DR.

NADYA AISYAH WIDOWATI

Skipping Breakfast and 5-

Year Changes in Body
Mass Index and Waist
Circumference in
Japanese Men and
Women
 Andraina - 01071190139
Elrich Manggala - 01071190109
Hana Oktaviani - 01071190126
Iglesias Owen - 01071190176
Indra Kusuma - 01071190214
Kaila Alodia - 01071190110
Muhammad Saifulloh - 01071190223
Natasya Kweeswara - 01071190016
Penradee Piyarat - 01071190201
Rizky Fariza - 01071190143
Vincent Christianto - 01071190035

PBL A12
 PLACE

Toyama Prefecture, Japan

Located on the coast of the sea of Japan.

Factory
Produces zippers and aluminium sashes.
PERSON

Factory Employees Current Smoker Low Dose Alcoholic Young Adults

TIME

2009
WHAT'S ON 2009?
HYPOTHESIS
Skipping breakfast does not affect
Body Mass Index (BMI) nor Waist
Circumference (WC), instead there are
other closely-related variables that
affect BMI and WC
 ASSOCIATION

Chance Bias Causal Reverse Time Confounding

Order
The research was started in 2009, which
was the time when Japan was in an
economy plunge.

Sample population is not representative of

the whole Japanese population.
CHANCE
The p value is more significant towards to
the person who have more breakfast.

The subject of women is not significant.

 SELECTION BIAS
The sample selected not enough to represent the
Toyama population.

RESPONSE BIAS
When the WC of the subject were being
measured, there was a tendency for them to tuck
their stomach in, leading to a small
SELECTION circumference.

BIAS VOLUNTEER BIAS

The subject were not selected randomly, only the
one who volunteered were part of the study.
 INFORMATION BIAS

The information about the baseline

conditions (ex : smoking status or Calories intake were different between
alcohol consumption) were not each individuals.
followed.
 Instead of skipping breakfast increases BMI and
WC, the individual skipped breakfast due to
increased BMI and WC.

REVERSE
TIME
The second statement is influenced by popular
media such as VOX or INSIDER, with articles
such as “Eating Breakfast is not a good weight
loss strategy, Scientists confirm.” from VOX.
ORDER
https://www.vox.com/2019/2/1/18206873/breakfast-diet-weight-loss
 STRENGTH OF ASSOCIATION
The journal is focused only on the data analytic
instead of finding Relative Risk.

CONSISTENCY
Because the results of this study did not indicate

CAUSAL
any association and other studies showed
association and some aren’t.

SPECIFICITY
There is still a lot other factors.

TEMPORALITY
They didn’t follow up the sample until 5 years,
however they are stuck in the baseline.
 DOSE RESPONSE

The data showed that skipping breakfast 4-7 times

gain more WC and BMI increase than 1-3 times.

EXPERIMENT

The study design they use is cohort.

CAUSAL

ANALOGY

There is no analogical experiment on animal.

 PLAUSIBILITY/COHERENCE

It is stated that skipping breakfast affect

metabolism. Skipping breakfast has been associated
with a lack of feeding satiety, postpradinal
hyperinsulinema, expression of the biological clock
gene and circadian rhythms of glucose metabolism,
which cause body weight gain.

CAUSAL it’s unlikely to be causal.

 CONFOUNDING

Alcoholic Age Current Smoker

On small dose, Sake have a lower Younger age (<40) have a tendency Nicotine can suppress human
calorie compared to other of not doing recommended appetite, giving habits to
alcoholic beverages, thus the physical exercise - Work hour of skipping breakfast as smoking
alternative calorie intake. being a factory worker. is used as an alternative.
 All study participants should be
randomly selected

SOLUTION

Measure the confounding factor in the

follow up. Additional time to follow up.
THANK YOU