Interesting and novel analysis on the association between psychosocial behavioural problems and breakfast consumption habits, including breakfast quality and place of consumption in Spanish children and adolescents aged 4-14 years. The authors have analysed data from the National Health Survey (2017), which has the advantage of including a large sample, but also some limitations to the study, as the authors acknowledge.  

On the one hand, it is a cross-sectional study, i.e. it provides a snapshot of the situation; all the information was collected at the same time. As the authors state, they found an association between usual breakfast consumption, breakfast quality and eating breakfast at home with a lower likelihood of psychosocial problems. On the other hand, the information on food consumption habits allows us to consider some indicators, but does not allow us to estimate the usual intake and other details that would be necessary to assess the association observed, so it will be necessary to further analyse the problem with other studies with appropriate design and protocols for this purpose. 

Although some controversy has arisen, several studies have shown that regular consumption of an adequate quality breakfast in schoolchildren and adolescents, especially if it is consumed at home, with sufficient time and company, is associated with favourable indicators of the nutritional characteristics of the usual diet, health and well-being. The results of the study by López-Gil et al. are consistent with this.

This study is an analysis of children aged 4-14 included in the 2017 National Health Survey. It is therefore not a study specifically and exclusively designed to study childhood psychological problems in relation to dietary patterns or eating behaviours.  

As such, it has the limitations inherent in the questions and design included in a survey that was conducted at one point in time. A key problem is that children who do not eat breakfast at home or who eat breakfasts of poorer nutritional quality are, in a high percentage, those with parents working very early or who have lower incomes, with lower educational attainment, i.e. children of lower socio-economic status. In turn, children of lower socio-economic status are more likely to have psychological problems in childhood for many different reasons. 

Another important limitation of the study is that it was conducted in 2017 and the pandemic has greatly influenced both the socioeconomic status of families in Spain, as well as their diet and psychological problems in childhood. Therefore, this type of study/analysis should be repeated today.  

Current evidence shows that more and more households and families in Spain are suffering from food insecurity, and that many vulnerable children and families do not have an adequate diet, not even for one meal a day. For this reason, measures have been included throughout Europe in the Child Guarantee Plan to ensure that schools provide at least one healthy meal a day, with a special focus on children living in poverty or at risk of social exclusion. Spain was one of the seven EU countries where an in-depth study was carried out on the basic services of education, health, nutrition and equal housing to combat child poverty and its consequences.