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Cardiovascular and Metabolic Risk
Breakfast skipping is associated with persistently increased arterial stiffness in patients with type 2 diabetes
  1. Tomoya Mita1,2,
  2. Yusuke Osonoi1,
  3. Takeshi Osonoi3,
  4. Miyoko Saito3,
  5. Shiho Nakayama1,
  6. Yuki Someya1,
  7. Hidenori Ishida3,
  8. Masahiko Gosho4,
  9. Hirotaka Watada1,2,5,6
  1. 1Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
  2. 2Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, Tokyo, Japan
  3. 3Naka Kinen Clinic, Naka, Japan
  4. 4Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
  5. 5Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, Tokyo, Japan
  6. 6Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
  1. Correspondence to Dr Tomoya Mita; tom-m{at}juntendo.ac.jp

Abstract

Objective While certain lifestyle habits may be associated with arterial stiffness, there is limited literature investigating the relationship between lifestyle habits and longitudinal changes in arterial stiffness in patients with type 2 diabetes mellitus (T2DM). This is an exploratory study to determine whether lifestyle habits, in addition to conventional atherosclerotic risk factors, are associated with increased arterial stiffness.

Research design and methods The study participants comprised 734 Japanese outpatients with T2DM and no history of apparent cardiovascular diseases. Lifestyle habits were analyzed using self-reported questionnaires, and brachial-ankle pulse wave velocity (baPWV) was measured at baseline, and at years 2 and 5. A multivariable linear mixed-effects model was used to determine the predictive value of lifestyle habits and possible atherosclerotic risk factors for longitudinal change in baPWV.

Results Over 5 years of follow-up, baPWV values significantly increased. In a multivariable linear mixed-effects model that adjusted for age and gender, a low frequency of breakfast intake was significantly associated with persistently high baPWV, independently of other lifestyle habits. Furthermore, in a multivariable linear mixed-effects model that included both lifestyle habits and possible atherosclerotic risk factors, a low frequency of breakfast intake remained the only independent predictive factor for persistently high baPWV. Subjects who ate breakfast less frequently tended to have additional unhealthy lifestyle habits and atherosclerotic risk factors.

Conclusions Our analyses suggest that breakfast skipping is an independent lifestyle habit that is associated with persistently increased arterial stiffness in patients with T2DM.

Trial registration number UMIN000010932.

  • conventional atherosclerotic risk factors
  • breakfast skipping
  • arterial stiffness
  • type 2 diabetes mellitus
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-001162

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    Footnotes

    • Contributors All authors contributed to the study design and were involved in all stages of manuscript development. TM and YO drafted the manuscript. MG, a statistician, was primarily responsible for data analysis. TM, YO, TO, MS, SN, YS, HI, MG and HW also collected, analyzed and interpreted the data, reviewed and edited the manuscript and approved the final manuscript. HW is the principal guarantor of this work; he has full access to all study data and takes responsibility for the integrity of the data and the accuracy of data analysis. All authors have read and agreed to the publication of the manuscript.

    • Funding This study was conducted through a research grant from the Manpei Suzuki Diabetes Foundation (to TM).

    • Disclaimer This funding agency had no role in study design, data collection or analysis, decision to publish or preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the institutional review board of Juntendo University Hospital and conducted in accordance with the principles described in the Declaration of Helsinki. All patients provided written informed consent prior to participation.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. The analyzed datasets are available from the corresponding author (tom-m@juntendo.ac.jp) on reasonable request.