Breakfast energy intake and dietary quality and trajectories of cardiometabolic risk factors in older Spanish adults

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. ### Competing Interest Statement 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. ### Clinical Trial ISRCTN89898870 ### Funding Statement 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. ### Author Declarations 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][1]). 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\_scommittee@googlegroups.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. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN89898870