Diet and Physical Activity
Meal Frequency and Childhood Obesity
Andre ´ M. Toschke,* Helmut Ku ¨chenhoff,† Berthold Koletzko,‡ and Ru ¨diger von Kries*
BERTHOLD KOLETZKO, AND RU¨DIGER VON KRIES.
Meal frequency and childhood obesity. Obes Res. 2005;13:
Objective: Previous studies have demonstrated an inverse
association between meal frequency and the prevalence of
obesity in adulthood. The aim of this study was to assess the
relationship between meal frequency and childhood obesity.
Research Methods and Procedures: Stature and weight of
4370 German children ages 5 to 6 years were determined in
six Bavarian (Germany) public health offices during the
obligatory school entry health examination in 2001/2002.
An extensive questionnaire on risk factors for obesity was
answered by their parents. Obesity was defined according to
sex- and age-specific BMI cut-off points proposed by the
International Obesity Task Force. The main exposure was
daily meal frequency.
Results: The prevalence of obesity decreased by number of
daily meals: three or fewer meals, 4.2% [95% confidence
interval (CI), 2.8 to 6.1]; four meals, 2.8% (95% CI, 2.1 to
3.7); and 5 or more meals, 1.7% (95% CI, 1.2 to 2.4). These
effects could not be explained by confounding due to a wide
range of constitutional, sociodemographic, and lifestyle fac-
tors. The adjusted odds ratios for obesity were 0.73 (95%
CI, 0.44 to 1.21) for four meals and 0.51 (95% CI, 0.29 to
0.89) for five or more meals. Additional analyses pointed to
a higher energy intake in nibblers compared with gorgers.
Discussion: A protective effect of an increased daily meal
frequency on obesity in children was observed and appeared
to be independent of other risk factors for childhood obesity.
A modulation of the response of hormones such as insulin
might be instrumental.
M., HELMUT KU¨CHENHOFF,
Key words: epidemiology, diet, prevention and control,
energy metabolism, feeding behavior
Overweight and obesity are the most common nutritional
disorders in industrialized countries, and they continue to
increase in their prevalences (1–3). Childhood obesity pre-
dicts obesity in adulthood (4–6) and later cardiovascular
disease (7–9). Effective prevention strategies against child-
hood obesity are needed because therapeutic interventions
are expensive and tend to have poor long-term results
Previous studies have demonstrated an inverse associa-
tion between meal frequency and the prevalence of over-
weight and obesity in adults (11–14). In other studies, the
failure to find a significant protective effect among adults
might possibly have been due to lack of sample power
(15–17). Differences in the ascertainment and definitions of
meals across studies, e.g., total number of meals per day
(11–14) vs. predefined meal periods (15–17), might have
further contributed to the heterogeneity of the findings.
To our knowledge, the association between meal fre-
quency and body weight in children has been addressed in
only three studies, one study including 226 children 6 to 16
years (18) and two recent studies including 1562 children
(19) and 1584 children (20). The failure to detect a signif-
icant association between meal frequency and the preva-
lence of overweight in these studies was possibly due to
lack of sample power (18–20). Thus, the predictive poten-
tial of an increased habitual meal frequency in younger
children remains unknown.
To assess the impact of increased meal frequency on
overweight and obesity among apparently healthy preschool
children, we analyzed data from a cross-sectional survey
performed as part of the 2001/2002 Bavarian school entry
health examination with an extensive questionnaire on a
wide range of sociodemographic and lifestyle factors pos-
sibly related to overweight and obesity in children.
Research Methods and Procedures
Study Population and Data Sources
Children in the year before school entry have to attend a
mandatory school entry health examination in local public
Received for review October 12, 2004.
Accepted in final form August 4, 2005.
The costs of publication of this article were defrayed, in part, by the payment of page
charges. This article must, therefore, be hereby marked “advertisement” in accordance with
18 U.S.C. Section 1734 solely to indicate this fact.
*Division of Pediatric Epidemiology at the Institute of Social Pediatrics and Adolescent
Medicine, †Department of Statistics, and ‡Dr. von Hauner Children’s Hospital, Ludwig-
Maximilians-University Munich, Munich, Germany.
Address correspondence to Andre ´ M. Toschke, Institute of Social Pediatrics and Adolescent
Medicine, Division of Pediatric Epidemiology, Ludwig-Maximilians-University Munich,
Heiglhofstrasse 63, D-81377 Munich, Germany.
Copyright © 2005 NAASO
1932OBESITY RESEARCH Vol. 13 No. 11 November 2005
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