New Delhi: Breakfast is often touted as the most important meal of the day, giving the body the required energy and nutrients. But what happens when you skip it on a regular basis?
According to a study by Chinese researchers published in the Journal of General Internal Medicine, habitually skipping breakfast is associated with a greater risk of gastrointestinal (GI) cancers, including oesophageal, gastric, colorectal, liver, gallbladder, and extrahepatic bile duct cancers.
The study was published in March and involved 62,746 participants, all Chinese citizens, who were part of a large-scale project — Kailuan Cohort Study, named after a coal mining community in China. The participants were followed for a median of 5.6 years.
At the end of the study, 369 cases of GI cancers were identified among the participants, higher among people who had been skipping breakfast.
“Habitually skipping breakfast was associated with a greater risk of GI cancers including oesophageal, gastric, colorectal, liver, gallbladder, and extrahepatic bile duct cancer,” noted authors of the study.
India nutrition experts and doctors ThePrint spoke to said that skipping breakfast on a regular basis has been associated with multiple health issues in the short and long-term, but added that the findings of the study should be seen in context.
“There are now conflicting views on whether breakfast is an absolute must, especially for adults, but our previous research has established its usefulness for children,” said a scientist with the Indian Council of Medical Research-National Institute of Nutrition (ICMR-NIN) who did not wish to be named.
“The findings from the China study are quite stark and it may be useful to carry out a similar analysis in India too, to understand how harmful skipping breakfast can be,” the scientist added.
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Study findings
Among the 62,746 participants, who had a median age of 51 years, 53,796 or 86 percent reported breakfast consumption everyday while 5,037 or 8 percent reported having no breakfast or breakfast only once or twice a week. After the follow-up, 369 incident GI cancer cases were identified.
Compared with participants who had breakfast regularly, the 1-2 breakfasts per week group and no-breakfast group were associated with a 2.35-fold and 2.06-fold elevated risk of GI cancer incidence.
The risk was particularly high for gall bladder and extrahepatic bile duct cancers.
The researchers also found that the risk of GI cancer increased with the number of breakfasts skipped per week. Participants who ate breakfast only 1 or 2 times per week had a higher risk of GI cancer than those who ate breakfast every day.
According to Dr Sajjan Rajpurohit, senior director, medical oncology, Max Super Speciality Hospital and BLK-Max Super Speciality Hospital in Delhi, the exact mechanisms by which skipping breakfast increases the risk of GI cancer are not fully understood.
“However, researchers believe that several factors may be involved such as chronic inflammation,” he said.
Skipping breakfast can lead to changes in blood sugar levels and hormone levels, which can trigger chronic inflammation and inflammation is a known risk factor for cancer, he pointed out.
According to him, skipping breakfast can also lead to changes in metabolism, such as increased insulin resistance and elevated blood lipid levels which can then raise the risk of cancer.
Also, Rajpurohit said, skipping breakfast can alter the gut microbiome, which is the community of bacteria that live in the digestive tract. A healthy gut microbiome is important for overall health and well-being, and a disrupted microbiome has been linked to an increased risk of cancer.
The findings of the China study, said the oncologist, suggest that eating breakfast regularly may be an important way to reduce the risk of GI cancers.
He, however, added that more research was needed to confirm these findings and to better understand the underlying mechanisms.
‘Correlation does not necessarily mean causation’
According to Dr Rajeev Jayadevan, a gastroenterologist and medical researcher from Kerala, while the study could sound alarming initially, in science, correlation does not necessarily mean causation.
“For example,” he said, “firefighters are frequently seen at the site of a fire (correlation), but that does not mean they caused the fire (causation).”
Likewise, the people who got cancer need not necessarily have got it only because they skipped breakfast. This is called confounding in medical statistics, Jayadevan explained.
“A confounder is a hidden variable that is indirectly associated with an observation. In other words, people who skipped breakfast might have had other features that put them at risk of cancer,” he added.
The clinician also underlined that a person with undiagnosed cancer, for instance, might have poor appetite and may decide to skip meals, thus classifying that person as someone who “skipped breakfast”.
Besides, people who skip breakfast may have other health behaviours that put them at greater risk of cancer. It could be that they are on a night shift in the coal mine and more exposed to smoke, he said.
“Although similar findings have been reported from Japan earlier, by no means can we conclude based on available evidence that skipping breakfast will directly lead to cancer,” the doctor said.
“That being said, it is generally accepted that having a balanced healthy breakfast is the best way to start one’s day,” Jayadevan added.
“This is because there is no food intake for approximately 8-10 hours after dinner. Breakfast is the immediate source of energy and nutrition for the start of the day. If someone starts persistently skipping breakfast, it could be because they have developed a medical condition that is making them do so, and this requires investigation” he pointed out.
(Edited by Nida Fatima Siddiqui)
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