Translated Titles

Multiple dietary behavior trajectories among economically disadvantaged children: an example of breakfast, fruits and vegetables, and snacks and beverages





Key Words

多重飲食行為 ; 兒童 ; 經濟弱勢 ; 群體基礎軌跡模型 ; multiple dietary behaviors ; children ; economic disadvantage ; group-based trajectory modeling



Volume or Term/Year and Month of Publication

36卷4期(2017 / 08 / 15)

Page #

397 - 411

Content Language


Chinese Abstract


English Abstract

Objectives: Dietary behaviors in childhood have a great influence on future health. Currently, most of the evidence has been focused on non-economically disadvantaged children and single dietary behaviors. The aim of this study was to explore multiple dietary behavior trajectories of breakfast, fruits and vegetables, and snacks and beverages, and associated factors. Methods: The partial data for this study were obtained from the Taiwan Database of Children and Youth in Poverty in 2009, 2011, and 2013, with a total sample size of 1001 elementary school children (50.25% girls and 49.75% boys; mean age at baseline = 9.07 [standard deviation = 1.24] years). Group-based multi-trajectory modeling and multinomial logistic regression were the main analytic methods. Results: Three multiple dietary behavior trajectories were identified, as follows: (1) the "regular eating" group (21.28%) with most children eating breakfast and fruits and vegetables daily, but the frequency of eating fruits and vegetables decreased significantly from time 1 to time 3; (2) the "irregular breakfast and fruits and vegetables eating" group (77.62%) with the lowest frequencies of eating breakfast at all time points and having an irregular pattern of eating fruits and vegetables; and (3) the "lack of fruits and vegetables" group (1.10%), in which children ate fruits and vegetables 1 day or less per week at all time points. There were similar trajectories of eating snacks and consuming beverages in all groups. Older age and parents with lower levels of education were associated with higher probabilities of unhealthy eating behaviors. Conclusions: The associations between eating breakfast, fruit and vegetable intake, and snack and beverage consumption were not as simple as linear relationships, with heterogeneity in the development of these dietary behaviors. Other potential factors were only minimally noted in our study. Future research should explore associated factors and mechanisms of different multiple dietary behavior trajectories.

Topic Category 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
  1. United States Department of Agriculture. Fresh Fruit and Vegetable Program. Available at: https://www.fns.usda.gov/ffvp/fresh-fruit-and-vegetable-program. Accessed June 24, 2017.
  2. United States Department of Agriculture. School Breakfast Program (SBP). Available at: https://www.fns.usda.gov/sbp/school-breakfast-program-sbp. Accessed June 24, 2017.
  3. 衛生福利部:2012年國民營養健康狀況變遷調查。http://obesity.hpa.gov.tw/TC/research.aspx。引用2017/02/22。Ministry of Health and Welfare, R.O.C. (Taiwan). The 2012 Nutrition and Health Survey in Taiwan. Available at: http://obesity.hpa.gov.tw/TC/research.aspx. Accessed February 22, 2017. [In Chinese]
  4. Albertson, AM,Franko, DL,Thompson, D(2007).Longitudinal patterns of breakfast eating in black and white adolescent girls.Obesity,15,2282-92.
  5. Attorp, A,Scott, JE,Yew, AC(2014).Associations between socioeconomic, parental and home environment factors and fruit and vegetable consumption of children in grades five and six in British Columbia, Canada.BMC Public Health,14,150.
  6. Bae, HO,Kim, M, ,Hong, SM(2008).Meal skipping children in low-income families and community practice implications.Nutr Res Pract,2,100-6.
  7. Bayer, O,Nehring, I,Bolte, G,von Kries, R(2014).Fruit and vegetable consumption and BMI change in primary school-age children: a cohort study.Eur J Clin Nutr,68,265-70.
  8. Bi, HS,Gan, Y,Yang, C,Chen, YW,Tong, XY,Lu, ZX(2015).Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies.Public Health Nutr,18,3013-19.
  9. Bruening, M,Larson, N,Story, M,Neumark-Sztainer, D,Hannan, P(2011).Predictors of adolescent breakfast consumption: longitudinal findings from project EAT.J Nutr Educ Behav,43,390-5.
  10. Brugman, E,Meulmeester, JF,Spee-Van der Wekke, A,Verloove-Vanhorick, SP(1998).Breakfast-skipping in children and young adolescents in the Netherlands.Eur J Public Health,8,325-8.
  11. Cheng, TS,Tse, LA,Yu, IT,Griffiths, S(2008).Children's perceptions of parental attitude affecting breakfast skipping in primary sixth-grade students.J Sch Health,78,203-8.
  12. Coppinger, T,Jeanes, YM,Mitchell, M,Reeves, S(2013).Beverage consumption and BMI of British schoolchildren aged 9-13 years.Public Health Nutr,16,1244-9.
  13. DeJong, CS,van Lenthe, FJ,van der Horst, K,Oenema, A(2009).Environmental and cognitive correlates of adolescent breakfast consumption.Prev Med,48,372-7.
  14. Dong, YR,Peng, CYJ(2013).Principled missing data methods for researchers.Springerplus,2,222.
  15. Dykstra, H,Davey, A,Fisher, JO(2016).Breakfastskipping and selecting low-nutritional-quality foods for breakfast are common among low-income urban children, regardless of food security status.J Nutr,146,630-6.
  16. Gan, Y,Tong, X,Li, L(2015).Consumption of fruit and vegetable and risk of coronary heart disease: a metaanalysis of prospective cohort studies.Int J Cardiol,183,129-37.
  17. Gonzalez, W,Jones, SJ,Frongillo, EA(2009).Restricting snacks in US elementary schools is associated with higher frequency of fruit and vegetable consumption.J Nutr,139,142-4.
  18. Hallström, L,Vereecken, CA,Labayen, I(2012).Breakfast habits among European adolescents and their association with sociodemographic factors: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study.Public Health Nutr,15,1879-89.
  19. Horikawa, C,Kodama, S,Yachi, Y(2011).Skipping breakfast and prevalence of overweight and obesity in Asian and Pacific regions: a meta-analysis.Prev Med,53,260-7.
  20. Hsu, HC,Jones, BL(2012).Multiple trajectories of successful aging of older and younger cohorts.Gerontology,52,843-56.
  21. Hsu, HC,Luh, DL,Chang, WC,Pan, LY(2013).Joint trajectories of multiple health-related behaviors among the elderly.Int J Public Health,58,109-20.
  22. Huang, CJ,Hu, HT,Fan, YC,Liao, YM,Tsai, PS(2010).Associations of breakfast skipping with obesity and health-related quality of life: evidence from a national survey in Taiwan.Int J Obes,34,720-5.
  23. Jackson, LW(2013).The most important meal of the day: why children skip breakfast and what can be done about it.Pediatr Ann,42,184-7.
  24. Kapantais, E,Chala, E,Kaklamanou, D,Lanaras, L,Kaklamanou, M,Tzotzas, T(2011).Breakfast skipping and its relation to BMI and health-compromising behaviours among Greek adolescents.Public Health Nutr,14,101-8.
  25. Keski-Rahkonen, A,Kaprio, J,Rissanen, J,Virkkunen, M,Rose, RJ(2003).Breakfast skipping and healthcompromising behaviors in adolescents and adults.Eur J Clin Nutr,57,842-53.
  26. Lazzeri, G,Ahluwalia, N,Niclasen, B(2016).Trends from 2002 to 2010 in daily breakfast consumption and its socio-demographic correlates in adolescents across 31 countries participating in the HBSC study.PLoS One,11,e0151052.
  27. Lazzeri, G,Pammolli, A,Azzolini, E(2013).Association between fruits and vegetables intake and frequency of breakfast and snacks consumption: a cross-sectional study.Nutr J,12,123.
  28. Lehto, E,Ray, C,Haukkala, A,Yngve, A,Thorsdottir, I,Roos, E(2015).Predicting gender differences in liking for vegetables and preference for a variety of vegetables among 11-year-old children.Appetite,95,285-92.
  29. Lehto, E,Ray, C,te Velde, S(2015).Mediation of parental educational level on fruit and vegetable intake among schoolchildren in ten European countries.Public Health Nutr,18,89-99.
  30. Lima Passos, V,Klijn, S,van Zandvoort, K,Abidi, L,Lemmens, P(2017).At the heart of the problem - a personcentred, developmental perspective on the link between alcohol consumption and cardio-vascular events.Int J Cardiol,232,304-14.
  31. Lin, LJ,Chang, HY,Luh, DL,Hurng, BS,Yen, LL(2014).The trajectory and the related physical and social determinants of body mass index in elementary school children: results from the child and adolescent behaviors in long-term evolution study.J Obes,2014,728762.
  32. Lin, W,Yang, HC,Hang, CM,Pan, WH(2007).Nutrition knowledge, attitude, and behavior of Taiwanese elementary school children.Asia Pac J Clin Nutr,16,534-46.
  33. Louvet, B,Gaudreau, P,Menaut, A,Genty, J,Deneuve, P(2007).Longitudinal patterns of stability and change in coping across three competitions: a latent class growth analysis.J Sport Exerc Psychol,29,100-17.
  34. Mullan, B,Wong, C,Kothe, E,O'Moore, K,Pickles, K,Sainsbury, K(2014).An examination of the demographic predictors of adolescent breakfast consumption, content, and context.BMC Public Health,14,264.
  35. Nagin, DS(1999).Analyzing developmental trajectories: a semiparametric, group-based approach.Psychol Methods,4,139-57.
  36. Nagin, DS,Odgers, CL(2010).Group-based trajectory modeling in clinical research.Annu Rev Clin Psychol,6,109-38.
  37. Oellingrath, IM,Hestetun, I,Svendsen, MV(2016).Genderspecific association of weight perception and appearance satisfaction with slimming attempts and eating patterns in a sample of young Norwegian adolescents.Public Health Nutr,19,265-74.
  38. Ostachowska-Gasior, A,Piwowar, M,Kwiatkowski, J,Kasperczyk, J,Skop-Lewandowska, A(2016).Breakfast and other meal consumption in adolescents from southern Poland.Int J Environ Res Public Health,13,453.
  39. Pandey, D,Buzgeia, MH,Suneetha, E(2013).Breakfast skipping pattern among Benghazi primary school children.Br Food J,115,837-49.
  40. Papoutsou, S,Briassoulis, G,Hadjigeorgiou, C(2014).The combination of daily breakfast consumption and optimal breakfast choices in childhood is an important public health message.Int J Food Sci Nutr,65,273-9.
  41. Paynter, L,Koehler, E,Howard, AG,Herring, AH,Gordon-Larsen, P(2015).Characterizing long-term patterns of weight change in China using latent class trajectory modeling.PLoS One,10,e0116190.
  42. Pedersen, TP,Meilstrup, C,Holstein, BE,Rasmussen, M(2012).Fruit and vegetable intake is associated with frequency of breakfast, lunch and evening meal: cross-sectional study of 11-, 13-, and 15-year-olds.Int J Behav Nutr Phys Act,9,9.
  43. Peltzer, K,Pengpid, S(2012).Fruits and vegetables consumption and associated factors among inschool adolescents in five southeast Asian countries.Int J Environ Res Public Health,9,3575-87.
  44. Pendergast, FJ,Livingstone, KM,Worsley, A,McNaughton, SA(2016).Correlates of meal skipping in young adults: a systematic review.Int J Behav Nutr Phys Act,13,125.
  45. Piernas, C,Popkin, BM(2010).Trends in snacking among US children.Health Aff,29,398-404.
  46. Rasmussen, M,Krolner, R,Klepp, KI(2006).Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part I: quantitative studies.Int J Behav Nutr Phys Act,3,22.
  47. Savige, G,MacFarlane, A,Ball, K,Worsley, A,Crawford, D(2007).Snacking behaviours of adolescents and their association with skipping meals.Int J Behav Nutr Phys Act,4,36.
  48. Shaw, ME(1998).Adolescent breakfast skipping: an Australian study.Adolescence,33,851-61.
  49. Smith, KJ,Gall, SL,McNaughton, SA,Blizzard, L,Dwyer, T,Venn, AJ(2010).Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study.Am J Clin Nutr,92,1316-25.
  50. So, HK,Nelson, EA,Li, AM(2011).Break fast frequency inversely associated with BMI and body fatness in Hong Kong Chinese children aged 9-18 years.Br J Nutr,106,742-51.
  51. Stuart, B,Panico, L(2016).Early-childhood BMI trajectories: evidence from a prospective, nationally representative British cohort study.Nutr Diabetes,6,e198.
  52. Tang, F(2014).Successful aging: multiple trajectories and population heterogeneity.Int J Soc Sci Stud,2,12-22.
  53. Taylor, JP,Evers, S,Mckenna, M(2005).Determinants of healthy eating in children and youth.Can J Public Health,96(Suppl 3),S22-9.
  54. Tin, SP,Ho, SY,Mak, KH,Wan, KL,Lam, TH(2011).Lifestyle and socioeconomic correlates of breakfast skipping in Hong Kong primary 4 schoolchildren.Prev Med,52,250-3.
  55. Turrell, G(1997).Determinants of gender differences in dietary behavior.Nutr Res,17,1105-20.
  56. van Ansem, WJC,van Lenthe, FJ,Schrijvers, CTM,Rodenburg, G,van de Mheen, D(2014).Socio-economic inequalities in children's snack consumption and sugar-sweetened beverage consumption: the contribution of home environmental factors.Br J Nutr,112,467-76.
  57. Wang, M,Zhong, JM,Wang, H(2016).Breakfast consumption and its associations with health-related behaviors among school-aged adolescents: a crosssectional study in Zhejiang Province, China.Int J Environ Res Public Health,13,761.
  58. Wang, ZH,Zhai, FY,Zhang, B,Popkin, BM(2012).Trends in Chinese snacking behavior and socio-economic role from 1991 to 2009.Asia Pac J Clin Nutr,21,253-62.
  59. Wolnicka, K,Taraszewska, AM,Jaczewska-Schuetz, J,Jarosz, M(2015).Factors within the family environment such as parents' dietary habits and fruit and vegetable availability have the greatest influence on fruit and vegetable consumption by Polish children.Public Health Nutr,18,2705-11.
  60. 邱詩揚、陳富莉、劉潔心(2012)。促進小學童健康飲食行為之研究:整合跨理論模式及問題導向學習模式。台灣衛誌,31,581-96。