Is breakfast the most important meal of the day? It’s a topic that’s been debated for a century or more. Some dietitians, deservedly or not, have been skeptical, drawing attention to the involvement of the food industry in financing research that supports the claim while also pointing out the high sugar content of some cereals and the possible problems associated with foods like bacon and eggs. On the other hand, some researchers contend that because the body uses energy during the night to repair itself, that energy needs to be replenished in the morning. One expression that has been used is that breakfast “jumpstarts” the body’s metabolism, which helps a person burn more calories during the day. And more energy during the day means the likelihood of more exercise. Also, some studies have suggested that people who make breakfast their biggest meal of the day tend to have a lower body-mass index (BMI; a measure of weight in relation to height) than those who prefer large lunches or dinners. Skeptics counter that people who work regular hours (and therefore find it easier to schedule breakfast) and can afford more nutritious foods tend to have better overall health in general.
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The issue of breakfast is of special interest to people with diabetes because some research suggests that whether or not a person eats breakfast might affect that person’s risk of developing the illness or their ability to control blood sugar. For example, a study done in Israel in 2015 indicated that skipping breakfast was associated with an increase in blood sugar spikes during the day. And in January 2019, German researchers published in The Journal of Nutrition a “meta-analysis” of previous studies and concluded their survey “provides evidence that breakfast skipping is associated with an increased risk of type 2 diabetes.”
Now a new study from a team of researchers in China and the United States has revealed yet more precise data on the possible connection between the size of breakfast and the risk of death from diabetes. The researchers, who were led by Tianshu Han, PhD, of the department of nutrition and food hygiene at Harbin Medical University School of Public Health, studied data taken from 4,699 adult diabetes patients (about half were men, half were women) who had taken part in the U.S. National Health and Nutrition Examination Survey from 2003 to 2014. They also acquired death data from the U.S. National Death Index, a centralized database of death record information. The researchers evaluated food intake by means of the patients’ recollections and estimated dietary and energy intake through the use of guidelines issued by the U.S. Department of Agriculture. They used statistical models to evaluate connections between death from diabetes, cardiovascular disease (CVD), and other causes to differences in energy intake. During the study period 913 of the subjects died, with 269 deaths ascribed to diabetes and 314 to CVD.
The researchers found that the subjects who showed the greatest difference in energy intake between breakfast (low) and dinner (high) were almost twice as likely to die of diabetes and nearly 70% more likely to die of CVD. They then examined the data to see if replacing energy intake at dinner with energy intake at breakfast would make a difference. The concluded that replacing 5% of total energy at dinner with breakfast was associated with a 4% lower risk of death from diabetes and a 5% lower risk of death from CVD.
The researchers acknowledged that the study was limited by the short duration of the dietary measurements and cautioned that “future research is needed to evaluate the longitudinal effect of energy and macronutrient distribution on mortality outcomes.” Nevertheless, they concluded, “The most important finding of this study was that higher intake of energy at dinner than breakfast was significantly associated with diabetes and CVD mortality, and this association was independent of a series of traditional dietary risk factors, in particular, breakfast skipping and diet quality. This study provides evidence of adverse effects of high energy intake at dinner and emphasized the importance of energy distribution across meals…. Higher intake of energy, total fat and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes.”
Want to learn more about breakfast and diabetes? Read “What You Should Eat for Breakfast If You Have Diabetes,” “The Benefits of Breakfast” and “The Importance of Breakfast.”