Breakfast energy intake and dietary quality and trajectories of cardiometabolic risk factors in older adults - 06/11/24

Doi : 10.1016/j.jnha.2024.100406

Karla-Alejandra Pérez-Vega ^a,^b,^c, Camille Lassale ^a,^b,^d,^e, María-Dolores Zomeño ^a,^b,^f, Olga Castañer ^a,^g, Jordi Salas-Salvadó ^b,^h,ⁱ, F. Javier Basterra-Gortari ^j,^k, Dolores Corella ^b,^l, Ramón Estruch ^b,^m,ⁿ, Emilio Ros ^b,ⁿ, Francisco J. Tinahones ^b,^o, Gemma Blanchart ^a, Mireia Malcampo ^a,^b, Daniel Muñoz-Aguayo ^a,^b, Helmut Schröder ^a,^g, Montserrat Fitó ^a,^b, Álvaro Hernáez ^a,^f,^p,⁎
^a Hospital del Mar Research Institute (IMIM), Carrer Doctor Aiguader 88, 08003 Barcelona, Spain
^b Consorcio Centro de Investigación Biomédica En Red (CIBER), M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Avenida Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
^c PhD Program in Food Science and Nutrition, Universitat de Barcelona, Campus Diagonal, Avinguda Joan XXIII 27-31, 08028 Barcelona, Spain
^d Barcelona Institute for Global Health (ISGlobal), Carrer Doctor Aiguader 88, 08003 Barcelona, Spain
^e Universitat Pompeu Fabra (UPF), Carrer Ramon Trias Fargas 25-27, 08005 Barcelona, Spain
^f Blanquerna School of Health Sciences, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain
^g Consorcio Centro de Investigación Biomédica En Red (CIBER), M.P. Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Avenida Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
^h Universitat Rovira i Virgili, Departament de Bioquimica i Biotecnologia, Alimentaciò, Nutrició, Desenvolupament i Salut Mental ANUT-DSM, Carrer Sant Llorenç 21, 43201 Reus, Spain
ⁱ Institut d'Investigació Pere Virgili, Carrer Sant Llorenç 21, 43201 Reus, Spain
^j University of Navarra, Department of Preventive Medicine and Public Health, IdiSNA, Calle Irunlarrea 1, 31008 Pamplona, Spain
^k Department of Endocrinology and Nutrition, Hospital Universitario de Navarra, IdiSNA, Universidad Pública de Navarra, Calle Irunlarrea 3, 31008 Pamplona, Spain
^l Department of Preventive Medicine, Universidad de Valencia, Avinguda Vicent Andrés Estellés s/n, 46100 Valencia, Spain
^m Internal Medicine Service, Hospital Clinic, Carrer Villarroel 170, 08036 Barcelona, Spain
ⁿ August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Carrer Rosselló 149, 08036 Barcelona, Spain
^o Virgen de la Victoria Hospital, Department of Endocrinology, Biomedical Research Institute of Málaga, University of Málaga, Campus de Teatinos s/n, 29010 Málaga, Spain
^p Consorcio Centro de Investigación Biomédica En Red (CIBER), M.P. Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Avenida Monforte de Lemos 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain

^⁎Corresponding author.

Graphical abstract

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Highlights

•	Eating 20−30% of daily energy in breakfast links to less adiposity in older adults.
•	It is also related to less triglycerides and more HDL cholesterol (HDL-C).
•	A high-quality breakfast is linked to better adiposity, HDL-C, and kidney function.
•	Healthy breakfast habits relate to healthy aging by improving heart risk factors.

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Abstract

Objectives

Not skipping breakfast is associated with a better overall diet quality and lower cardiometabolic risk. However, the impact of calorie intake and dietary quality of breakfast on cardiovascular health remains unexplored. We aimed to study the associations between breakfast energy intake and quality and time trajectories of cardiometabolic traits in high cardiovascular risk participants.

Design

Prospective observational exploratory study with repeated measurements.

Setting

Spanish older adults.

Participants

383 participants aged 55–75 with metabolic syndrome from PREDIMED-Plus, a clinical trial involving a weight-loss lifestyle intervention based on the Mediterranean diet.

Measurements

Participants were followed for 36 months. Longitudinal averages of breakfast energy intake and quality were calculated. Three categories were defined for energy intake: 20−30% (reference), <20% (low), and >30% (high). Quality was estimated using the Meal Balance Index; categories were above (reference) or below the median score (low). Natural cubic spline mixed effects regressions described trajectories of cardiometabolic indicators (anthropometry, blood pressure, lipids, glucose, glycated hemoglobin, and kidney function) in breakfast groups. Inter-group differences in predicted values were estimated by linear regressions. Analyses were adjusted for age, sex, PREDIMED-Plus intervention group, education, smoking, physical activity, and total daily kilocalorie intake. Lipid profile analyses were further adjusted for baseline hypercholesterolemia, blood pressure analyses for baseline hypertension, and glucose/glycated hemoglobin analyses for baseline diabetes. Breakfast energy intake analyses were adjusted for breakfast quality, and vice versa.

Results

At 36 months, compared to the reference, low- or high-energy breakfasts were associated with differences in body mass index (low: 0.61 kg/m² [95% confidence interval: 0.19; 1.02]; high: 1.18 kg/m² [0.71; 1.65]), waist circumference (low: 2.22 cm [0.96; 3.48]; high: 4.57 cm [3.13; 6.01]), triglycerides (low: 13.8 mg/dL [10.8; 16.8]; high: 28.1 cm [24.7; 31.6]), and HDL cholesterol (low: −2.13 mg/dL [−3.41; −0.85]; high: −4.56 mg/dL [−6.04; −3.09]). At 36 months, low-quality breakfast was associated with higher waist circumference (1.50 cm [0.53; 2.46]), and triglycerides (5.81 mg/dL [3.50; 8.12]) and less HDL cholesterol (−1.66 mg/dL [−2.63; −0.69]) and estimated glomerular filtration rate (−1.22 mL/min/1.73m² [−2.02; −0.41]).

Conclusions

Low- or high-energy and low-quality breakfasts were associated with higher adiposity and triglycerides, and lower HDL cholesterol in high-risk older adults. Low-quality breakfasts were also linked to poorer kidney function.

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Keywords : Breakfast, Body mass index, Waist circumference, Triglycerides, HDL cholesterol, Glomerular filtration rate