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Review Article
Nutritional epidemiology
Diabetes mellitus is considered one of the important public health challenges in modern society, both in developed and developing countries(1). Type 2 diabetes (T2D), which composes more than 95 % of diabetes in the world(2), is characterized by reduced insulin sensitivity and relative insulin deficiency(3). It is estimated that the world prevalence of diabetes among adults will increase to 7·7 %, corresponding to 439 million patients, by the year 2030(4). Therefore, the identification of modifiable risk factors for the primary prevention of T2D is of considerable public health importance.
Breakfast is defined as the first meal of the day, within 2 h of waking, typically eaten no later than 10.00 hours, which provides between 20 and 35 % of total daily energy needs(5). Breakfast skipping is the behaviour that people do not consume breakfast regularly. The prevalence of breakfast skipping has increased progressively over the past decades(6). It is highly prevalent in the USA and Europe (10 to 30 %) and the prevalence varies among different age and ethnic groups(7). There is increasing evidence that breakfast skipping is directly associated with excess weight gain and other adverse health outcomes, including insulin resistance and T2D(5). However, the associations between breakfast skipping and T2D risk have not been summarized. Thus, we performed a meta-analysis to systematically assess the association between breakfast skipping and the risk of T2D based on observational studies.
Methods
The present review was conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines(8).
Search strategy
We did a literature search of PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI) and SINOMED up to 9 August 2014 to identify observational studies examining an association between breakfast skipping and the risk of T2D. The search terms were 'breakfast' or 'eating patterns' or 'meal frequency' (MeSH) or 'diabetes' or 'diabetes mellitus' (MeSH) or 'type 2 diabetes' or 'impaired glucose tolerance' or 'impaired fasting glucose' or 'insulin resistance' or 'metabolic syndrome'. Only articles...