Obese women who skip breakfast may be at higher risk for type 2 diabetes

Issue: August 2013

SAN FRANCISCO — During a press conference here at ENDO 2013, Elizabeth A. Thomas, MD, an endocrinology fellow and instructor at the University of Colorado School of Medicine’s Anschutz Medical Campus, said skipping breakfast could have adverse cardiometabolic effects in obese women, including an increased risk for type 2 diabetes.

Perspective from Moahad S. Dar, MD

Thomas and colleagues conducted a randomized, crossover trial of 9 obese women aged 29.2 years (BMI 31.4 kg/m²) during 2 study days, roughly 1 month apart during the follicular phase of their menstrual cycle. They were randomly assigned to either breakfast containing 25% of daily energy intake or no breakfast at all. Their lunch contained a 35% of their daily energy intake, Thomas said.

According to data, pre-lunch insulin levels did not differ between groups. However, glucose total AUC was greater in the no-breakfast group compared with the breakfast group (20,775 mg/dL vs. 18,126 mg/dL×180 minutes; P=.004).

Further, pre-lunch free fatty acids appeared higher among patients in the no-breakfast group compared with the breakfast group (705 mEq/L vs. 25,692 mEq/L×180 minutes; P=.0002).

Additional study data indicate the incremental AUC for free fatty acids was also greater among patients in the no-breakfast group compared with the breakfast group (–92980 vs. –26008 mEq/L ×180 minutes; P<.001). This suggests pre-lunch free fatty acids did not promote the increased AUC, according to Thomas.

Pre-lunch triglycerides were also lower in the no-breakfast group. However, the AUC did not vary between groups, suggesting that a pre-lunch triglyceride level drove the response, Thomas said.

“In obese women, skipping breakfast results in acute relative insulin resistance and elevated levels of free fatty acids,” Thomas said. “It’s possible that insulin resistance over time may predispose patients to further metabolic derangements and possibly progression to type 2 diabetes.”

Thomas told Endocrine Today that she and colleagues plan to conduct a larger study consisting of 20 patients. – by Samantha Costa

For more information:

Thomas E. #OR09-2. Presented at: The Endocrine Society Annual Meeting and Expo; June 15-18, 2013; San Francisco.

Disclosure: The researchers report no relevant financial disclosures.

Perspective

Moahad S. Dar, MD

This study seems counterintuitive because it seems like eating less would improve all of these parameters. Yet, skipping a breakfast meal somehow makes parameters worse here. Perhaps the patients that are skipping breakfast have other maladaptive habits; maybe they are sleeping late and don’t have time to eat breakfast or they’re eating junk food during the day. Although the study was interesting, other details need to be examined such as their other eating habits, which may be playing a role.

Moahad S. Dar, MD

Assistant professor of medicine

East Carolina University

Disclosures: Dar reports no relevant financial disclosures.