This article from the clickbait off-shoot of The Independent newspaper, iNews (archive) states that:

Skipping breakfast on a regular basis could be linked to an increased risk of dying from heart disease

citing a study of the National Health and Nutrition Examination Survey by University of Iowa researchers. However to me this just sounds like the standard case of mistaking correlation for causation.

The reason why I'm asking is because the study was published in a peer-reviewed journal. I would like to know what I'm missing out here, and how accurate is this outcome that iNews gleaned from the study?

Related questions:

As far as I can tell, these questions are not concerning the increased risk of heart disease but rather the general effects on the human body.

  • This question is confusing. The article you are citing does not claim causality. It claims correlation. So, what's the question? – Oddthinking Apr 23 '19 at 22:46
  • Answer has been edited. Let me know what you think! – Barry Harrison Apr 24 '19 at 7:28
  • There is no notable claim showing that anyone claims there is causality. A correlation has been shown; that is interesting in its own right, and a cause for concern for people who skip breakfast, but not proof of causality.Whether that is sufficient to change people's behaviours is a personal call. – Oddthinking Apr 24 '19 at 7:52
  • @Oddthinking after looking more closely, it appears I was confused by the wording. I'm a bit new to this but I guess your close is fair game – dylan-myers Apr 24 '19 at 8:47

Note: I could only find studies that either (1) correlated some sort of cardiovascular disease or (2) some sort of cardiovascular risk factor with skipping breakfast. Thus, there were articles that state "It is generally accepted that skipping breakfast is associated with higher incidences of cardiovascular disease." but not "Skipping breakfast was shown to cause heart disease." To quote St-Onge et al. "findings from observational studies cannot establish causality." All bolded words in block quotes are my own added emphasis.

In the below answer are some studies that I found relevant to the question (please point out if I am drawing conclusions when I shouldn't).

In 2018, Uzhova et al. wrote

Breakfast is considered to be one of the most important meals of the day. [Breakfast's] omission has been reported to be associated with increased disease risk, such as obesity, diabetes, and coronary heart disease, as well as unhealthy lifestyle and lower dietary quality.

Breakfast skipping, conversely, has been reported to be associated with several cardiovascular risk factors, including unfavorable lipid profile, obesity, and diabetes, as well as atherosclerosis and coronary heart disease

Also in 2018, Sharma et al. studied coronary artery disease (CAD) in Western Indians.

Our primary finding suggests that apart from classical risk factors of CAD breakfast skipping is an independent associate of CAD in Indians. We found that habitual breakfast skippers are at 1.34 times (P = 0.009; 95% CI 1.076–1.689) higher risk of developing CAD when compared with breakfast eaters. One of the alarming finding of the study is that, the habit of skipping the breakfast imparts more risk than physical inactivity (odds ratio: 0.520; 95% CI 0.413–0.656; P < 0.0001) and obesity (odds ratio: 0.670; 95% CI 0.534–0.841; P = 0.001) in Indians. Breakfast skippers also demonstrated greater tendency of development of hypertension as indicated by higher correlation coefficient (0.05, P = 0.043).

Breakfast skipping is one of the important risk factor[s] of CAD and hypertension in Western Indians...

In 2017, St-Onge et al. wrote

Finally, data suggest that irregular eating patterns [including skipping breakfast] appear less favorable for achieving a healthy cardiometabolic profile.

Because feeding and fasting entrain clock genes, which regulate all aspects of metabolism, meal timing can have serious implications for the development of cardiovascular disease (CVD), type 2 diabetes mellitus, and obesity.

In cross-sectional studies, daily breakfast eaters were less likely to have CVD risk factors, including elevated serum low-density lipoprotein (LDL) cholesterol, low serum high-density lipoprotein (HDL) cholesterol, and elevated blood pressure.

To the best of our knowledge, only 2 prospective studies have examined the association between breakfast skipping and risk of CVD. Over 16 years of follow-up, men who reported usually skipping breakfast had a 27% (relative risk, 1.27; 95% CI, 1.06–1.53) higher risk of CHD (defined as a nonfatal myocardial infarction or fatal CHD) compared with men who did not skip breakfast after adjustment for age, demographic factors, and dietary and lifestyle factors. In the second study, conducted in Japan, infrequent breakfast consumption was associated with a greater risk of CVD, specifically greater risk of hemorrhagic stroke, after adjustment for age, sex, dietary and lifestyle factors, perceived mental stress, living alone, physical labor, and public health center area.

Epidemiological studies provide strong evidence of a relation between breakfast skipping and cardiometabolic risk. ... Although findings from observational studies cannot establish causality, large, prospective studies with long-term follow-up and the assessment of clinical end points, including CVD and diabetes mellitus, can provide important insight into these associations. These are particularly meaningful when supported by evidence from experimental studies and clinical interventions.

A 2019 study from 6 days ago associated skipping breakfast with myocardial infarction (or heart attacks).

Epidemiological and interventional studies suggest that skipping breakfast and late-night dinner eating (LNDE) are associated with a greater risk of obesity, insulin resistance and cardiovascular diseases.

In conclusion, the association between skipping breakfast concomitant with LNDE increases four to fivefold the likelihood of death, reinfarction and postinfarction angina within 30 days after hospital discharge.

Cahill et al. studied correlations between coronary heart disease and skipping breakfast in 2013.

Eating breakfast was associated with significantly lower CHD [coronary heart disease] risk in this cohort of male health professionals.

As part of the procedure, Cahill et al. accounted for lifestyle effects.

Multivariate models were adjusted for known and suspected risk factors of CHD such as energy intake (quintiles of kilocalories per day), alcohol intake (0, 0.1–<5, 5–<15, 15–<30, ≥30 g/d), diet quality using the 2010 Alternate Healthy Eating Index (quintiles of score), physical activity (quintiles of metabolic equivalent hours per week), television watching (asked in categories 0–1.5, 2.0–6.0, 7.0–20.0, ≥21.0 h/wk), sleep (<7, 7–8, >8 h/24 h), smoking status (never, past, current), marital status (married, not married), full-time work status (yes, no), a physical examination in the last 2 years (yes, no), and family history of CHD <60 years of age (yes, no). We then additionally adjusted for potential mediators, including diabetes mellitus (yes, no), hypertension (yes, no), hypercholesterolemia (yes, no), and BMI (<18.5,18.5–24.9, 25–29.9, ≥30 kg/m2). These variables were updated for each 2-year follow-up period, as were all covariates except dietary covariates, which were updated every 4 years. Cumulative averages of dietary covariates were calculated at each time point to better represent long-term diet and to minimize within-person variation.

Finally, a 2010 study by Smith et al. wrote

Skipping breakfast over a long period may have detrimental effects on cardiometabolic health. Promoting the benefits of eating breakfast could be a simple and important public health message.

In addition, the American Heart Association advocates eating breakfast due to the risks of skipping breakfast (quoted below).

Some studies indicate that breakfast-skippers are more likely to:

  • have diabetes, heart disease and high cholesterol

To summarize:

Can skipping breakfast increase risk of heart disease?

Skipping breakfast has been correlated with an increased risk of heart disease in many studies. This appears to be the scientific consensus and appears undisputed. Thus, the results of the University of Iowa study are not unexpected. The difference with this new study is that the authors also explicitly looked at mortality rather than just risk factors and/or incidences of cardiovascular diseases.

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    Uh, how does the study differentiate the effects of meal timing from other lifestyle effects?? – Daniel R Hicks Apr 22 '19 at 22:05
  • @DanielRHicks Thanks for commenting! Are you talking about in general or one study in particular? EDIT: I see what you mean. I will edit the answer. – Barry Harrison Apr 22 '19 at 22:12
  • Thank you for this response! I'm not sure if this is considered out of scope (as it's not in the title) but what are your thoughts on the study the original article links? – dylan-myers Apr 22 '19 at 22:15
  • @dylan-myers I did look at it, but didn't cite as you already did. My thoughts are: Yes, you are right in that correlation does not equal causation. However, there isn't another way to study such complex dependent variables (thus, the need for large sample sizes). I cannot find any obvious flaw in the study. (It accounts for lifestyle as well "After adjustment for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, body mass index, and cardiovascular risk factors..."). – Barry Harrison Apr 22 '19 at 22:17
  • You quote studies that show correlation and draw the conclusion of causation. This is exactly what the OP was worried about - I am not sure why it has been accepted as it seems to beg the question. – Oddthinking Apr 23 '19 at 22:48

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