Physicians' Academy for Cardiovascular Education

Skipping breakfast or eating late at night increases risk of coronary heart disease

Cahill LE, Chiuve SE, Mekary RA et al. - Circulation. 2013 Jul 23;128(4):337-43

Prospective Study of Breakfast Eating and Incident Coronary Heart Disease in a Cohort of Male US Health Professionals.

Cahill LE, Chiuve SE, Mekary RA, et al.
Circulation. 2013 Jul 23;128(4):337-43. doi: 10.1161/CIRCULATIONAHA.113.001474


Although breakfast is commonly considered to be the most important meal of the day, no evidence-based recommendation exist about eating habits for adults. The 2002 National Health and Nutrition Examination Survey (NHANES) suggests that American adults frequently skip breakfast (18%) and snack (86%)[1]. Habits such as skipping meals have been positively associated with cardiometabolic health outcomes such as overweight [2] and weigh gain [3], dyslipidemia [4,5], blood pressure [6], insulin sensitivity [4,5] and diabetes mellitus [7].
This study aimed to prospectively determine whether eating habits, including skipping breakfast, are related to the risk of coronary heart disease (CHD). 51529 male participants were followed in the Health Professionals Follow-up Study (HPFS) through mailed questionnaires.

Main results

  • Men who did not eat breakfast had a 33% higher risk of CHD as compared to men who eat breakfast (RR: 1.33, 95%CI: 1.13-1.57). Adjusting for demographic, dietary and activity factors hardly changed the risk (RR: 1.27, 95CI%: 1.06-1.53), while further correction for potential mediators of BMI, hypercholesterolemia, hypertension and diabetes mellitus attenuated the risk (RR: 1.18, 95%CI: 0.98-1.43).
  • Men who eat late at night had a 55% higher CHD risk than men who did not eat late at night (RR: 1.55, 95%CI: 1.05-2.29). Performing the same analysis, but removing men with BMI>30 gave similar results (RR: 1.58, 95%CI: 1.02-2.46).
  • No association was found between eating frequency and risk of CHD.
  • Exclusion of participants with diabetes mellitus, hypertension or hypercholesterolemia at baseline gave very similar results.
  • When stratifying by age, men <60 years old who skipped breakfast had a higher CHD risk than men who ate breakfast (RR: 1.55, 95%CI: 1.09-2.22), while in older men skipping breakfast did not significantly increase risk of CHD (RR: 1.06, 95%CI: 0.84-1.33).


This large prospective study showed a higher risk of CHD in men who skip breakfast and among men who regularly eat late at night. Eating frequency was not associated with CHD risk. The found associations were consistent but modest, thus require confirmation in other studies and in women and other ethno-cultural group before a daily breakfast can be recommended to prevent CHD.


1. Kant AK, Graubard BI. Secular trends in patterns of self-reported food consumption of adult Americans: NHANES 19
2. Song WO, Chun OK, Obayashi S, et al. Is consumption of breakfast associated with body mass index in US adults? J Am Diet Assoc. 2005;105:1373–1382.
3. van der Heijden AA, Hu FB, Rimm EB, van Dam RM. A prospective study of breakfast consumption and weight gain among U.S. men. Obesity (Silver Spring). 2007;15:2463–2469.
4. Farshchi HR, Taylor MA, Macdonald IA. Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. Am J Clin Nutr. 2005;81:388–396.
5. Jenkins DJ, Wolever TM, Vuksan V, et al. Nibbling versus gorging: metabolic advantages of increased meal frequency. N Engl J Med. 1989;321:929–934.
6. Stote KS, Baer DJ, Spears K, et al. A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults. Am J Clin Nutr. 2007;85:981–988.
7. Mekary RA, Giovannucci E, Willett WC et al. Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking. Am J Clin Nutr. 2012;95:1182–1189.

Find this article on Pubmed