Author + information
- Received September 3, 2018
- Revision received December 8, 2018
- Accepted January 8, 2019
- Published online April 22, 2019.
- Shuang Rong, MD, PhDa,b,
- Linda G. Snetselaar, PhDb,
- Guifeng Xu, MDb,
- Yangbo Sun, MD, PhDb,
- Buyun Liu, MD, PhDb,
- Robert B. Wallace, MDb and
- Wei Bao, MD, PhDb,c,d,∗ (, )@UIowaCPH
- aDepartment of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China
- bDepartment of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
- cObesity Research and Education Initiative, University of Iowa, Iowa City, Iowa
- dFraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, Iowa
- ↵∗Address for correspondence:
Dr. Wei Bao, Department of Epidemiology, College of Public Health, University of Iowa, 145 North Riverside Drive, Room S431 CPHB, Iowa City, Iowa 52242.
Background Skipping breakfast is common among U.S. adults. Limited evidence suggests that skipping breakfast is associated with atherosclerosis and cardiovascular disease.
Objectives The authors sought to examine the association of skipping breakfast with cardiovascular and all-cause mortality.
Methods This is a prospective cohort study of a nationally representative sample of 6,550 adults 40 to 75 years of age who participated in the National Health and Nutrition Examination Survey III 1988 to 1994. Frequency of breakfast eating was reported during an in-house interview. Death and underlying causes of death were ascertained by linkage to death records through December 31, 2011. The associations between breakfast consumption frequency and cardiovascular and all-cause mortality were investigated by using weighted Cox proportional hazards regression models.
Results Among the 6,550 participants (mean age 53.2 years; 48.0% male) in this study, 5.1% never consumed breakfast, 10.9% rarely consumed breakfast, 25.0% consumed breakfast some days, and 59.0% consumed breakfast every day. During 112,148 person-years of follow-up, 2,318 deaths occurred including 619 deaths from cardiovascular disease. After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, body mass index, and cardiovascular risk factors, participants who never consumed breakfast compared with those consuming breakfast everyday had hazard ratios of 1.87 (95% confidence interval: 1.14 to 3.04) for cardiovascular mortality and 1.19 (95% confidence interval: 0.99 to 1.42) for all-cause mortality.
Conclusions In a nationally representative cohort with 17 to 23 years of follow-up, skipping breakfast was associated with a significantly increased risk of mortality from cardiovascular disease. Our study supports the benefits of eating breakfast in promoting cardiovascular health.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received September 3, 2018.
- Revision received December 8, 2018.
- Accepted January 8, 2019.
- 2019 American College of Cardiology Foundation
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