Eating breakfast is important for the growth and nutritional well-being of children. The aims of the study

were to compare nutrient intake, Giardia infection, mean score and anthropometric factors, in 2 groups,

children who ate breakfast and children who did not.

This cross-sectional study was conducted with 20 randomly selected primary schools from 2 regions of

Ardebil Province, Iran, in 2005. Anthropometric factors were measured, ie height, weight, and mid-arm muscle

circumference (MAC) of 401 males. Three-day food intake was estimated for energy and other nutrients by

24-hour-recall method, and the children were asked whether they ate breakfast, or not. A stool specimen from

each girl was prepared in saline and examined by light microscopy and direct smear using the zinc sulfate

flotation method. The data were analyzed using independent samples-T test and Chi-square, and Iranian

food processor.

Of the girls, 20.8% reported having skipped breakfast. Among the girls who ate breakfast, the Giardia-infected

skipped breakfast more often than the non-infected (15.4% vs 12.2%), but the difference was insignificant. On

average, the taller girls skipped breakfast significantly more often (p < 0.05), but height was not a significant factor

among the boys. Weight, BMI (body mass index) and MAC among the children skipping breakfast were significantly

higher than among those who ate breakfast (p < 0.05). The average mean scores were not significantly different.

There was no association between eating breakfast and Giardia infection. The caloric and nutrient intakes of the

children who ate or skipped breakfast were not significantly different.

In the present study, skipping breakfast was more prevalent among primary-school girls, which could

affect anthropometric factors. However, it did not correlate with Giardia infection, school success, or caloric

intake

اتحاد, غلامحسین

دریانی, احمد

نعمتی, علی

نقی زاده باقی, عباس

English

ArUMS Digital Repository (سامانه اطلاعات زیست پزشکی و سلامت)

Available online at www.ptat.thaigov.net
63P r o c  o f  t h e  3 r d  A S E A N  C o n g r  o f  T r o p  M e d  a n d  P a r a s i t o l .  P a r a s i t e s :  a  H i d d e n  T h r e a t  t o  G l o b a l  H e a l t h
Breakfast, Giardia and School Success of Girls 
in Ardebil Province, Iran
GH Ettehad1, A Nemati1,  A Daryani2, A Naghizadeh Baghi1
1 Department of Basic Sciences, Faculty of Medicine, Ardebil University of Medical Sciences, Ardebil; 
2 Department of Parasitology and Mycology, Sari Medical School, Mazandaran University of Medical Sciences, 
Sari, Mazandaran, Iran
ABstrAct
Eating breakfast is important for the growth and nutritional well-being of children. The aims of the study were to compare nutrient intake, Giardia infection, mean score and anthropometric factors, in 2 groups, 
children who ate breakfast and children who did not.
 This cross-sectional study was conducted with 20 randomly selected primary schools from 2 regions of 
Ardebil Province, Iran, in 2005. Anthropometric factors were measured, ie height, weight, and mid-arm muscle 
circumference (MAC) of 401 males. Three-day food intake was estimated for energy and other nutrients by 
24-hour-recall method, and the children were asked whether they ate breakfast, or not. A stool specimen from 
each girl was prepared in saline and examined by light microscopy and direct smear using the zinc sulfate 
flotation method. The data were analyzed using independent samples-T test and Chi-square, and Iranian 
food processor.
 Of the girls, 20.8% reported having skipped breakfast. Among the girls who ate breakfast, the Giardia-infected 
skipped breakfast more often than the non-infected (15.4% vs 12.2%), but the difference was insignificant. On 
average, the taller girls skipped breakfast significantly more often (p < 0.05), but height was not a significant factor 
among the boys. Weight, BMI (body mass index) and MAC among the children skipping breakfast were significantly 
higher than among those who ate breakfast (p < 0.05). The average mean scores were not significantly different. 
There was no association between eating breakfast and Giardia infection. The caloric and nutrient intakes of the 
children who ate or skipped breakfast were not significantly different.
 In the present study, skipping breakfast was more prevalent among primary-school girls, which could 
affect anthropometric factors. However, it did not correlate with Giardia infection, school success, or caloric 
intake.
Keywords:  Giardia, children, school, breakfast, anthropometric factors, nutrients
Introduction
 Breakfast can be defined simply as the first meal 
of the day. What this bald definition fails to account 
for, however, is the importance of eating breakfast, 
particularly for growing children, who tend to skip 
breakfast more frequently than any other meal [1]. 
This dietary omission has been associated with poor 
school performance [2] and lower daily nutrient intake, 
which could lead to dietary inadequacies [3] for these 
children. Furthermore, poor eating habits established 
correspondence: 
 GH Ettehad, 
 E-mail: <ettehad321@yahoo.com>
Proc ASEAN Congr Trop Med Parasitol. 2008;3:63-8.	 	
64
in childhood often continue into adulthood [4]. A 
limited number of studies have investigated secular 
trends of breakfast consumption or the influence 
of breakfast consumption on the total daily nutrient 
intake of children and young adults [5,6]. Studies 
have shown that breakfast provides important 
nutrients, and that individuals who skip breakfast 
do not compensate for potential nutrient and energy 
losses at other meals [7]. Deficiencies in vitamins A 
and B-6, iron, calcium, magnesium, copper, and zinc 
pose special problems for children [8]. Moreover, 
many studies have shown significant relationships 
between skipping breakfast and high body mass index 
(BMI) in adolescents [9-12]. For children, breakfast 
consumption has been associated with learning and 
better school performance [13]. Despite breakfast’s 
positive attributes, many children go to school without 
breakfast [14]. A strong association between Giardia 
infection and under-nutrition, wasting, and stunting 
was noted in children [15].
 The aims of the study were to compare 
nutrient intake, Giardia infection, mean score and 
anthropometric factors, in 2 groups, children who ate 
breakfast and children who did not.
Materials and methods
study design and population
 In this descriptive cross-sectional study, 394 
females from 20 primary schools in 2 regions of Ardebil 
Province, Iran, were selected by multi-stage sampling. 
Their ages, anthropometric factors (height, weight, 
and mid-arm muscle circumference (MAC)), dietary 
methods, and school success, were examined. They 
all underwent stool examinations. A questionnaire was 
used to assess their histories of skipping or eating 
breakfast, and mean scores were calculated.
Anthropometric measurements
 Height (to the nearest 0.5 cm) and weight (to 
the nearest 0.1 kg) were measured by the first author 
and trained research assistants using a Soehnle 
portable digital scale and portable digital stadiometer, 
respectively, according to the standard techniques. 
The students were measured without shoes and 
dressed in light summer school uniform. BMI was 
calculated from height and weight.
Dietary methods
 Food intake was estimated for energy and other 
nutrients by 24-hour recall method for 3 days in a week, 
and subjects were also asked to record their breakfast 
consumption. Calorie and nutrient intake data were 
analyzed by Iranian food processor.
school success
 Educational progression was assessed from the 
average test score for basic primary school class for 
the schoolchildren. The school success score was 
rated out of maximum possible score of 20.
stool examination
 Participants were aged 7-12 years. Each student 
was given a clean glass container to collect a stool 
sample. From each stool specimen, a direct saline 
preparation was prepared and examined by light 
microscopy. Samples that did not reveal any intestinal 
parasite on direct smear were examined further by zinc 
sulfate flotation method.
statistical analysis
 The results are expressed as mean ± SD. The 
data were analyzed by independent samples-t test 
and Chi square. The level of significance was set at 
p < 0.05.
results
 Of the total number of participants, 20.8% 
reported they had skipped breakfast. The girls who 
skipped breakfast tended to be significantly taller than 
those who did not (p < 0.05). Weight, BMI and MAC 
values for the group who omitted eating breakfast were 
significantly greater than those who ate breakfast (p < 
0.05) (Table 1). The average mean score for the group 
who ate breakfast was higher (but not statistically 
significantly higher) than the group who skipped 
breakfast (19 ± 1.4 vs 18.8 ± 1.4). 14.5% of the girls 
had Giardia infections. The group of girls who ate 
breakfast had a higher rate of Giardia infection than the 
group who did not (15.4% vs 12.2%), but no significant 
relationship was found. Caloric and nutrient intakes 
(except for vitamin B2, and the calcium intakes of the 
7-10 year-old boys) were not significantly different 
between the two groups (those eating and those 
Breakfast, Giardia and School Success of Girls in Ardebil Province, Iran
65
skipping breakfast) (Table 2). There was no significant 
relationship between Giardia infection and average 
mean score.
Discussion
 Overall, 20.8% of participants reported having 
skipped breakfast. Nicklas et al [7] and Shaw 
[16] reported that 19% of American and 12% of 
Australian adolescents skipped breakfast, respectively. 
Haapalahti et al [17] showed skipping meals was 
uncommon among Finnish children aged 10-11 years. 
Skipping breakfast was associated with higher BMI 
[18]. In the present study, weight, BMI, and MAC in 
the group of children who skipped breakfast were 
Breakfast, Giardia and School Success of Girls in Ardebil Province, Iran
table 1  Association between eating breakfast and anthropometric factors among the schoolchildren.
 Girls
 Variable Age  Eating   Not eating 
  (year) breakfast  N breakfast N
   (x ± sD)  (x ± sD) 
  7 120.6 ± 5.5 68 116.3 ± 6.2 5
  8 124.1 ± 5.8 59 125.7 ± 6.1 9
 Height 9 130.8 ± 7.4 55 132.9 ± 4.8 18
 (cm) 10 134.3 ± 7.7 59 136.7 ± 9.1 25
  11 140.1 ± 6.9 54 136.8 ± 6.6 18
  12 144.1 ± 6.9 17 139.7 ± 11.3 7
  Total 130.3 ± 10.1 312 133. 7 ±  9.4* 82
  7 22.5 ± 3.5 68 22.2 ± 2.2 5
  8 23.9 ± 3.5 59 29.4 ± 5.2* 9
 Weight 9 27.3 ± 4.9 55 32.6 ± 8.7* 18
 (kg) 10 30.6 ± 6.7 59 33.2 ± 9.5 25
  11 33.6 ± 6.3 54 32.1 ± 5.8 18
  12 38.2 ± 7.2 17 38.6 ± 9.9 7
  Total 27.9 ± 7 312 32.2 ± 8.4* 82
  7 15.4 ± 1.6 68 16.4 ± 1.6 5
  8 15.5 ± 1.5 59 17.1 ± 2* 9
 BMI (kg/m2) 9 15.8 ± 1.6 55 17.6 ± 3.8* 18
  10 16.8 ± 2.8 59 17.5 ± 2.9 25
  11 17.1 ± 2.5 54 17.1 ± 1.8 18
  12 18.3 ± 2.6 17 19.6 ± 3.6 7
  Total 16.2 ± 2.2 312 17.5 ± 2.9* 82
  7 17.5 ± 1.6 68 17.7 ± 1.9 5
  8 17.8 ± 1.4 59 20 ± 1.5* 9
 MAC (cm) 9 18.6 ± 1.7 55 20.7 ± 3.7* 18
  10 19.3 ± 2.3 59 20.2 ± 2.9 25
  11 19.9 ± 2.4 54 20.4 ± 2.7 18
  12 21.1 ± 2.1 17 21.6 ± 4.3 7
  Total 18.7 ± 2.2 312 20.3 ± 3* 82
Values are mean ± SD;  * p < 0.05
66
table 2  Association between eating breakfast with caloric and other nutrient intake, among the girls.
 Girls
   7-10 years   11-12 years
 Variable Breakfast Omission P Omission Breakfast  P 
  eating  breakfast value eating breakfast  value 
  (x ± sD) (x ± sD)  (x ± sD) (x ± sD)
  N = 252 N = 45  N = 83 N = 13
Calorie (cal) 1,723.6 ± 474.1 1,606.9 ± 471.2 0.09 1,692.3 ± 628.9 1,827.9 ± 412.5 0.22
Protein (g) 61.8 ± 27.6 60.6 ± 25.7 0.76 57.7 ± 33.7 68.3 ± 23.9 0.09
CHO (g) 246.4 ± 78.8 230.3 ± 65.3 0.15 245.9 ± 95.7 266.3 ± 70.6 0.26
Fiber (g) 11.1 ± 7.9 9.6 ± 4.7 0.16 10.6 ± 7.1 11.2 ± 5.7 0.65
Total fat (g) 56.7 ± 22.5 53.2 ± 20.5 0.27 56.5 ± 31.8 55.5 ± 22.2 0.86
Vitamin B1 (mg) 1.2 ± 0.4 1.2 ± 0.3 0.92 1.2 ± 0.5 1.3 ± 0.3 0.09
Vitamin B2 (mg) 1.1 ± 0.5 0.9 ± 0.7 0.83 0.9 ± 0.4 1.1 ± 0.5 0.11
Vitamin B3 (mg) 17.7 ± 9.7 18.3 ± 10.5 0.65 17.2 ± 12.4 19.5 ± 8.8 0.30
Vitamin B6 (mg) 0.9 ± 0.5 0.9 ± 0.4 0.96 0.9 ± 0.6 1.1 ± 0.6 0.38
Folacin (µg) 92.3 ± 65.3 93.9 ± 38.8 0.86 85.1 ± 74.5 93.4 ± 65.9 0.59
Vitamin B5 (mg) 2.8 ± 1.5 2.6 ± 1.4 0.76 2.3 ± 1.5 2.9 ± 1.7 0.14
Vitamin C (mg) 48.6 ± 37.2 52.2 ± 66.6 0.58 41.6 ± 27.7 44.2 ± 33.4 0.73
Vitamin E (mg) 2.9 ± 2.1 2.8 ± 1.8 0.61 4.2 ± 2.1 2.9 ± 2.8 0.14
Ca (mg) 508.1 ± 301.5 443.5 ± 255.9 0.13 409.8 ± 217.9 488.9 ± 259.1 0.17
Cu (mg) 0.7 ± 0.4 0.6 ± 0.3 0.18 0.7 ± 0.5 0.7 ± 0.4 0.87
Fe (mg) 15.8 ± 7.3 16.4 ± 10.1 0.63 15.1 ± 8.2 17.3 ± 5.5 0.12
Mg (mg) 115.6 ± 60.9 116.6 ± 85 0.91 101.8 ± 63.1 119.2 ± 56.3 0.20
P (mg) 656.3 ± 322.6 639.5 ± 262.5 0.66 600.8 ± 376.4 669.7 ± 330.2 0.39
K (mg) 1,590.2 ± 863.7 1,469.3 ± 787.9 0.33 1,521.3 ± 1095.8 1,568.1 ± 794.2 0.82
Se (µg) 36.6 ± 21.2 34.8 ± 24.6 0.58 44.3 ± 35.7 42.3 ± 24.7 0.75
Na (mg) 2,049.3 ± 1,149.2 2,079.8 ± 1,137.2 0.85 1,906.9 ± 1,414 2,059.8 ± 1,122.8 0.58
ZN (mg) 4.6 ± 2.4 4.5 ± 2.2 0.78 4.8 ± 3.2 5.2 ± 2.6 0.58
CHO = carbohydrate, Ca = calcium, Cu = copper, Fe = iron, Mg = magnesium, P = phosphorus, K = potassium, 
S = selenium, Na = sodium, Zn = zinc
significantly higher than the group who ate breakfast. 
Children who ate breakfast had a lower risk of being 
overweight. These findings confirm and clarify the 
impact of skipping breakfast on BMI—the high BMI 
among the group of children who skipped breakfast 
was indeed related to skipping breakfast. Conversely, 
eating breakfast may result in children having normal 
BMI. Other studies, including Stockman et al [19] and 
Berkey et al [11], have yielded similar results, showing 
that irregular breakfast consumption was significantly 
associated with being overweight. The reduced 
likelihood of breakfast consumption is of particular 
concern in light of growing evidence of a link between 
breakfast consumption and academic performance, 
school attendance, and other psychosocial factors 
[20]. When children completed a visual-perception 
or spatial-memory task, they generally performed 
better after consuming breakfast. The benefit is most 
likely related to the blood glucose response following 
a meal. Modest increases in circulating glucose 
enhance learning and memory [21], perhaps through 
the synthesis of acetylcholine [22]. However, only 
Breakfast, Giardia and School Success of Girls in Ardebil Province, Iran
67
limited data suggest that the type of breakfast also 
influences cognitive functioning [23,24]. Studies 
have shown that breakfast provides important 
nutrients and that individuals who skip breakfast do 
not compensate for potential nutrient and energy 
losses at other meals [25,26]. Our study showed 
the difference in average mean scores between the 
breakfast eaters and non-eaters was insignificant. 
In children, breakfast consumption has been linked 
to nutritional adequacy. In spite of this study, Chitra 
et al [27] showed the average total energy intake 
was significantly lower among children who did not 
eat breakfast. Children who consumed breakfast 
had higher daily intakes of energy and protein than 
children who skipped breakfast. Compared with the 
breakfasting group, a significantly higher percentage 
of the non-breakfasting group failed to meet two-thirds 
of the National Academy of Science’s recommended 
dietary allowances for vitamins A, B-6, and D, calcium, 
magnesium, riboflavin, folacin, and nutrients such as 
zinc, phosphorus, and iron [3]. Our study showed 
the energy and protein intakes, and intake of some 
nutrients among the breakfasting schoolchildren 
was slightly higher than the group who skipped 
breakfast.
conclusion
 This study showed that a high proportion of 
schoolchildren in Ardebil Province, Iran, skipped 
breakfast on school days. The omission of breakfast 
correlated with overweight, but not with Giardia 
infection, school success, or caloric/nutrient intake.
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Breakfast, Giardia and School Success of Girls in Ardebil Province, Iran


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Breakfast, Giardia and School Success of Girls in Ardebil Province, Iran

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