Regularly eating breakfast and fibre associated with a lower overall mortality risk

9th September 2021

Regularly eating both breakfast and fibre appears to be associated with a significantly reduced risk of overall and cardiovascular mortality.

It is often said that breakfast (BF) is the most important meal of the day and there are numerous studies indicating the positive health benefits among those who eat BF. For example, some evidence suggests that not eating breakfast is associated with an increased risk of heart disease, a 21% higher risk of developing type 2 diabetes and a greater risk of all-cause mortality. Nevertheless, while these data are relatively consistent, less is known about which BF foods are potentially associated with a lower incidence and risk of cardiovascular events. One dietary component that is present in common BF foods such as oatmeal, fruit and cereals, is fibre. Furthermore, a recent umbrella review of prospective observational studies concluded that higher fibre intake appears to positively impact on not only cardiovascular disease but overall mortality.

These data led a team from the Department of Family Medicine, West Virginia University School of Medicine, West Virginia, US, to confirm the association between BF, dietary fibre and mortality. The team used the National Health and Nutrition Examination Survey (NHANES) dataset and included individuals aged 40 years and over who self-reported on dietary intake between 1999 and 2002. To determine survival information, the team used a 2015 database which provided mortality follow-up details from the NHANES study. Using the NHANES data, the researchers included those who self-reported as BF eaters and based on the foods eaten, categorised dietary fibre intake as high (> 25 g/day) and low (< 25 g/day). Since hypertension, diabetes and cardiovascular disease can negatively impact on mortality, the analysis included these three factors as covariates. The primary outcomes of the study were all-cause and cardiovascular disease (CVD) mortality and the team included a cohort of non-breakfast eaters which served as a control group.

Findings
A total of 5761 individuals were identified, 4778 BF eaters with a mean age of 57.5 years (46.6% male) and the remainder, a matched cohort of non-breakfast eaters. The average calorie intake was higher in breakfast eaters compared to non-breakfast eaters (2041.1 vs 1871.1, p = 0.001). Furthermore, dietary fibre intake was also higher among BF eaters (16.9g vs 12.8 g, p < 0.0001). During the follow-up period of approximately 147.6 months, there were 2027 (35.2%) all-cause deaths and 469 (8.1%) CVD deaths. After adjustment for covariates, breakfast eaters had a reduced risk of all-cause mortality (adjusted Hazard ratio, aHR = 0.45, 95% CI 0.32 – 0.63) and CVD mortality (aHR = 0.79). Among BF eaters with a fibre intake > 25g/day, there was a 21% reduction in all-cause mortality (aHR = 0.79, 95% CI 0.66 – 0.96) compared to non-breakfast eaters. While there was a trend towards lower CVD mortality among breakfast eaters with fibre intakes > 25g/day, this was not significant (aHR = 0.82, 95% CI 0.50 – 1.35, p = 0.42). Among non-breakfast eaters, there were no significant associations between fibre intake and either all-cause or CVD mortality.
The authors concluded that the mortality benefit from eating breakfast observed in both their own and earlier studies appears to be linked with higher intake of fibre.

Citation
King DE et al. A Relationship Between Mortality and Eating Breakfast and Fiber. J Am Board Fam Med 2021

Dapagliflozin approved for chronic kidney disease

10th August 2021

In patients with chronic kidney disease, a mortality benefit from dapagliflozin has led to a license extension for use in this condition.

According to the UK Kidney Association, chronic kidney disease (CKD) is defined by abnormalities of kidney function or structure and which are present for more than 3 months. This definition will include those with an estimated glomerular filtration rate (eGFR) of less than 60ml/min/1.73m2 on at least two occasions, 90 days part. The condition is common and thought to affect and left untreated, chronic kidney disease is a major cause of kidney failure, leading to around one million deaths per year. Moreover, figures compiled by Kidney Care UK, suggest that around 3 million people in the UK have CKD and that are currently receiving treatment for kidney failure and that between 40 and 45,000 premature deaths occur every use in the UK due to CKD. Globally, it is thought that there are around 840 million people with CKD, acute kidney injury and renal replacement therapy.

While there are several recognised causes of kidney disease, the top two causes are hypertension and diabetes, followed by glomerulonephritis, in which damage occurs to the glomeruli although the condition is usually asymptomatic and only revealed upon testing.

The only known treatments capable of slowing a reduction in kidney function are angiotensin-converting-enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARBs). Now, a European license extension has been granted to manufacturer, AstraZeneca, for the use of its drug, dapagliflozin (brand name Forxiga), in the treatment of patients with chronic kidney disease, with or without diabetes. Dapagliflozin is a sodium-glucose co-transporter 2 inhibitor and which is indicated for the management of type 2 diabetes as an adjunct to diet and exercise, either alone or in combination with other diabetic treatments. It is also licensed in patients with symptomatic chronic heart failure with a reduced ejection fraction.

Clinical data

The license extension was granted based on the findings of the DAPA-CKD Phase III trial. This was an international, multi-centre, randomised, double-blind, placebo-controlled study in adults with and without type 2 diabetes and who had stage 2 to 4 (i.e., eGFR 25 to 75 ml/min/1.73m2) CKD. A total of 4,304 patients were randomised to either dapagliflozin 10mg or placebo and the primary outcome was a composite of a sustained decline in eGFR of at least 50%, end-stage kidney disease (i.e., stage 5) or death from either renal or cardiovascular causes. The study was terminated early after only 2.4 years when the primary outcome had occurred in 9.2% of those taking dapagliflozin and 14.5% in the placebo arm, giving a hazard ratio, HR, of 0.61 (95% CI 0.51–0.72, p < 0.001). There was also a significant mortality difference between both groups (HR = 0.69, 95% CI 0.53–0.88, p = 0.004) and the effect of taking dapagliflozin was similar in patients with and without type 2 diabetes.

Source: AstraZeneca press release