Is Breakfast Really the Most Important Meal of the Day?

Is Breakfast Really the Most Important Meal of the Day?

The bottom line on morning fare

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FFor years, the conventional wisdom has held that not only is a good breakfast vital, but it?s also the most important meal of the day. A good breakfast promotes overall better health, the thinking goes. Some experts advise that eating an early morning meal boosts metabolism and helps people lose weight over time.

Science isn?t so sure about all that. Neither is Tim Spector, a professor of genetics at King?s College London and author of The Diet Myth: The Real Science Behind What We Eat. ?Breakfast has no special importance ? other than being the first time you eat after a long fast (i.e. sleep) and when our metabolism is working at its best,? he says. ?Of course, the breakfast cereal manufacturers will tell us otherwise.?

Flavia Cicuttini, a researcher at Monash University, agrees that having breakfast holds no special importance for a person?s overall well-being. Cicuttini was part of a team that recently reviewed 13 studies on the relationship between breakfast and a person?s weight and energy. Cicuttini and her colleagues published their findings in The BMJ in late January 2019.

?We can conclude that modification of diets to include consumption of breakfast might not be a good strategy for weight loss.?

They found that people who regularly ate breakfast consumed about 260 calories more per day than people who routinely skipped it, and on average, they weighed about one pound more ? a statistical dead heat, for all practical purposes.

?We can conclude that modification of diets to include consumption of breakfast might not be a good strategy for weight loss,? says Cicuttini in an email. ?Importantly, there was no evidence for improved metabolism in those who ate breakfast or that they were less likely to overeat later in the day.?

However, studies suggest there may be significant health risks associated with skipping breakfast, though the science on this is fuzzy.

One recent study looked at nutrition surveys of 6,550 U.S. residents ages 40 to 75, none of whom had a history of cardiovascular disease. Just 5.1% said they never ate breakfast. In follow-ups with the people about 18 years later ? by which time 2,300 of the participants had died ? researchers found that the breakfast abstainers had an 87% higher risk of death related to cardiovascular disease than those who ate breakfast daily. (The study was detailed in the April 30, 2019 issue of the Journal of the American College of Cardiology.)

?We cannot tell whether breakfast is ?the most important,? but the results at least indicate that breakfast is an important meal and skipping breakfast may increase risk of cardiovascular death,? says study team member Wei Bao, an assistant professor of epidemiology at the University of Iowa. ?The findings in our study are in line with previous findings on the relation of skipping breakfast with cardiovascular risk factors, such as diabetes, hypertension, and lipid disorders. Breakfast should be encouraged as part of an overall healthy diet.?

But Cicuttini, the Monash scientist, points out that Bao?s conclusion is the result of an observational study that doesn?t indicate cause-and-effect (a fact that Bao readily admits).

While the link between skipping breakfast and increased cardiovascular risk is clear, Cicuttini says, it?s not at all clear whether skipping breakfast is a cause. Other health behaviors among people who skip breakfast could be raising the risk of cardiovascular disease. ?This can only be tested by performing a randomized clinical trial,? she says.

Spector, who wrote an opinion piece in The BMJ to accompany Cicuttini?s study, agrees. The study on breakfast and cardiovascular mortality ?is an observational epidemiology study that is prone to many biases and can confuse cause and effect,? he says.

Other research underlines that point. A 2017 study published in the Journal of the American College of Cardiology found that people who regularly avoided a morning meal had more plaque buildup in their blood vessels ? a sign of increased risk for heart attack and stroke. But it also uncovered an important difference in overall lifestyle that was the more likely cause of the elevated risk.?The people who were skipping breakfast were more likely to fall into what?s called a social business-eating pattern,? says Dr. Haitham Ahmed, a cardiologist at the Cleveland Clinic who was not involved in the study. ?Those are people who are eating out at work, spending a lot of time eating out, eating larger meals, having alcohol, and eating more fast food.? Ahmed says the study, therefore, doesn?t mean that skipping breakfast will kill you, but it does show a connection between that and unhealthy eating.

Those fruity puffs and cocoa loops that were once touted as ?part of a balanced breakfast? in many cases are more than 40% sugar by weight.

Bao, meanwhile, sees a positive link between his heart-health findings and Cicuttini?s The BMJ review, which both showed only minimal weight gain among breakfast eaters, despite the additional calories they consumed. That may be good news for habitual breakfast eaters, says Bao.

?The debate of eating breakfast should go beyond focusing on weight gain or loss, and pay attention to the long-term health outcomes, such as cardiovascular disease and diabetes,? he says. ?People can enjoy eating breakfast with potential long-term cardiovascular benefits but no concern on weight management.?

IfIf you do eat breakfast, what you eat almost surely matters, though none of these studies looked at that part of the equation.

Chocolate-covered donuts with sprinkles may not be the best choice every morning. Plain oatmeal gets good reviews for its nutrition and health benefits. And while the advice on eggs has been scrambled of late, most experts still put them in the ?good for you in moderation? category.

As for the breakfast of champions? If you must eat processed cereal, go for boxes that contain 100% whole grains and the fewest other ingredients. Those fruity puffs and cocoa loops that were once touted as ?part of a balanced breakfast? in many cases are more than 40% sugar by weight.

?The key message is that if a person likes to eat breakfast, that is fine,? says Cicuttini. ?However, there is no evidence that we should be encouraging people to change their eating patterns to include breakfast in order to prevent weight gain or obesity. People need to work out what suits them.?


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