Aims To explore the associations between breakfast energy intake and quality and time trajectories of cardiometabolic traits in high cardiovascular risk.

Methods 383 participants aged 55-75 from the PREDIMED-Plus cohort were included. Longitudinal averages of breakfast energy intake and quality were calculated. Three categories were defined for energy intake: 20-30% (reference), <20% (low), and >30% (high). Quality was estimated using the Meal Balance Index; categories were above (reference) or below the median score (low). Smoothed cubic spline mixed effects regressions described trajectories of cardiometabolic indicators (anthropometry, blood pressure, lipids, glucose, glycated hemoglobin, and estimated glomerular filtration rate) at breakfast groups. Inter-group differences in predicted values were estimated by linear regressions.

Results At 36 months, compared to the reference, low- or high-energy breakfasts were associated with differences in: body mass index (low: 0.62 kg/m2 [95% confidence interval: 0.28; 0.96]; high: 1.17 kg/m2 [0.79; 1.56]), waist circumference (low: 2.24 cm [1.16; 3.32]; high: 4.55 cm [3.32; 5.78]), triglycerides (low: 18.3 mg/dL [15.3; 21.4]; high: 34.5 cm [31.0; 38.1]), and HDL cholesterol (low: −2.13 mg/dL [−3.40; −0.86]; high: −4.56 mg/dL [−6.02; −3.10]). At 36 months, low-quality breakfast was associated with higher waist circumference (1.49 cm [0.67; 2.31]), and triglycerides (3.46 mg/dL [1.13; 5.80]) and less HDL cholesterol (−1.65 mg/dL [−2.61; −0.69]) and glomerular filtration rate (−1.21 mL/min/1.73m2 [−2.01; −0.41]).

Conclusions Low- or high-energy and low-quality breakfasts were associated with higher adiposity and circulating triglycerides, and lower HDL cholesterol in high-risk older adults. Low-quality breakfasts were also linked to poorer kidney function.

LAY SUMMARY Our work studied the relationship of the amount of energy consumed at breakfast or the dietary quality of breakfast with the evolution over time of 10 cardiometabolic traits (body mass index, waist circumference, triglycerides, HDL cholesterol, LDL cholesterol, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, glycated hemoglobin, and estimated glomerular filtration rate) in older adults with excess weight and metabolic syndrome.

Key findings

Compared to a breakfast with an adequate energy intake (containing 20-30% of daily energy), participants consuming either an insufficient or excessive energy in breakfast had higher values of body mass index, waist circumference, and triglycerides, and lower levels of HDL cholesterol.

Participants with poor breakfast quality, compared to those following a breakfast of higher quality, had higher waist circumference and triglycerides, and lower HDL cholesterol levels and estimated glomerular filtration rate.

Graphical abstract BMI: body mass index; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; Hb1Ac: glycated hemoglobin; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; SBP: systolic blood pressure; WC: waist circumference.

J.S.-S. reports being a board member and personal fees from Instituto Danone Spain; being a board member and grants from the International Nut and Dried Fruit Foundation. R.E. reports being a board member of the Research Foundation on Wine and Nutrition, the Beer and Health Foundation, and the European Foundation for Alcohol Research; personal fees from KAO Corporation; lecture fees from Instituto Cervantes, Fundacion Dieta Mediterranea, Cerveceros de Espana, Lilly Laboratories, AstraZeneca, and Sanofi; and grants from Novartis, Amgen, Bicentury, and Grand Fountaine. E.R. reports personal fees, grants, and nonfinancial support from the California Walnut Commission and Alexion; and nonfinancial support from the International Nut Council. All other authors report no conflicts of interest.

ISRCTN89898870

This work was supported by the Instituto de Salud Carlos III (grant numbers IFI20/00002, PI19/00017, PI15/00047, PI18/00020, PI16/00533, PI13/00233, PI21/00024, PI20/00012, and CP21/00097) and co-funded by the European Union. The funders played no role in study design, collection, analysis, or interpretation of data, and neither in the process of writing the manuscript and the publish process.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study follows the Declaration of Helsinki for Medical Research on human subjects. Before the study started, ethical approval was given by the Hospital del Mar Clinical Research Ethics Committee (Barcelona, Spain). All participants signed an informed consent before enrolling in the study. The protocol was registered in the ISRCTN Registry (PREDIMED-Plus: ISRCTN89898870). We followed the EQUATOR Network principles for guidance on study ethics and reporting.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

The generation and analysis of the data sets within this study are not projected to be open to access beyond the core research group. This is because the participants’ consent forms and ethical approval did not include provisions for public accessibility. However, we follow a controlled data-sharing collaboration model, as the informed consent documents signed by the participants allowed for regulated collaboration with other researchers for study-related research. Following an application and approval process by the PREDIMED-Plus Steering Committee, the data described in the manuscript, alongside the codebook and analytic code, will be available upon request. Researchers interested in this study can reach out to the Committee by sending a request letter to predimed_plus_scommitteegooglegroups.com. For those proposals that gain approval, a data-sharing agreement, outlining the specifics of the collaboration and data management, will be prepared and finalized.