Michalsen: Other reasons to skip meals
Many scientists doubt the informative value of the study: “I consider epidemiological studies in this context to be absolutely unreliable. Their informative value regarding TRE (time-restricted eating, editor’s note) is extremely low. The data is only given as an overview reports. What is most irritating is that there has been an observation period of eight to eleven years. However, TRE has only been a more common practice for about three to five years. It must therefore be assumed that there were other reasons for skipping meals,” explained Professor Andreas Michalsen , chief physician for internal medicine at the Immanuel Hospital in Berlin. A case number of 31 cardiovascular deaths is not suitable for deriving values of 91 percent. In addition, there are no basic studies that indicate this effect. “Epidemiological studies with a low level of evidence are not relevant here for me.”
It must therefore be assumed that there were other reasons for skipping meals.
Professor Andreas Michalsen Chief Physician for Internal Medicine at the Imanuel Hospital Berlin
Does skipping breakfast lead to evening gluttony?
According to Michalsen, skipping meals could also have to do with lack of time and other stressors. It is also important to know whether breakfast or dinner was left out. “Skipping breakfast can lead to ‘gluttony’ in the evening in cardiometabolic diseases, which is unfavorable,” explained Michalsen.
Intermittent fasting not queried during data collection
Tillmann Kühn, professor of public health and nutrition at the University of Vienna, also doubts the validity of the study. Intermittent fasting was not specifically examined in the study. Skipping meals could also indicate existing illnesses. “The NHANES data that the authors used are in principle very good – unfortunately there is no record of intermittent fasting there. The pure time information for food intake on individual days is only suitable to a very limited extent,” explained Kühn. It is not clear whether this is a causal connection or a pure correlation. “Since conscious, intentional intermittent fasting was not examined in the study, no conclusions can be drawn about its effects among different groups of people. Good long-term studies on intermittent fasting are completely missing. Therefore, neither the advantages nor disadvantages have been adequately proven.
Does the illness itself lead to skipping meals?
Similar to Michalsen, Kühn also believes it is possible that the reason for the missing meals could be the illnesses themselves. “It is conceivable that people in the study who suffered more severely from cancer or cardiovascular diseases had restricted their diet due to their illnesses. Then the illness itself would explain the mortality risk,” explained Kühn.
Is it because of the high proportion of smokers?
Stefan Kabisch from the Clinic for Endocrinology and Metabolic Medicine at the Charité Universitätsmedizin Berlin sees another connection. The proportion of smokers is highest among people who eat fewer meals. The increased mortality could also be related to low socioeconomic status and other statistically linked factors, such as smoking, alcohol consumption or lack of exercise. “Actual causal factors for mortality may have already existed before the study participants even started intermittent fasting. Obesity, type 2 diabetes and elevated blood lipids often motivate many people to start intermittent fasting,” explained Kabisch. This is also the case in the present study: “The intermittent fasting group has the highest BMI and the highest proportion of smokers. The ethnic distribution also plays a role, because in the USA – where the NHANES cohort was collected – African Americans contribute primarily for social reasons the greatest health risk.”
National Health and Nutrition Examination Surveys (NHANES) The goals of NHANES are to assess the health and nutritional status of adults and children in the United States and to document changes over time. This is achieved through a combination of patient consultation and physical examination. The conversation includes demographic, socioeconomic, dietary and health-related questions. The examination places emphasis on medical, dental and physiological aspects and also includes laboratory tests by medical staff. Source: Wikipedia