Regularly skipping breakfast linked to hardening of the arteries

Atherosclerosis doesn’t usually cause any noticeable symptoms at first but can eventually lead to life-threatening problems, such as heart attacks and strokes, if it gets worse.

The researchers looked at the breakfast habits and artery health of around 4,000 middle-aged bank workers who were not known to have heart disease. They found those who skipped breakfast were more likely to have plaques than those who ate a breakfast containing at least a fifth of their daily calories – this would be 500kcal or more for a man whose daily intake was the recommended 2,500kcal.

The study is planning to follow up the participants to see what happens to their arteries over time.

This study can’t say for certain whether skipping breakfast was affecting artery health directly, as both were assessed at the same time. However, skipping breakfast did seem to be a habit shared by people who also tended to be unhealthy in other ways, such as being more likely to be a smoker or to have a higher body mass index (BMI).

While skipping breakfast may seem a tempting option if you’re trying to lose weight, it’s counterproductive if you find yourself having unhealthy snacks and overeating during the rest of the day.

Where did the story come from?

The study was carried out by researchers from the Centro Nacional de Investigaciones Cardiovasculares Carlos III, Santander Bank, and other hospitals and research centres in Spain and the US. It was funded by the Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Santander, the Instituto de Salud Carlos III and the European Regional Development Fund.

The study was published in the peer-reviewed Journal of the American College of Cardiology.

The research was covered well by The Guardian, which pointed out limitations and explained that skipping breakfast was not likely to be affecting heart health directly; instead, it was likely to be a marker for other unhealthy behaviours.

The Mail Online suggested that skipping breakfast “triggered the same emergency response in the body as starvation”, but the study itself didn’t assess this. Also, its headline stated that skipping breakfast to lose weight was the problem, but not all of the participants who skipped breakfast did so to lose weight.

The Daily Telegraph took a more cautious approach, explaining there may be a potential link between skipping breakfast and heart attacks but that additional research with long-term follow-up is probably required to confirm or disprove it.

What kind of research was this?

People who skip breakfast are thought to be at greater risk of heart disease. However, no studies have so far looked at whether breakfast habits are linked to the early build-up of fatty tissue in the arteries (atherosclerosis) before a person starts to experience symptoms. Atherosclerosis is an early sign of heart disease.

The current study was a cross-sectional analysis looking at whether people who skipped breakfast were more likely than those who ate breakfast to have atherosclerosis that was not yet causing any symptoms of heart disease.

The analysis was part of the ongoing Progression of Early Subclinical Atherosclerosis (PESA) study, which will follow the participants to see whose atherosclerosis progresses. This initial analysis cannot tell us whether breakfast habits directly caused the atherosclerosis seen, as both the people’s habits and their fatty tissue build-up were measured at the same time.

What did the research involve?

Researchers recruited 4,082 adults aged 40 to 54 who worked at the headquarters of Santander Bank in Madrid. To be eligible, participants could not have heart or kidney disease, could not be morbidly obese (BMI of 40 or more) and could not have a serious disease that could lead to death in the next six years.

They reported their breakfast habits over 15 days by filling out a detailed computerised questionnaire about what and when they ate and drank, and the researchers looked at their arteries to see if they showed signs of fatty tissue build-up. The results were then analysed to see whether breakfast habits were linked to artery health.

The researchers used the questionnaire information to calculate what percentage of their daily energy intake the participants consumed at breakfast. Anything eaten before 10am was considered to be breakfast, and they were grouped into those who consumed:

• more than 20% of their daily energy intake at breakfast (“high-energy breakfast”)
• 5-20% of their daily energy intake at breakfast (“low-energy breakfast”)
• less than 5% of their total energy intake at breakfast (“skipped breakfast”)

The energy level for skipping breakfast was equivalent to just having an orange juice or coffee.

The researchers used ultrasound to assess whether people had fatty build-ups in major arteries in the neck (carotid arteries), the major artery leading from the heart through the abdomen (infrarenal abdominal aorta) and major arteries in the groin (iliofemoral arteries). They also assessed the level of calcium in the walls of the arteries supplying the heart, as this is a sign of fatty deposits.

This identified people who had signs of atherosclerosis either in any of the arteries, in the arteries supplying the heart or in multiple (four or more) sites.

They then looked at whether people with different breakfast habits were more or less likely to have atherosclerosis or other unhealthy outcomes, such as being overweight or having high blood pressure. In their analyses, they accounted for potential confounders such as:

• age
• education level
• physical activity level
• smoking status
• dietary characteristics (such as whether they were dieting to lose weight)

What were the basic results?

Only 3% of the participants skipped breakfast. Most (69%) had a low-energy breakfast, and 28% had a high-energy breakfast. Those who skipped breakfast were more likely to:

• be male
• be smokers
• have changed their diet to try to lose weight in the past year
• consume most of their calories at lunch
• have a more unhealthy diet (higher in calories, animal protein and cholesterol; and lower in fibre and carbohydrates)

Overall, about 63% of participants showed some signs of atherosclerosis, and it was more common among people who skipped breakfast than those who did not.

Once the researchers took into account other factors that could have affected the results, people who skipped breakfast were more likely to have atherosclerosis at multiple sites or in the arteries not feeding the heart.

How did the researchers interpret the results?

They concluded that skipping breakfast was associated with an increased likelihood of having fatty tissue build-up in multiple arteries or in arteries not feeding the heart. This increase was found to be independent of other risk factors for heart disease.

Conclusion

This study found a link between skipping breakfast and fatty tissue build-up in the arteries – an early sign of heart disease.

However, because it assessed people’s diets and artery health at the same point in time, and fatty deposits build up gradually in arteries, we can’t say their breakfast habits directly influenced their artery health. Also, as breakfast habits were only assessed over 15 days, we can’t be sure they were representative of lifelong patterns.

It looks like people who skip breakfast tend to have other unhealthy habits, such as smoking and eating more. While the researchers did try to account for the impact of these other factors, it’s possible they still affected the results.

But overall, it looks like skipping breakfast tends to be a sign of someone whose habits may put them at risk of heart disease.

In general, while this study can’t prove that eating breakfast will reduce the risk of heart disease, eating a healthy breakfast is in line with current UK guidance from the National Institute for Health and Care Excellence (NICE). The advice is part of its guidance about preventing excessive weight gain.

NICE recommends eating breakfast, without increasing overall daily calorie intake, as one way to help prevent excess weight gain. This means you shouldn’t just eat breakfast without considering your overall calorie consumption – cut down elsewhere if you need to.

What you eat at breakfast is also likely to be important. NICE recommends that breakfast should reflect existing healthy eating advice. So for example, opt for unsweetened wholegrain cereals or bread, lower-fat milk and a portion of fruit, rather than a fry-up.

Read more about healthy breakfast choices specifically designed for people who don’t like eating breakfast.