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Prevention of Non Communicable Diseases

Association of breakfast consumption frequency with fasting glucose and insulin sensitivity/b cells function (HOMA-IR) in adults from high-risk families for type 2 diabetes in Europe: the Feel4Diabetes Study



This study aimed to investigate the association of breakfast consumption frequency (BCF) with glycemic control indices in a cross-sectional sample of adults from families at high risk for type 2 diabetes mellitus (T2DM), exploring the role of sex and socioeconomic status (SES).


In 2370 adults (40.8 ± 5.6 years) from 6 European countries, sociodemographic, lifestyle, anthropometric and biochemical characteristics were assessed through standardized procedures. Multivariable regression models were used to examine the association between fasting glucose (FG), fasting insulin (FI), and insulin resistance (HOMA-IR) (dependent variables) with BCF (independent variable) controlling for multiple possible confounders.


A linear association of BCF with FG (β = −0.557, 95% CI (−0.834, −0.280)) and a quadratic association with FI and HOMA-IR with the highest point of curve observed at BCF = 2.989 (times/week) and at BCF = 2.746, respectively, independent of the used covariates. In males and in participants of high SES, BCF was linearly and inversely associated with FG, while with FI and HOMA-IR there was an association with BCF in quadratic function. In females, BCF was linearly and inversely associated with FG and HOMA-IR, and there was a quadratic association with FI. In low SES there was only a linear association with FG, yet with no statistically significant findings for FI and HOMA-IR.


Regular breakfast consumption, especially >3 times/week is associated with improved indices of glycemic control. This association was diminished in low SES participants in the presence of the used covariates.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available, since the data used is confidential based on Feel4Diabetes publications rules, but are available from the corresponding author on reasonable request.


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The authors would like to thank the members of the Feel4Diabetes-study group: coordinator, YM; steering committee, YM, GC, Jaana Lindström, Peter Schwarz, KM, Lieven Annemans, and Winne Ko; Harokopio University (Greece), YM, KK, Odysseas Androutsos, George Moschonis, Spyridon Kanellakis, Christina Mavrogianni, Konstantina Tsoutsoulopoulou, Christina Katsarou, Eva Karaglani, Irini Qira, Efstathios Skoufas, Konstantina Maragkopoulou, Antigone Tsiafitsa, Irini Sotiropoulou, Michalis Tsolakos, Effie Argyri, Mary Nikolaou, Eleni-Anna Vampouli, Christina Filippou, Kyriaki Apergi, Amalia Filippou, Gatsiou Katerina, and Efstratios Dimitriadis; Finnish Institute for Health and Welfare (Finland), Jaana Lindström, Tiina Laatikainen, Katja Wikström, Jemina Kivelä, Päivi Valve, Esko Levälahti, Eeva Virtanen, Tiina Pennanen, Seija Olli, and Karoliina Nelimarkka; Ghent University (Belgium), Department of Movement and Sports Sciences, GC, Vicky Van Stappen, and Nele Huys; Department of Public Health, Lieven Annemans and Ruben Willems; Department of Endocrinology and Metabolic Diseases, Samyah Shadid; Technische Universität Dresden (Germany), Peter Schwarz and Patrick Timpel; University of Athens (Greece), KM, Stavros Liatis, George Dafoulas, Christina-Paulina Lambrinou, and Angeliki Giannopoulou; International Diabetes Federation European Region (Belgium), Winne Ko and Ernest Karuranga; Universidad De Zaragoza (Spain), Luis Moreno, Fernando Civeira, Gloria Bueno, Pilar De Miguel-Etayo, Esther M Gonzalez-Gil, María L. Miguel-Berges, Natalia Giménez-Legarre; Paloma Flores-Barrantes, Aleli M. Ayala-Marín, Miguel Seral-Cortés, Lucia Baila-Rueda, Ana Cenarro, Estíbaliz Jarauta, and Rocío Mateo-Gallego; Medical University of Varna (Bulgaria), Violeta Iotova, Tsvetalina Tankova, Natalia Usheva, Kaloyan Tsochev, Nevena Chakarova, Sonya Galcheva, Rumyana Dimova, Yana Bocheva, Zhaneta Radkova, Vanya Marinova, Yuliya Bazdarska, and Tanya Stefanova; University of Debrecen (Hungary), Imre Rurik, Timea Ungvari, Zoltán Jancsó, Anna Nánási, László Kolozsvári, Csilla Semánova, Éva Bíró, Emese Antal, and Sándorné Radó; Extensive Life Oy (Finland), Remberto Martinez and Marcos Tong.


The publication of this supplement was funded by Feel4Diabetes study. The Feel4Diabetes-study has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement n° 643708. The content of this article reflects only the authors’ views and the European Community is not liable for any use that may be made of the information contained therein.

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Authors and Affiliations



Conceptualization: KA, KK, and YM; Methodology: KA, KK, and YM; formal analysis, KA and KK; Investigation and data collection: KA, KK, KR, CM, SS, GC, PFB, PME, YB, TT, RS, RI, KW, VI, and YM.; Resources: YM, GC, VI, KM, YM; Data curation: KA, KK, and YM; Writing-original draft preparation: KA, KK, and YM; Writing—review and editing: KA., KK, KR, CM, SS, GC, PFB, PME, YB, TT, RS, RI, KW, VI, and YM; Visualization: KA, KK, YM; Supervision: YM; Project administration: YM; Funding acquisition: YM, GC, VI, KM, YM.

Corresponding author

Correspondence to Kiriaki Apergi.

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Competing interests

The authors declare no competing interests. All authors have made substantial contributions to this work and approve the final version of the paper to be submitted.

Ethics approval and consent to participate

The Feel4Diabetes-study adhered to the Declaration of Helsinki and the conventions of the Council of Europe on human rights and biomedicine. All participating countries obtained ethical clearance from the relevant ethical committees and local authorities. More specifically, in Belgium, the study was approved by the Medical Ethics Committee of the Ghent University Hospital (ethical approval code: B670201524437); in Bulgaria, by the Ethics Committee of the Medical University of Varna (ethical approval code: 52/10-3-2016r) and the municipalities of Sofia and Varna, as well as the Ministry of Education and Science local representatives; in Finland, by the hospital district of Southwest Finland ethical committee (ethical approval code: 174/1801/2015); in Greece, by the Bioethics Committee of Harokopio University (ethical approval code: 46/3–4-2015) and the Greek Ministry of Education; in Hungary, by the National Committee for Scientific Research in Medicine (ethical approval code: 20095/2016/EKU); and in Spain, by the Clinical Research Ethics Committee and the Department of Consumers’ Health of the Government of Aragón (ethical approval code: CP03/2016). This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the ethics committees in all countries (in Belgium, by the Medical Ethics Committee of the Ghent University Hospital; in Bulgaria, by the Ethics Committee of the Medical University of Varna; in Finland, by the hospital district of Southwest Finland ethical committee; in Greece, by the Bioethics Committee of Harokopio University; in Hungary, by the National Committee for Scientific Research in Medicine; in Spain, by the Clinical Research Ethics Committee). Written informed consent was obtained from all subjects. All participants gave their written informed consent prior to their enrollment in the study.

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Apergi, K., Karatzi, K., Reppas, K. et al. Association of breakfast consumption frequency with fasting glucose and insulin sensitivity/b cells function (HOMA-IR) in adults from high-risk families for type 2 diabetes in Europe: the Feel4Diabetes Study. Eur J Clin Nutr (2022).

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