Skipping breakfast concomitant with late-night dinner eating is associated with worse outcomes following ST-segment elevation myocardial infarction

Nutrition plays a key role in cardiovascular disease prevention and treatment. Currently, new evidence reinforces the importance of specific foods and overall diet patterns, rather than single isolated nutrients for cardiovascular risk. In addition, a food-based approach facilitates patient guidance, and changes in eating behaviours in parents or children could modify the home food environment. Notwithstanding this evidence, eating behaviours are increasingly varied. Typical breakfast, lunch and dinner meals are difficult to distinguish because skipping meals has become more prevalent. Epidemiological and interventional studies suggest that skipping breakfast and late-night dinner eating (LNDE) are associated with a greater risk of obesity, insulin resistance and cardiovascular diseases. Thus the objective of this study was to evaluate the association between skipping breakfast concomitant with LNDE and the primary composite endpoint of death, reinfarction and postinfarction angina within 30 days after hospital discharge following ST-segment elevation myocardial infarction (STEMI). This was a prospective observational study approved by the ethics committee of the Botucatu Medical School (69513317.4.0000.5411). Written informed consent was obtained from all patients prior to their inclusion in the study. All patients older than 18 years with STEMI who were submitted to primary percutaneous coronary intervention and admitted to the coronary intensive care unit (ICU) from August 2017 to August 2018 were evaluated. The exclusion criteria were altered mental status and the need for mechanical ventilation, which did not allow eating behaviour assessment. On admission, a blood sample was taken and the patients’ demographic and clinical information were recorded. In addition, the eating behaviours, skipping breakfast and LNDE were evaluated. During ICU stay an echocardiography analysis was performed. All patients were followed during their hospital stays and for 30 days after hospital discharge. The primary composite endpoint was death, reinfarction and postinfarction angina within 30 days after hospital discharge. Skipping breakfast was defined as not eating anything before lunch, excluding beverages, such as coffee and water, at least three times per week. LNDE was defined as having dinner within 2 hours before bedtime at least three times per week. The data are expressed as the means standard deviations (SDs) or medians (including the lower and upper quartiles) or percentages. The statistical comparisons between groups for continuous variables were performed using Student’s t-tests for parameters that were normally distributed. For data that were not normally distributed, the comparisons between groups were made using the Mann–Whitney test. Fisher’s tests or chi-square tests were used for all categorical data. We also constructed two multiple logistic regression models to evaluate the association between skipping breakfast and LNDE with the primary composite endpoint. In the first model, skipping breakfast and LNDE were adjusted by age, gender, creatine phosphokinase myocardial type (CK-MB) and ejection fraction.