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Meal Skipping and Shorter Meal Intervals Are Associated with Increased Risk of All-Cause and Cardiovascular Disease Mortality among US Adults

Published:August 10, 2022DOI:https://doi.org/10.1016/j.jand.2022.08.119

      Abstract

      Background

      Previous dietary studies and current dietary guidelines have mainly focused on dietary intake and food patterns. Little is known about the association between eating behaviors such as meal frequency, skipping and intervals, and mortality.

      Objective

      The objective was to examine the associations of meal frequency, skipping, and intervals with all-cause and cardiovascular disease (CVD) mortality.

      Design

      This was a prospective study.

      Participants/setting

      A total of 24,011 adults (aged ≥40 years) who participated in the National Health and Nutrition Examination Survey 1999-2014 were included in this study. Eating behaviors were assessed using 24-hour recall. Death and underlying causes of death were ascertained by linkage to death records through December 31, 2015.

      Main outcome measures

      The outcomes were all-cause and CVD mortality.

      Statistical analyses performed

      Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) of all-cause and CVD mortality.

      Results

      During 185,398 person-years of follow-up period, 4,175 deaths occurred, including 878 cardiovascular deaths. Most participants ate three meals per day. Compared with participants eating three meals per day, the multivariable-adjusted HRs for participants eating one meal per day were 1.30 (95% CI 1.03 to 1.64) for all-cause mortality, and 1.83 (95% CI 1.26 to 2.65) for CVD mortality. Participants who skipped breakfast have multivariable-adjusted HRs 1.40 (95% CI 1.09 to 1.78) for CVD mortality compared with those who did not. The multivariable-adjusted HRs for all-cause mortality were 1.12 (95% CI 1.01 to 1.24) for skipping lunch and 1.16 (95% CI 1.02 to 1.32) for skipping dinner compared with those who did not. Among participants eating three meals per day, the multivariable-adjusted HR for participants with an average interval of ≤4.5 hours in two adjacent meals was 1.17 (95% CI 1.04 to 1.32) for all-cause mortality, comparing with those having a meal interval of 4.6 to 5.5 hours.

      Conclusions

      In this large, prospective study of US adults aged 40 years or older, eating one meal per day was associated with an increased risk of all-cause and CVD mortality. Skipping breakfast was associated with increased risk of CVD mortality, whereas skipping lunch or dinner was associated with increased risk of all-cause mortality. Among participant with three meals per day, a meal interval of ≤4.5 hours in two adjacent meals was associated with higher all-cause mortality.

      Keywords

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      Biography

      Y. Sun is an assistant professor, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis; at the time of the study, she was a postdoctoral research scholar, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.

      Biography

      S. Rong is an associate professor, Department of Nutrition and Food Hygiene, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China.

      Biography

      B. Liu is a postdoctoral research scholar, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.

      Biography

      Y. Du is a PhD candidate, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.

      Biography

      Y. Wu isa PhD candidate, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.

      Biography

      L. Snetselaar is a professor and chair, Section of Preventive Nutrition Education, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.

      Biography

      R. Wallace is a professor and the Irene Ensminger Stecher Professorship in Cancer Research, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.

      Biography

      Q. Xiao is an assistant professor, Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City.

      Biography

      L. Chen is a postdoctoral research scholar, Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

      Biography

      W. Bao is an assistant professor, Department of Epidemiology, College of Public Health, and a member, Obesity Research and Education Initiative and Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City.