Etude sur les rapports entre petit-déjeuner et risques cardiovasculaires (ENG)

American Heart Association

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Etude sur les rapports entre petit-déjeuner et risques cardiovasculaires (ENG)

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• Publié par: Fil_Sante
• Publié le: 24 juillet 2013
• Nombre de lectures: 1 194
• Langue: English

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Prospective Study of Breakfast Eating and Incident Coronary Heart Disease in a Cohort of Male US Health ProfessionalsClinical Perspective Leah E. Cahill, Stephanie E. Chiuve, Rania A. Mekary, Majken K. Jensen, Alan J. Flint, Frank B. Hu and Eric B. Rimm

Circulation.2013;128:337-343 doi: 10.1161/CIRCULATIONAHA.113.001474 Circulationis published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2013 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

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A dations exist for adults in terms of eating habits (the frequency prospective studies report that eating habits such as skipping and or timing of meals, snacks, and caloric beverages). The meals have been positively associated with several cardio- 2010 Dietary Guidelines for Americans recommend breakfast metabolic health outcomes, including overweight 4 and weight for children but make no recommendation for adults, stating gain, 5  dyslipidemia, 6,7  pressure, blood 8  insulin sensitivity, 6,7   “behaviors have been studied, such as snacking and frequency and diabetes mellitus. 9 However, to the best of our knowledge, of eating, but there is currently not enough evidence to support no human studies of eating habits and coronary heart disease a specific recommendation for these behaviors.” 1 (CHD) have been published. The objective of our study was to Clinical Perspectie on p 343 prospectively determine whether eating habits, including skip- ping breakfast, are related to an increased risk of CHD. Results from the 2002 National Health and Nutrition Examination Survey (NHANES) suggest that snacking andMethods skipping breakfast are common practices among American Study Population adults, with 18% skipping breakfast and 86% snacking each The Health Profession ls Follow-up Study (HPFS) is an ongoing day. 2  The Nationwide Food Consumption Survey 1965 to iossfero pthalhe ,stsitned( slan a vet-pve studyrospecti92m la eo  f155  1991 reported that breakfast consumption is down from erinarians, pharmacists, optometrists, osteopaths, and podiatrists) 86% (1965) to 75% (1991). 3  This trend may have adverse 40 to 75 years of age at enrollment in 1986. Approximately 97% of

Epidemiology and Preention

Backgroundassociated with excess body weight, hypertension, insulin resistance, and—Among adults, skipping meals is elevated fasting lipid concentrations. However, it remains unknown whether specific eating habits regardless of dietary composition influence coronary heart disease (CHD) risk. The objective of this study was to prospectively examine eating habits and risk of CHD. Methods and Results—Eating habits, including breakfast eating, were assessed in 1992 in 26 902 American men 45 to 82 years of age from the Health Professionals Follow-up Study who were free of cardiovascular disease and cancer. During 16 years of follow-up, 1527 incident CHD cases were diagnosed. Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals for CHD, adjusted for demographic, diet, lifestyle, and other CHD risk factors. Men who skipped breakfast had a 27% higher risk of CHD compared with men who did not (relative risk, 1.27; 95% confidence interval, 1.06–1.53). Compared with men who did not eat late at night, those who ate late at night had a 55% higher CHD risk (relative risk, 1.55; 95% confidence interval, 1.05–2.29). These associations were mediated by body mass index, hypertension, hypercholesterolemia, and diabetes mellitus. No association was observed between eating frequency (times per day) and risk of CHD. Conclusions—Eating breakfast was associated with significantly lower CHD risk in this cohort of male health professionals. (Circulation. 2013;128:337–343.) Key Words: disease coronary ◼  epidemiology ◼  myocardial infarction ◼  sciences nutritional ◼  prevention &  control

Prospectie Study of Breakfast Eating and Incident Coronary Heart Disease in a Cohort of Male US Health Professionals Leah E. Cahill, PhD; Stephanie E. Chiuve, ScD; Rania A. Mekary, PhD; Majken K. Jensen, PhD; Alan J. Flint, MD, DrPh; Frank B. Hu, MD, PhD; Eric B. Rimm, ScD

the most consequences at a population level because results from short- duration trials, preliminary cross-sectional studies, and small

Received September 20, 2012; accepted May 23, 2013. From the Departments of Nutrition (L.E.C., S.E.C., R.A.M., M.K.J., A.J.F., F.B.H., E.B.R.) and Epidemiology (F.B.H., E.B.R.), Harvard School of Public Health, Boston, MA; and Division of Preventive Medicine (S.E.C.) and Channing Division of Network Medicine (F.B.H., E.B.R.), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA. Guest Editor for this article was Robert H. Eckel, MD. The online-only Data Supplement is aailable with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA. 113.001474/-/DC1. Correspondence to Leah E. Cahill, PhD, Harvard School of Public Health, 655 Huntington Ave, Bldg II, Room 349, Boston, MA 02115. E-mail [e-mail] © 2013 American Heart Association, Inc. Circulationis aailable at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.113.001474 Downloaded fromhttp://circ.ahajo 3 u 3 r 7 nals.org/by guest on July 24, 2013

338 CirculationJuly 23, 2013

participants were of white European descent. Participants have been height. Weights reported on the questionnaires were validated in a followed up through mailed biennial questionnaires that ascertained subsample of 123 men from the HPFS in which self-reported and medical history, lifestyle, and health-related behaviors, as previously measured weights were found to be highly correlated (Pearson cor - described. 10,11  Thisstudy was approved by the Institutional Review  relation=0.97). 18 Similarly, the validity of self-reported diabetes mel- Board of the Harvard School of Public Health, Boston, MA, and all litus has been documented previously in the HPFS with confirmation participants gave informed consent. by supplementary questionnaire and medical records. 19 Diabetes mel- Baseline for the present analysis was in 1992 when eating habits litus was defined according to the National Diabetes Data Group cri- were first assessed. The follow-up period for each participant started teria 20 until 1997 when the fasting plasma glucose threshold for the at the month of return of the 1992 questionnaire through confirmed diagnosis of diabetes mellitus was changed to the American Diabetes CHD outcome, death, or January 31, 2008. Men were excluded from Association criterion. 21 Validation against medical records has also the analysis if they died between 1986 and 1992 (n=1758) or did shown that hypertension is accurately self-reported by HPFS partici- not complete the food frequency questionnaire dietary assessment pants, 22 and although the soundness of self-reported hypercholester - (n=14 776; includes men who dropped out before 1992, men who olemia has not been assessed in the HPFS, it has been successfully received a shorter version of the questionnaire without questions on validated in a cohort of nurses using the same biennial questionnaire. 23 diet because they not respond to the full questionnaire after 4 mail- ings, and men who reported total energy intake outside 800–4200 Statistical Analysis cal/d). By 1992, the 0.5% who were lost to follow-up were on aver - age 7 years older, 12% more smoked, 7% more had hypertension,  T C o o   x e   x p a r m op in o e rt   i a o s n s a o l c   i h a a ti z o a n r s d   s  be m t o w d e e e l n s    s e t a r t a i t n i g fi   e h d a   b b i y t   s  a a g n e  d (   i C n  H m D o ,  nt w h e s   )  u a s n e d d     4% more had diabetes mellitus, and 7% fewer ate breakfast com-  follow-up cycle to estimate relative risks (RRs) and 95% confidence pared with the participants who were not lost to follow-up. Men were  intervals (CIs). In addition to breakfast and late-night eating, we excluded from the present analysis if they did not answer the eating  evaluated the other individual meals and snacks and eating frequency habits question (n=2123) or had cancer (except nonmelanoma skin cancer) or a history of cancer (n=2041), CHD or a history of myo- t ( h to e t r a   l c   o e d a e ti d n  t g h  t e i   m ea e t s i   n p g e   r h   a d b a i y ts )    i d n a   t r a e   l i a n t t i o o   n n   e to w     t v h a e r   i r a is bl k e   s o   f t   h C at H  c D a . t   eg W o e r   i f z u e r d -   cardial infarction (n=1528), angina or a history of angina (n=1601), and stroke or a history of stroke (n=800). After exclusions, the final  q p u ar e t n ic c i y p   a or n   t b s  y b  t y h  t e h i e r  ir n   u br m e b a e k r f   a o s f t     e e a a t t i i n n g g     o st c a c t a u s s i   o c n o s m  ( b s i n n a e c d k   s w )  i i t n h     a e d at d i i n ti g o  f n r  t e o -   sample size was 26 902 men. The characteristics of the participants in our sample were not substantially different from those of the original  the 3 main meals (breakfast, lunch, and dinner) and analyzed these full cohort at baseline. 12,13 ected risk  rnkwo nna dusps HD rto C Mult isk.nir el soi nleta dj arewefod teusetairavi sledom  avirba factors of CHD such as energy intake (quintiles of kilocalories per Eating Habits and Other Dietary Assessment day), alcohol intake (0, 0.1–<5, 5–<15, 15–<30,≥30 g/d), diet quality In 1992, HPFS participants were asked to respond to the following  u p s h i y n s g i   c t a h l  e  a 2 ct 0 i 1 vi 0 t   y A  ( lt q e u r i n n a ti t l e e   s H  o e f a   lt m h e y t   a E b a o t l i i n c  g e  I q n ui d v e a x l   e ( n q t u   i h n o t u il r e s s     p o e f r     s w c e o e re k ) ) , ,     prompt: “Please indicate the times of day that you usually eat (mark all that apply): before breakfast, breakfast, between breakfast and lunch,  television watching (asked in categories 0–1.5, 2.0–6.0, 7.0–20.0, lunch, between lunch and dinner, dinner, between dinner and bed time, ≥21.0 h/wk), sleep (<7, 7–8, >8 h/24 h), smoking status (never, past, and after going to bed.” We totaled the number of responses to calcu- ( c y u e r s r , e   n n t) o , )   ,  m a a   r p it h a y l  s s i t c a a t l u   s e   x ( a m m a i r n ri a e ti d o ,  n n   o i t n    t m h a e r   r l i a e s d t  ), 2     fu y l e l a -t r i s  m ( e y   e w s, o   r n k o   ) s , t   a a t n us d     late a participant’s eating frequency per day. Because some men who reported skipping breakfast also reported that they ate before breakfast  f a a ll m y i   l a y d   j h u i s s t t e o d r   y f   o o r f     p C ot H en D t   ia < l 6   0 m   e y d e i a a r t s o   r o s f ,    i a n g c e l  ( u y d e in s, g     n d o i ) a . b   e W te e  s t   h m e e n l   l a it d u d s i   t ( ion-   (3%) or between breakfast and lunch (20%), we defined breakfast as  no), hypertenion (yes, no), hypercholesterolemia (yes, no), and B ye M s, I  a positive response to any of the first 3 eating times (before breakfast,  (<185,18.5–2 s 4.9, 25–29.9, ≥30 kg/m 2 ). These variables were updated breakfast, between breakfast and lunch) to differentiate those who  f  .  ch 2-year follow-up period, as were all covariates except dietary broke fast from those who did not break fast. We defined late-night  c o o r v  e a a riates, which were updated every 4 years. Cumulatiges  eating as a positive response to eating after going to bed. of dietary covariaalculated at each time poi v nt e     t a o v   e b ra etter  In the HPFS, diet over the previous year is assessed every 4 years  represent long-ter t m es d   i w et e   r a e n   d c  to minimize within-person variation. 24   with a 131-item food frequency questionnaire. Nutrient intakes were calculated by converting the frequency of responses to daily intakes  Dietary covariates were not updated if there was a diagnosis of inter - for each food or beverage, multiplying the daily intakes of each food  h m y e p d e i r a c te h s o   le o s f  te C ro H le D m ,  ia i , n   c b l e u c d a i u n s g e    i d n i d a i b v e i t d e u s  al m s  e w ll i i t t h u  t s, h   e h s yper n te di n t s i i o o n n s , and  and beverage with its corresponding nutrient content, and summing the  e co may contributions of all items. The validity and reproducibility of the food  a c b h l a e n ,  g i e n   d t i h c e a ir t   o d r i   e v t a . 2 r 5 isgn mis forevelte larapes a htiw seblia -na yaviring for ere missad fw at< hgo %2Al outh frequency questionnaire have been reported elsewhere. 14,15  To assess  were cre- the overall diet quality of the participants, a diet score for each partici- i at m e p d u .  ta C ti o o m ns p ) l   et w e e   r c e a   s a e l   s a o  n c al o y n s d is u   c a te n d d multiple imputa l t t i s o   n fr  ana   l d y i s f i f s e   r ( e 10  pant was calculated 16  to on the basis of the 2010 Alternate Healthy Eating  nt om compare resu Index, which was designed to target food choices and macronutrient  ti m o e n t s h   o w d e s r   e o   f  n a o p t  p v r i o o a la c t h e i d n   g f   o m r  i a s n si y n  o g f     d t a h t e a   . c  P o r v o ar p i o a r t t e i s o .  n I a n l    h m a o z d a e r l d s s     i a n s   s w u h m i p h -   sources that have been associated with reduced chronic disease risk.  c eating frequency was not the main exposure, we adjusted for the num- ber of eating times (continuous). In sensitivity analyses, we further Assessment of CHD Outcomes and Intermediates adjusted for aspirin use (yes, no), antidepressant medication (yes, Incident CHD was defined as nonfatal myocardial infarction or fatal  no), daily number of cigarettes among smokers (1–14, 15–24,≥25 CHD. On each biennial questionnaire, participants were asked whether  cigarettes a day), reported stress in the workplace or at home (yes, they had experienced a myocardial infarction, and when an event was  no), body weight gain (continuous), and quintiles of specific nutrients reported, it was confirmed by review of medical records and autopsy  such as dietary folate, whole grains, fiber, and saturated fat, all residu- reports by study physicians blinded to the participant’s exposure sta-  ally adjusted for energy. A sensitivity analysis using models with the tus. Myocardial infarction was diagnosed with the World Health  original continuous versions of continuously gathered covariates was Organization’s criteria (symptoms plus either diagnostic ECG changes  conducted for comparison with categorical use of these originally or elevated levels of cardiac enzymes). 17 Fatal CHD was confirmed by  variables. To evaluate whether the association between continuous hospital records or an autopsy. Between return of the 1992 question-  late-night eating and risk of CHD was attributable to underlying naire and January 31, 2008, there were 1527 incident CHD cases.  sleep apnea, known to be more common in late-night eaters, 26,27 we On each biennial questionnaire, participants were asked for their  conducted a sensitivity analysis excluding participants with BMI≥30   weight and whether they had been professionally diagnosed with any  kg/m 2  and another sensitivity analysis excluding participants who of a long list of health conditions, including diabetes mellitus, hyper -  snore as proxies for sleep apnea. We used these proxies because the cholesterolemia, and hypertension. Body mass index (BMI) was  most significant risk factor for sleep apnea is obesity, 28 whereas habit- calculated using the self-reported weight and most recently reported  ual snoring is the most common symptom of sleep apnea, reported in Downloaded fromhttp://circ.ahajournals.org/by guest on July 24, 2013