Tianshu Han1,2, Jian Gao1, Lihong Wang2, Chao Li3, Lu Qi4, Changhao Sun5, Ying Li5. 1. Department of Nutrition and Food Hygiene, National Key Discipline, School of Public Health, Harbin Medical University, Harbin, China. 2. Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China. 3. Medical University of South Carolina, Charleston, SC. 4. Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA. 5. Department of Nutrition and Food Hygiene, National Key Discipline, School of Public Health, Harbin Medical University, Harbin, China liying_helen@163.com changhaosun2002@163.com.
Abstract
OBJECTIVE: This study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes. RESEARCH DESIGN AND METHODS: A total of 4,699 people with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrient intake was measured by a 24-h dietary recall. The differences (Δ) in energy and macronutrient intake between dinner and breakfast (Δ = dinner - breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between Δ and diabetes, cardiovascular disease (CVD), and all-cause mortality. RESULTS: Among the 4,699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quintile of Δ in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (hazard ratio [HR]Δenergy 1.92, 99% CI 1.08-3.42; HRΔprotein 1.92, 99% CI 1.06-3.49) and CVD (HRΔenergy 1.69, 99% CI 1.02-2.80; HRΔprotein 1.96, 99% CI 1.14-3.39). The highest quintile of Δtotal fat was related to CVD mortality (HR 1.67, 99% CI 1.01-2.76). Isocalorically replacing 5% of total energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR 0.96, 95% CI 0.94-0.98) and CVD (HR 0.95, 95% CI 0.93-0.97) mortality, respectively. CONCLUSIONS: Higher intake of energy, total fat, and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes.
OBJECTIVE: This study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes. RESEARCH DESIGN AND METHODS: A total of 4,699 people with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrient intake was measured by a 24-h dietary recall. The differences (Δ) in energy and macronutrient intake between dinner and breakfast (Δ = dinner - breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between Δ and diabetes, cardiovascular disease (CVD), and all-cause mortality. RESULTS: Among the 4,699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quintile of Δ in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (hazard ratio [HR]Δenergy 1.92, 99% CI 1.08-3.42; HRΔprotein 1.92, 99% CI 1.06-3.49) and CVD (HRΔenergy 1.69, 99% CI 1.02-2.80; HRΔprotein 1.96, 99% CI 1.14-3.39). The highest quintile of Δtotal fat was related to CVDmortality (HR 1.67, 99% CI 1.01-2.76). Isocalorically replacing 5% of total energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR 0.96, 95% CI 0.94-0.98) and CVD (HR 0.95, 95% CI 0.93-0.97) mortality, respectively. CONCLUSIONS: Higher intake of energy, total fat, and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes.