In the JournalsPerspective

Skipping breakfast linked to increased CV risk

Prakash Deedwania
The omission of breakfast could potentially be a marker of unhealthy dietary and lifestyle behavior and is associated with increased risk for noncoronary and generalized atherosclerosis, according to new data.

According to the study, the number and quality of eating occasions are included among potential targets for primary prevention strategies that have a large effect on CV health.

“Eating patterns are highly dependent on cultural, social and psychological determinants, as people integrate them into their daily life routines,” Irina Uzhova, MSc, from the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Madrid, and colleagues wrote. “A particular habit that might have a significant effect on CV health is breakfast consumption, as it is associated with factors such as satiety, daily energy intake, metabolic efficiency on the diet and appetite regulation.”

To assess the association between breakfast patterns and CVD risk factors, Uzhova and colleagues performed a cross-sectional analysis of the PESA study, which included asymptomatic adults aged 40 to 54 years.

The study collected lifestyle and multivascular imaging data and clinical covariates from 4,052 patients (mean age, 46 years) and analyzed the data using multivariate logistic regression models.

The researchers studied three patterns of breakfast consumption:

  • high-energy breakfast, contributing to > 20% of total daily energy intake (27% of the cohort);
  • low-energy breakfast, contributing between 5% and 20% of total daily energy intake (70% of the cohort); and
  • skipping breakfast, consuming < 5% of total daily energy (3% of thecohort).

Independent of the presence of traditional and dietary CV risk factors, compared with high-energy breakfast, frequent skipping of breakfast was linked to higher rates of noncoronary (OR = 1.55; 95% CI, 0.97-2.46) and generalized (OR = 2.57; 95% CI, 1.54-4.31) atherosclerosis risk.

“Considering the importance of regular breakfast consumption for primary CVD prevention, our findings are important for health professionals and might be used as an important key and simple message for lifestyle-based interventions and public health strategies, as well as informing dietary recommendations and guidelines,” the researchers wrote.

According to a related editorial from Prakash Deedwania, MD, from the University of California, San Francisco, and Tushar Acharya, MD, from Advanced Cardiovascular Imaging, NHLBI, the need for corrective public health measures to curb the global epidemic of obesity is urgent.

“Given the emerging evidence of association between altered dietary patterns and increased risk of obesity, metabolic syndrome, diabetes, subclinical atherosclerosis and clinical CV events, it seems prudent to pay attention to diet and educate the public to implement simple lifestyle changes that include emphasis on a regular, hearty and nutritious breakfast,” they wrote. “These easy and economical public health measures can curb the oncoming tsunami of diabetes and CV disorders. Indeed, the wisdom of the ages that breakfast is the most important meal of the day has been proven.” – by Dave Quaile

Disclosures: Acharya, Deedwania and Uzhova report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

Prakash Deedwania
The omission of breakfast could potentially be a marker of unhealthy dietary and lifestyle behavior and is associated with increased risk for noncoronary and generalized atherosclerosis, according to new data.

According to the study, the number and quality of eating occasions are included among potential targets for primary prevention strategies that have a large effect on CV health.

“Eating patterns are highly dependent on cultural, social and psychological determinants, as people integrate them into their daily life routines,” Irina Uzhova, MSc, from the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Madrid, and colleagues wrote. “A particular habit that might have a significant effect on CV health is breakfast consumption, as it is associated with factors such as satiety, daily energy intake, metabolic efficiency on the diet and appetite regulation.”

To assess the association between breakfast patterns and CVD risk factors, Uzhova and colleagues performed a cross-sectional analysis of the PESA study, which included asymptomatic adults aged 40 to 54 years.

The study collected lifestyle and multivascular imaging data and clinical covariates from 4,052 patients (mean age, 46 years) and analyzed the data using multivariate logistic regression models.

The researchers studied three patterns of breakfast consumption:

  • high-energy breakfast, contributing to > 20% of total daily energy intake (27% of the cohort);
  • low-energy breakfast, contributing between 5% and 20% of total daily energy intake (70% of the cohort); and
  • skipping breakfast, consuming < 5% of total daily energy (3% of thecohort).

Independent of the presence of traditional and dietary CV risk factors, compared with high-energy breakfast, frequent skipping of breakfast was linked to higher rates of noncoronary (OR = 1.55; 95% CI, 0.97-2.46) and generalized (OR = 2.57; 95% CI, 1.54-4.31) atherosclerosis risk.

“Considering the importance of regular breakfast consumption for primary CVD prevention, our findings are important for health professionals and might be used as an important key and simple message for lifestyle-based interventions and public health strategies, as well as informing dietary recommendations and guidelines,” the researchers wrote.

According to a related editorial from Prakash Deedwania, MD, from the University of California, San Francisco, and Tushar Acharya, MD, from Advanced Cardiovascular Imaging, NHLBI, the need for corrective public health measures to curb the global epidemic of obesity is urgent.

“Given the emerging evidence of association between altered dietary patterns and increased risk of obesity, metabolic syndrome, diabetes, subclinical atherosclerosis and clinical CV events, it seems prudent to pay attention to diet and educate the public to implement simple lifestyle changes that include emphasis on a regular, hearty and nutritious breakfast,” they wrote. “These easy and economical public health measures can curb the oncoming tsunami of diabetes and CV disorders. Indeed, the wisdom of the ages that breakfast is the most important meal of the day has been proven.” – by Dave Quaile

Disclosures: Acharya, Deedwania and Uzhova report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

 

    Perspective
    Erin D. Michos

    Erin D. Michos

    In February 2017, the American Heart Association put forward a scientific statement about the impact of meal timing and frequency and CVD prevention. (St-Onge MP, et al. Circulation. 2017;doi:10.1161/CIR.0000000000000476.) This statement endorsed “mindful eating,” ie, paying attention not only to the quality of food but also the timing and pattern of food consumption. Thoughtful planning of meals in advance can minimize unhealthy snacking out of boredom, emotions or stress. The AHA statement also suggested that eating a greater proportion of the calories earlier in the day had favorable cardiometabolic associations, whereas a late dinner eating pattern was less favorable. 

    As the old adage goes, one should “eat breakfast like a king, lunch like a prince, and dinner like a pauper.”

    Indeed, other prior studies have found “breakfast skippers” had higher rates of obesity and impaired glucose metabolism, but studies were largely cross-sectional, and it is not clear whether skipping breakfast caused obesity or whether obese individuals skipped breakfast for dieting purposes. However, a 2017 longitudinal study of 50,660 church-community members followed for an average of 7 years found that breakfast eaters experienced a relative decrease in BMI over time compared with breakfast skippers, with the largest decreases among those who had breakfast for their largest meal of the day. (Kahleova H, et al. J Nutr. 2017;doi:10.3945/jn.116.244749.)

    In this latest breakfast study of 2017, Uzhova and colleagues reported data from the PESA study of 4,052 adults aged 40 to 54 years free of CVD at baseline who completed dietary questionnaires and extensive vascular imaging in multiple territories. Skipping breakfast was defined as consuming < 5% of daily total calories before 10 a.m., compared with low-energy breakfast (5% to 20% of daily calories) and high-energy breakfast (>20% of total calories) consumers.

    Some important observations: No. 1, breakfast skippers (3% of sample) had a lower diet quality overall. Breakfast skippers were more likely to have higher intake of red and processed meats, sugar-sweetened beverages and alcohol; were more likely to have a lower consumption of fruits, vegetables and whole grains; had a lower adherence to a Mediterranean diet pattern; and were more likely to be men and current smokers. Not surprisingly, skipping breakfast was associated with adiposity and adverse cardiometabolic profile. As the authors stated, skipping breakfast could simply be a marker of an unhealthy lifestyle overall.

    However, even after adjusting for cardiometabolic risk factors and also for intake of red meat, alcohol and salt, breakfast skippers had a significant approximately 2.6-fold increased risk for generalized atherosclerosis (ie, plaque present in four to six vascular sites), as well as a significant 1.7- to 1.8-fold increased risk for plaque presence in the abdominal aorta, carotid artery and ilofemoral artery, compared with high-energy breakfast consumers. Regarding coronary artery calcium (CAC), skipping breakfast was associated with CAC prevalence (> 0) after adjusting for demographics and cardiometabolic risk factors (OR = 1.62; 95% CI, 1-2.63) but was attenuated after adjusting for red meat, alcohol and salt (OR = 1.43; 95% CI, 0.87-2.36). The PESA study was limited by its cross-sectional design, which limits conclusions about temporality and causality.

    Of course, daily breakfast intake should be in conjunction with mindful eating during the remainder of the day and regular physical activity.

    A bit of caution: The AHA statement reported that advice related to consuming breakfast in and of itself did not lead to weight loss because of compensatory behaviors the rest of the day. But breakfast consumption in conjunction with a healthier eating pattern could promote a favorable cardiometabolic profile, and the PESA study would suggest healthier arteries as well.

    • Erin D. Michos, MD, MHS
    • Cardiology Today Next Gen Innovator Associate Professor of Medicine Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine

    Disclosures: Michos reports receiving an honorarium from Siemens Healthcare.

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