Elsevier

Physiology & Behavior

Volume 140, 1 March 2015, Pages 215-221
Physiology & Behavior

Female breakfast skippers display a disrupted cortisol rhythm and elevated blood pressure

https://doi.org/10.1016/j.physbeh.2014.12.044Get rights and content

Highlights

  • Breakfast skipping is associated with increased concentrations of free cortisol.

  • Chronic breakfast skippers also displayed elevations in blood pressure.

  • Changes in cortisol metabolism may lead to deleterious metabolic outcomes.

Abstract

Chronic stress and over-activity in the hypothalamic–pituitary–adrenal (HPA) axis may link breakfast skipping and poor cardiometabolic health. Missing the first major meal of the day in rodents prolongs elevated circulating corticosterone at a time when it's normally decreasing. To extend these findings to humans, we hypothesized that habitual breakfast skippers would display a similar pattern of circulating cortisol and alterations in meal and stress-induced cortisol reactions. Normal weight to obese women aged 18–45 years old who were strictly defined as either breakfast skippers (n = 30) or breakfast eaters (n = 35) were invited to participate in our study. Normal breakfast habits were maintained for the entire study period and each participant attended 4 lab visits. Over the first 2 lab visits, body composition, fasting clinical chemistries, and self-reports of chronic stress were assessed. On each of 2 additional days (lab visits 3 and 4), salivary free cortisol was measured at home upon waking and at bedtime, and in the lab in response to a standard lunch, ad libitum afternoon snack buffet, and stress and control (relaxation) tasks. The order of the control and stress test visits was randomized. While body weight, body composition, HOMA-IR, total and HDL cholesterol did not statistically differ (p > 0.05), both diastolic and systolic blood pressure was elevated (p < 0.01) and LDL cholesterol was lower (p = 0.04) in the breakfast skipper group. Compared to the breakfast eaters and on the control task visit only, breakfast skippers had higher circulating cortisol from arrival to midafternoon (p < 0.01) and during the snack buffet (p < 0.05). Furthermore, the lunch-induced cortisol reaction was larger in the ‘skippers’ (p = 0.03). On both stress and control visit days, the diurnal cortisol amplitude was significantly (p = 0.02) blunted in breakfast skippers. Self-reports of chronic stress did not differ between the groups. These data indicate that habitually skipping breakfast is associated with stress-independent over-activity in the HPA axis which, if prolonged, may increase risk (e.g., hypertension) for cardiometabolic disease in some people.

Introduction

Breakfast skipping is prevalent and occurs regularly in 20% of US adults [1]. Among young men, minorities and the economically disadvantaged, this phenomenon is even higher [2], [3]. Habitual breakfast skipping may be detrimental to health [4] and has been linked to elevated blood pressure [5], insulin resistance [6], and dyslipidemia [7]. While associations between breakfast skipping and BMI, or increased energy intake have been reported [1], [8], [9], [10], recent evidence disputes these claims [11], [12]. Differences in the physiological response to skipping breakfast may explain the apparent discrepancies. However, a physiological basis connecting regular breakfast skipping and poor metabolic health is unclear. Given the negative effects of chronically elevated cortisol on metabolic health [13], [14], [15], [16], cortisol increases in response to skipping breakfast may, over time, promote risk for metabolic dysfunction. Persistent increases in cortisol are linked to hyperglycemia [17], insulin resistance [15], abdominal obesity [18], and high blood pressure [19].

In one of the few human studies looking at the frequency of breakfast intake and circulating cortisol concentrations, individuals eating breakfast every day had lower daytime mean salivary cortisol than those individuals who never ate breakfast [20]. In another study, breakfast skipping accounted for 22% of the inverse association between socioeconomic status and salivary cortisol [21]. In rodents, preventing consumption of the first meal of the day (lights off) significantly elevates corticosterone, which resolves when the animals are allowed to eat [22]. This phenomenon has not been well documented in humans.

We hypothesized that self-reported breakfast skippers would have elevated circulating cortisol, particularly during the morning and up until lunch. Secondly, we hypothesized cardiometabolic disease risk factors including insulin sensitivity, lipid profile, waist to hip circumference, and blood pressure will be higher in breakfast skippers, relative to breakfast eaters. Thirdly, we hypothesized that ongoing (chronic) stress may be more prominent in breakfast skippers and may contribute to elevated cortisol.

Section snippets

Participants and recruitment

The Institutional Review Board at the University of California, Davis, approved the protocol. Based on the following criteria, women were invited to participate in a cross sectional observational study. Participants were premenopausal aged 18 to 45 years with a BMI of less than 40 kg/m2, weight stable, maintained a typical diurnal schedule and were classified as either being “breakfast eaters” or “breakfast skippers.” A breakfast eater was defined as someone who consumed at least 15% of their

Participants and anthropometric measures

Sixty-five women (n = 35 breakfast eaters, n = 30 breakfast skippers) completed all visits and were included in the final analyses. Body weight, BMI, fat mass, fat free mass, waist to hip ratio, total cholesterol, and HDL cholesterol measured at screening were not different between breakfast conditions (p > 0.05). However, LDL cholesterol was lower and systolic and diastolic blood pressures were higher in the skipper group (p = 0.043, p = 0.003, p = 0.009, respectively) (Table 3). Fasting glucose and

Discussion

The mechanisms linking breakfast skipping and poor health are unclear. Breakfast is typically consumed after an extended fast and after a period of sleep. It has been proposed that the typically elevated waking cortisol promotes arousal and drive to eat [36], [37]. When breakfast is consumed, cortisol steadily drops. In meal-trained rats, if the first meal is missed, corticosterone (primary glucocorticoid in rodents) concentrations remain elevated hours after it would typically fall [22], [35],

Conclusion

In conclusion, our results suggest that breakfast skippers have prolonged daily elevations in cortisol, which may explain higher blood pressure and other previously described cardiometabolic dysfunction in persons habitually skipping breakfast. We did not find other cardiometabolic disease risk factors to be elevated in breakfast skippers. However, if this breakfast skipping along with altered cortisol activity persists, development of chronic disease is possible [67]. The women in our study

Funding/support

This research was supported with funding from USDA-CSREES NRI grant 2009-35215-05364 and USDA Agricultural Research Service intramural project number 5306-51530-019-00.

Acknowledgments

The USDA is an equal opportunity provider and employer.

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