Can daily eating patterns influence long-term cardiometabolic health? A large study of nearly 16,000 adults suggests that frequently skipping breakfast may be associated with higher odds of metabolic syndrome, a major risk factor for heart disease.
Study: Relationship between skipping breakfast and metabolic syndrome among adults aged 35–74 years: a cross-sectional study in Northwest China, 2018–2020. Image credit: TanyaJoy/Shutterstock.com
Skipping breakfast may be linked to a higher risk of metabolic syndrome (MetS), according to a study published in Frontiers in Nutrition. Since MetS is a major risk factor for cardiovascular disease (CVD), such findings highlight the potential importance of regular breakfast consumption for improved cardiometabolic health.
Breakfast habits as a potential cardiometabolic risk modifier
Metabolic syndrome (MetS) affected 2.1 billion people in 2013, up from 857 million in 1980. This corresponds to a 28 % increase in adult prevalence, versus a 47 % rise in children. One of the modifiable risk factors for MetS might be irregular meals.
Breakfast is the first meal of the day, supplying about 20 % to 35 % of daily calories and jump-starting metabolic processes for the day. However, about 30 % of young Chinese routinely skip this meal, even though such a habit is linked to poorer nutrition, impaired cognition, altered behavior, and increased risk of metabolic disease.
Northwest China has a high prevalence of cardiometabolic disease. The current study focused on identifying an association between skipping breakfast and MetS in this region, so as to provide evidence for region-specific guidelines.
Examines breakfast habits and metabolic health
Evidence suggests that people who skip breakfast may face a higher risk of MetS, but whether this relationship is causal remains unclear, prompting the current cross-sectional observational study.
The study involved 15,959 adults aged 35–74 years who were part of the Northwest China Cohort–Ningxia Project (CNC-NX). The typical diet here is rich in carbohydrates. Participants were asked to self-report on lifestyle factors like smoking, alcohol, and breakfast consumption. Physical activity and food habits were also self-reported. Alongside, clinical data was collected (blood sugar, cholesterol levels, blood pressure, and waist circumference).
MetS was diagnosed by the presence of abdominal obesity plus two or more of the following: fasting hyperglycemia or diabetes, blood pressure 130/85 or higher, high plasma triglycerides or being on lipid-lowering medication, low high-density cholesterol (HDL).
Skipping breakfast tied to higher glucose, blood pressure, lower HDL
In this group, 8.3 % never skipped breakfast, while 87.1 % reported skipping breakfast four or more times per week, meaning most participants fell into the frequent-skipping group. In all breakfast categories, the largest proportion comprised people between 50 and 65 years.
MetS prevalence was 76.7 %. Among participants with MetS, 59.8 % were female and 40.2 % were male, which reflects the sex composition of the sample rather than indicating a higher risk in women. Notably, when different criteria were used, the prevalence dropped to 42.6 %, because the alternative NCEP ATP III criteria use higher thresholds for waist circumference and fasting blood glucose than the IDF criteria applied for Asian populations.
The subgroup that skipped breakfast most often, four or more times a week, had about 24 % higher odds of having MetS compared to those who regularly consumed breakfast. Among males, the odds were about 33 % higher among those who routinely skipped breakfast compared to those who never did, suggesting the association may be stronger in men. This was similar to the increase among those with a body mass index (BMI) between 24 and 27.9 kg/m².
When individual MetS components were analyzed, those who skipped breakfast four or more times a week were more likely to have high fasting blood sugar levels (about 33 % higher odds), high blood pressure (about 25 % higher odds), and low HDL-cholesterol (about 40 % higher odds) compared to those who regularly had breakfast. Abdominal obesity and high triglyceride levels were not associated with skipping breakfast.
These findings agree with prior research in other populations, but do not fully control for other important factors such as sleep patterns and diet quality. However, these findings were robust to adjustment for other factors, including demographic and lifestyle factors. Sensitivity analyses also confirmed their robustness. Moreover, the association continued to be observed when alternative MetS criteria were used.
According to the authors, skipping breakfast prolongs the overnight fast, which may trigger hyperinsulinemia and insulin resistance. This could help explain the observed rise in fasting blood glucose.
Skipping breakfast may coexist with changes in food intake later in the day, or altered metabolic response to prolonged fasting. This may also contribute to the observed low HDL levels. These hypothesized mechanisms may help explain the observed association. The authors emphasize that these are not causal inferences due to the cross-sectional nature of the study.
Self-reported diet and lifestyle data may introduce bias
According to the authors, this is the first large-scale study of this topic in Northwest China. The analysis was adjusted for confounding factors like lifestyle and food intake. However, much of the data was self-reported, possibly introducing recall bias, and residual confounding might be present due to differences in meal composition, body rhythms (including sleep), and socioeconomic characteristics.
The participants were drawn from a single region, possibly affecting generalizability and introducing selection bias. In addition, part of the data collection period overlapped with the early COVID-19 pandemic, which may have influenced daily routines and lifestyle behaviors.
Regular breakfast consumption may support cardiometabolic health strategies
Skipping breakfast is associated with MetS among adults. Encouraging middle-aged and older adults with a high BMI to have breakfast regularly may be a practical strategy worth evaluating in future research and public health programs, particularly in regions with high cardiometabolic risk.
Future experimental studies with longitudinal follow-up are required to provide causality data and decide on the impact of regular breakfast consumption on MetS risk.
Download your PDF copy by clicking here.
Nearly 70 weeks after infection, long COVID patients show no detectable inflammation in blood tests