Don’t believe in the importance of a healthy breakfast? A new study published in the Journal of the American College of Cardiology adds even more credence to the old adage: Eat breakfast like a king, lunch like a prince, and dinner like a pauper.

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Research in recent years has already provided ample evidence that breakfast skippers tend to have higher rates of obesity and type 2 diabetes, as well as higher blood pressure, cholesterol, glucose, and insulin levels.

But this new study is the first to find that what you eat in the morning has an impact on your risk of early stage atherosclerosis (hardening or narrowing of the arteries caused by plaque buildup). Unchecked, atherosclerosis can ultimately lead to serious health issues, such as heart attack or stroke.  

Here’s why a healthy breakfast may be good for your heart, and suggestions for what you should be eating.

How the Study Looked at Breakfast Habits

The new research involved just over 4,000 adults ages 40 to 54, none of whom had a previous history of cardiovascular disease.

Based on their responses to dietary questionnaires, the subjects were divided into three groups: breakfast skippers, which included people who had only coffee or juice; consumers of “low energy” breakfasts (whose morning meals were 5 to 20 percent of their daily caloric intake); and those who ate “high energy” breakfasts, consuming more than 20 percent of their daily calories first thing in the morning.

Ultrasound and other imaging techniques were used to identify signs of atherosclerosis. 

Why Breakfast Matters for Your Heart

While doing their calculations, the researchers accounted for various other heart-disease risk factors (such as smoking, waist circumference, and high blood pressure). Even so, they determined that both the breakfast skippers and the low-energy breakfast consumers were at a higher risk for developing atherosclerosis than those who ate a hearty morning meal.

In terms of the numbers, the study found that the odds of finding atherosclerotic plaques were up to 2.5 times greater in those who regularly skipped breakfast and 1.2 times higher in those who ate low-energy breakfasts.

“Our results indicate that there is an independent association between breakfast consumption and cardiovascular disease,” says José L. Peñalvo, Ph.D., assistant professor at the Friedman School of Nutrition Science and Policy at Tufts University and senior author of the study.

And though the the mechanism of that association isn’t yet known, Peñalvo hypothesizes that “a higher caloric intake in the morning could result in better glucose regulation throughout the day, as well as increased satiety and balanced appetite regulation that could prevent overeating during the day.”

In addition to finding evidence of atherosclerosis, researchers also gained insights into participants’ other health habits. Although this study didn’t specifically analyze the nutritional content of the breakfasts reported (the focus was on the percentage of daily calories), the questionnaires did assess other measures of daily diet and lifestyle.

The research also found that the importance of a healthy breakfast extended well into the day. “The people who skipped breakfast also made poor choices for their food intake later in the day,” says Prakash Deedwania, M.D., professor of medicine at the University of California, San Francisco, and author of an editorial accompanying the study. They consumed more red and processed meat, drank more sweetened beverages and alcohol, and ate less fruit, vegetables, and fiber than the group who ate a hearty breakfast.

More people in the breakfast-skipping group were obese, and those participants were also more likely to be dieting. “Many people have the false belief that skipping breakfast will help them lose weight, when in fact it can have the reverse consequence,” Deedwania says. “The truth is that eating a nutritious breakfast will help you maintain a healthy metabolic balance, which reduces your risk of obesity, diabetes, and heart disease.”  

And though this study can’t directly prove cause and effect, the takeaway message on the importance of a healthy breakfast is clear. “If you introduce a good quality breakfast into your diet, it will probably help correct unhealthy behaviors later in the day,” Peñalvo says. “It’s a simple change that has the potential to change a whole lifestyle.”  

Tips for a Better Breakfast

More convinced of the importance of breakfast? Here’s how to make the smartest choices:

“Many people load up on carbohydrates in the morning—bagels, cereal, fruit, juice, toast,” says Amy Keating, R.D., a dietitian at CR. “Even if the cereal and bread are whole grain, you need to balance the carbohydrates with protein and healthy fats.” Keating suggests the following quick ideas:

• Blend a whole-grain cereal (look for one that has at least 5 grams of fiber per serving) with Greek yogurt instead of milk. Stir in nuts or seeds for healthy fat, and some fruit, if you like, for sweetness and extra fiber.

• Top whole-grain toast with a nut butter (healthy fat and protein) and sliced fruit, such as apple, banana, or strawberries, instead of jam or jelly. You’ll take in less added sugars and fewer calories than if you used jam, and you’ll increase the fiber.

• Have a tapas-style breakfast with an assortment of fruit, cheese, nuts, and a few whole-wheat crackers. Keep the nuts and cheese to about an ounce each.

• Mash ½ avocado and mix in sliced hard-boiled egg, diced tomato, and salt and pepper. Serve in a whole-wheat pita.