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

[Association of regular consumption of breakfast and health-related behavior among adolescents]

The objective of this study was to estimate the frequency of regular breakfast consumption (five or more times a week) among adolescents, and to investigate the association with demographic variables, school and job shift, health-related behaviors, eating habits and food consumption. A cross-sectional study was conducted in 30 state schools in Curitiba, State of Paraná, with the participation of 1,232 adolescents. The prevalence of regular breakfast consumption was 58,6% (95% CI 53,9, 63.2). After adjusted analysis, higher regular breakfast consumption was observed among adolescents who: attended the evening and intermediate/full shifts; performed supervised physical activity; reported sleeping more than eight hours/night; reported having lunch and dinner with the family every day; and took 4 or more meals per day. The weekly frequency of breakfast was associated with higher consumption of milk and dairy products and the lower consumption of instant noodles and soft drinks. It is noteworthy that the habit of eating breakfast was associated with healthy eating practices and habits, reinforcing its values as a marker of other health-related behaviors. Partaking of breakfast should be encouraged among adolescents.

Breakfast association with arterial stiffness and carotid atherosclerotic burden. Insights from the 'Corinthia' study

BACKGROUND AND AIMS

The role of dietary patterns, in cardiovascular diseases has been challenged. The role of breakfast as an element of balance energy intake has gained research interest. However, the effects of dietary patterns related to breakfast consumption on vascular function are unknown. We explored the association of breakfast consumption habits with arterial wall elastic properties and carotid atherosclerosis.

METHODS AND RESULTS

In this cross-sectional study we enrolled 2043 inhabitants of the Corinthia region in Greece. Carotid-femoral pulse wave velocity (cf-PWV) was used to assess arterial stiffness. Carotid intima-media thickness (cIMT) was measured and the mean and the maximum cIMT were calculated. According to food frequency questionnaires, breakfast contribution in total daily energy intake (>20%; 5-20% and <5%) was estimated. Subjects were categorized as high-energy breakfast consumers (HeBC), low-energy breakfast consumers (LeBC) and those skipping breakfast (SBf) respectively. From the study population 240 subjects were categorized as HeBC, 897 as LeBC, and 681 as SBf. The mean cf-PWV was significantly higher in subjects SBf compared to LeBC and HeBC (9.35 ± 2.82 m/s vs. 9.09 ± 2.77 m/s vs. 8.76 ± 2.69 m/s, p = 0.02). The mean cIMT was significantly higher in subjects SBf compared to LeBC and HeBC (1.04 ± 0.46 mm vs. 0.99 ± 0.43 mm vs. 0.92 ± 0.39 mm, p = 0.01). Even after adjustment for potential confounders and cardiovascular risk factors SBf subjects have significantly increased mean cIMT and cf-PWV.

CONCLUSION

Skipping breakfast has an adverse effect on arterial stiffness and carotid atheromatic burden. Increased breakfast total energy intake may act protectively against atherosclerosis, a finding worth of further pathophysiologic exploration with potential clinical implications.

The Influence of Meal Frequency and Timing on Health in Humans: The Role of Fasting

The influence of meal frequency and timing on health and disease has been a topic of interest for many years. While epidemiological evidence indicates an association between higher meal frequencies and lower disease risk, experimental trials have shown conflicting results. Furthermore, recent prospective research has demonstrated a significant increase in disease risk with a high meal frequency (≥6 meals/day) as compared to a low meal frequency (1⁻2 meals/day). Apart from meal frequency and timing we also have to consider breakfast consumption and the distribution of daily energy intake, caloric restriction, and night-time eating. A central role in this complex scenario is played by the fasting period length between two meals. The physiological underpinning of these interconnected variables may be through internal circadian clocks, and food consumption that is asynchronous with natural circadian rhythms may exert adverse health effects and increase disease risk. Additionally, alterations in meal frequency and meal timing have the potential to influence energy and macronutrient intake.A regular meal pattern including breakfast consumption, consuming a higher proportion of energy early in the day, reduced meal frequency (i.e., 2⁻3 meals/day), and regular fasting periods may provide physiological benefits such as reduced inflammation, improved circadian rhythmicity, increased autophagy and stress resistance, and modulation of the gut microbiota.

Breakfast eating patterns and drivers of a healthy breakfast composition

Breakfast has long been described as the most important meal of the day. While breakfast habits and their consequences on children's health and performance are well documented, studies on the adult population are lacking. The present study will fill this gap, providing a comprehensive picture of the Swiss breakfast habits and insights into the determinants of a healthy breakfast composition. Data were collected through a postal survey sent out to a randomly selected sample of 1917 German-speaking Swiss residents, yielding a final sample size of N = 460. Breakfast habits were disclosed, and individual breakfast healthiness scores were assessed by two nutrition specialists. A multiple regression analysis was then performed to investigate the influence of several motivational, socio-demographic, health- and knowledge-related determinants on breakfast healthiness. The sample showed recommendable habits in terms of consumption frequency and quite traditional eating patterns, illustrated by the prevalence of continental breakfasts and equally marked by the frequent consumption of dairy products. Overall, the Swiss breakfast composition is moderately healthy, lacking fruits and whole grain products. Paying attention to healthy food choices in general, higher education level, being a woman and reporting to be fit are factors linked to a healthier breakfast composition; while preferences for low-fat, familiar or convenient foods are correlated to less healthy patterns. Given the parallel between the determinants of a healthy breakfast composition and those of a healthy diet and taking some limiting factors, such as consumers preference for convenience and strong habits, into account, we support the current nutritional advice focusing on balancing the diet over the day or the week rather than on recommendations dedicated to specific meals.

Daily Fasting Improves Health and Survival in Male Mice Independent of Diet Composition and Calories

The importance of dietary composition and feeding patterns in aging remains largely unexplored, but was implicated recently in two prominent nonhuman primate studies. Here, we directly compare in mice the two diets used in the primate studies focusing on three paradigms: ad libitum (AL), 30% calorie restriction (CR), and single-meal feeding (MF), which accounts for differences in energy density and caloric intake consumed by the AL mice. MF and CR regimes enhanced longevity regardless of diet composition, which alone had no significant impact within feeding regimens. Like CR animals, MF mice ate quickly, imposing periods of extended daily fasting on themselves that produced significant improvements in morbidity and mortality compared with AL. These health and survival benefits conferred by periods of extended daily fasting, independent of dietary composition, have major implications for human health and clinical applicability.

Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Background

Epidemiologic studies have indicated that breakfast skipping is associated with risk of type 2 diabetes. However, the shape of the dose-response relation and the influence of adiposity on this association have not been reported.

Objective

We investigated the association between breakfast skipping and risk of type 2 diabetes by considering the influence of the body mass index (BMI).

Methods

In this systematic review and meta-analysis, PubMed and Web of Science were searched up to August 2017. Prospective cohort studies on breakfast skipping and risk of type 2 diabetes in adults were included. Summary RRs and 95% CIs, without and with adjustment for BMI, were estimated with the use of a random-effects model in pairwise and dose-response meta-analyses.

Results

In total 6 studies, based on 96,175 participants and 4935 cases, were included. The summary RR for type 2 diabetes comparing ever with never skipping breakfast was 1.33 (95% CI: 1.22, 1.46, n = 6 studies) without adjustment for BMI, and 1.22 (95% CI: 1.12, 1.34, n = 4 studies) after adjustment for BMI. Nonlinear dose-response meta-analysis indicated that risk of type 2 diabetes increased with every additional day of breakfast skipping, but the curve reached a plateau at 4-5 d/wk, showing an increased risk of 55% (summary RR: 1.55; 95% CI: 1.41, 1.71). No further increase in risk of type 2 diabetes was observed after 5 d of breakfast skipping/wk (P for nonlinearity = 0.08).

Conclusions

This meta-analysis provides evidence that breakfast skipping is associated with an increased risk of type 2 diabetes, and the association is partly mediated by BMI.

Associations between questionnaires on lifestyle and atherosclerotic cardiovascular disease in a Japanese general population: A cross-sectional study

Objective

We aimed to investigate the association between questionnaires related to lifestyle habits and atherosclerotic cardiovascular diseases (ASCVD).

Design

Cross-sectional observational study.

Settings

Community-based medical checkups, called specific health checkups started in Japan since 2008. This checkup includes standard medical examinations as well as a specific questionnaire related to lifestyle habits.

Participants

Overall, 47,842 subjects (males = 16,913, 35.4%) aged ≥40 years who underwent a Japanese specific health checkup in 2014 in Kanazawa city were included.

Main outcome measures

Association between 12 lifestyle habits-related questionnaires and the presence of ASCVD, including coronary artery disease and stroke. The questionnaire included the following 12 questions on lifestyle habits: 1) weight gain (>10 kg/20 years), 2) exercise (>30 min, twice a week, >1 year), 3) daily walking or equivalent (>1 h), 4) walking faster (than others in the same generation), 5) body weight changes (>3 kg/year), 6) eating faster (than others in the same generation), 7) eating within 2 h before going to bed (more than three times a week), 8) having a snack after dinner (more than three times a week), 9) skipping breakfast (more than three times a week), 10) daily drinking (alcohol), 11) heavy drinking (more than 60 g ethanol/day), and 12) good sleeping.

Results

Multivariable logistic regression analyses revealed that walking faster (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.69–0.79, p < 0.0003), body weight changes (>3 kg/year, OR = 1.26, 95% CI = 1.16–1.37, p < 0.0003), eating faster (OR = 1.09, 95% CI = 1.03–1.15, p = 0.003), daily drinking (OR = 0.83, 95% CI = 0.76–0.89, p < 0.0003), and good sleeping (OR = 0.86, 95% CI = 0.79–0.93, p < 0.0003) were independently associated with ASCVD. Subjects with a high lifestyle habits risk score (number of bad habits: 7–12) had significantly higher odds for ASCVD than those with a low risk score (number of bad habits: 0–3, OR = 1.78, 95%CI = 1.62–1.95, p < 0.0003).

Conclusion

Simple questionnaires related to lifestyle habits were associated with self-reported ASCVD.

A time to fast

Nutrient composition and caloric intake have traditionally been used to devise optimized diets for various phases of life. Adjustment of meal size and frequency have emerged as powerful tools to ameliorate and postpone the onset of disease and delay aging, whereas periods of fasting, with or without reduced energy intake, can have profound health benefits. The underlying physiological processes involve periodic shifts of metabolic fuel sources, promotion of repair mechanisms, and the optimization of energy utilization for cellular and organismal health. Future research endeavors should be directed to the integration of a balanced nutritious diet with controlled meal size and patterns and periods of fasting to develop better strategies to prevent, postpone, and treat the socioeconomical burden of chronic diseases associated with aging.

Regularity of Breakfast Consumption and Diet: Insights from National Adult Nutrition Survey

Breakfast is considered to be one of the most important meals of the day. Its omission has been reported to be associated with increased disease risk, such as obesity, diabetes, and coronary heart disease, as well as unhealthy lifestyle and lower dietary quality. Using data from the National Adult Nutrition Survey (NANS)-a food consumption survey conducted among 1500 Irish men and women over 18 years of age, residing in the Republic of Ireland at the time the survey was conducted-we aimed to characterize breakfast regularity, identify dietary patterns associated with regular breakfast consumption, and assess the nutritional quality of such dietary patterns, using the nutrient-rich food index score NRF9.3. We determined two breakfast regularity categories and assessed dietary quality, by means of adherence to the principal component analysis derived dietary patterns and the NRF9.3 dietary index. Regular breakfast consumers were identified as those who consumed breakfast 3⁻4 times out of the 4 days of the collection period; such consumers comprised the majority of the population (94.4%). They had the highest adherence to healthier dietary patterns, namely, the "vegetarian" (odds ratio (OR): 2.59: 95% Confidence Interval (CI): 1.40, 4.77), "fish and vegetables" (OR: 2.88: 95% CI: 1.63, 5.10), and "breakfast cereals" (OR: 4.62: 95% CI: 2.43, 8.79) dietary patterns. Breakfast significantly contributed to the daily micronutrient intake by providing, on average, 24% of dietary fiber, 32% of iron, 30% of calcium, 32% of folate, and 37% of riboflavin. The importance of regular breakfast consumption on those who skip breakfast should be highlighted, in order to improve compliance with nutritional recommendations and adherence to a healthy lifestyle.

Breakfast Consumption in Spain: Patterns, Nutrient Intake and Quality. Findings from the ANIBES Study, a Study from the International Breakfast Research Initiative

This study aimed to investigate energy, nutrient and food group intakes at breakfast in Spain and to examine for the first time, their relationship to the overall Diet Quality (DQ). The data used were from the Spanish ANIBES (anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain), a cross-sectional study using a nationally representative sample of the Spanish population (9⁻75 years old). DQ was assessed using the Nutrient Rich Foods Index, adapted to total diets (NRF9.3d). Most (>85%) of the Spanish population were regular breakfast consumers, although one in five adolescents were breakfast skippers. Breakfast provides just 16⁻19% of the daily intake of energy. Relative to its daily energy contribution, the Spanish breakfast contributed a higher proportion of daily total carbohydrates, added sugars, sodium, thiamin, riboflavin, folates, iron, potassium, magnesium, phosphorus and especially in calcium. By contrast, the breakfast is low in water intake, protein, dietary fibre, total fat, polyunsaturated fatty acids, beta-carotene and vitamins E and D. In children and teenagers, the most commonly consumed breakfast food was chocolate (mainly as chocolate-flavoured milk and powder), followed by bakery and pastry, whole milk and semi-skimmed milk. In the older groups, a bigger variety of foods were reported. Consumers in the highest NRF9.3d tertile for diet quality tended to have a higher intake of positive nutrients at breakfast than other tertiles, most notably among adults.

Breakfast in Human Nutrition: The International Breakfast Research Initiative

Breakfast is often referred to as the most important meal of the day and in recent years has been implicated in weight control, cardio-metabolic risk factors and cognitive performance although, at present, the literature remains inconclusive as to the precise health benefits of breakfast. There are extensive reports of breakfast’s contributions to daily food and nutrient intakes, as well as many studies that have compared daily food and nutrient intakes by breakfast consumers and skippers. However, significant variation exists in the definitions of breakfast and breakfast skippers, and in methods used to relate breakfast nutrient intakes to overall diet quality. The present review describes a novel and harmonised approach to the study of the nutritional impact of breakfast through The International Breakfast research Initiative involving national dietary survey data from Canada, Denmark, France, Spain, the UK and the USA. It is anticipated that the analysis of such data along harmonised lines, will allow the project to achieve its primary goal of exploring approaches to defining optimal breakfast food and nutrient intakes. Such data will be of value to public health nutrition policy-makers and food manufacturers and will also allow consistent messaging to help consumers to optimize food choices at breakfast.

Generic Meal Patterns Identified by Latent Class Analysis: Insights from NANS (National Adult Nutrition Survey)

Nutritional data reduction methods are widely applied in nutrition epidemiology in order to classify individuals into meaningful groups with similar dietary patterns. To date, none of the existing studies have applied latent class analysis to examine dietary patterns which include meal types consumed throughout a day. We investigated main meal patterns followed on weekend and weekdays, and evaluated their associations with cardio-metabolic biomarkers. The analyses were performed within the NANS (National Adult Nutrition Survey) a cross-sectional national food consumption survey of 1500 nationally representative Irish adults. A total number of seven dietary patterns were identified using latent class analysis. The typical meal pattern followed by the majority of the population was characterized by consumption of cereal or toast for breakfast, skipping or consuming a sandwich for light meal, and meat or fish with potatoes, pasta or vegetables for the main meal. Eating patterns differed on weekends, and those participants who consumed meat and eggs for breakfast instead of breakfast cereal and skipped light meal were more likely to have an unhealthier dietary pattern, a higher diastolic blood pressure, and increased serum ferritin. The application of data reduction techniques to simplify the multifaceted nature of dietary data is a useful approach to derive patterns, which might shed further light on the typical dietary patterns followed by populations.

Cultural primer for cardiometabolic health: health disparities, structural factors, community, pathways to improvement, and clinical applications

The quest to optimize cardiometabolic health has created great interest in nonmedical health variables in the population, community-based research and coordination, and addressing social, ethnic, and cultural barriers. All of these may be of equal or even greater importance than classical health care delivery in achieving individual well-being. One dominant issue is health disparity - causes, methods of reduction, and community versus other levels of solutions. This communication summarizes some major views regarding social structures, followed by amplification and synthesis of central ideas in the literature. The role of community involvement, tools, and partnerships is also presented in this Primer. Recent views of how these approaches could be incorporated into cardiometabolic initiatives and strategies follow, with implications for research. Two examples comparing selected aspects of community leverage and interventions in relation to individual approaches to health care equity are examined in depth: overall performance in reducing cardiovascular risk and mortality, and the recent National Diabetes Prevention Program, both touching upon healthy diets and adherence. Finally, the potential that precision medicine offers, and possible effects on disparities are also discussed.