Meal Timing of Subtypes of Macronutrients Consumption With Cardiovascular Diseases

NHANES, 2003 to 2016

Wanying Hou; Jian Gao; Wenbo Jiang; Wei Wei; Huanyu Wu; Yuntao Zhang; Changhao Sun; Ying Li; Tianshu Han

Disclosures

J Clin Endocrinol Metab. 2021;106(7):e2480-e2490. 

In This Article

Abstract and Introduction

Abstract

Context: Emerging evidence suggests that not only the quantity but also the quality and food sources of macronutrients plays an important role in CVD. However, limited studies have examined the association of meal timing of different quality of macronutrients with CVD risk.

Objective: This study aimed to examine the association of subtypes of macronutrient consumption at dinner vs breakfast with cardiovascular diseases (CVD).

Methods: A total of 27 911 participants from the National Health and Nutrition Examination Survey (2003–2016) were included. The differences of subtypes of macronutrients at dinner vs breakfast (Δratio) were categorized into quintiles. Multiple logistic regression models and isocaloric substitution effects of subtypes were performed.

Results: After adjustment of a variety of covariates, participants in the highest quintile of the Δratio of low-quality carbohydrates had a higher risk of angina (odds ratio [OR] = 1.63; 95% CI, 1.16–2.29) (P for trend = .007) and heart attack (OR = 1.47; 95% CI, 1.13–1.93) (P for trend = .068) compared with the lowest quintile. The highest quintile of the Δratio of animal protein had a higher risk of coronary heart disease (OR = 1.44; 95% CI, 1.06–1.95) (P for trend = .014) and angina (OR = 1.44; 95% CI, 1.01–2.07) (P for trend = .047). For the Δratio of unsaturated fatty acid (USFA), the highest quintile of the Δratio of USFA was related to lower stroke risk (OR = 0.76; 95% CI, 0.58–0.99) (P for trend = .049). Isocaloric substitution of low-quality carbohydrates/animal protein by high-quality carbohydrates/plant protein at dinner reduced CVD risk by around 10%.

Conclusion: This study indicated that overconsumption of low-quality carbohydrates and animal protein at dinner rather than breakfast was significantly associated with higher CVD risk and USFA consumption at dinner related to lower CVD risk among US adults. Substitution of low-quality carbohydrates or animal protein by high-quality carbohydrates or plant protein at dinner could reduce CVD risk.

Introduction

Cardiovascular disease (CVD) is the main cause of mortality regardless of race, ethnicity, or sex, and almost 46% of noncommunicable disease deaths are attributable to CVD around the globe.[1,2] Diet plays a critical role in the prevention and treatment of CVD.[3] Emerging evidence suggests that not only the quantity but also the quality and food sources of macronutrients is a relevant aspect of nutrition and plays an important role in human health.[4–7] However, limited studies have examined the association of meal timing of different quality of macronutrients with CVD risk.

Nowadays it appears that meal timing has major effects on metabolic and physiological parameters.[8] For example, breakfast skipping,[9,10] late lunch eating,[11] and high energy intake at dinner[12–15] were related to a higher risk of obesity, as well as lower overall diet quality and poorer cognitive performance. Late-night eating has been related to a higher risk of poor cardiometabolic health in several observational studies.[12,14,16] Further, it has been reported that dietary patterns with higher energy load in the evening may lead to metabolic syndrome by the deterioration of postprandial glucose and insulin.[17] On the other hand, a high-energy breakfast with a reduced dinner was suggested to be beneficial and considered to be a useful alternative for the management of obesity and metabolic syndrome.[18] Meanwhile, a large number of studies have indicated that time-restricted feeding is beneficial for a variety of metabolic responses, reducing insulin resistance, and increasing glucose tolerance.[19–22] During the past 2 decades, the overall macronutrient consumption has remained unchanged among US adults, but subtypes of macronutrients obviously changed.[23] However, to the best of our knowledge, no studies have examined the association of macronutrients with CVD risk by considering subtypes and meal timing of macronutrients.

In the present study, we classified subtypes of macronutrients based on the food sources using data from the US National Health and Nutrition Examination Survey (NHANES) and examined the association of subtypes consumption at dinner vs breakfast with CVD risk.

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