The PESA study shows that people who regularly eat a ‘low energy’ breakfast (supplying less than 5% of recommended daily calorie intake) double their risk of developing atherosclerosis independently of classical cardiovascular risk factors.
Skipping breakfast or eating very little at the start of the day doubles the risk of atherosclerosis. This is the latest finding from the Progression and Early Detection of Atherosclerosis study (PESA), led by the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) in partnership with Banco Santander, and is published today in the Journal of American College of Cardiology (JACC). The report shows that people whose breakfast contains less than 5% of the recommended daily calorie intake (100 calories for a daily intake of 2000) have on average twice the number of atherosclerotic lesions as those who eat a high-energy breakfast . This increased risk, moreover, is independent of classical risk factors such as smoking, high cholesterol, and physical inactivity. The report not only confirms the importance of eating breakfast for cardiovascular health, but also suggests that skipping breakfast could indicate more generally unhealthy eating and lifestyle habits.
The PESA-CNIC-Santander study is a prospective cohort study of more than 4000 middle-aged office workers and is led by CNIC General Director Dr. Valentín Fuster. Study participants are monitored with the latest imaging technologies over a 6-year period with the aim of characterizing the prevalence and progression of latent, ‘subclinical’ atherosclerotic lesions. These imaging findings are scrutinized for associations with molecular markers and environmental factors, including dietary habits, physical activity, biorhythms, psychosocial characteristics, and exposure to environmental pollutants. Atherosclerotic plaques are fatty deposits in the walls of arteries that first appear at a young age, but in these early phases they produce no symptoms, thus giving rise to the term subclinical atherosclerosis.
The significant impact of breakfast on cardiovascular health is well known. What the latest PESA project has done is to evaluate the relationship between 3 distinct breakfast patterns and the presence of atherosclerotic plaques in asymptomatic individuals. The results suggest that skipping breakfast is an indicator of more generally unhealthy lifestyle habits, associated with a higher prevalence of generalized atherosclerosis.
In the study population, 20% of participants regularly ate a high-energy breakfast, providing >20% of the recommended calorie intake. The largest proportion, 70%, ate a low-energy breakfast (between 5% and 20% of daily calorie intake), and 3% either skipped breakfast or ate very little (<5% of daily calorie intake). Individuals in this last category spent less than 5 minutes on breakfast, consuming only coffee or fruit juice, or skipped breakfast entirely. The CNIC research team also found that this group tended to have more generally unhealthy eating habits and a higher prevalence of cardiovascular risk factors.
Using ultrasound technology, the research team observed 1.5 times more atherosclerotic plaques in the arteries of breakfast skippers than in the vessels of study participants eating an energy-rich breakfast. Moreover, for some vascular regions the number of plaques was as much as 2.5 times higher in participants who skipped breakfast or ate very little.
Dr. Fuster, the principal investigator on the PESA study, considers that the support for PESA from the Santander group and the CNIC provides a model for other research and business organizations to follow: “We need earlier and more precise risk markers for the early phases of atherosclerosis that will allow us to improve strategies to prevent myocardial infarction, stroke, and sudden death. These latest results make a definite contribution to achieving this goal.”