A study led by researchers in Spain has suggested that skipping breakfast doubles the risk of "subclinical atherosclerosis."

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A healthful, high-energy breakfast can consist of yogurt, whole grains, and fruit.

Atherosclerosis occurs when fatty deposits, along with cholesterol and other forms of cellular waste, build up inside the arteries. This reduces arterial elasticity, and, over time, it can lead to coronary heart disease, angina, or peripheral artery disease, among other conditions.

Subclinical atherosclerosis is a latent form of the condition, which does not produce symptoms straight away.

Popular wisdom has it that breakfast is the most important meal of the day - and the first set of findings from the Progression and Early Detection of Atherosclerosis study (PESA) suggests that the meal may be even more important than traditionally believed.

The results of the research show that those who consume less than 5 percent of their daily calorie intake for breakfast may have double the risk of subclinical atherosclerosis compared with people who have a high-energy breakfast.

A high-energy breakfast might comprise a good source of protein - such as yogurt or eggs - whole grains, and fruit.

The first author of the new study is Dr. Irina Uzhova, of the Centro Nacional de Investigaciones Cardiovasculares Carlos III in Madrid, Spain, and the findings were published in the Journal of American College of Cardiology.

Studying breakfast patterns

Dr. Uzhova and her team examined three types of breakfast consumption, looking for a connection between breakfast patterns and the incidence of subclinical atherosclerosis in a healthy population.

PESA is a prospective study, comprising more than 4,000 participants with no history of cardiovascular disease. Participants were aged between 40 and 54.

They used multivascular imaging techniques and collected information about the participants' lifestyle. The former informed the team about the presence of plaques in the carotid arteries, iliofemoral arteries, the aorta, and the coronary arteries.

Participants were monitored for 6 years, and the data gathered were statistically analyzed using multivariate regression models.

Breakfast skippers are at risk

The study found that 27 percent of the participants regularly consumed a high-energy breakfast, or a breakfast that offered over 20 percent of the daily recommended calories.

Most of the population sample (70 percent) regularly consumed a low-energy breakfast, or one that provided between 5 and 20 percent of the daily calorie intake.

Finally, 3 percent of the participants either ate very little (under 5 percent of the recommended calories) or skipped breakfast entirely.

Overall, the researchers found that people in this latter group were more likely to have unhealthful eating and lifestyle habits. These included a poor diet, smoking, and frequent alcohol use.

Imaging data also revealed that they had 1.5 times more atherosclerotic lesions than people who consumed a high-energy breakfast.

Also, in some vascular areas - such as the carotid artery and the iliofemoral arteries - breakfast skippers were up to 2.5 times more likely to have atherosclerotic plaques.

This group also scored higher on the list of cardiovascular risk factors; those who skipped breakfast tended to have a higher waist circumference and body mass index (BMI), as well as increased fasting blood sugar levels and blood lipids, or fats.

Significance of the findings

Study co-author Dr. Valentin Fuster says that the findings show that skipping breakfast is "one bad habit people can proactively change to reduce their risk for heart disease."

It is known that making lifestyle changes can reduce the risk of cardiometabolic disorders such as diabetes, obesity, and hypertension.

"[The] PESA study makes an incalculable contribution to scientific knowledge and public health," adds Dr. Fuster.

"Our findings are important for health professionals and might be used as a simple message for lifestyle-based interventions and public health strategies, as well as informing dietary recommendations and guidelines."

Study co-author Prof. Jose L. Peñalvo, Friedman School of Nutrition Science and Policy at Tufts University

In an editorial comment accompanying the study, Dr. Prakash Deedwania - a professor of medicine at the University of California, San Francisco - writes:

"Poor dietary choices are generally made relatively early in life and, if remained unchanged, can lead to clinical cardiovascular disease later on."

He explains, "Adverse effects of skipping breakfast can be seen early in childhood in the form of childhood obesity, and although breakfast skippers are generally attempting to lose weight, they often end up eating more and unhealthy foods later in the day."

"Skipping breakfast can cause hormonal imbalances and alter circadian rhythms. That breakfast is the most important meal of the day has been proven right in light of this evidence," concludes Dr. Deedwania.