Harry E. Davis II , MD, FACP
Cahill LE, Chiuve SE, Mekary RA, et al. Prospective study of breakfast eating and incident coronary heart disease in a cohort of male US health professionals. Circulation
The contribution of personal habits such as eating, drinking, smoking, and exercise to health status and long-term survival form a key component of disease prevention. However, it is very difficult to prove that specific preventive efforts actually improve a person’s health. We can assume that lifelong efforts to maintain a healthy diet, exercise regularly, or avoid smoking will contribute to preventing coronary heart disease. But, to paraphrase Harvey Fineberg, MD, PhD, President of the Institute of Medicine, success in disease prevention is invisible,1
and the need for evidence-based recommendations to support preventive efforts is appreciated.
Cahill et al have attempted to provide some of this evidence.2
They have examined the dietary habits in a large cohort of males that included dentists, veterinarians, pharmacists, optometrists, osteopaths, and podiatrists. As part of the ongoing prospective study of 51,529 male health professionals in the Health Professionals Follow-up Study (HPFS), they followed a cohort of these professionals from 1992 until January 31, 2008, using mailed biennial questionnaires that addressed medical history, lifestyle, and health-related behaviors. After excluding men who had died before the start of this collection period, those with extremes of caloric intake (total energy intake outside the range of 800 cal/d to 4,200 cal/d), and individuals with known cancer, coronary heart disease (CHD), myocardial infarction, angina, or stroke, they examined the responses to these serial questionnaires in a final sample size of 26,902 men.
Through a series of statistical analyses they found significant differences, primarily with regard to eating breakfast and eating late at night. Breakfast was defined as any of 3 eating times (before breakfast, breakfast, and between breakfast and lunch). Men who skipped breakfast had a 33% higher age-adjusted risk of CHD, were younger, and were more likely to be smokers, unmarried, less physically active, and to drink more alcohol. The late-night eaters (defined as eating after going to bed) had a 55% higher risk of CHD and were more likely to smoke, to sleep less than 7 hours a night, or to have baseline hypertension. On the other hand, men who ate breakfast were more likely to be nonsmokers, to be married, to be more physically active, and less likely to work full-time (71% worked full-time vs 77% for the non-breakfast eaters).
Overall diet quality was assessed using a calculated diet score based on the 2010 Alternate Eating Index,3
which has been shown to predict the risk of chronic disease. The authors concluded “Eating breakfast was associated with significantly lower CHD risk in this cohort of male health professionals.” They indicated they had not found evidence of any prior such studies and concluded they were the first to conduct a prospective analysis of eating habits and the risk of CHD. Accordingly, they recognized the need for replication “in women and other ethno-cultural groups” but, if confirmed, a recommendation for daily breakfast eating would be warranted.