Behind the headlines

Does skipping breakfast raise your risk of heart disease?

Breakfast of cereal, fruit and juice
31st January 2017

News stories have suggested that if you skip breakfast you can increase your risk of heart disease. But are you really risking your health if you’re not a breakfast person?

The research

The report is actually a ‘scientific statement’ from the American Heart Association looking at pre-existing studies, rather than a new study. It was led by led by experts at Columbia University in New York, and looked at studies into breakfast skipping, meal frequency, meal timing, and fasting, and the link between people’s risk of heart disease, obesity, diabetes, stroke and high blood pressure.

Should you eat breakfast?  

The researchers found that skipping breakfast was linked to obesity, diabetes, high blood pressure, stroke risk and people not getting enough vitamins and minerals from their diet. One study found that 74 per cent of breakfast skippers did not meet two thirds of the (American) Recommended Dietary Allowance for vitamins and minerals, compared with 41 per cent of those who consumed breakfast. Another study showed that daily breakfast eaters were less likely to have risk factors for heart and circulatory disease, high levels of LDL (bad) cholesterol, low levels of HDL (good) cholesterol, and high blood pressure.

They concluded that an irregular meal pattern where meals are skipped, which is most commonly breakfast or sometimes lunch, may affect risk factors for CVD such as type 2 diabetes, raised cholesterol and high blood pressure. Eating breakfast every day could help you to eat healthily the rest of the day.

Media coverage

The study was covered in the Daily Mail, the Express, and The Sun, who all focused on the skipping breakfast part of the study. 

The researchers suggest there is a link, not a cause and effect

The Sun said ‘medics warn’ that skipping breakfast ‘could leave you at risk of a heart attack, stroke or diabetes’. But the researchers suggest there is a link, not a cause and effect, and say that more research is needed before any definitive statements are made. The researchers said there was ‘limited evidence’ in this area. 

Some coverage overemphasised the size of the review, describing it as ‘a major review’ though it looked at a total of 26 studies: 10 studies on intermittent fasting and the risk of coronary heart disease (CHD), and 16 studies on meal frequency, including skipping meals, and CHD risk. Moreover, some of the studies were short (some lasting two weeks), or based in Japan or South Korea – where the diet could be very different to the UK.

The BHF view

Victoria Taylor, Senior Dietitian at the British Heart Foundation, said: “This study shows that it’s not only what we eat but also when we eat it that affects our risk of heart disease. 

“What we eat is still important, but when we are rushed it can seem simpler to just grab what is available rather than seeking out a healthy choice. Taking a few minutes to plan ahead before you do your food shop will help to ensure that you eat regular meals and make nutritious choices throughout the week.”

How often should you eat?

Eating more often was associated with a lower risk of obesity. For example, a study based in Massachusetts, USA, looked at nearly 500 people, and found people who ate four times a day or more had a significantly lower risk of obesity compared to people who ate three times a day or less. Overall, eating more frequently was associated with lower cholesterol, and a lower risk of developing diabetes.

More research is needed before there are any definitive conclusions

But the researchers admit ‘these findings should be interpreted with caution’ as some trials didn’t have a control group, very few studies controlled exactly what participants ate and when, and sample sizes of some of the groups being compared in individual studies  were quite small (between 7–19 people). More research is needed before there are any definitive conclusions on the impact of meal frequency on diabetes, heart disease or stroke.

What time should you eat?

The researchers admit that ‘very few’ studies look at meal timing and risk of heart or circulatory disease, and most have been single day studies with few participants.

They said that the timing of meals and eating late needs further study, but some studies suggest a potential detrimental effect of late meals on heart health. Another important limitation is that the definition of late-night eating differs between studies.

The research has ‘been limited in scope and too diverse to draw definitive conclusions and make recommendations,’ the report said.

Does fasting work?

The research also looked at periodic fasting (reducing your calorie intake substantially, usually to 500 calories, or less than a quarter of your daily calorie requirements, on one or two days a week), as well as fasting on alternate days. The effect on people’s cholesterol varied – for some people intermittent fasting reduced it and for other people it had no effect. To lower their blood pressure, participants had to lose a minimum 6 per cent of their body weight to see an effect. However, the researchers admitted that there is no data that indicates whether the weight loss from fasting can be sustained long term.

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