Breakfast energy intake and dietary quality and trajectories of cardiometabolic risk factors in older Spanish adults
Authors: Pérez-Vega Karla Alejandra , Lassale Camille , Zomeño María Dolores , Castañer Olga , Salas-Salvadó Jordi , Basterra-Gortari F. Javier , Corella Dolores , Estruch Ramón , Ros Emilio , Tinahones Francisco J. , Blanchart Gemma , Malcampo Mireia , Muñoz-Aguayo Daniel , Schröder Helmut , Fitó Montserrat , Hernáez Álvaro 
Published: January 2024

Aims

To explore the associations between breakfast energy intake and quality and time trajectories of cardiometabolic traits in high cardiovascular risk.

Methods

383 participants aged 55-75 from the PREDIMED-Plus cohort were included. 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). Smoothed cubic spline mixed effects regressions described trajectories of cardiometabolic indicators (anthropometry, blood pressure, lipids, glucose, glycated hemoglobin, and estimated glomerular filtration rate) at breakfast groups. Inter-group differences in predicted values were estimated by linear regressions.

Results

At 36 months, compared to the reference, low- or high-energy breakfasts were associated with differences in: body mass index (low: 0.62 kg/m2[95% confidence interval: 0.28; 0.96]; high: 1.17 kg/m2[0.79; 1.56]), waist circumference (low: 2.24 cm [1.16; 3.32]; high: 4.55 cm [3.32; 5.78]), triglycerides (low: 18.3 mg/dL [15.3; 21.4]; high: 34.5 cm [31.0; 38.1]), and HDL cholesterol (low: −2.13 mg/dL [−3.40; −0.86]; high: −4.56 mg/dL [−6.02; −3.10]). At 36 months, low-quality breakfast was associated with higher waist circumference (1.49 cm [0.67; 2.31]), and triglycerides (3.46 mg/dL [1.13; 5.80]) and less HDL cholesterol (−1.65 mg/dL [−2.61; −0.69]) and glomerular filtration rate (−1.21 mL/min/1.73m2[−2.01; −0.41]).

Conclusions

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

LAY SUMMARY

Our work studied the relationship of the amount of energy consumed at breakfast or the dietary quality of breakfast with the evolution over time of 10 cardiometabolic traits (body mass index, waist circumference, triglycerides, HDL cholesterol, LDL cholesterol, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, glycated hemoglobin, and estimated glomerular filtration rate) in older adults with excess weight and metabolic syndrome.

Key findings

Compared to a breakfast with an adequate energy intake (containing 20-30% of daily energy), participants consuming either an insufficient or excessive energy in breakfast had higher values of body mass index, waist circumference, and triglycerides, and lower levels of HDL cholesterol.

Participants with poor breakfast quality, compared to those following a breakfast of higher quality, had higher waist circumference and triglycerides, and lower HDL cholesterol levels and estimated glomerular filtration rate.

Graphical abstract

BMI: body mass index; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; Hb1Ac: glycated hemoglobin; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; SBP: systolic blood pressure; WC: waist circumference.