Men who eat breakfast have a significantly lower risk of coronary heart disease (CHD) than those who do not, a large prospective study based on data from the Health Professionals Follow-up Study has found.

The study analysed the eating habits of 26,902 American men aged 45 to 82 who were free of cardiovascular disease and cancer at entry into the study in 1992.

During 16 years of follow-up there were 1,527 cases of incident CHD, defined as fatal myocardial infarction (MI) or nonfatal CHD.

The results were adjusted for multiple factors such as demographics, diet quality, calories, alcohol intake, eating frequency, sleep characteristics, physical activity, smoking, having a parent who had an MI at a young age and work status (part or full time).

Men who reported not eating breakfast were younger and more likely to work full time, drink more alcohol, smoke, be single and less active compared with the other men.

Men who skipped breakfast had a 27% higher risk of CHD compared with men who did not, relative risk (RR) 1.27 (95% CI:1.06-1.53).

Furthermore, those who ate late at night had a 55% higher CHD risk RR 1.55 (95% CI:1.05-2.29). There was no association seen between eating frequency and risk of CHD.

The authors observed that these associations were at least partly the result of adverse changes in body mass index, hypertension, hypercholesterolaemia, and diabetes mellitus as after adjusting for these factors the increased risk from missing breakfast fell to 18%, RR 1.18 (95% CI:0.98-1.43).

The mechanism for raised CHD risk in those who do not eat breakfast could involve higher levels of fasting insulin, triglycerides, and LDL-cholesterol as the body reacts to the fact that there has been no new calorie source for 12–14 hours.

These findings would appear to give a very simple, cheap and easy to implement public health message.

We should take this opportunity to remind our patients of the old adage: ‘Breakfast like a king, lunch like a prince and dine like a pauper.’

Dr Peter Savill