Skipping breakfast is associated with an increased long‐term cardiovascular mortality in metabolic dysfunction‐associated fatty liver disease (MAFLD) but not MAFLD‐free individuals

Abstract

Background: Balancing calorie control to prevent cardiovascular diseases (CVDs) by skipping breakfast while guarding against its potential risks is a challenge. Aims:To explore the association between skipping breakfast and cardiovascular mortality in individuals with metabolic dysfunction-associated fatty liver disease (MAFLD).Methods: A total of 9926 individuals (including 3004 MAFLD participants) aged 20 years or older were enrolled in the Third National Health and Nutrition Examination Survey and followed for up to 27 years. All participants were classified according to the frequency of breakfast consumption (every day, some days, rarely and never).Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality. Results:During the 212 239 person-years of follow-up, we documented a total of 2595 deaths including 603 deaths from CVDs. Of these, 1039 deaths including 253 deaths from CVDs were recorded in MAFLD individuals. MAFLD individuals showed higher cardiovascular mortality than MAFLD-free controls (P < 0.001). Furthermore, skipping breakfast was independently associated with high cardiovascular mortality risk (adjusted HR: 2.850, 95% CI: 1.490-5.452; P = 0.002), and a high cerebrovascular disease mortality risk (adjusted HR: 5.570, 95% CI: 1.814-17.099; P = 0.003) in participants with MAFLD. However, skipping breakfast was not associated with cardiovascular mortality in MAFLD-free individuals (adjusted HR: 1.526, 95% CI: 0.701-3.326; P = 0.280). Conclusions:In this US population-based study, skipping breakfast was associated with a high risk of cardiovascular mortality in MAFLD but not MAFLD-free individuals.| 213 XIE Et al. | INTRODUC TI ONCardiovascular diseases (CVDs), a leading cause of death that claimed 18.6 million lives globally in 2019, 1 pose growing health and economic burdens to all societies. Metabolic dysfunction-associated fatty liver disease (MAFLD), formerly named non-alcoholic fatty liver disease (NAFLD), affects up to a third of the world's adult population and is an independent risk factor for the increased cardiovascular mortality. [2][3][4] Considering that CVDs are the most common cause of death in the MAFLD population, it is urgent to take strategies to reduce cardiovascular mortality in the MAFLD population. Given the absence of FDA-approved pharmacological therapies for MAFLD, dietary interventions remain the cornerstone. 5 Multiple diets, including Dietary Approaches to Stop Hypertension diets, low-carbohydrate diets, and Mediterranean diets, have been evaluated. However, dietary patterns remain largely unexplored. 6 Only caloric restriction was proved effective and consistently recommended in the current guidelines. 7 The American Association for the Study of Liver Diseases (AASLD), the European Association for the Study of the Liver/European Association for the Study of Diabetes/ European Association for the Study of Obesity (EASL-EASD-EASO), the National Institute for Health and Care Excellence (NICE...

Role of Circadian Clock on the Pathogenesis and Lifestyle Management in Non-Alcoholic Fatty Liver Disease

“…Similarly, in 194 patients with type-2 diabetes mellitus who do not work shift work, a late chronotype was associated with skipping breakfast ( p = 0.014) [ 109 ]. In fact, it has been demonstrated that frequent breakfast skipping was independently associated with higher cardiovascular mortality risk ( p < 0.001) in 3004 participants with metabolic associated fatty liver disease (MAFLD), but not in MAFLD-free individuals ( p = 0.280) [ 110 ].…”

Letter: skipping breakfast is associated with an increased long‐term cardiovascular mortality in metabolic dysfunction‐associated fatty liver disease (MAFLD) but not in MAFLD‐free individuals. Authors' reply

“…The authors' declarations of personal and financial interests are unchanged from those in the original article. 5…”

Letter: skipping breakfast is associated with an increased long‐term cardiovascular mortality in metabolic dysfunction‐associated fatty liver disease (MAFLD) but not MAFLD‐free individuals

“…We have read the cohort study by Xie et al regarding the metabolic dysfunction-associated fatty liver disease (MAFLD) in the health database using the National Health and Nutrition Examination Survey (NHANES) with great interest. 1 The authors pointed out the association between skipping breakfast and long-term cardiovascular mortality in MAFLD individuals. We appreciate the valuable contribution of the authors to clarifying the possible underlying causes of the disease in the health database.…”

“…The authors defined MAFLD using strict criteria, including abdominal ultrasound diagnosed-hepatic steatosis in addition to one of the following three conditions: (a) overweight/ obesity (BMI ≥23 kg/m 2 ); (b) presence of type 2 diabetes mellitus and (c) lean/normal weight with two metabolic dysregulations. 1 However, considering that the majority ethnicity in NHANES is Caucasians, the definition of overweight/obesity as BMI ≥23 kg/m 2 might be inappropriate. Besides, according to the MAFLD definition suggested by Eslam et al, overweight or obesity were defined as BMI ≥25 kg/m 2 in Caucasians.…”