Both low and high breakfast energy intake, as well as poor breakfast quality, were associated with adverse cardiometabolic outcomes in older adults with metabolic syndrome, according to a new study.
In the prospective observational study, published in The Journal of Nutrition, Health and Aging, researchers followed 383 participants (51.4% women, mean age = 65.4 ± 4.60 years) with metabolic syndrome for 36 months. At baseline, 80.7% of the participants had obesity, 69.7% had hypercholesterolemia, and 85.6% had hypertension.
The researchers analyzed 1,103 3-day food records collected at baseline, 24 months, and 36 months. The study found that compared with consuming 20% to 30% of daily energy intake at breakfast, both low (< 20%) and high (> 30%) breakfast energy intake were associated with adverse cardiometabolic outcomes.
At 36 months, participants with low breakfast energy intake showed increased body mass index (BMI) (+ 0.61 kg/m², 95% confidence interval [CI] = 0.19–1.02) and waist circumference (+ 2.22 cm, 95% CI = 0.96–3.48) compared with those consuming 20% to 30% of daily energy at breakfast. Those with high breakfast energy intake demonstrated even greater differences in BMI (+ 1.18 kg/m², 95% CI = 0.71–1.65) and waist circumference (+ 4.57 cm, 95% CI = 3.13–6.01).
The study examined breakfast quality using the Meal Balance Index, which evaluated nine nutrients including proteins, total fat, fiber, potassium, calcium, iron, sodium, added sugars, and saturated fat. The participants with low-quality breakfasts showed higher waist circumference (+ 1.50 cm, 95% CI = 0.53–2.46) and triglycerides (+ 5.81 mg/dL, 95% CI = 3.50–8.12), along with lower high-density lipoprotein (HDL) cholesterol (–1.66 mg/dL, 95% CI = –2.63 to –0.69) and estimated glomerular filtration rate (–1.22 mL/min/1.73m², 95% CI = –2.02 to –0.41).
Mean daily energy intake was 1,630 ± 300 kcal. Breakfast energy intake progressed from 23% at baseline to 24% at 24 months and 25% at 36 months. No correlation was found between percentage of energy consumed at breakfast and breakfast quality (r = 0.037, P-value = 0.47).
HDL cholesterol levels at 36 months showed statistically significant differences for both energy intake and quality groups. Low energy intake was associated with –2.13 mg/dL (95% CI = –3.41 to –0.85) and high energy intake with –4.56 mg/dL (95% CI = –6.04 to –3.09) compared with reference. Low quality breakfast was associated with –1.66 mg/dL (95% CI = –2.63 to –0.69).
Triglyceride differences at 36 months were similarly pronounced, with low energy intake associated with + 13.8 mg/dL (95% CI = 10.8–16.8) and high energy intake with + 28.1 mg/dL (95% CI = 24.7–31.6) compared with reference. Low quality breakfast was associated with + 5.81 mg/dL (95% CI = 3.50–8.12).
The study adjusted for multiple variables including age, sex, education, smoking, physical activity, and total daily caloric intake. Additional adjustments were made for baseline conditions such as hypercholesterolemia, hypertension, and diabetes when analyzing related parameters.
The researchers noted several limitations, including the observational design limiting causal inference, the specific study population of older adults with metabolic syndrome, potential self-reporting bias in food records, and the inability to assess energy intake and quality of other meals. All participants were also undergoing a weight loss intervention as part of the PREDIMED-Plus study.
The study employed validated measurement tools and protocols and implemented regular quality control measures for laboratory analyses. The findings suggested potential clinical implications for breakfast recommendations in older adults with metabolic syndrome.
Potential conflict of interest declarations can be found in the study.
