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Skipping breakfast increases CVD mortality risk
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Adults who skipped breakfast had a significantly increased risk for CV mortality, according to a study published in the Journal of the American College of Cardiology.
Shuang Rong, MD, PhD, of the department of nutrition and food hygiene at Wuhan University of Science and Technology in China and of the department of epidemiology at University of Iowa College of Public Health in Iowa City, and colleagues analyzed data from 6,550 participants (mean age, 53 years; 48% men) from the National Health and Nutrition Examination Survey III aged 40 to 75 years who were free from CVD or cancer at baseline.
Questionnaires were completed to collect information such as breakfast frequency and categorized as never (n = 336), rarely (n = 713), some days (n = 1,639) and every day (n = 3,862). Participants were followed up until death or Dec. 31, 2011, for a median of 18.8 years.
During follow-up, there were 2,318 deaths including 619 deaths from CVD. Participants who never consumed breakfast had an HR for all-cause mortality of 1.19 (95% CI, 0.99-1.42) and 1.87 for CV mortality (95% CI, 1.14-3.04) after adjusting for socioeconomic status, race/ethnicity, sex, age, dietary and lifestyle factors, BMI and CV risk factors.
“Taken together, [previous] studies as well as our findings underscore the importance of eating breakfast as a simple way to promote cardiovascular health and prevent cardiovascular morbidity and mortality,” Rong and colleagues wrote.
“What is clear is that a pattern of skipping breakfast identifies a population at risk,” Borja Ibáñez, MD, PHD, professor at the Spanish National Centre for Cardiovascular Research in Madrid, and Juan M. Fernández-Alvira, PhD, postdoctoral researcher at the Spanish National Centre for Cardiovascular Research, wrote in a related editorial. “Surveying the breakfast pattern might be useful in improving risk prediction in the general population. In fact, CV risk scores accounting only for lifestyle habits (ie, without laboratory tests), such as the Fuster-BEWAT score or the ideal cardiovascular health score, have been shown to be able to predict atherosclerosis presence. Including a question related to breakfast pattern might further improve the performance of such scores.” – by Darlene Dobkowski
Disclosures: The authors, Ibáñez and Fernández-Alvira report no relevant financial disclosures.
Perspective
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Martha Gulati, MD, MS, FACC, FAHA
Like your mother told you, breakfast is the most important meal of the day.
This prospective study showed that skipping breakfast was significantly associated with an increased risk for CV mortality, especially death from stroke.
The most important implication is that when we chose to consume calories seems to matter.
We have seen this in prior studies, that skipping breakfast, even after adjusting for other things associated with CVD, can affect heart health. How precisely is not clear, but distribution of calories may matter.
Those who ate breakfast did not necessarily consume more calories than those who skipped breakfast or rarely ate breakfast.Certainly, when advising patients, it is important to emphasize that skipping meals is not a good idea on a regular basis.
Additionally, what we eat matters too (but from this study, we do not know the quality of the food, ie, what people ate for breakfast).
No one should be too busy to eat, but in the morning, the rush is often on with people getting to work, dropping children off, using public transport, etc. One solution is to make breakfast the night before or have healthy foods that are convenient and prepared or packed the night before.
I do that sometimes with all meal prep, and it works.Breakfast seems to improve weight control, BP, blood glucose levels, cholesterol and ultimately the risk for heart disease and mortality from CVD. Its mechanism is not entirely understood, but it seems to affect the cardiometabolic system and makes metabolism more stable. By providing nutrients at the beginning of the day, it may help with metabolism, glycemic control, in addition to influencing food choices and food quality during the day.
It may be that we require energy and need to provide that energy earlier in the day to maintain normal metabolism. Distribution of calories over the day may help metabolism.
The idea of “breakfast like a king, lunch like a prince, dinner like a pauper” with mindful food choices is probably the best idea for all of us.It is not just breakfast; it is what you eat that matters too.
Lean protein, healthy fats and breakfast with soluble fiber is what I recommend. It is not just oatmeal (but that is a great breakfast!), but be creative if you do not like oatmeal.
I make combinations of quinoa and oatmeal, or whole wheat, fiber-rich bread with avocado (we all like avocado toast!), or a shake with avocado, vegetables and some fruits can be an excellent way to start the day.
Yogurt, nuts, fruits are easy to grab and far more healthy than eating most breakfast bars that often are high in sugar and fats.
Be careful; read labels, but do eat breakfast. I would rather you avoid the doughnut and grab the banana and yogurt if you have minimal time.
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