Skipping breakfast is associated with an increased risk of atherosclerosis, according to research published Oct. 2 in the Journal of the American College of Cardiology.

Irina Uzhova, MSC, et al., examined the diets of male and female volunteers who were free from cardiovascular or chronic kidney disease. A computerized questionnaire was used to estimate the usual diet of the participants, and breakfast patterns were based on the percentage of total daily energy intake consumed at breakfast. Three groups were identified – those consuming less than five percent of their total energy intake in the morning (skipped breakfast and only had coffee, juice or other non-alcoholic beverages); those consuming more than 20 percent of their total energy intake in the morning (breakfast consumers); and those consuming between five and 20 percent (low-energy breakfast consumers). Of the 4,052 participants, 2.9 percent skipped breakfast, 69.4 percent were low-energy breakfast consumers and 27.7 percent were breakfast consumers.

Atherosclerosis was observed more frequently among participants who skipped breakfast and was also higher in participants who consumed low-energy breakfasts compared with breakfast consumers. Additionally, cardiometabolic risk markers were more prevalent in those who skipped breakfast and low-energy breakfast consumers compared with breakfast consumers. Participants who skipped breakfast had the greatest waist circumference, body mass index, blood pressure, blood lipids and fasting glucose levels.

Participants who skipped breakfast were more likely to have an overall unhealthy lifestyle, including poor overall diet, frequent alcohol consumption and smoking. They were also more likely to be hypertensive and overweight or obese. In the case of obesity, the study authors said reverse causation cannot be ruled out, and the observed results may be explained by obese patients skipping breakfast to lose weight.

In an accompanying editorial comment, Prakash Deedwania, MD, FACC, writes that this study provides clinically important information by demonstrating the evidence of subclinical atherosclerosis in people who skip breakfast.

"Between 20 and 30 percent of adults skip breakfast and these trends mirror the increasing prevalence of obesity and associated cardiometabolic abnormalities," Deedwania says. "Poor dietary choices are generally made relatively early in life and, if remained unchanged, can lead to clinical cardiovascular disease later on. Adverse effects of skipping breakfast can be seen early in childhood in the form of childhood obesity and although breakfast skippers are generally attempting to lose weight, they often end up eating more and unhealthy foods later in the day. Skipping breakfast can cause hormonal imbalances and alter circadian rhythms. That breakfast is the most important meal of the day has been proven right in light of this evidence."

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Diet, Smoking

Keywords: Breakfast, Pediatric Obesity, Waist Circumference, Coffee, Blood Pressure, Body Mass Index, Smoking, Circadian Rhythm, Lipids, Fasting, Overweight, Body Weight, Energy Intake, Life Style, Cardiovascular Diseases, Renal Insufficiency, Chronic, Atherosclerosis, Volunteers, Alcohol Drinking, Glucose