Researchers from the American College of Cardiology used self-reported data from 6,550 Americans aged 40 to 75 (48% male, 52% female), collected between 1988 and 1994 who had no history of cardiovascular disease or cancer. They were asked, "how often do you eat breakfast?" and possible answers included, "every day," "some days," "rarely" and "never". Among the participants, 5.1% never ate breakfast, 10.9% rarely ate breakfast, 25% ate breakfast some days and 59% ate breakfast every day.
The health of the participants was then analysed through to 2011 using separate data. Within this period, 2,318 participants died, and 619 of these deaths were due to cardiovascular disease.
After making adjustments for age, sex, race/ethnicity, socioeconomic status, dietary and lifestyle factors, body mass index, and cardiovascular risk factors, the researchers concluded that people who never ate breakfast had an 87% higher risk of cardiovascular disease-specific mortality than those who consumed breakfast every day.
It said missing breakfast was associated with increased risk of obesity, elevated cholesterol or fats in the blood, high blood pressure, Type 2 diabetes, metabolic syndrome, and heart disease.
“In a nationally representative cohort with 17 to 23 years of follow-up, skipping breakfast was associated with a significantly increased risk of mortality from cardiovascular disease,” concluded the research. “Our study supports the benefits of eating breakfast in promoting cardiovascular health.”
The benefits of eating breakfast
The researchers claimed that skipping breakfast, which is related to changes in appetite and decreased satiety, might lead to overeating later and impairment in insulin sensitivity. By contrast, they said eating breakfast has a beneficial effect on appetite regulation and also improves the glycemic response at the next eating occasion with increased sensitivity to insulin.
They added that skipping breakfast was associated with stress-independent overactivity in the hypothalamic-pituitary-adrenal axis because of longer period of fasting, leading to elevated blood pressure in the morning.
“Eating breakfast has also been shown to help lower blood pressure, which in turn may prevent blood vessel clogging, hemorrhage, and cardiovascular events,” they wrote, adding “skipping breakfast might also induce deleterious changes in lipid levels, such as higher total cholesterol and atherogenic low-density lipoprotein cholesterol concentrations, which are independent risk factors of Atherosclerosis.”
Are unhealthy people more likely to miss breakfast?
The researchers pointed out that skipping breakfast may be a behavioural marker for unhealthy dietary and lifestyle habits. But they added that the study was adjusted for a variety of dietary and lifestyle factors including smoking, alcohol drinking, physical activity, total energy intake, and overall diet quality, and the association between skipping breakfast and cardiovascular mortality remained significant.
The study was limited, however, by not knowing exactly what people were eating for breakfast and whether their eating habits changed in the follow-up period.
The most important meal of the day?
These findings are at odds with evidence suggesting that intermittent fasting has some health benefits, and adds to the debate about the importance of breakfast.
Priya Tew Priya Tew, a BDA Spokesperson and Registered Dietitian, agreed that there is evidence that fasting can be positive. “For some people, following a fasting-style diet can work. The reason it works is because it restricts their intake of calories,” she said.
But she added that breakfast is still something people need to eat. “If you’re not eating breakfast it can lead you getting hungrier whereas having a wholegrain, whole fibre breakfast cereal is better in terms of heart health.”