Are dietary patterns at breakfast associated with abdominal obesity in a population-based survey?

Introduction Abdominal obesity is a strong predictor of cardio-metabolic abnormalities. There is limited evidence about the most favorable breakfast composition. We explored the association between data-driven breakfast dietary patterns and abdominal obesity in regular breakfast eaters coming from a national population-based sample. Methods The cross-sectional nutrition survey menuCH assessed diet using two 24-hour dietary recalls (24HDR) in a representative sample of Swiss adults aged 18 to 75 years. Regular breakfast eaters were defined as people breakfasting in both 24HDR and reporting eating breakfast at least 5 days in a usual week. Among them, we derived dietary patterns using principal component analysis based on the intake of 22 breakfast-specific food groups. All regular breakfast eaters were predicted an individual score for each identified pattern, and then classified into tertiles (T1, T2, T3). We defined abdominal obesity as waist-to-hip ratio (WHR) ≥ 0.9 in men and ≥ 0.85 in women. Logistic models were adjusted for sex, age, physical activity, total energy intake, diet quality outside breakfast, alcohol intake, education, food literacy, smoking, nationality, household status, season, and linguistic region. Results Of the 2019 survey participants 1351 (67%) were regular breakfast eaters (42% of men). Among them, we identified 3 patterns:  –traditional breakfast - white bread, butter, sweet spread;  –prudent breakfast - fruit, natural cereal flakes, nuts/seeds, yogurt;  –western breakfast - sweetened breakfast cereals, milk. After adjustment for potential cofounders, the prudent breakfast pattern was negatively associated with abdominal obesity (OR: 0.65 T3 vs. T1, 95% CI: 0.43 to 0.97, P for trend = 0.03). People taking a prudent breakfast (in T3) had 1.4% lower WHR compared to people taking a breakfast distant from prudent (in T1). We found no association for traditional and western breakfast patterns (T3 vs. T1: OR: 1.00, 95% CI: 0.67 to 1.50 and OR: 1.20, 95% CI: 0.82 to 1.76, respectively). Findings were similar when defining abdominal obesity with other anthropometric parameters, such as waist-to-height ratio. Conclusions Consuming regularly a prudent breakfast, i.e., rich in fruit, natural cereal flakes, nuts/seeds and yogurt, was associated with less abdominal obesity in a population-based sample of Swiss adults. Further longitudinal and long-term experimental research is needed to provide recommendations on the optimal breakfast.