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Midnight Snacks May Hurt Heart

Skipping breakfast or eating late at night should top the not-to-do lists of men in middle age and beyond; not only do they have metabolic effects, they may also put men at higher risk for coronary heart disease…. 

According to Leah Cahill, PhD, of the Harvard School of Public Health in Boston, and colleagues, male health professionals over a 16-year period, who said they regularly skipped breakfast were 27% more likely to die, and those who said they ate late at night were 55% more likely to die.

Both relationships, however, fell shy of statistical significance after further adjustment for BMI, hypertension, hypercholesterolemia, and diabetes, "suggesting that eating habits may affect risk of coronary heart disease through pathways associated with these traditional risk factors." The results should be validated in other studies, researchers said.

"If replicated in women and other ethno-cultural groups, the findings from the present study provide evidence to support a recommendation of daily breakfast eating by clinicians and health authorities to prevent coronary heart disease and to improve health at both the individual and population levels," they wrote.

Co-author Eric Rimm, ScD added that, "There’s lots of things we know that we can do to reduce our coronary heart disease risk." "

In a scientific statement from the American Heart Association in 2012, researchers outlined effective population approaches to improve dietary habits. In 2013, the organization updated its guide for improving cardiovascular health at the community level.

Previous studies have demonstrated associations between skipping meals and excess weight, dyslipidemia, hypertension, insulin resistance, and diabetes, but a possible association with coronary heart disease had not been explored.

Cahill and colleagues examined the relationship between coronary heart disease risk and skipping breakfast and other eating habits using data from the Health Professionals Follow-Up Study (HPFS), an ongoing investigation of male health professionals.

The current analysis included 26,902 men ages 45 to 82 who were free from cardiovascular disease and cancer in 1992, which served as baseline. At that point, 13% reported not eating breakfast and 0.2% said they ate late at night.

Through follow-up, there were 1,527 incident cases of coronary heart disease, defined as nonfatal MI or fatal coronary heart disease.

The relationships between coronary heart disease and both skipping breakfast and eating late at night became nonsignificant after adjustment for potential mediators — RR 1.18 (95% CI 0.98-1.43) for skipping breakfast and RR 1.41 (95% CI 0.95-2.08) for late-night eating.

"However," the authors noted, "we were underpowered with cases for a detailed mediation analysis, especially for late-night eating." "The late-night eaters in our study represented only a small percentage of the HPFS population, and too few other population studies have reported the frequency of late-night eating for an accurate assessment of whether late-night eating is a common habit," they wrote. "Therefore, it remains unknown whether the association that we observed between late-night eating and risk of coronary heart disease is relevant as a public health concern."

The number of times the men ate per day was not associated with the risk of coronary heart disease, even though previous analyses of this cohort have shown relationships between eating frequency and weight gain and type 2 diabetes.

Circulation: Journal of the American Heart Association

Source reference: Cahill L, et al "Prospective study of breakfast eating and incident coronary heart disease in a cohort of male U.S. health professionals" Circulation 2013; DOI: 10.1161/CIRCULATIONAHA.113.001474.