Based on new research, cardiologists are now echoing the popular maxim that breakfast is the most important meal of the day.

When compared to people who consumed more than 20 percent of their daily energy at breakfast, habitual breakfast skippers were at a 1.55-fold increased risk of noncoronary atherosclerosis and a 2.57-fold increased risk of generalized atherosclerosis, independent of traditional and dietary cardiovascular risk factors.

These findings were published Oct. 2 in the Journal of the American College of Cardiology.

The researchers noted previous studies have shown a healthy breakfast can promote heart health, but this was the first study to analyze the link between breakfast and the presence of subclinical atherosclerosis—the hardening and narrowing of arteries due to plaque buildup.

“Aside from the direct association with cardiovascular risk factors, skipping breakfast might serve as a marker for a general unhealthy diet or lifestyle which in turn is associated with the development and progression of atherosclerosis,” Jose L. Peñalvo, PhD, an assistant professor at the Friedman School of Nutrition Science and Policy at Tufts University and the senior author of the study, said in a press release. “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.”

A computerized questionnaire was used to evaluate the dietary habits of 4,052 participants, all between the ages of 40 and 54 and free of any cardiovascular or chronic kidney disease.

Participants were grouped into three categories based on the proportion of daily energy consumed in the morning: less than 5 percent (skipped breakfast and had only coffee, juice or another beverage), between 5 and 20 percent (low-energy breakfast consumers) and more than 20 percent (breakfast consumers). Among the study sample, 2.9 percent skipped breakfast, 69.4 percent were low-energy breakfast consumers and 27.7 percent were breakfast consumers.

Breakfast skippers were the most likely to develop atherosclerosis, followed by those who consumed a low-energy breakfast. Participants who skipped breakfast had the greatest waist circumference, body mass index, blood pressure and cholesterol levels, and were more likely to have a poor overall diet, consume alcohol frequently and smoke.

The researchers acknowledged reverse causation may have impacted their results in that obese patients may have been skipping breakfast to lose weight.

Still, the results point to the benefit an easy choice—whether to consume a substantial breakfast—can have on heart health.

“Between 20 and 30 percent of adults skip breakfast and these trends mirror the increasing prevalence of obesity and associated cardiometabolic abnormalities,” Prakash Deedwania, MD, author of an accompanying editorial in JACC, said in the press release.

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