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Skipping or skimping on breakfast may increase risk of heart trouble

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A study published recently in the Journal of the American College of Cardiology adds even more credence to the adage "Eat breakfast like a king, lunch like a prince and dinner like a pauper."

Research 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 study is the first to find that breakfast has an impact on your risk of early-stage atherosclerosis (hardening or narrowing of the arteries caused by plaque buildup). Unchecked, atherosclerosis can lead to serious health issues such as heart attack or stroke.

This research involved just over 4,000 people ages 40 to 54, none with a history of cardiovascular disease. Based on their responses to dietary questionnaires, the subjects were divided into three groups: breakfast skippers (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.

The researchers accounted for heart-disease risk factors such as smoking 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 atherosclerosis than those who ate a hearty morning meal.

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, an assistant professor at the Friedman School of Nutrition Science and Policy at Tufts University and senior author of the study.

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."

The research also found that "the people who skipped breakfast also made poor choices for their food intake later in the day," says Prakash Deedwania, a professor of medicine at the University of California at 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 produce 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.

And although this study can't prove cause and effect, Peñalvo says, "if you introduce a good-quality breakfast into your diet, it will probably help correct unhealthy behaviors later in the day."

How can you make healthy breakfast choices? "Many people load up on carbohydrates in the morning: bagels, cereal, fruit, juice, toast," says Amy Keating, a dietitian at Consumer Reports. "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 with at least five 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 sugar and fewer calories than if you used jam, and 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 half an avocado and mix in sliced hard-boiled egg, diced tomato and salt and pepper. Serve in a whole-wheat pita.

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