Skimpy, skipped breakfasts associated with plaque in Spanish study
by Nicole Lou, Contributing Writer, MedPage Today October 02, 2017

Action Points
• Skipping breakfast was associated with atherosclerotic buildup in a Spanish study, with light breakfasts also tied to subclinical plaque formation.
• Note that skipping breakfast was associated with male gender, smoking, drinking more alcoholic beverages, and eating more red meat.
Skipping breakfast was associated with atherosclerotic buildup in a Spanish study, with light breakfasts also tied to subclinical plaque formation.
As opposed to eating large breakfasts, habitually skipping them was associated with more generalized atherosclerosis (29.2% versus 10%, OR 2.57, 95% CI 1.54-4.31), independent of traditional and dietary cardiovascular risk factors.
Breakfast-skippers were more likely to have atherosclerosis in the abdominal aorta (54.7% versus 27.9% OR 1.79, 95% CI 1.16-2.77) and carotid arteries (81% versus 36% OR 1.76, 95% CI 1.17-2.65), according to Valentin Fuster, MD, PhD, of Mount Sinai in New York City and Madrid’s Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, and colleagues in the October 10 issue of the Journal of the American College of Cardiology.
Compared with a full breakfasts, light ones comprising 5% to 20% of daily calories were still associated with more carotid artery (adjusted OR 1.21, 95% CI 1.03-1.43) and iliofemoral artery plaques (adjusted OR 1.17, 95% CI 1.00-1.37).
“The overall dietary pattern followed by skipping breakfast participants falls predominantly into our previously defined ‘social–business eating pattern’, with 45% of participants following this specific behavior. It is characterized by overall unhealthy food choices, frequent eating out, and busy schedules, which might shed light not only on the factors affecting the association between skipping breakfast and disease outcomes, but on the underlying reasons for this habit,” the authors suggested.
“In line with this cluster of behaviors, we hypothesize that aside from a direct association with cardiovascular risk factors, and atherosclerosis that deserves further research, skipping breakfast might serve as a marker for a general unhealthy diet or lifestyle, which in turn is associated with the development and progression of atherosclerosis.”
Men and smokers were more likely to skip breakfast. Skippers also drank more alcoholic beverages and ate more red meat.
Additionally, there was a trend toward more non-coronary atherosclerosis among those who didn’t eat before 10 in the morning (72.8% versus 54.8%, OR 1.55, 95% CI 0.97-2.46), their Progression of Early Subclinical Atherosclerosis (PESA) study data showed.
For it, Fuster’s group relied on employees of the Bank Santander Headquarters in Madrid (n=4,082), ages 40 to 54 years, to fill out a questionnaire self-reporting foods eaten in the past 15 days.
Participants averaged 2,315 kcal per day. The cohort was separated into those who had high-energy breakfasts contributing more than 20% of daily energy intake (27.7%), eaters of low-energy breakfasts comprising 5% to 20% of intake (69.4%), and the group that skipped breakfast altogether, eating less than 5%, or 123 kcal, of the daily intake in the morning (2.9%).
“It is worth mentioning that the percentage of participants in our study who were overweight or obese was significantly higher among skipping breakfast compared with low-energy breakfast or high-energy breakfast participants. In has been shown that adipose tissue not only serves as body energy storage but also plays an important role in cardiovascular inflammation processes,” according to the investigators.
The researchers acknowledged a lack of follow-up data, leaving them unable to ascertain whether obesity had a causative effect.
“Dietary patterns have changed significantly over the last few decades such that an estimated 20% to 30% of adults skip breakfast. These trends mirror the increase in obesity and associated cardiometabolic derangements,” commented Prakash Deedwania, MD, of the University of California San Francisco, and Tushar Acharya, MD, of the National Heart, Lung, and Blood Institute in Washington D.C.
“It is less clear whether skipping breakfast causes more people to be obese or if the obese skip breakfast with the misguided goal of losing weight,” Deedwania and Acharya suggested in a accompanying editorial, calling it a “chicken or egg” paradox.
Nevertheless, they said, “[g]iven the emerging evidence of association between altered dietary patterns and increased risk of obesity, metabolic syndrome, diabetes, subclinical atherosclerosis, and clinical cardiovascular 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 cardiovascular disorders,” according to the editorialists.

The PESA study was funded by the Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III, Banco Santander, Institute of Health Carlos III, and the European Regional Development Fund. The CNIC is supported by the Ministry of Economy, Industry and Competitiveness (MINECO) and the Pro-CNIC Foundation.
Fuster disclosed no relevant relationships with industry. A key co-author disclosed now being employed by Merck.
The editorialists disclosed no relevant relationships with industry.
• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
last updated 10.02.2017
• Primary Source
Journal of the American College of Cardiology
Source Reference: Uzhova I, et al “The importance of breakfast in atherosclerosis disease: insights from the PESA study” J Am Coll Cardiol 2017; DOI: 10.1016/j.jacc.2017.08.027.
• Secondary Source
Journal of the American College of Cardiology
Source Reference: Deedwania P and Acharya T “Hearty breakfast for healthier arteries” J Am Coll Cardiol 2017; DOI: 10.1016/j.jacc.2017.08.054.