In the JournalsPerspective

Men who skip breakfast may be at higher risk for CHD

Skipping breakfast was associated with higher risk for CHD in a 16-year cohort study of male health professionals.

Eating late at night was also associated with elevated CHD risk, but researchers said it may be difficult to draw conclusions from this study about late-night eaters because they made up a small percentage of participants.

Leah E. Cahill, PhD, of the departments of nutrition and epidemiology at Harvard School of Public Health, and colleagues said this study is the first to relate eating habits with risk for CHD. Previous studies have associated skipping meals with excess body weight, hypertension, insulin resistance and elevated fasting lipid concentrations.

Leah E. Cahill, PhD 

Leah E. Cahill

The researchers assessed eating habits of men in the Health Professionals Follow-up Study (n=26,902, 97% white) from 1992 to 2008. Participant age ranged from 45 to 82 years at baseline. Those with a history of CVD or cancer at baseline were excluded.

In 1992, participants were asked which times of day they usually ate: before breakfast; at breakfast; between breakfast and lunch; at lunch; between lunch and dinner; at dinner; between dinner and bedtime; and after going to bed. Skipping breakfast was defined as not eating during any of the following periods: before breakfast, breakfast, or between breakfast and lunch.

The primary outcome was CHD, defined as nonfatal MI or fatal CHD. Nonfatal MIs were reported by participants on biennial questionnaires and confirmed by reviewing medical records and autopsy reports. Fatal CHD was confirmed by hospital records or autopsy. When estimating CHD risk, the researchers adjusted for demographic, diet, lifestyle and other CHD risk factors.

During the 16-year study period, 1,527 cases of CHD were confirmed. Men who skipped breakfast had a 27% higher risk for CHD compared with men who ate breakfast (RR=1.27; 95% CI, 1.06-1.53). Men who ate after going to bed were at a 55% greater risk for CHD than men who did not (RR=1.55; 95% CI, 1.05-2.29). The associations were weakened when adjusted for BMI, hypercholesterolemia, hypertension and diabetes (RR=1.18; 95% CI, 0.98-1.43 for skipping breakfast and CHD; RR=1.41, 95% CI, 0.95-2.08 for late-night eating and CHD).

There was no association detected between how many times a participant ate per day and risk for CHD.

“The timing of the meal may be directly responsible for the metabolic effects that lead to CHD or, alternatively, eating habits may be a proxy for specific foods more likely to be consumed at breakfast or late at night such as breakfast cereals high in dietary fiber and fortified micronutrients like folate or late-night snack foods high in calories,” the researchers wrote.

They also said that the study findings need to be replicated in women and other ethnic groups. However, once that happens, “the findings from the present study provide evidence to support a recommendation of daily breakfast eating by clinicians and health authorities to prevent CHD and to improve health at both the individual and population levels.”

Disclosure: The researchers report no relevant financial disclosures.

Skipping breakfast was associated with higher risk for CHD in a 16-year cohort study of male health professionals.

Eating late at night was also associated with elevated CHD risk, but researchers said it may be difficult to draw conclusions from this study about late-night eaters because they made up a small percentage of participants.

Leah E. Cahill, PhD, of the departments of nutrition and epidemiology at Harvard School of Public Health, and colleagues said this study is the first to relate eating habits with risk for CHD. Previous studies have associated skipping meals with excess body weight, hypertension, insulin resistance and elevated fasting lipid concentrations.

Leah E. Cahill, PhD 

Leah E. Cahill

The researchers assessed eating habits of men in the Health Professionals Follow-up Study (n=26,902, 97% white) from 1992 to 2008. Participant age ranged from 45 to 82 years at baseline. Those with a history of CVD or cancer at baseline were excluded.

In 1992, participants were asked which times of day they usually ate: before breakfast; at breakfast; between breakfast and lunch; at lunch; between lunch and dinner; at dinner; between dinner and bedtime; and after going to bed. Skipping breakfast was defined as not eating during any of the following periods: before breakfast, breakfast, or between breakfast and lunch.

The primary outcome was CHD, defined as nonfatal MI or fatal CHD. Nonfatal MIs were reported by participants on biennial questionnaires and confirmed by reviewing medical records and autopsy reports. Fatal CHD was confirmed by hospital records or autopsy. When estimating CHD risk, the researchers adjusted for demographic, diet, lifestyle and other CHD risk factors.

During the 16-year study period, 1,527 cases of CHD were confirmed. Men who skipped breakfast had a 27% higher risk for CHD compared with men who ate breakfast (RR=1.27; 95% CI, 1.06-1.53). Men who ate after going to bed were at a 55% greater risk for CHD than men who did not (RR=1.55; 95% CI, 1.05-2.29). The associations were weakened when adjusted for BMI, hypercholesterolemia, hypertension and diabetes (RR=1.18; 95% CI, 0.98-1.43 for skipping breakfast and CHD; RR=1.41, 95% CI, 0.95-2.08 for late-night eating and CHD).

There was no association detected between how many times a participant ate per day and risk for CHD.

“The timing of the meal may be directly responsible for the metabolic effects that lead to CHD or, alternatively, eating habits may be a proxy for specific foods more likely to be consumed at breakfast or late at night such as breakfast cereals high in dietary fiber and fortified micronutrients like folate or late-night snack foods high in calories,” the researchers wrote.

They also said that the study findings need to be replicated in women and other ethnic groups. However, once that happens, “the findings from the present study provide evidence to support a recommendation of daily breakfast eating by clinicians and health authorities to prevent CHD and to improve health at both the individual and population levels.”

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Udho Thadani

    Udho Thadani

    In a subgroup of males (n=26,902, 97% white) who participated in the Health Professionals Follow-up Study and were free of CVD and cancer in 1992, Cahill and colleagues report that over an observation period of 16 years, skipping breakfast or eating late at night was associated with an increased incidence of nonfatal MI or fatal CHD. These associations, however, were markedly weakened and were not statistically significant when adjustments were made for hypertension, BMI, hypercholesterolemia and diabetes. Such observational, population-based cohort studies create a lot of publicity and media attention. However, in my opinion, the results of this study, although of great public and CHD-related adverse-outcome interest, are merely hypothesis-generating. Before changing our eating habits, these results need to be confirmed in adequately powered, large randomized clinical trials, controlling for meal size as well as for skipping or not skipping breakfast.

    • Udho Thadani, MD, MRCP, FRCPC, FACC, FAHA
    • Cardiology Today Editorial Board member

    Disclosures: Thadani consults for Arbor Pharmaceuticals, Gilead Science and Servier.