Skipping breakfast is associated with an increased long‐term cardiovascular mortality in metabolic dysfunction‐associated fatty liver disease (MAFLD) but not MAFLD‐free individuals

Summary Background Balancing calorie control to prevent cardiovascular diseases (CVDs) by skipping breakfast while guarding against its potential risks is a challenge. Aims To explore the association between skipping breakfast and cardiovascular mortality in individuals with metabolic dysfunction‐associated fatty liver disease (MAFLD). Methods A total of 9926 individuals (including 3004 MAFLD participants) aged 20 years or older were enrolled in the Third National Health and Nutrition Examination Survey and followed for up to 27 years. All participants were classified according to the frequency of breakfast consumption (every day, some days, rarely and never). Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality. Results During the 212 239 person‐years of follow‐up, we documented a total of 2595 deaths including 603 deaths from CVDs. Of these, 1039 deaths including 253 deaths from CVDs were recorded in MAFLD individuals. MAFLD individuals showed higher cardiovascular mortality than MAFLD‐free controls ( P < 0.001). Furthermore, skipping breakfast was independently associated with high cardiovascular mortality risk (adjusted HR: 2.850, 95% CI: 1.490‐5.452; P = 0.002), and a high cerebrovascular disease mortality risk (adjusted HR: 5.570, 95% CI: 1.814‐17.099; P = 0.003) in participants with MAFLD. However, skipping breakfast was not associated with cardiovascular mortality in MAFLD‐free individuals (adjusted HR: 1.526, 95% CI: 0.701‐3.326; P = 0.280). Conclusions In this US population‐based study, skipping breakfast was associated with a high risk of cardiovascular mortality in MAFLD but not MAFLD‐free individuals.