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Breakfast Skipping Is Associated with Vitamin D Deficiency among Young Adults entering Initial Military Training

Published:September 30, 2021DOI:



      Vitamin D deficiency (VDD), defined as serum 25-hydroxyvitamin D (25[OH]D) levels < 20 ng/mL [to convert 25[OH]D ng/mL to nmol/L, multiply by 2.5]) is prevalent in young adults and has been associated with adverse health outcomes, including stress fracture during periods of increased physical activity such as military training. Foods commonly consumed at breakfast provide an important source of vitamin D, yet breakfast skipping is common among young adults. However, whether breakfast skipping is associated with VDD in young adults is unclear.


      This study aimed to determine whether breakfast skipping is associated with odds of VDD among recruits entering initial military training (IMT), and with changes in serum 25(OH)D during IMT. In addition, whether diet quality and vitamin D intake mediated these associations was determined.


      Secondary analysis of individual participant data collected during five IMT studies. Breakfast skipping (≥ 3 times/week) was self-reported. Dietary intake was determined using food frequency questionnaires, and vitamin D status was assessed using circulating 25(OH)D concentrations pre- and post-IMT.

      Participants and setting

      Participants were healthy US Army, US Air Force, and US Marine recruits (N = 1,569, 55% male, mean ± standard deviation age 21 ± 4 years) entering military service between 2010 and 2015 at Fort Jackson, SC; Fort Sill, OK; Lakeland Air Force Base, TX; or the Marine Corps Recruit Depot, Parris Island, SC.

      Main outcome measures

      Primary outcomes were VDD pre-IMT and change in 25(OH)D from pre- to post-IMT.

      Statistical analysis performed

      Associations were determined using multivariate-adjusted logistic and linear regression and mediation models.


      Forty-six percent of military recruits were classified as breakfast skippers pre-IMT, and 30% were VDD. Breakfast skipping was associated with a higher odds of pre-IMT VDD (odds ratio 1.5, 95% CI 1.1 to 1.9), and lower vitamin D intake and diet quality were partial mediators of the association. Serum 25(OH)D concentrations improved (P = 0.01) among habitual breakfast skippers versus nonskippers during IMT; however, regression to the mean could not be ruled out. Neither change in diet quality nor vitamin D intake were associated with change in 25(OH)D concentrations during IMT.


      Breakfast skipping is prevalent among incoming military recruits and is associated with VDD. This relationship may be mediated by lower diet quality and vitamin D intake.


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      H. S. Fagnant is a research dietitian and A. T. Nakayama is an ORISE research fellow, US Army Research Institute of Environmental Medicine, Natick, MA; and Oak Ridge Institute of Science and Education, Belcamp, MD.


      L. J. Lutz and J. P. Karl are research dietitians, and J. P. McClug is chief, Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA.


      E. Gaffney-Stomberg is a research physiologist, Combat Capabilities Development Command—Soldier Center, Natick, MA.