Literature

More atherosclerosis seen in those who skip breakfast

9-10-2017 • Uzhova I et al., J Am Coll Cardiol 2017


The Importance of Breakfast in Atherosclerosis Disease - Insights From the PESA Study


Uzhova I, Fuster V, Fernández-Ortiz A, et al.
J Am Coll Cardiol 2017;70:183342
 

Introduction and Methods

Not only the nutritional quality of a diet, but also eating patterns are important in the context of CVD prevention strategies. There are data showing that skipping breakfast is associated with obesity, diabetes, lipid disorders, and CHD risk [1-3].
This analysis of the PESA study evaluated the association between different breakfast patterns and subclinical atherosclerosis or CVD risk factors, in individuals without a history of CVD. The PESA study is an ongoing observational prospective cohort, assessing factors related to development and progression of atherosclerosis [4].
The breakfast patterns were evaluated with the computerized questionnaire of the ENRICA study [5]. Three groups were identified:
  • The ‘skipping breakfast’ (SBF) group: <5% of their total energy intake in the morning
  • The ‘low energy breakfast’ (LBF) group: 5 to 20% of their total energy intake in the morning
  • The ‘high energy breakfast’ (HBF) group: >20% of total energy intake in the morning
Of 4,052 participants aged between 40 and 54 years, 2.9% were in the SBF group, 69.4% were in the LBF group, and 27.7% were in the HBF group.
The ESC Systematic Coronary Risk Evaluation tool was used to assess CV risk. Non-coronary atherosclerosis was defined as the presence of a plaque in the right or the left carotid, or the aorta, or the right or left iliofemoral arteries. Coronary atherosclerosis was defined with a CAC score >0. Generalized atherosclerosis was defined by 4 to 6 affected arterial beds.
 

Main results

  • Compared with HBF and LBF, the SBF group consisted of mostly men, who were current smokers, were more likely to consume more energy and dietary cholesterol, and tended to consume more alcoholic and sugar-sweetened beverages, as well as red meat.
  • Cardiometabolic risk markers were more prevalent in the LBF group and even more so in the SBF group as compared with the HBF group, showing the greatest waist circumference and BMI, blood pressure, blood lipids, and fasting glucose levels, and the probabilities of presenting with obesity, abdominal obesity, metabolic syndrome, low HDL-c levels and hypertension were higher in the SBF than in the HBF group.
  • SBF participants had the highest ESC Systematic Coronary Risk Evaluation scores.
 
Subclinical atherosclerosis was observed more frequently in the SBF group (74.6%) than in the LBF (64.5%) and HBF (56.6%) group, with higher odds (vs. HBF) of having plaques in:
  • abdominal aorta OR: 1.79; 95% CI: 1.16 - 2.77
  • carotid OR: 1.76; 95% CI: 1.17 - 2.65
  • iliofemoral OR: 1.72; 95% CI: 1.11 - 2.64
Rectification: please note that initially, wrong percentages for subclinical atherosclerosis were written for the different breakfast groups
  • Compared with HBF, SBF participants had significantly more non-coronary (OR: 1.55; 95% CI: 0.97 - 2.46) and generalized atherosclerosis (OR: 2.57; 95% CI: 1.54 - 4.31).
  • Participants in the LBF group had a higher risk of carotid (OR: 1.21; 95% CI: 1.03 - 1.43; (OR: 1.21; 95% CI: 1.03 - 1.43) or iliofemoral atherosclerotic plaques (OR: 1.17; 95% CI: 1.00 - 1.37).
 

Conclusion

Skipping breakfast was associated with a higher risk of non-coronary and generalized atherosclerosis in a sample of asymptomatic individuals. These findings support the importance of healthy eating, including a rich breakfast.
 

Editorial comment [6]

In their editorial article, Deedwania and Acharya [6] note that breakfast skippers eat more unhealthy and fatty food later during the day and at night, and adopt a general lifestyle that leads to metabolic disorders, and they conclude: ‘There is an urgent need for corrective public health measures to curb the global epidemic of obesity. Given the emerging evidence of association between altered dietary patterns and increased risk of obesity, metabolic syndrome, diabetes, subclinical atherosclerosis, and clinical CV events, it seems prudent to pay attention to diet and educate the public to implement simple lifestyle changes that include emphasis on a regular, hearty, and nutritious breakfast. These easy and economical public health measures can curb the oncoming tsunami of diabetes and CV disorders. Indeed, the wisdom of the ages that breakfast is the most important meal of the day has been proven right in the light of emerging evidence.’
 
Find this article online at JACC
 

References

1. van der Heijden AA, Hu FB, Rimm EB, et al. A prospective study of breakfast consumption and weight gain among U.S. men. Obesity 2007;15:2463–9.
2. Mekary RA, Giovannucci E, Willett WC, et al. Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking. Am J Clin Nutr 2012;95: 1182–9.
3. Shafiee G, Kelishadi R, Qorbani M, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr (Rio J) 2013;89:575–82.
4. Fernández-Ortiz A, Jiménez-Borreguero LJ, Peñalvo JL, et al. The Progression and Early detection of Subclinical Atherosclerosis (PESA) study: rationale and design. Am Heart J 2013;166:990–8.
5. Guallar-Castillon P, Sagardui-Villamor J, Balboa-Castillo T, et al. Validity and reproducibility of a Spanish dietary history. PLoS One 2014;9:e86074. 
6. Deedwania P and Acharya T. Hearty breakfast for healthier arteries. J Am Coll Cardiol 2017
 


atherosclerosisbreakfastdietlifestyleLipidsPESA

Upcoming meetings

Meeting reports & resources

EPCCS 2017 Report of the Cardiovascular Summit held in Dublin, Ireland
EPCCS Guidance Documents Evidence- and meeting-based guidance for primary care
EPCCS 2015 Report of 8th Annual EPCCS meeting held in Prague.
EPCCS 2014 Report of 7th Annual EPCCS meeting held in Brussels.
All meeting reports...