3345/kjp.2016.59.2.65

Eckel RH, Kahn R, Robertson RM, Rizza RA. Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes. Association and the American Heart Association. Circulation. 2006;29(7):1697-9. https://doi.org/10.2337/dc06-9911

Moschonis G, Tsoutsoulopoulou K, Efstathopoulou E, Tsirigoti L, Lambrinou CP, Georgiou A. Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood. Expert Rev Cardiovasc Ther. 2015;13(6):673-92. https://doi.org/10.1586/14779072.2015.1039992

Szajewska H, Ruszczyński M. Systematic review demonstrating that breakfast consumption influences body weight outcomes in children and adolescents in Europe. Crit Rev Food Sci Nutr. 2010;50(2):113-9. https://doi.org.10.1080/10408390903467514

Wang S, Schwartz MB, Shebl FM, Read M, Henderson KE, Ickovics JR. School breakfast and body mass index: a longitudinal observational study of middle school students. Pediatr Obes. 2017;12(3):213-20. https://doi.org/10.1111/ijpo.12127

Jakubowicz D, Wainstein J, Ahren B, Landau Z, Bar-Dayan Y, Froy O. Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: a randomized clinical trial. Diabetes Care. 2015;38(10):1820-6. https://doi.org/10.2337/dc15-0761

World Health Organization. Physical status: the use of and interpretation of anthropometry: report of a WHO expert committee. Geneva (CH): WHO; 1995 [cited 2020 Aug 22]. (WHO Technical Report Series; nº 854). Available from: https://apps.who.int/iris/handle/10665/37003

Viswanathan M, Berkman ND. Development of the RTI item bank on risk of bias and precision of observational studies. J Clin Epidemiol 2012;65(2):163-78. https://doi.org/10.1016/j.jclinepi.2011.05.008

Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Ciência e Tecnologia. Diretrizes metodológicas: Sistema GRADE – Manual de graduação da qualidade da evidência e força de recomendação para tomada de decisão em saúde. Brasília, DF; 2014 [cited 2020 Aug 22]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_metodologicas_sistema_grade.pdf.

Timlin MT, Pereira MA, Story M, Neumark-Sztainer D. Breakfast eating and weight change in a 5-year prospective analysis of adolescents: Project EAT (Eating Among Teens). Pediatrics. 2008;121(3):e638-45. https://doi.org/10.1542/peds.2007-1035

Cayres SU, Urban JB, Fernandes RA. Physical activity and skipping breakfast have independent effects on body fatness among adolescents. J Pediatr Gastroenterol Nutr. 2018;67(5):666-70. https://doi.org/10.1097/MPG.0000000000002081

Hassan BK, Cunha DB, Veiga GV, Pereira RA, Sichieri R. Changes in breakfast frequency and composition during adolescence: The Adolescent Nutritional Assessment Longitudinal Study, a cohort from Brazil. PLoS One. 2018;13(7):e0200587. https://doi.org/10.1371/journal.pone.0200587

Hassan BK, Cunha DB, Veiga GV, Pereira RA, Hoffman DJ, Sichieri R. Breakfast consumption, family breakfast, and adiposity trajectory in adolescence: The Adolescent Nutritional Assessment Longitudinal Cohort Study. J Acad Nutr Diet. 2019;119(6):944-56. https://doi.org/10.1016/j.jand.2018.11.014

Harding S, Teyhan A, Maynard MJ, Cruickshank KJ. Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle. Int J Epidemiol. 2008;37(1):162-72. https://doi.org/10.1093/ije/dym252

Maddah M. Risk factors for overweight in urban and rural school girls in Iran: skipping breakfast and early menarche. Int J Cardiol. 2008;136(2):235-8. https://doi.org/10.1016/j.ijcard.2008.04.046

Mota J, Fidalgo F, Silva R, Ribeiro JC, Santos R, Carvalho J, et al. Relationships between physical activity, obesity and meal frequency in adolescents. Ann Hum Biol. 2008;35(1):1-10. https://doi.org/10.1080/03014460701779617

Henríquez Sánchez P, Doroeste Alonso J, Laínez Sevillano P, Estévez Gonzáles MD, Iglesias Valle M, López Martin G, et al. Prevalencia de obesidad y sobrepeso en adolescentes canarios. Relación con el desayuno y la actividad física. Med Clin (Barc). 2008;130(16):606-10. https://doi.org/10.1157/13120339

Alexander KE, Ventura EE, Spruijt-Metz D, Weigensberg MJ, Goran MI, Davis JN. Association of breakfast skipping with visceral fat and insulin indices in overweight Latino youth. Obesity (Silver Spring). 2009;17(8):1528-33. https://doi.org/10.1038/oby.2009.127

Croezen S, Visscher TLS, Bogt NCW, Veling ML, Haveman-Nies A. Skipping breakfast, alcohol consumption and physical inactivity as risk factors for overweight and obesity in adolescents: results of the E-MOVO project. Eur J Clin Nutr. 2009;63(3):405-12. https://doi.org/10.1038/sj.ejcn.1602950

Kollias A, Antonodimitrakis P, Grammatikos E, Chatziantonakis N, Grammatikos EE, Stergiou GS. Trends in high blood pressure prevalence in Greek adolescents. J Hum Hypertens. 2009;23(6):385-90. https://doi.org/10.1038/jhh.2008.166

Maddah M, Rashidi A, Mohammadpour B, Vafa R, Karandish M. In-school Snacking, Breakfast Consumption, and Sleeping Patterns of Normal and Overweight Iranian High School Girls: a study in urban and rural areas in Guilan, Iran. J Nutr Educ Behav. 2009;41(1):27-31. https://doi.org/10.1016/j.jneb.2008.03.115

Sun Y, Sekine M, Sadanobu K. Lifestyle and overweight among Japanese adolescents: The Toyama Birth Cohort Study. J Epidemiol. 2009;19(6):303-10. https://doi.org/10.2188/jea.je20080095

Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002. J Am Coll Nutr. 2010;29(4):407-18. https://doi.org/10.1080/07315724.2010.10719858

Kapantais E, Chala E, Kaklamanou D, Lanaras L, Kaklamanou M, Tzotzas T. Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents. Public Health Nutr. 2010;14(1):101-8. https://doi.org/10.1017/S1368980010000765

Maddah M, Nikooyeh B. Obesity among Iranian adolescent girls: location of residence and parental obesity. J Health Popul Nutr. 2010;28(1):61-6. https://doi.org/10.3329/jhpn.v28i1.4524

Thompson-McCormick JJ, Thomas JJ, Bainivualiku A, Khan AN, Becker AE. Breakfast skipping as a risk correlate of overweight and obesity in school-going ethnic Fijian adolescent girls. Asia Pac J Clin Nutr. 2010;19(3):372-82.

Kim JH, So WY. Association between frequency of breakfast eating and obesity in Korean adolescents. Iran J Public Health. 2012;41(6):50-7.

Kuriyan R, Thomas T, Sumithra S, Lokesh DP, Sheth NR, Joy R, et al. Potential factors related to waist circumference in urban South Indian children. Indian Pediatr. 2012;49(2):124-8. https://doi.org/10.1007/s13312-012-0027-3

Vaezghasemi M, Lindkvist M, Ivarsson A, Eurenius E. Overweight and lifestyle among 13-15 year olds: a cross-sectional study in northern Sweden. Scand J Public Health. 2012;40(3):221-8. https://doi.org/10.1177/1403494812443603

Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J). 2013;89(6):575-82. https://doi.org/10.1016/j.jped.2013.03.020

Boričić K, Simić S, Vasiljević N, Marinković J. Risk factors associated with overweight among adolescents in Serbia. Zdr Varst. 2014;53(4):283-93. https://doi.org/10.2478/sjph-2014-0031

Díez-Navarro A, Martín-Camargo A, Solé-Llussà A, Marrodán MD, Gónzales-Montero de Espinoza M. [Influence of breakfast on overweight and obesity in child and adolescent population from Madrid]. Nutr Clin Diet Hosp. 2014;34(2):9-17. Spanish.

Faizi N, Khan IM, Amir A, Azmi SA, Ahmad A, Khalique N. Breakfast skipping and proposed effects of breakfast on obesity: a school-based study in adolescents in Aligarh, India. Ann Trop Med Public Health. 2014;7(1):43-7.

Garcia-Continente X, Allue N, Pérez-Giménez A, Ariza A, Sánchez-Martínez F, López MJ et al. [Eating habits, sedentary behaviors and overweight and obesity among adolescents in Barcelona (Spain)]. An Pediatr (Barc). 2015;83(1):3-10. Spanish. https://doi.org/10.1016/j.anpede.2015.05.017

Garg M, Rajesh V, Kumar P. Effect of breakfast skipping on nutritional status and school performance of 10-16 years old children of Udupi district. Health Popul Perspect Issues. 2014;37(3-4):98-117.

Gökler ME, Buğrul N, Metintaş S, Kalyoncu C. Adolescent obesity and associated cardiovascular risk factors of rural and urban life (Eskisehir, Turkey). Cent Eur J Public Health. 2015;23(1):20-5. https://doi.org/10.21101/cejph.a3958

Talat MA, El Shahat E. Prevalence of overweight and obesity among preparatory school adolescents in Urban Sharkia Governorate, Egypt. Egypt Pediatr Assoc Gaz. 2016;64(1):20-5. https://doi.org/10.1016/j.epag.2015.11.004

Cayres SU, Freitas Júnior IF, Barbosa MF, Christofaro DGD, Fernandes RA. Breakfast frequency, adiposity, and cardiovascular risk factors as markers in adolescents. Cardiol Young. 2016;26(2):244-9. https://doi.org/10.1017/S1047951115000050

Morales A, Montilva M. Hábitos alimentarios no saludables, actividad física y obesidad en adolescentes entre 15 y 19 años. An Venez Nutr. 2016;29(1):4-10.

Badr HE, Lakha SF, Pennefather P. Differences in physical activity, eating habits and risk of obesity among Kuwaiti adolescent boys and girls: a population-based study. Int J Adolesc Med Health. 2017;31(1):20160138. https://doi.org/10.1515/ijamh-2016-0138

Frayon S, Cherrier S, Cavaloc Y, Touitou A, Zongo P, Wattelez G, et al. Nutrition behaviors and sociodemographic factors associated with overweight in the multi-ethnic adolescents of New Caledonia. Ethn Health. 2019;24(2):194-210. https://doi.org/10.1080/13557858.2017.1315530

Zalewska M, Maciorkowska E. Selected nutritional habits of teenagers associated with overweight and obesity. PeerJ. 2017;5:e3681. https://doi.org/10.7717/peerj.3681

De Cnop ML, Monteiro LS, Rodrigues PRM, Estima CCP, Veiga GV, Pereira RA. Meal habits and anthropometric indicators in adolescents from public and private schools of the metropolitan region of Rio de Janeiro. Rev Nutr. 2018;31(1):35-47. https://doi.org/10.1590/1678-98652018000100004

Khan A, Khan SR, Burton NW. Missing breakfast is associated with overweight and obesity in Bangladeshi adolescents. Acta Paediatr. 2018;108(1):178-9. https://doi.org/10.1111/apa.14553

Silva FA, Padez C, Sartorelli DS, Oliveira RMS, Netto MP, Mendes LL, et al. Cross-sectional study showed that breakfast consumption was associated with demographic, clinical and biochemical factors in children and adolescents. Acta Paediatr. 2018;107(9):1562-9. https://doi.org/10.1111/apa.14363

Tee ES, Nurliyana AR, Norimah AK, Mohamed HJBJ, Tan SY, Appukutty M, et al. Breakfast consumption among Malaysian primary and secondary school children and relationship with body weight status: findings from the MyBreakfast Study. Asia Pac J Clin Nutr. 2018;27(2):421-32. https://doi.org/10.6133/apjcn.062017.12

Werneck AO, Agostinete RR, Cayres SU, Urban JB, Wigna A, Chagas LGM, et al. Association between Cluster of Lifestyle Behaviors and HOMA-IR among Adolescents: ABCD Growth Study. Medicina (Kaunas). 2018;54(6):96. https://doi.org/10.3390/medicina54060096

Forkert ECO, Moraes ACF, Carvalho HB, Manios Y, Whidhalm K, González-Gross M, et al. Skipping breakfast is associated with adiposity markers especially when sleep time is adequate in adolescents. Sci Rep. 2019;9:6380. https://doi.org/10.1038/s41598-019-42859-7

Mustafa N, Abd Majid H, Toumpakari Z, Carroll HA, Jalaludin Y, Al Sadat N, et al. The association of breakfast frequency and cardiovascular disease (CVD) risk factors among adolescents in Malaysia. Nutrients. 2019;11(5):973. https://doi.org/10.3390/nu11050973

Intiful FD, Lartey A. Breakfast habits among school children in selected communities in the eastern region of Ghana. Ghana Med J. 2014;48(2):71-7. https://doi.org/10.4314/gmj.v48i2.3

Vissers PAJ, Jones AP, Corder K, Jennings A, Sluijs EMF, Welch A, et al. Breakfast consumption and daily physical activity in 9-10 year old British children. Public Health Nutr. 2013;16(7):1281-90. https://doi.org/10.1017/S1368980011002175

Depoortere I. Targeting the ghrelin receptor to regulate food intake. Regul Pept. 2009;156(1-3):13-23. https://doi.org/10.1016/j.regpep.2009.04.002

Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. https://doi.org/10.1371/journal.pmed.0010062

Deshmukh-Taskar P, Nicklas TA, Radcliffe JD, O'Neil CE, Liu Y. The relationship of breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome in young adults. The National Health and Nutrition Examination Survey (NHANES): 1999-2006. Public Health Nutr. 2013;16(11):2073-82. https://doi.org/10.1017/S1368980012004296

Ginsberg HN, Zhang YL, Hernandez-Ono A. Regulation of plasma triglycerides in insulin resistance and diabetes. Arch Med Res. 2005;36(3):232-40. https://doi.org/10.1016/j.arcmed.2005.01.005

Perret B, Mabile L, Martinez L, Tercé F, Barbaras R, Collet X. Hepatic lipase: structure/function relationship, synthesis, and regulation. J Lipid Res. 2002;43(8):1163-9. https://doi.org/10.1194/jlr.R100020-JLR200

Vanderlei LCM, Pastre CM, Freitas Júnior IF, Godoy MF. Analysis of cardiac autonomic modulation in obese and eutrophic children. Clinics. 2010;65(8):789-92. https://doi.org/10.1590/S1807-59322010000800008

Hirooka Y, Sagara Y, Kishi T, Sunagawa K. Oxidative stress and central cardiovascular regulation. Pathogenesis of hypertension and therapeutic aspects. Circ J. 2010;74(5):827-35. https://doi.org/10.1253/circj.cj-10-0153

Tolfrey K, Zakrzewski J. Breakfast, glycaemic index and health in young people. J Sport Health Sci. 2012;1(3):149-59. https://doi.org/10.1016/j.jshs.2012.09.001

Oosterman JE, Kalsbeek A, La Fleur SE, Belsham DD. Impact of nutrients on circadian rhythmicity. Am J Physiol Regul Integr Comp Physiol. 2015;308(5):R337-50. https://doi.org/10.1152/ajpregu.00322.2014

Dialektakou KD, Vranas PBM. Breakfast skipping and body mass index among adolescents in Greece: whether an association exists depends on how breakfast skipping is defined. J Am Diet Assoc. 2008;108(9):1517-25. https://doi.org/10.1016/j.jada.2008.06.435

Ministério da Saúde (BR), Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Guia alimentar para a população brasileira. 2. ed. Brasília, DF; 2014 [cited 2020 Aug 22]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/guia_alimentar_populacao_brasileira_2ed.pdf

Pagliai G, Dinu M, Madarena MP, Bonaccio M, Iacoviello L, Sofi F. Consumption of ultra-processed foods and health status: a systematic review and meta-analysis. Br J Nutr. 2021;125(3):308-18. https://doi:10.1017/S0007114520002688

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2021-12-17

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Review

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Souza, M. R., Neves, M. E. A., Gorgulho, B. M., Souza, A. M., Nogueira, P. S., Ferreira, M. G., & Rodrigues, P. R. M. (2021). Breakfast skipping and cardiometabolic risk factors in adolescents: Systematic review. Revista De Saúde Pública, 55, 107. https://doi.org/10.11606/s1518-8787.2021055003077

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