Breakfast Quality Index Trajectories and Association With Obesity Outcomes Among Australian Children Under 5 Years of Age

Background: Breakfast quality in early childhood remains understudied. This study described the changes in breakfast quality index (BQI) (i.e. trajectory) and assessed the association between BQI trajectories and obesity outcomes in early childhood.Methods: Data of children who participated in the Melbourne InFANT Program were used (n=328). Dietary intakes were assessed at ages 1.5, 3.5 and 5.0 years using three 24-hour recalls. BQI was calculated using a revised 9-item BQI tool based on Australian dietary recommendations for young children. Group-based trajectory modelling identified BQI trajectory groups. Multivariable linear and logistic regression examined the associations between identified BQI trajectory groups and obesity outcomes at age 5 years. Results: Mean BQI at ages 1.5, 3.5 and 5.0 years was 4.8, 4.8, 2.7 points, respectively. Two BQI trajectory groups were identified, and both showed a decline in BQI. The mean BQI of most children (74%) decreased from 5.0 to 4.0 points from ages 1.5 to 5.0 years (referred as “High BQI” group). The remaining children (26%) had a mean BQI of 4.8 and 1.2 points at age 1.5 and 5.0 years, respectively (referred as “Low BQI” group). The “Low BQI” group appeared to show higher risk of overweight (OR:1.39, 95%CI: 0.67, 2.88) at age 5 years than the “High BQI” group.Conclusions: Two BQI trajectory groups were identified. Both groups showed a decline in breakfast quality from ages 1.5 to 5.0 years. Our study highlights the need for early health promotion interventions and strategies to improve and maintain breakfast quality across early childhood.