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May 13, 2020
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Smaller dinner, bigger breakfast may reduce risks for death from diabetes, CVD

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People with diabetes who ate more at dinner compared with breakfast had greater risks for death from diabetes and cardiovascular disease; however, a model suggests replacing 5% of total energy intake at dinner with breakfast can reduce mortality risks, according to findings published in Diabetes Care.

“In recent years, accumulating evidence shows that energy distribution across a day can influence the physiological metabolism; particularly, high energy intake at dinner may be associated with metabolic disorder through disrupted clock gene expression,”

Tianshu Han, PhD, of the department of nutrition and food hygiene at Harbin Medical University School of Public Health, China, and colleagues wrote in the study background. “Nowadays, people are still consuming a high proportion of daily energy at dinner; however, limited research has focused on the extent to which the distribution of energy and macronutrient intake in a day impacts the natural course of diabetes.”

Assessing energy intake

People with diabetes who ate more at dinner compared with breakfast had greater risks for death from diabetes and cardiovascular disease; however, a model suggests replacing 5% of total energy intake at dinner with breakfast can reduce mortality risks.
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In an observational study, Han and colleagues analyzed data from 4,699 adults with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 (2,413 men). Researchers assessed energy and macronutrient intake via 24-hour dietary recall for two nonconsecutive days; dietary nutrients and energy intake were estimated by using the guidelines of the U.S. Department of Agriculture’s Food and Nutrient Database for Dietary Studies. Differences in energy and macronutrient intake between dinner and breakfast were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Researchers used Cox proportional hazards regression models to evaluate the survival relationship between differences in energy intake and mortality from diabetes, cardiovascular disease and all causes.

Within the cohort, 913 adults died, with 269 deaths attributed to diabetes and 314 deaths attributed to CVD.

Researchers found that participants in the highest quintile of difference in energy intake between breakfast and dinner were nearly twice as likely to die of diabetes (HR = 1.92; 99% CI, 1.08-3.42) and 69% more likely to die of CVD (HR = 1.69; 99% CI, 1.02-2.8) compared with adults in the lowest quintile of difference in energy intake between meals.

Predicted isocaloric models

Researchers built three sets of predicted isocaloric models to evaluate the extent to which a theoretical shift of total energy and energy from macronutrients would affect diabetes and CVD mortality by holding total energy and all other macronutrients intake constant.

For set 1, 5% of total energy intake was switched from dinner to breakfast; for set 2, 5% of energy intake from fat at dinner was substituted with 5% of energy intake from carbohydrate, protein, saturated fatty acids or unsaturated fatty acids at breakfast; and for set 3, 5% of energy intake from protein at dinner was replaced with 5% of energy from carbohydrate, protein, saturated fatty acids or unsaturated fatty acids at breakfast.

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Researchers found that isocalorically replacing 5% of total energy at dinner with breakfast was associated with a 4% lower risk for death due to diabetes (HR = 0.96; 95% CI, 0.94-0.98) and a 5% lower risk for CV death (HR = 0.95; 95% CI, 0.93–0.97).

“The most important finding of this study was that higher intake of energy at dinner than breakfast was significantly associated with diabetes and CVD mortality, and this association was independent of a series of traditional dietary risk factors, in particular, breakfast skipping and diet quality,” the researchers wrote. “This study provides evidence of adverse effects of high energy intake at dinner and emphasized the importance of energy distribution across meals.”

The researchers noted that only two dietary measurements across 2 weeks were used to predict long-term survival status for people with diabetes, who may change dietary habits over time.

“Therefore, future research is needed to evaluate the longitudinal effect of energy and macronutrient distribution on mortality outcomes,” the researchers wrote. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.