Healthy Breakfast May Help Lower Cardiovascular Disease Risk

• In a new study, researchers say what you eat at breakfast is just as important as how much you eat.
• People who consumed between 20% and 30% of their daily energy intake at breakfast and ate higher quality foods showed improvements in waist circumference, triglycerides, and HDL (good) cholesterol.
• Experts recommend healthy breakfast choices such as oatmeal, avocado toast, fruit, and eggs.

Eating a substantial breakfast is important for heart health, but what you eat at that first meal of the day is also important.

Researchers examined the average energy intake of breakfast meals compared to a person’s total daily intake and the quality of the morning meals in terms of proteins, fats, fibers, and other nutrients.

They concluded that a person who consumes an adequate amount of calories at breakfast and does so with high-quality food is at a lower risk of cardiovascular disease.

“Breakfast is the most important meal of the day, but what and how you eat it matters,” said Álvaro Hernáez, a researcher at the Hospital del Mar Research Institute’s CIBER for Cardiovascular Diseases (CIBERCV) in Spain, in a press release.

“Eating controlled amounts — not too much or too little — and ensuring good nutritional composition is crucial. Our data show that quality is associated with better cardiovascular risk factor outcomes. It’s as important to have breakfast as it is to have a quality one,” Hernáez continued.

For their study, researchers examined 383 participants in the PREDIMED-Plus Project, a randomized clinical trial that compared the effects of a Mediterranean diet and regular physical activity with dietary recommendations.

The participants were followed for three years with measurements taken at the beginning of the study as well as at 24 months and 36 months.

The researchers divided the subjects into three categories:

• less than 20% of daily energy intake consumed at breakfast
• 20% to 30% of daily energy intake consumed at breakfast
• more than 30% of daily energy intake consumed at breakfast

The researchers reported that people who consumed 20% to 30% of their energy intake at breakfast had 2% to 3% lower body mass index (BMI) measurements than participants who had less than 20% or higher than 30% of daily energy intake at breakfast.

They added that the individuals in the 20% to 30% range also had:

• 2% to 4% smaller waist circumference
• 9% to 18% reduction in triglyceride levels
• 4% to 8% increase in the level of HDL or “good” cholesterol

In addition, the researchers said that participants who had high quality breakfasts had:

• 1.5% smaller waist circumference
• 4% lower triglycerides
• 3% higher HDL cholesterol measurement

“Our body’s daily metabolic rhythms are governed by an internal clock that is affected by when we eat our meals,” explained Cheng-Han Chen, MD, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California.

“Changes in typical mealtimes, such as skipping meals or eating during normal sleep times, can then potentially influence the development of cardiometabolic diseases such as diabetes and obesity,” he told Healthline. Chen wasn’t involved in the study.

Mir Ali, MD, abariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at the Orange Coast Medical Center in California, told Healthline the new research aligns with other studies showing the health benefits of eating a healthy breakfast.

Ali wasn’t involved in the study but told Healthline the study was interesting but noted a few limitations. “The limitations are a relatively small sample size confined to a narrow ethnic group. Thus, the findings may vary to some extent in different areas, but overall, generally applicable,” he said.

Kate Donelan, MS, RD, a registered dietitian at Stanford Health Care in California, likewise not involved in the study, noted some additional limitations to the research.

“My overall impression of the study is that it reflects what we generally know about health and nutrition. Since it’s just observational, it doesn’t suggest any causality between breakfast and changes in health markers, which is not as helpful as controlled experiments that can determine cause and effect,” Donelan told Healthline.

“Also, the study only included Spanish older adults, which limits the study’s generalizability. Whenever we include only one population in a study, it’s difficult to determine what is due to the factors being studied and what is due to cultural food habits, behavioral patterns, and genetic predisposition,” she added.

These new findings are not the first to find that a healthy and substantial breakfast is important for good health.

In 2017, researchers reported that people who make breakfast their biggest meal of the day were more likely to lose weight than those who skipped breakfast or ate lighter meals in the morning.

In 2020, another group of researchers reported that people who eat a big breakfast burn twice the calories daily compared to those who eat a larger dinner.

Other studies have concluded that eating a lot of protein at breakfast can also help people lose weight.

“Breakfast is important because it’s your first chance to fuel your body after an extended period of time without any nutrients,” Donelan said.

“Eating a breakfast with protein, fiber, and fat [regulates] your metabolism [and] improves cognitive function and energy levels. Skipping breakfast can lead to overeating later in the day and create unnecessary blood sugar dips and spikes,” she noted.

“Eating breakfast helps regulate our blood sugar control and helps to limit overeating later in the day. We also think that eating breakfast helps to prevent rises in stress hormones, which could then increase blood pressure,” Chen added.

Kristin Kirkpatrick, a registered dietitian at the Cleveland Clinic Department of Wellness Prevention & Medicine, echoed the benefits of a healthy breakfast.

“We’ve seen other studies, especially in pediatrics that show better attention, performance on tests, etc., when breakfast is consumed,” she told Healthline.

“Breakfast (or, let’s say the first meal of the day) can often set the stage for eating habits the rest of the day. Starting the day in a nutrient-dense manner may help with continuing that form of eating. Additionally, breakfast offers a great opportunity to get in important vitamins and minerals. Finally, depending on the breakdown of macros, having breakfast may play a role in keeping you fuller and satisfied,” Kirkpatrick continued.

Ali added that breakfast “stimulates the metabolism early in the day and if the right types of food are consumed, may help reduce hunger throughout the day. It has also been linked to improved cognitive function, concentration, and mood.”

Experts say diet quality is essential for overall health and well-being.

“Quality of diet is often a good indicator (over quantity) related to health,” Kirkpatrick said.

“The ‘how much’ really boils down to how individuals are assessing their hunger and what aspects relate to those hunger cues (such as social aspects, sleep quality, etc.). However, there is a big difference between having a nutrient-rich breakfast (i.e., oats, eggs, etc.) and an empty calorie breakfast (i.e., breakfast pastry, refined grains, etc.) in terms of health outcomes,” she noted.

Christopher Gardner, PhD, the immediate past president of the American Heart Association’s nutrition committee and a professor of medicine at Stanford University in California, noted it’s important to make healthy choices throughout the day — not just at breakfast. Gardner wasn’t involved in the study.

“Overall dietary pattern is a better indicator of eating in a heart-healthy way versus focusing on one specific meal or food,” he told Healthline.

Ali agreed. “The type of calories a person consumes is just as important as the quantity, not only for breakfast but all meals. Reducing carbohydrate, sugar and highly processed food intake is beneficial for any meal,” he said.

Donelan said that what you eat matters more than how much you eat at any time of the day.

“I think we all know one cup of Oreos is not the same thing as one cup of fruit. Nutrient-dense foods like fruits, vegetables, and whole grains support metabolism and positive health outcomes,” she said.

In the new study, researchers defined a quality breakfast as one that included healthy amounts of protein, high-value fats, fiber, and minerals such as potassium and iron.

In addition, these breakfasts avoided excessive added sugars and saturated fats.

In general, experts say this is the proper strategy when it comes to choosing breakfast foods. Gardner recommended the following suggestions for breakfast:

• whole grain cereal such as steel cut oats with fruits and nuts
• avocado toast on whole wheat grain toast with toppings such as kimchi or sautéed greens
• veggie scramble with eggs sautéed with vegetables and herbs

Other experts have similar recommendations.

“Nutrient-dense options may include steel-cut oats, eggs, berries, avocado toast (on whole grain bread), yogurt with berries, etc.,” Kirkpatrick said. “However, we can add to these meals (such as adding berries and hemp seeds to our oats, adding vegetables to our eggs like a frittata).”

Chen recommends eating breakfast within one hour of waking up. He suggested foods such as:

• oatmeal
• eggs
• yogurt
• fresh fruit

“A balanced breakfast includes whole grains, protein, healthy fats, and fruit. This could be oatmeal with nuts and berries, Greek yogurt with fruit and granola, or avocado toast with eggs,” Donelan said.

Ali emphasized that people should choose natural foods and avoid highly processed products.

“I recommend to my patients to consume primarily proteins and vegetables and reduce simple carbohydrates and sugars,” he said. “As mentioned in this study, a Mediterranean type of diet is along those lines. This consists of low fat dairy products, whole grains, proteins, and a limited amount of fruit.”

Researchers say people who consume 20% to 30% of their daily energy intake at breakfast have smaller waist circumferences, lower levels of triglycerides, and higher levels of HDL or “good” cholesterol.

They add that people who eat high quality foods during their morning meals experience similar health benefits. Those factors help lower a person’s risk of cardiovascular disease.

Experts recommend people have whole grain cereal, such as oatmeal, or avocado toast or eggs along with fruit at breakfast.