Author + information
- Irina Uzhova, MSc and
- José L. Peñalvo, PhD∗ ()
- ↵∗Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, Massachusetts 02111
In our study, skipping breakfast was associated with a higher presence of subclinical atherosclerosis. We singled out this association by including in the multivariate regression models lifestyle-related variables identified as strongly associated with both the habit of skipping breakfast and atherosclerosis. Although an independent association seems to exist, the nature of our study did not allow for further elucidation of the physiological mechanisms involved. We read with great interest the letter by Reis and colleagues introducing the potential role of sleep restriction and levels of free fatty acids. Although this information is not currently available in our study, we agree it would be interesting to factor it into the relationship between breakfast patterns and development of subclinical atherosclerosis. In addition to the potential role that skipping breakfast may have on metabolic processes, and from a public health point of view, we underline in our study the fact that the habit of skipping breakfast tends to cluster with other unhealthy choices, including smoking. As suggested in the letter by Drs. Weinrauch and D'Elia, the breakfast patterns identified in our population are clearly linked to smoking habits, with twice the number of smokers in the group who skips breakfast compared to those in the high-energy breakfast group (1). Also, among smokers, and holding other variables constant, we found 1.6-higher odds of prevalent atherosclerosis among those who skipped breakfast (Table 1). In our study, participants who skipped breakfast also reported an overall suboptimal diet characterized by unhealthier food choices, frequently eating out, and greater intake of red and processed meat, snacks, sugary drinks, and alcoholic beverages. This cluster of unhealthy habits may explain the underlying reasons for a higher prevalence of subclinical atherosclerosis among these participants. As Drs. Weinrauch and D'Elia point out, specific interventions and clear messages are needed to achieve effective impacts on public health. In our study, we concluded that skipping breakfast could serve as an indicator of an overall unhealthy lifestyle, including smoking, and could be used as a simple educational message about the importance of healthy choices to prevent the onset of cardiovascular disease.
Please note: The PESA study is cofunded equally by the Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) and Banco Santander. The study also receives funding from the Institute of Health Carlos III grant PI15/02019 and European Regional Development Fund. The CNIC is supported by the Ministry of Economy, Industry and Competitiveness (MINECO) and the Pro CNIC Foundation and is a Severo Ochoa Center of Excellence (MINECO award SEV-2015-0505). Dr. Peñalvo is an employee of Merck KGaA. Ms. Uzhova has reported that she has no relationships relevant to the contents of this paper to disclose.
- 2018 American College of Cardiology Foundation