ABSTRACT
Most adolescents skip breakfast despite its advantages in providing energy and nutrient intake and contributing to high cognition and academic performance. Research on breakfast consumption among adolescents has solely focused on students in high income countries but information is scanty among in-school adolescents in low income countries like Nigeria. Therefore, this study investigated the pattern of breakfast consumption and nutritional status among in- school adolescents in secondary schools in Ogbomosho Local Government Area, Oyo State. Nigeria.
The study design was a descriptive cross-sectional survey and multistage random sampling was used to select 299 students from 13 registered secondary schools (6 public and 7 private schools) in Ogbomosho. The study was conducted using a pretested semi-structured self-administered questionnaire which contained 8-point knowledge scale, 11-point perception scale, 24-point breakfast consumption pattern scale, questions relating to factors influencing breakfast consumption pattern and nutritional status using Body Mass Index was used for data collection. Knowledge scores 0-4 and >4 were classified as poor and good respectively, perception scores 0-5 and >5 were classified as poor and good respectively, breakfast consumption pattern scores 0-12 and >12 were classified as unhealthy and healthy breakfast consumption pattern respectively while nutritional status was classified using the World Health Organisation classification (underweight: <18.50, normal: 18.50-24.99, overweight: >=25.00 and obese: >=30.00. The data were cleaned, coded and analysed using descriptive statistics and inferential statistics such as Chi square at p<0.05.
Results indicated that majority (32.8%) of the respondents were aged 15 years and 36.5% consumed breakfast daily. Nearly half 48.8% reportedly consumed ready-to-eat cereals for breakfast daily and 11.7% eat cooked noodles. Majority (93.6%) of those that consumed breakfast did so to boost their academic performance. A higher proportion of all respondents (63.5%) had infrequent breakfast consumption. Waking up late (51.2%), lack of appetite (39.8%) desire to lose weight (46.8%) and busy schedule (lack of time) (38.5%) were major reasons attributed for skipping breakfast. Two thirds (66.6%) and slightly above half (52.8%) of the respondents had good knowledge and good perception of the health benefits of breakfast consumption respectively. Overall nutritional status of the respondents indicated underweight (17.7%), overweight (30.4%), obese (1.7%) and normal weight (50.2%). Respondents who reportedly consumed healthy breakfast showed better nutritional status as 38.8% had normal weight compared with 11.4% of those that consumed unhealthy breakfast. Statistical significant (P< 0.001) relationship exists between breakfast consumption pattern and nutritional status. More than half (57.8%) of the respondents recommended that school breakfast programme should be organized by schools, benefits and negative health effects associated with consuming and skipping breakfast to encourage breakfast consumption practices.
There is a knowledge-practice gap in breakfast consumption. Parents and other stakeholders should encourage nutritious breakfast consumption among adolescents in secondary school setting to meet their daily dietary allowance.
CHAPTER ONE
INTRODUCTION
1.1 Background to the study
Breakfast is defined as the first meal that is taken after rising from a nights sleep, most often eaten in the morning before undertaking the days work, typically no later than 10am (Giovannini, Verduci, Scaglioni, Salvatici, Bonza, Riva and Agostoni, 2018) which keeps an individual alert and keep active to work for several hours in a day before lunch break (Arora, Nazar, Gupta, Perry, Reddy and Stigler, 2012; Mathys, Henauw, Bellemans, Maeyer and Backer, 2017 and Reeves, Halsey, McMeel and Huber, 2013). It serves as part of a healthy diet which provides approximately 20% of daily energy requirements (British Dietetic Association, 2010) and has consistently been linked with positive health benefits. Breakfast meal is known to provide key macronutrients and micronutrients in the diet, including B-vitamins, iron and calcium (Ruxton and Kirk, 2023; Chitra and Reddy, 2017; Williams, 2017).
This has been shown in the observation that the prevalence of inadequate nutrient intake is lower among adolescents who consume breakfast with those who skip breakfast (Hallstrom, Labayen, Ruiz, Patterson, Vereecken, and Breidenassel, 2013; Hoyland, McWilliams, Duff and Walton, 2012; Ruxton, Kirk, Belton and Holmes, 2023 and Nicklas, Bao, Webber and Berenson, 2023).
Breakfast consumption has been associated with adolescents’ mental and physical health (O’Sullivan, Robinson, Kendall, Miller, Jacoby, Silburn and Oddy, 2013; Pearson, Biddle, and Gorely, 2019), increase ability to concentrate at school due to its effect on blood glucose level thereby enhancing cognition and learning (Bellisle, 2014; Huda and Ruzita, 2011; Obbagy, Patricia and Eve, 2011), reduced risk of developing chronic diseases (World Health Organization, 2013), healthy body mass index and reduced likelihood of obesity development (De la Hunty and Ashwell, 2017; Szajewska and Ruszczynski, 2010), it may also be protective of weight gain over time (Ask, Hernes, Aarek, Johannessen, Haugen, 2016; Albertson, Franko, Thompson, Eldridge, Holschuh, Affenito, Bauserman and Striegel-Moore, 2017).
Skipping of breakfast tends to increase with age after childhood and appears to be most frequent in adolescents (Barton, Eldridge, Thompson, Affenito, Striegel-Moore, Franko, Albertson and Crockett, 2015).
Skipping breakfast is becoming prominent particularly among adolescent girls in secondary schools ((Arora et al., 2012 and Hoyland et al., 2012). Several studies attributed this phenomenon to lower socio economic status, food deprivation, long use of cell-phones and other electronic devices especially at night (Burghardt and Devaney, 2023; Hoyland et al.,2012; Pereira, Erickson, McKee, Schrankler, Raatz, Lytle and Pellegrini, 2011 and Utter, Scragg, Mhurchu and Schaaf, 2017). Adolescents and children are still dependents and they need adequate attention and care in order for them to be able to develop meals and food habits that are healthy and will promote good nutritional status (Lazzeri, Pammolli, Azzolini, Meoni, Simi, Wet and Giacchi, 2013; Nanney, Olaleye, Wang, Motyka and Klund-Schubert, 2011; Story, Pearce, Ashfield-Watt, Wood, Baines and Nelson, 2011 and Wate, Snowdon, Millar, Nichols, Mavoa, Goundar and Swinburn, 2013). People who skip breakfast are more likely to have difficulty concentrating by mid-morning and to experience space in intellectual performance (Keski- Rahkonen, Kaprio, Rissanen, Virkkunen and Rose, 2013 and Nicklas et al., 2014) as well as low physical activity levels (Sandercock, Voss and Dye, 2010). The practice of skipping breakfast may aid the consumption of snacks that are high in fat, salt and sugar (Resnicow, 2023; Berge,
Wall, Larson, Loth, and Neumark-Sztainer, 2013; Feeley and Norris, 2014 and Rodrigues, Pereira, Cunha,Sichieri, Ferreire, Vilela and Goncalves-Silva, 2012) and predisposes them to obesity. Skipping breakfast and Unhealthy food consumption may lead to micro nutrient deficiency and poor nutritional status (Acham, Kikafunda, Malde, Oldewage-Theron and Egal, 2012; Hallstrom et al; 2013 and Pereira et al., 2011). Breakfast skipping in adolescents has also been linked with other unhealthy behaviours, such as frequent alcohol intake, infrequent exercise, smoking (Keski-Rahkonen, Kaprio, Rissanen, Virkkunen, and Rose, 2013).
Majority of the adolescents skip breakfast due to different reasons such as not liking the food served at breakfast, not being hungry in the morning, being on a diet to lose weight, insufficient time to eat, insufficient time to cook, lack of perceived parental emphasis on breakfast, lack of time, poverty, individual choice, not feeling good and loss of appetite (Rampersaud, Pereira, Girard, Adams and Metzl, 2015). Also, unlike children in primary schools, it is believed that most parents of in-school adolescents have lesser control over what they eat. This is because at this stage, less attention is paid to them as it is believed they can take care of themselves. What majority of them eat is largely determined by peer influence, school environment including what is available to them in the school premises or what is provided by the school canteen.
The main problem however arises when the nutritive value of the food, the hygienic condition under which it has been prepared and the portion size of food being taken are compromised which is not certain and unclear among adolescents in our setting. Malnutrition is therefore, a known major contributor to the total global disease burden and the possibility of these adolescents becoming malnourished is very high (Timlin and Pereira, 2018). The students therefore, needs to be educated and reinforced on healthy eating behaviour, healthy choice of food (Hu, Manson, Stampfer, Colditz, Liu, Solomon and Willett, 2011; Sobngwi, Mbanya,
Unwin, Kengne, Fezeu, Minkoulou, Aspray and Alberti, 2012; Key, Schatzkin, Willett, Allen, Spencer and Travis, 2014; Lakka and Bouchard, 2015; Lindstrom, Peltonen and Tuomilehto, 2015) and importance of adequate nutrients intake. Though, the association between breakfast pattern and Nutritional status among University students are widely studied, few or no research has been conducted among in-school adolescents in Nigeria.
Therefore, this study aim to investigate the breakfast consumption pattern and nutritional status among in-school secondary school adolescents Ogbomosho Local Government Area, Oyo state.
1.2 Statement of Problem
Breakfast consumption during adolescence is very important for physical growth, psychosocial development, cognitive performance, and prevention of diet-related chronic diseases. Research on breakfast consumption among adolescents has solely been focused on high income countries rather than the patterns of breakfast consumption, its perceived health benefits and nutritional status among in-school adolescent in Low income countries like Nigeria. Irrespective of large number of literature linking breakfast consumption with a generally healthy lifestyle (Ruxton and Kirk, 2023; De la Hunty and Ashwell, 2017), limited information exists that directly relates breakfast consumption to measures of nutritional status and healthy lifestyles among adolescents in Low income countries.
High levels of meal skipping particularly breakfast skipping, has been reported among adolescents worldwide (O’Dea and Caputi, 2011 and Samuelson, 2010). Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012 reported that 13-14% of children aged 6 to 11 and 30-31% aged 12-19 are skipping breakfast on any given day (U.S Department of Agriculture).
Skipping of breakfast tends to increase with age after childhood and appears to be most frequent in adolescents (Barton et al., 2015). During the adolescents stage, it has been observed that most parents of in-school adolescents have lesser control over what they eat. This is because at this stage, less attention is paid to them as it is believed they can take care of themselves. What majority of them eat is largely determined by peer influence, school environment including what is available to them in the school premises or what is provided by the school canteen and lack of knowledge of healthy food choices may negatively affect nutritional status and eating habits (Gan, Mohd, Zalilah and Hazizi, 2011). The main problem however arises when the nutritive value of the food, the hygienic condition under which it has been prepared and the portion size of food being taken are compromised which is not certain and unclear among adolescents in our setting. Malnutrition is therefore, a known major contributor to the total global disease burden and the possibility of these adolescents becoming malnourished is very high (Dubois, 2015 and Matthys, 2016).
The consequences of poor nutritional status at the early stage of life can result to depression, lack of self esteem, unconsciousness, anxiety and in extreme condition a premature death among school childfren and adolescents (Acham et al., 2012; Arora et al., 2012; Bhurtun and Jeewon, 2013; Hoyland et al.,2012; Mathys et al., 2017; Pereira et al., 2011 and Utter et al., 2017)
Many research findings on adolescents in secondary schools has reported low fruits and vegetables consumption, increasing snacks and soda drinks consumption, these were attributed to food environments such as inability of parents to eat breakfast with their children and food transition that most less developed countries like Nigeria are currently experiencing (Berge et al., 2013; Feeley and Norris, 2014; Fieischhacker, Evenson, Rodriguez and Ammerman, 2011; Fulkerson, Farbakhsh, Lytle, Hearst, Dengel, Pasch and Kubik, 2011; Giskes, Van Lenthe, Avendano-Pabon and Brug, 2011; Popkin, 2011 and Rodrigues et al., 2012).
The study conducted among adolescents in public secondary schools in Kwara state showed that 23% skipped breakfast (Lateef et al., 2016), 14.1% of adolescents skipped breakfast in a study conducted by Omuemu and Oko-Oboh, (2015). Adolescents who skipped breakfast are reported to have higher daily intakes of fat, cholesterol, and energy, and lower intakes of fiber, vitamins, and minerals in comparison to breakfast eaters, thereby increasing the likelihood of gastrointestinal disease later in life (Timlin and Pereira, 2017).
Skipping breakfast has been linked with adverse effects on cognitive function (including memory), academic performance, psychosocial function, and mood in children and young people (Rampersaud et al., 2015). Reduced breakfast energy intake is associated with higher total daily energy intake (Schusdziarra, Hausmann, Wittke, Mittermeier, Kellner, Naumann, Wagenpfeil and Erdmann, 2011) and when breakfast is skipped it can be difficult to properly compensate for it later in the day.
High prevalence of Obesity and malnutrition is common among adolescents who skip breakfast compare to those who consume breakfast (Keski-Rahkonen et al., 2013; Moy, Johari, Ismail, Mahad, Tie and Wan Ismail, 2019). Research has linked the consumption of breakfast with adolescents mental and physical health (O’Sullivan, Robinson, Kendall, Miller, Jacoby, Silburn and Oddy, 2018; Pearson et al., 2019).
1.3 Justification
It is necessary to promote and encourage a healthy eating breakfast pattern in adolescents. This study aims to investigate the breakfast consumption pattern (Behaviours, Beliefs, Motivations, and Personal and Environmental Influences) and nutritional status among in-school adolescents Ogbomosho Local Government Area, Oyo state. Providing information on nutrition and the eating habits of adolescents is important in order to identify risky and unhealthy behaviour in this age group and advocate to parents and care givers to ensure the provision of breakfast for their school adolescents.
Moreover such information will guide educational ministries to develop new policy frame work or adjust the existing framework to meet the current food and health situations so as to bring about positive changes in breakfast consumption and to reduce the occurrence and development of chronic Non communicable diseases later in life. Conducting this study will also provide answers to the study questions below.
1.4. Research Questions
a. What is the level of respondents knowledge on breakfast consumption and its perceived health benefits?
b. What is the perception of respondents on breakfast consumption and its health benefits?
c. What are the breakfast consumption patterns among the respondents?
d. What are the factors influencing breakfast consumption pattern among the respondents?
e. What is the nutritional status using Body Mass Index (BMI) among the respondents?
1.5. Broad Objective
To investigate the breakfast consumption pattern and nutritional status among in-school adolescents in Ogbomosho Local Government Area, Oyo state.
1.6. Specific Objectives
a. To assess the level of knowledge of the respondents on breakfast consumption and its perceived health benefits.
b. To explore the perception of respondents on breakfast consumption and its health benefits
c. To determine breakfast consumption pattern among the respondents.
d. To identify factors influencing breakfast consumption pattern among the respondents.
e. To determine the nutritional status using Body Mass Index (BMI) among the respondents.
1.7. Research Hypotheses
a. There is no significant relationship between breakfast consumption pattern and nutritional status among the respondent.
b. There is no significant relationship between the level of knowledge of the perceived health benefits of breakfast consumption and pattern of breakfast consumption among respondents.
c. There is no significant relationship between breakfast consumption pattern and family structure of respondents.
d. There is no significant relationship between breakfast consumption pattern and gender of respondents.
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