The new study, published in the Journal of the American College of Cardiology, builds on previous evidence that suggests eating breakfast promotes greater heart health, including healthier weight and cholesterol. While previous investigations have linked skipping breakfast to coronary heart disease risk, this is the first study to evaluate the association between breakfast and the presence of subclinical atherosclerosis.
"People who regularly skip breakfast likely have an overall unhealthy lifestyle," said study author Valentin Fuster, MD, PhD, MACC director of Mount Sinai Heart and editor-in-chief of the Journal of the American College of Cardiology. "This study provides evidence that this is one bad habit people can proactively change to reduce their risk for heart disease."
High energy breakfasts: the most important meal of the day
Researchers in Madrid examined male and female volunteers who were free from cardiovascular or chronic kidney disease. A computerized questionnaire estimated the usual diet of the participants, and breakfast patterns were based on the percentage of total daily energy intake consumed at breakfast.
The researchers identified three groups: “breakfast skippers”, who consumed less than 5% of their daily energy at breakfast; “low-energy breakfast consumers” who eat 5-20% of their daily intake at breakfast; and those consuming more than 20% of their total energy intake in the morning – “breakfast consumers”.
Of the 4,052 participants, 2.9% skipped breakfast, 69.4% were low-energy breakfast consumers and 27.7% were breakfast consumers.
Atherosclerosis was observed more frequency among participants who skipped breakfast and was also higher in participants who consumed low-energy breakfasts compared to breakfast consumers. Additionally, cardiometabolic risk markers were more prevalent in those who skipped breakfast and low-energy breakfast consumers compared to breakfast consumers.
Participants who skipped breakfast had the greatest waist circumference, body mass index, blood pressure, blood lipids and fasting glucose levels, the study concluded.
According to the researchers, participants who skipped breakfast were more likely to have an “overall unhealthy lifestyle”, including poor overall diet, frequent alcohol consumption and smoking.
Breakfast skippers were also more likely to be hypertensive and overweight or obese. However, in this case the study authors said reverse causation cannot be ruled out, and the observed results may be explained by obese patients skipping breakfast to lose weight.
"Aside from the direct association with cardiovascular risk factors, skipping breakfast might serve as a marker for a general unhealthy diet or lifestyle which in turn is associated with the development and progression of atherosclerosis," said Jose L. Peñalvo, PhD, assistant professor at the Friedman School of Nutrition Science and Policy at Tufts University and the senior author of the study.
"Our findings are important for health professionals and might be used as a simple message for lifestyle-based interventions and public health strategies, as well as informing dietary recommendations and guidelines."
Prakash Deedwania, MD and professor of medicine at the University of California, added: “Between 20 and 30% of adults skip breakfast and these trends mirror the increasing prevalence of obesity and associated cardiometabolic abnormalities.
“Poor dietary choices are generally made relatively early in life and, if remained unchanged, can lead to clinical cardiovascular disease later on. Adverse effects of skipping breakfast can be seen early in childhood in the form of childhood obesity and although breakfast skippers are generally attempting to lose weight, they often end up eating more and unhealthy foods later in the day. Skipping breakfast can cause hormonal imbalances and alter circadian rhythms. That breakfast is the most important meal of the day has been proven right in light of this evidence."
Source: Journal of the American College of Cardiology
Volume 70, Issue 15, October 2017, DOI: 10.1016/j.jacc.2017.08.027
"The Importance of Breakfast in Atherosclerosis Disease"
Authors: Jose Peñalvo, Irina Uzhova, Valenitn Fuster, Antonio Hernandez-Oritz, et al