Skipping Breakfast May Increase Stroke Risk

January 14, 2016

Eating breakfast every day may be beneficial for the prevention of stroke, particularly cerebral hemorrhage, a new study suggests.

The study, published in Stroke on January 5, was conducted by a team led by Yasuhiko Kubota, MD, Osaka University Graduate School of Medicine, Japan.

They note that several previous reports from both Western and Asian countries have shown missing breakfast has been associated with a higher prevalence of obesity, hypertension, dyslipidemia, and glucose intolerance, which are well-known risk factors of cardiovascular disease.

However, no guidelines have yet recommended that adults eat breakfast every day to prevent cardiovascular disease because there is not enough evidence to support such a recommendation.

They therefore conducted the current study to prospectively investigate whether skipping breakfast is related to increased risks for stroke and coronary heart disease in the general Japanese population.

"To the best of our knowledge, this is the first study to investigate the associations of breakfast intake frequency with cardiovascular events that include not only CHD but also stroke and its subtypes in an Asian population," they write.

For the study, 82,772 Japanese men and women aged 45 to 74 years without a history of cardiovascular disease or cancer were followed from 1995 to 2010. Participants were asked about their breakfast eating habits at baseline and classified as having breakfast 0 to 2, 3 to 4, 5 to 6, or 7 times per week.

During the 15-year follow-up, there were a total of 3772 strokes (1051 cerebral hemorrhages, 417 subarachnoid hemorrhages, and 2286 cerebral infarctions) and 870 cases of coronary heart disease.

Multivariable analysis showed that participants never eating breakfast had higher risks for total cardiovascular disease and total stroke, as well as a particularly higher risk for cerebral hemorrhage, compared with those consuming breakfast every day.

Table. Vascular Event Risk in Those Never Eating Breakfast vs Always Eating Breakfast

Event Hazard Ratio (95% Confidence Interval) P Value
Total cardiovascular disease 1.14 (1.01 - 1.27) .013
Total stroke 1.18 (1.04 - 1.34) .007
Cerebral hemorrhage 1.36 (1.10 - 1.70) .004


No significant association between the frequency of breakfast intake and the risk for coronary heart disease was observed.

Similar results were observed even after exclusion of early cardiovascular events.

Noting that the major risk factor for cerebral hemorrhage is hypertension — especially an increase in blood pressure in the morning — the researchers point out that in the current study those having breakfast every day were less likely to have high blood pressure than those skipping breakfast, although this was not significant.

They also report that several previous studies have shown that cerebral hemorrhage occurs more frequently in the morning than during the remainder of the day, and other studies have reported reductions in blood pressure from eating breakfast. One group has suggested that skipping breakfast was associated with overactivity in the hypothalamic-pituitary-adrenal axis because of a longer period of fasting, leading to elevated blood pressure in the morning.

"This effect of breakfast intake on blood pressure in the morning might be one of the mechanisms of the result from the present study," they speculate.

They note that a previous study has shown a significant association between the frequency of breakfast and the risk for coronary heart disease in US men. They suggest that the difference between this result and the current study may have resulted from the different populations; for example, in Japan the prevalence of coronary heart disease is lower and the prevalence of stroke, particularly cerebral hemorrhage, is higher compared with Western countries.

The researchers point out that they only breakfast habits only at baseline, and it is possible that these may have changed over follow-up. In addition, breakfast skippers may be more likely to have other unhealthy lifestyle behaviors.

The authors state that this study still showed a significant inverse association between the frequency of breakfast intake and the risk for cerebral hemorrhage even after adjustment for various kinds of diet and lifestyle factors, but because it was an observational study there may be other confounding factors that were not measured.

This study was supported by Grants-in-Aid for the Third Term Comprehensive Ten-Year Strategy for Cancer Control from the Ministry of Health, Labor and Welfare of Japan, as well as by National Cancer Center Research and Development Fund (since 2011) and a Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare of Japan (from 1989 to 2010). The authors have disclosed no relevant financial relationships.

Stroke. Published online January 5, 2016. Abstract


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