Participants who ‘eat like a King in the Morning’ have lower Cholesterol concentrations

Abstract

“Eat breakfast like a king, lunch like a prince, and dinner like a pauper” is a much heard quotation, although the evidence for this is uncertain. Meal frequency(1) and breakfast consumption(2) have been associated with lower serum cholesterol and reduced rate of weight gain respectively in the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). However, the association between time of day of maximum energy consumption in relation to serum cholesterol concentrations was not previously studied. The EPIC-Norfolk study started in 1993 and had 25,639 men and women, aged 40-79, who attended a health examination. Weight, height and blood samples were taken by a nurse and participants received instructions on completing a 7-day diet diary (7dDD)(3). We excluded nightshift workers, leaving 25,295 for analysis. For every diary day, energy intake was summed and re-categorised into: morning (M), afternoon (A) and evening (E) and calculated as a proportion of the whole day. Participants’ individual diary days were scored depending whether most energy was consumed in the M, A or E. The median of the scores across days determined the type of eater a participant was (91% provided 7 days of DD). Differences between M, A and E eaters in continuous variables were tested using Kruskal-Wallis, and if significant, followed by Mann-Whitney test; proportional variables tested with Chi-squared test. Differences in cholesterol concentrations were tested using ANOVA, adjusted for sex, age, smoking, social class, physical activity and body mass index (BMI). The majority of participants (72%) consumed most of their energy in the evening. Those who consumed the highest energy intake in the morning had significantly higher total daily energy intake. Among men, M-eaters had a higher proportion of smokers, manual occupation and were more physically active. After adjustment for sex and Having the highest energy intake in the morning was associated with lower cholesterol concentrations, a reduction similar to what can be achieved with dietary advice(4); however, residual confounding cannot be excluded and the proportion of M-eaters was limited. Moreover, possible interactions with meal frequency will require further study. confounders, cholesterol concentrations for M-eaters were 5.90 mmol/L (95% CI: 5.79,6.00), which was 0.29 mmol/L lower (95% CI: -0.40,-0.19) compared to A- and E-eaters.