Here’s more evidence why breakfast may be the most important meal of the day: Men who reported that they regularly skipped breakfast had a higher risk of a heart attack or fatal coronary heart disease in a study reported in the American Heart Association journal Circulation.

Researchers analyzed food frequency questionnaire data and tracked health outcomes for 16 years (1992-2008) on 26,902 male health professionals ages 45-82. They found:

Men who reported they skipped breakfast had a 27 percent higher risk of heart attack or death from coronary heart disease than those who reported they didn’t.

The men who reported not eating breakfast were younger than those who did, and were more likely to be smokers, employed full time, unmarried, less physically active and drank more alcohol.

Men who reported eating late at night (eating after going to bed) had a 55 percent higher coronary heart disease risk than those who didn’t. But researchers were less convinced this was a major public health concern because few men in the study reported this behavior.

During the study, 1,572 of the men had first-time cardiac events.

Related risk factors

“Skipping breakfast may lead to one or more risk factors, including obesity, high blood pressure, high cholesterol and diabetes, which may in turn lead to a heart attack over time,” said Leah E. Cahill, Ph.D., study lead author and Postdoctoral Research Fellow in the Department of Nutrition at Harvard School of Public Health in Boston, Mass.

“Our study group has spent decades studying the health effects of diet quality and composition, and now this new data also suggests overall dietary habits can be important to lower risk of coronary heart disease,” said Eric Rimm, Sc.D., senior author and Associate Professor of Epidemiology and Nutrition, Harvard School of Public Health and Associate Professor of Medicine at the Harvard Medical School.

Men who reported eating breakfast ate on average one more time per day than those who skipped breakfast, implying that those who abstained from breakfast were not eating additional make-up meals later in the day. Although there was some overlap between those who skipped breakfast and those who ate late at night, 76 percent of late-night eaters also ate breakfast, researchers said.

Other things taken into account

The study collected comprehensive questionnaire data from the participants and accounted for many important factors such as TV watching, physical activity, sleep, diet quality, alcohol intake, medical history, BMI, and social factors like whether or not the men worked full-time, were married, saw their doctor regularly for physical exams, or smoked currently or in the past.

While the current study group was composed of men who were of 97 percent white European descent, the results should also apply to women and other ethnic groups, but this should be tested in additional studies, researchers said.

A "great way to start the day"

“Don’t skip breakfast,” Cahill said. “Eating breakfast is associated with a decreased risk of heart attacks. Incorporating many types of healthy foods into your breakfast is an easy way to ensure your meal provides adequate energy and a healthy balance of nutrients, such as protein, carbohydrates, vitamins and minerals. For example, adding nuts and chopped fruit to a bowl of whole grain cereal or steel-cut oatmeal in the morning is a great way to start the day.”

Other co-authors are Stephanie Chiuve, Sc.D.; Rania Mekary, Ph.D.; Majken Jensen, Ph.D.; Alan Flint, M.D., Dr.Ph.; and Frank Hu, M.D., Ph.D. The authors had no relevant disclosures.