Long dubbed “the most important meal of the day,” breakfast may still be deserving of its title.

That’s according to a new study published Monday in the Journal of the American College of Cardiology that shows for the first time an association between skipping breakfast and an increased risk of death from cardiovascular disease.

A group of researchers in Iowa examined the results of a health and nutrition survey taken from 1988 to 1994 and compared them to death records through to the end of 2011. Of 6,674 adults aged 40 to 75 years of age during the survey, just over 5 per cent said they never consumed breakfast. Nearly 11 per cent rarely consumed breakfast, 25 per cent consumed breakfast some days and 59 per cent consumed breakfast daily. There were 2,318 deaths since the time of the survey, including 619 from cardiovascular disease.

“Skipping breakfast was associated with a significantly increased risk of mortality from cardiovascular disease,” the researchers report in the study.

The risk of heart disease was higher in those who never consumed breakfast even after adjusting for various other risk factors, including socioeconomic status and body mass index.

Despite the belief that breakfast is an important meal of the day, researchers noted that there has been an “increasing prevalence” of skipping breakfast in recent decades. As many as 23.8 per cent of young people in the U.S. skip breakfast every day, according to various studies cited in the new research. A study out of the University of Waterloo in 2018 found that 39 per cent of students reported eating breakfast fewer than three days in an average week.

While there appears to be an association between skipping breakfast and high risk of death from cardiovascular disease, the new research does not necessarily mean that skipping breakfast is a direct cause of cardiovascular disease.

“The group of subjects reporting that they never have breakfast were more frequently smokers, alcohol drinkers, physically inactive, and obese,” wrote Borja Ibanez and Juan M. Fernandez-Alvira in editorial commentary on the study.

Skipping breakfast could have secondary effects on behaviour and health, the research said. Forgoing the meal could lead to metabolic changes, including insulin resistance, increased blood pressure and changes in lipid levels. Skipping breakfast is also a behavioural marker for unhealthy patterns such as poor physical activity and lack of sleep.

The study did not take into account types of food and beverages consumed for breakfast or whether participants changed their breakfast habits over the years.

Still, the new research could prove to be a helpful addition to determining the risk of heart disease, said Borja Ibanez and Juan M. Fernandez-Alvira in the editorial commentary. “What is clear is that a pattern of skipping breakfast identifies a population at risk,” they wrote.