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We’ve heard for years that breakfast is the most important meal of the day. But, it actually might be even more important than previously thought, according to a study published in the Journal of the Academy of Nutrition and Dietetics, which examined the effects of skipping meals and meal frequency as related to mortality (死亡率) and heart health.

The study, which was published in August of last year, sought to find out if eating behaviors like meal frequency, meal skipping, and time between meals were associated with all-cause and cardiovascular disease (CVD) mortality.

The study consisted of 24,011 adults 40 years or older who participated from 1999 to 2014. Researchers looked at various eating behaviors of participants who self-reported their eating habits every 24 hours. Causes of death were tracked via death records through December 31, 2015.

After examining participants throughout the years, researchers found that certain eating behaviors were in fact linked to higher rates of premature death. Eating only one meal per day was associated with an increased risk of all-cause and CVD mortality while skipping breakfast was linked to an increased risk of CVD mortality, and skipping lunch or dinner was linked to an increased risk of all-cause mortality. Lastly, the study found that having meals too closely together (less than four and half hours apart) was also linked to all-cause premature death.

So, what does this mean for the average person? “At the end of the day what matters is that an individual can meet their nutritional needs for optimal (最佳) health,” explains Keri Gans, author of The Small Change Diet, “and breakfast typically is a good vehicle for nutrients associated with a decrease in cardiovascular risk, such as fiber and vitamins”. “If by eliminating meals they are missing out on important nutrients their body needs, then long term that can be harmful to their health,” leads to a “higher risk for certain cancers and heart disease,” she says.

While this study was large and comprehensive in many ways, there are also many limitations. It was mostly based on a 24-hour, self-reported dietary recall, “which may not always be the best method for dietary assessment,” explains Gans. “The participants may not accurately recall what they ate or honestly report it leading to the potential of misinformation.” Researchers noted that it was impossible to consider the role of sleep in the relationship between food and mortality, as well as a host of other unmeasured factors.

The bottom line is that while these findings about the relationships between meal skipping and mortality are important, there are a lot more factors that go into premature death.