Skipping Breakfast Ups Risk of CHD in Middle-Aged Men

Marlene Busko

July 23, 2013

BOSTON, Massachusetts — A large, prospective study supports the common wisdom that skipping breakfast is not a healthy way to start the day [1]. Compared with men who ate breakfast, those who skipped breakfast had a 27% increased risk of MI or death from CHD.

The study, based on data from the Health Professionals Follow-up Study (HPFS), was published online July 22, 2013 in Circulation.

The investigators followed approximately 27 000 middle-aged and older US male health professionals for more than 16 years. During that time, 1527 men had incident CHD, defined as fatal MI or nonfatal CHD.

"This was a pretty large study, with a very long follow-up, and a substantial number of incident CHD end points. So from that standpoint, the relationship [between skipping breakfast and increased risk of CHD] is pretty strong," senior author Dr Eric B Rimm (Harvard School of Public Health, Boston, MA) told heartwire . Of note, younger but not older men were at significantly increased risk, he pointed out.

"It's a pretty simple [overall] public health message, one that is cheap, [and involves habits that are] not hard to change compared with other diet and lifestyle factors," Rimm said. Physicians should advise patients to "eat regularly, and specifically eat in the morning," he advised.

Breakfast Like a King

According to data from the National Health and Nutrition Examination Survey (NHANES) 2002, 18–20% of US adults regularly skip breakfast. Previous studies based on data from the HPFS cohort showed that men who skipped breakfast were at increased risk of gaining substantial weight or developing type 2 diabetes.

To investigate how skipping breakfast might impact heart health, the group analyzed data from participants in the HPFS study who were aged 45–82 when they replied to a questionnaire about eating habits. Almost all the men (97%) were white and of European descent.

Men who reported not eating breakfast were younger and more likely to work full-time, drink more alcohol, and be single, less active, and smokers compared with the other men.

After adjusting for multiple factors--diet quality, calories, alcohol intake, eating frequency, sleep characteristics, physical activity, smoking, having a parent who had an MI at a young age, work status, and recent physical exam--skipping breakfast was linked with a 27% increased risk of CHD.

Not Eating Breakfast May Affect Traditional CV Risk Factors

After further adjustment for body mass index, hypertension, hypercholesterolemia, and diabetes, skipping breakfast only conferred an 18% increased risk of CHD, "suggesting that eating habits may affect risk of CHD through pathways associated with these traditional risk factors," the authors wrote.

"People who skip breakfast have higher levels of fasting insulin, triglycerides, and LDL-cholesterol, in part, because the body is likely reacting to the fact that there's no new calorie source for 12–14 hours, [which] may put extra [long-term] stress on the body," Rimm said.

The overall increased risk was due to the higher risk in middle-aged men: among 45- to 60-year-olds, those who skipped breakfast had a 50% higher risk of CHD than those who ate breakfast. Men aged >60 years who skipped breakfast did not have a significantly increased risk of CHD compared with other older men who ate breakfast.

The group is also investigating the relationship between eating breakfast and CHD using data from the Nurses' Health Study. Preliminary findings suggest that the healthy habit is just as important for women as men, Rimm said.

The study was funded by the National Institutes of Health and by a Canadian Institutes of Health Research postdoctoral fellowship to Dr Cahill. The authors have no potential conflicts of interest.

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