October 23, 2017
Many things in our daily lives are associated with the development of atherosclerosis and subsequently suffering a cardiovascular event. These include diabetes, hypertension, and dyslipidemia.1-3 Diet has always been and continues to be a highly researched field for preventing cardiovascular disease and lowering events. Research continues in understanding nutritional quality, eating patterns, and daily energy intake.4-6 As we continue to lead busier and busier lives, the effect on our eating patterns becomes greater. One particular effect may be the likelihood to consume breakfast, perhaps omitting it completely from our daily life routine. If this is the case, what is the association between different breakfast patterns and the development of atherosclerosis?
To understand the association researchers from Spain studied the association between breakfast patterns and cardiovascular risk factors and the presence, distribution and extension of subclinical atherosclerosis.7 Lifestyle, multi-vascular imaging data, and clinical information were collected from 4,052 participants of the Progression of Early Subclinical Atherosclerosis Study (PESA) who were free of cardiovascular events at baseline.
Participants were adults between 40-54 years old who filled out a questionnaire of self-reported food intake over the past 15 days. Three patterns of breakfast consumption were studied; high-energy breakfast (> 20% of total daily energy intake-27% of the study population); low-energy breakfast (5-20% of total daily energy intake-70%); and skipping breakfast (<5% of total daily energy intake-3%). Compared with high-energy breakfast intake, those persons who skipped breakfast had a higher prevalence of non-coronary atherosclerosis (HR: 1.55 [95% CI: 0.97-2.46]) and generalized atherosclerosis (HR: 2.57 [95% CI: 1.54-4.31]).
Atherosclerotic plaques were found in the aorta and carotid arteries. Low-energy breakfast was associated with more carotid artery and illiofemoral artery plaques. Skipping breakfast is characterized by overall unhealthy food choices, frequent eating out, and busy schedules. Men, smokers, or those who eat more red meat and drink more alcohol are more likely to skip breakfast. Persons who skipped breakfast were more frequently overweight or obese.
Clinicians should pay closer attention to dietary intake, especially meal consumption during the day, as part of their overall patient cardiovascular assessment. Those who do not eat breakfast or have breakfast on the run appear to be more prone to the development of subclinical atherosclerosis and therefore at higher risk of a cardiovascular event. Educating patients about the importance of a healthy nutritious breakfast appears to be important to overall health.
Mark A. Munger, PharmD, FCCP, FACC, is a professor of pharmacotherapy and adjunct professor of internal medicine, at the University of Utah, where he also serves as the associate dean of Academic Affairs for the College of Pharmacy.
Find references on page 2
1. Zhang X, Imperatore G, Thomas W, et al. Effect of lifestyle interventions on glucose regulation among adults without impaired glucose tolerance or diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract 2017;123:149-64.
2. Lin PH, Yet WT, Svetkey LP, et al. Dietary intakes consistent with the DASH dietary pattern reduce blood pressure increase with age and risk for stroke in a Chinese population. Asia Pac J Clin Nutr 2013;22:482-91.
3. Sonestedt E, Hellstrand S, Drake I, et al. Diet quality and change in blood lipids during 16 years of follow-up and their interaction with genetic risk for dyslipidemia. Nutrients 2016;8:274.
4. Goldberg GR, Black AE, Jebb SA, et al. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Deviation of cut-off limits to identify under-recording. Eur J Clin Nutr 1991;45:569-81.
5. Smith TJ, Dotson LE, Young AJ, et al. Eating patterns and leisure-time exercise among active duty military personnel: comparison to the Healthy People objectives. J Acad Nutr Diet 2013;113:907-19.
6. de Castro JM. The time of day of food intake influences overall intake in humans. J Nutr 2004;134:104-11.
7. Uzhova I, Fuster V, Fernȁndez-Ortiz, et al. The importance of breakfast in atherosclerotic disease. J Am Coll Cardiol 2017;70:1833-42.