Does the Risk of Early Death Go Up With Skipping Meals? Maybe

Few dietary trends are hotter than "intermittent fasting" or skipping meals and eating in restricted time windows on a regular basis. This is more properly called "time restricted eating" and the extreme is the "one meal a day" (OMAD) diet. While there are stories of weight loss like legendary Elon Musk, there is debate as to health vs. harm of skipping meals or eating in a narrow time window like the OMAD diet. Therefore, new data on this topic is important to guide our choices. 


The objective was to examine the associations of meal frequency, skipping, and intervals with all-cause and cardiovascular disease (CVD) mortality.


A total of 24,011 adults (aged ≥40 years) who participated in the National Health and Nutrition Examination Survey 1999-2014 were included in this study. Eating behaviors were assessed using 24-hour recall. Death and underlying causes of death were ascertained by linkage to death records through December 31, 2015. It was a prospective study. 


During 185,398 person-years of follow-up period, 4,175 deaths occurred, including 878 cardiovascular deaths. Most participants ate three meals per day.
Compared with participants eating three meals per day, the multivariable-adjusted risk for participants eating one meal per day were 30% higher for all-cause mortality, and 83% higher for CVD mortality.
Participants who skipped breakfast have multivariable-adjusted rate CVD mortality that was 40% higher compared with those who did not.
The multivariable-adjusted risk all-cause mortality were 12% higher for skipping lunch and 16% higher for skipping dinner compared with those who did not.


In this large, prospective study of US adults aged 40 years or older, eating one meal per day was associated with an increased risk of all-cause and CVD mortality. Skipping breakfast was associated with increased risk of CVD mortality, whereas skipping lunch or dinner was associated with increased risk of all-cause mortality.

Of note, meal-skipping was more prevalent among those who smoked more, drank more alcohol, were more food insecure, who ate less nutritious food, had more snacks, and took in less energy overall.

This study isn't comprehensive enough to determine if meal skipping actually causes earlier death, only that there's an association worthy of further research. It's possible that other factors are involved, affecting both eating habits and mortality risk.

That said, the research team did adjust their findings to account for variations in numerous dietary and lifestyle factors, including smoking, alcohol use, physical activity levels, energy intake, diet quality, and food insecurity – and the link was still there.

Prior studies in Spain also showed and increased risk of poor cardiac outcomes in those that routinely skipped breakfast. It would appear that planning 3 meals a day in 10-12 hours of an eating window spaced out 4-5 hours apart is the optimal timing for health. 

Dr. Joel Kahn

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