***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The circadian clock regulates glucose metabolism by mediating the activity of metabolic enzymes , hormones , and transport systems . Breakfast skipping and night eating have been associated with high HbA1c and postpr and ial hyperglycemia after lunch and dinner . Our aim was to explore the acute effect of breakfast consumption or omission on glucose homeostasis and clock gene expression in healthy individuals and individuals with type 2 diabetes . RESEARCH DESIGN AND METHODS In a crossover design , 18 healthy volunteers and 18 volunteers with 14.5 ± 1.5 years diabetes , BMI 30.7 ± 1.1 kg/m2 , and HbA1c 7.6 ± 0.1 % ( 59.6 ± 0.8 mmol/mol ) were r and omly assigned to a test day with breakfast and lunch ( YesB ) and a test day with only lunch ( NoB ) . Postpr and ial clock and clock-controlled gene expression , plasma glucose , insulin , intact glucagon-like peptide 1 ( iGLP-1 ) , and dipeptidyl peptidase IV ( DPP-IV ) plasma activity were assessed after breakfast and lunch . RESULTS In healthy individuals , the expression level of Per1 , Cry1 , Rorα , and Sirt1 was lower ( P < 0.05 ) but Clock was higher ( P < 0.05 ) after breakfast . In contrast , in individuals with type 2 diabetes , Per1 , Per2 , and Sirt1 only slightly , but significantly , decreased and Rorα increased ( P < 0.05 ) after breakfast . In healthy individuals , the expression level of Bmal1 , Rorα , and Sirt1 was higher ( P < 0.05 ) after lunch on YesB day , whereas the other clock genes remained unchanged . In individuals with type 2 diabetes , Bmal1 , Per1 , Per2 , Rev-erbα , and Ampk increased ( P < 0.05 ) after lunch on the YesB day . Omission of breakfast altered clock and metabolic gene expression in both healthy and individuals with type 2 diabetes . CONCLUSIONS Breakfast consumption acutely affects clock and clock-controlled gene expression leading to normal oscillation . Breakfast skipping adversely affects clock and clock-controlled gene expression and is correlated with increased postpr and ial glycemic response in both healthy individuals and individuals with diabetes Background There is no data on diet- and activity-related behaviors associated with overweight and obesity among Pakistani school-aged children . The study aim ed to explore  dietary behaviors , physical activity and sedentary lifestyle  associated with overweight and obesity , and their socio-demographic correlates , among Pakistani primary school children . Methods A population -based cross-sectional study was conducted with a representative multistage r and om cluster sample of 1860 children aged five to twelve years in Lahore , Pakistan . Overweight ( > + 1 SD ) and obesity ( > + 2 SD ) were defined using the World Health Organization reference 2007 . Chi-square test was used as the test of trend . Linear regression was used to examine the predictive power of independent variables in relation to body mass index ( BMI ) . Logistic regression was used to quantify the independent predictors and adjusted odds ratios ( aOR ) with 95 % confidence intervals ( CI ) were obtained . Statistical significance was considered at P < 0.05 . Results Children skipping breakfast ( 8 % ) , eating fast food and snacks ≥ once a week ( 43 % ) and being involved in sedentary lifestyle > one hour a day ( 49 % ) were significantly more likely to be overweight and obese while those participating in physical activity > twice a week ( 53 % ) were significantly less likely to be overweight and obese ( all P < 0.01 ) . Skipping breakfast ( P < 0.001 ) , eating fast food and snacks ( P = 0.001 ) and sedentary lifestyle ( P < 0.001 ) showed an independent positive association with BMI while physical activity showed an independent inverse association ( P = 0.001 ) . Skipping breakfast ( aOR 1.82 , 95 % CI 1.22 - 2.71 ) , eating fast food and snacks ≥ once a week ( OR 1.41 , 95 % CI 1.07 - 1.86 ) , physical activity > twice a week ( aOR 0.49 , 95 % CI 0.34 - 0.70 ) and sedentary lifestyle > one hour a day ( aOR 1.56 , 95 % CI 1.19 - 2.03 ) were independent predictors of being overweight . Skipping breakfast had independent inverse association with physical activity ( aOR 0.63 , 95 % CI 0.45 - 0.89 ) and eating fast food and snacks had independent positive association with sedentary lifestyle ( aOR 1.79 , 95 % CI 1.49 - 2.16 ) . Female gender was independently associated with skipping breakfast ( aOR 1.50 , 95 % CI 1.04 - 2.16 ) . Male gender ( aOR 1.64 , 95 % CI 1.33 - 2.02 ) , urban area with high SES ( aOR 5.09 , 95 % CI 3.02 - 8.60 ) and higher parental education ( aOR 1.74 , 95 % CI 1.12 - 2.68 ) were significant independent predictors of eating fast food and snacks ≥ once a week . Living in the rural area was independently associated ( aOR 2.51 , 95 % CI 1.71 - 3.68 ) with physical activity > twice a week . Male gender ( aOR 1.60 , 95 % CI 1.31 - 1.95 ) , urban area with low SES ( aOR 1.46 , 95 % CI 1.02 - 2.09 ) , high-income neighborhoods ( aOR 1.52 , 95 % CI 1.02 - 2.25 ) , higher parental education ( aOR 1.55 , 95 % CI 1.03 - 2.34 ) and fewer siblings ( aOR 1.38 , 95 % CI 1.10 - 1.73 ) were independent predictors of sedentary lifestyle > one hour a day . Conclusions Dietary behaviors , physical activity and sedentary lifestyle are independent predictors of overweight  and higher BMI among Pakistani primary school children , and are significantly affected by the child 's socio-demographic characteristics . These findings support the urgent need to develop a National strategy for diet and physical activity and to implement culturally relevant behavioral interventions in the re source -poor developing country setting OBJECTIVE To assess the prospect i ve associations of breakfast , lunch , and dinner skipping at age 4 years with body fat ( ie , percent fat mass , body mass index [ BMI ] , and weight status ) at age 6 years . STUDY DESIGN Data were analyzed from 5913 children participating in the Generation R Study , a population -based prospect i ve cohort study in Rotterdam , The Netherl and s. Meal-skipping behaviors were assessed through parent-report question naires . Children 's weight and height were objective ly measured and converted to BMI SDSs . Weight status ( ie , overweight or normal weight ) was defined according to age- and sex-specific cutoff points . At age 6 years , percent fat mass was assessed by dual-energy X-ray absorptiometry . Linear and logistic regression analyses were performed , adjusting for covariates and BMI at age 4 years . RESULTS Breakfast skipping at age 4 years was associated with a higher percent fat mass at age 6 years ( β = 1.38 ; 95 % CI , 0.36 - 2.40 ) . No associations were found with BMI or weight status . Furthermore , no associations were found between lunch and dinner skipping at age 4 years and body fat at age 6 years . CONCLUSION Breakfast skipping at age 4 years is associated with a higher percent fat mass at age 6 years . Further prospect i ve studies , including intervention studies , are warranted to extend the evidence base on the directionality and causality of this association Introduction The study aim was to evaluate risk factors of obesity in Polish children aged 7 to 9 years . Material and methods A representative group of 2571 children ( 1268 girls and 1303 boys ) was r and omly selected according to the European Childhood Obesity Group protocol . Weight and height were measured and body mass index ( BMI ) was calculated . A question naire was completed by the children 's parents with respect to behavioural and family-related risk factors of obesity . International Obesity Task Force criteria were used for classification of children 's obesity . Results Obesity was found in 3.7 % of girls and 3.6 % of boys . There was a statistically significant association between the prevalence of obesity in girls and their mother 's obesity : OR = 5.06 ( 1.96–13.05 ) , p < 0.001 , father 's obesity : OR = 5.19 ( 1.96–13.69 ) , p < 0.001 , and both parents ’ obesity : OR = 5.43 ( 1.39–21.29 ) , p = 0.01 . Obesity in boys was significantly associated with mother 's obesity : OR = 5.6 ( 2.6–12.02 ) , p < 0.001 , father 's obesity : OR = 6.21 ( 2.89–13.37 ) , p < 0.001 , and both parents ’ obesity : OR = 7.22 ( 2.44–31.33 ) , p < 0.001 . Skipping or irregular eating of breakfast was a risk factor for obesity in girls with OR = 2.71 ( 1.33–5.51 ) , p = 0.005 . Neither family income nor parents ’ education level was related to their offspring 's obesity . TV watching , physical activity level and eating in fast food places were not significant risk factors for obesity . Conclusions Eating breakfast regularly seems to protect girls from obesity development while low physical activity is not a significant obesity risk factor in this age group for either boys or girls . This finding stresses the more important role of healthy diet than physical activity promotion in obesity prevention in prepubertal children Background / Objectives : Childhood obesity is prevalent , and dietary habits are a key determinant . Some children skip breakfast for weight control , but studies have shown mixed results . Therefore , we assessed the association between breakfast skipping and body mass index ( BMI ) among young Chinese children in Hong Kong . Design /Subjects and Methods : A cohort of 113 457 primary 4 participants of the Department of Health Student Health Service in 1998–2000 was followed up for 2 years , with 68 606 ( 60.5 % ) participants available for analysis in primary 6 . The sociodemographic characteristics for traced and untraced participants were similar . At baseline and follow-up , students reported breakfast habit ( consumed vs skipped ) and other lifestyle characteristics using a st and ardized question naire . BMI was derived using height and weight measured by trained nurses . Multivariable linear regression was used to examine the cross-sectional relationship between breakfast habit and BMI , as well as the prospect i ve association between baseline breakfast habit and change in BMI . Models adjusted for demographic , socioeconomic and lifestyle characteristics . Results : A total of 1805 ( 5.3 % ) boys and 1793 ( 5.2 % ) girls skipped breakfast at baseline . In cross-sectional analyses , breakfast skippers had a higher mean BMI than did eaters among both primary 4 ( β=0.77 , 95 % confidence interval ( 95 % CI ) : 0.67–0.87 ) ( P<0.001 ) and primary 6 children ( β=0.86 , 95 % CI : 0.78–0.95 ) ( P<0.001 ) . Compared with eaters , baseline breakfast skippers experienced a greater increase in BMI in the subsequent 2 years ( β=0.11 , 95 % CI : 0.07–0.16 ) ( P<0.001 ) , and this association was stronger among lunch skippers than eaters ( P for interaction=0.04 ) . Conclusion : Our study provided prospect i ve evidence that skipping breakfast predicts a greater increase in BMI  among Hong Kong children . As breakfast is a modifiable dietary habit , our results may have important implication s for weight control . However , the underlying mechanism of this effect warrants further BACKGROUND Breakfast is associated with lower body weight in observational studies . Public health authorities commonly recommend breakfast consumption to reduce obesity , but the effectiveness of adopting these recommendations for reducing body weight is unknown . OBJECTIVE We tested the relative effectiveness of a recommendation to eat or skip breakfast on weight loss in adults trying to lose weight in a free-living setting . DESIGN We conducted a multisite , 16-wk , 3-parallel-arm r and omized controlled trial in otherwise healthy overweight and obese adults [ body mass index ( in kg/m² ) between 25 and 40 ] aged 20 - 65 y. Our primary outcome was weight change . We compared weight change in a control group with weight loss in experimental groups told to eat breakfast or to skip breakfast [ no breakfast ( NB ) ] . R and omization was stratified by prer and omization breakfast eating habits . A total of 309 participants were r and omly assigned . RESULTS A total of 283 of the 309 participants who were r and omly assigned completed the intervention . Treatment assignment did not have a significant effect on weight loss , and there was no interaction between initial 
    Output:
    
Skipping breakfast was associated with a worse lipid profile , blood pressure levels , insulin-resistance , and metabolic syndrome .
This review supports skipping breakfast as an easy marker of the risk of OW/OB and metabolic diseases , whether or not it is directly involved in causality .