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.
Article info
Publication history
Published online: August 10, 2022
Accepted:
August 8,
2022
Received:
February 13,
2021
Footnotes
Supplementary materials: Tables 5, 6, and 7 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.
AUTHOR CONTRIBUTIONS Y. Sun, S. Rong, and W. Bao contributed to the conception and design of the study. Y. Sun and S. Rong analyzed data and wrote the manuscript. All authors contributed to the acquisition, analysis, or interpretation of the data, and revised the manuscript for important intellectual content. W. Bao and Y. Sun primary responsibility for final content. All authors read and approved the final manuscript.
Identification
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© 2023 by the Academy of Nutrition and Dietetics.
