A Relationship Between Mortality and Eating Breakfast and Fiber

Dana E King, MD, MS; Jun Xiang, MS, MA


J Am Board Fam Med. 2021;34(4):678-687. 

In This Article

Abstract and Introduction


Background: Recent studies suggest that intermittent fasting or skipping breakfast may be good strategies for weight loss and better health. The objective of this study was to determine whether regular breakfast is associated with overall or cardiovascular mortality.

Methods: Cohort study with follow-up mortality data from the NHANES 1999–2002. National weighted sample. Outcomes were overall and cardiovascular mortality; secondary was fiber intake.

Results: Out of 5761 participants, there were 4778 (82.9%) identified as breakfast eaters and 2027 deaths (35.2%); 469 (23.1%) deaths were due to cardiovascular diseases. The average daily intake of calories was 2015, and fiber was 16.3 g/day. A total of 17.7%, 66.0%, and 11.4% of participants had diabetes, hypertension, and cardiovascular diseases, respectively. Analysis showed breakfast eaters were older, had lower body mass index, and ate more calories and fiber daily than non-breakfast eaters. Cox proportional hazard regression analyses showed that compared to non-breakfast eaters, the breakfast eaters were less likely to experience mortality after multivariable adjustments (overall mortality: hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.57–0.84 and cardiovascular mortality: HR, 0.45; 95% CI, 0.32–0.63). For the breakfast eaters, fiber intake >25 g/day was associated with 21% (HR, 0.79; 95% CI, 0.66–0.96) reduction in all-cause mortality after multivariable adjustments.

Conclusions: Regular daily intake of breakfast appears to be associated with lower overall and cardiovascular mortality, particularly when consuming fiber >25 g/day. Further studies examining specific breakfast foods and the timing of foods would be helpful.


Breakfast has been promoted as the healthiest meal of the day for many years in popular culture.[1,2] Recent studies suggest that eating breakfast is associated with reduced cardiovascular morbidity and mortality.[3,4] In recent work by Rong and colleagues that included 6550 participants followed for 17–23 years, after multivariable adjustment, participants who never consumed breakfast compared with those consuming breakfast every day had hazard ratios of 1.87 (95% confidence interval [CI], 1.14–3.04) for cardiovascular mortality but not all-cause mortality.[5] Two other recent cohort studies have found reduced all-cause and cardiovascular mortality in breakfast eaters.[6,7] However, less is known regarding which foods consumed at breakfast would be most beneficial.

Dietary fiber has been associated with lower mortality in several studies.[8,9] Many common breakfast foods such as oatmeal, cereal, and fruit are commonly consumed as breakfast foods and are high in fiber and may be contributing to the benefit of breakfast on mortality. Thus, dietary fiber should be considered and evaluated as an important mediator in the association between breakfast and mortality. However, specific data regarding fiber as a factor in the association of breakfast and mortality are lacking. Long-term cohorts that include fiber intake would help illuminate its role and clarify the relationship between breakfast and mortality.

The objective of this study was to confirm the association between breakfast and mortality and determine whether fiber plays a key mediator role.