ArticleLiterature Review

Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

November 2018
Journal of Nutrition 149(5)

DOI:10.1093/jn/nxy194

Authors:

Aurélie Ballon

Universitat Rovira i Virgili

Sabrina Schlesinger

German Diabetes Center

Background: Epidemiologic studies have indicated that breakfast skipping is associated with risk of type 2 diabetes. However, the shape of the dose-response relation and the influence of adiposity on this association have not been reported. Objective: We investigated the association between breakfast skipping and risk of type 2 diabetes by considering the influence of the body mass index (BMI). Methods: In this systematic review and meta-analysis, PubMed and Web of Science were searched up to August 2017. Prospective cohort studies on breakfast skipping and risk of type 2 diabetes in adults were included. Summary RRs and 95% CIs, without and with adjustment for BMI, were estimated with the use of a random-effects model in pairwise and dose-response meta-analyses. Results: In total 6 studies, based on 96,175 participants and 4935 cases, were included. The summary RR for type 2 diabetes comparing ever with never skipping breakfast was 1.33 (95% CI: 1.22, 1.46, n = 6 studies) without adjustment for BMI, and 1.22 (95% CI: 1.12, 1.34, n = 4 studies) after adjustment for BMI. Nonlinear dose-response meta-analysis indicated that risk of type 2 diabetes increased with every additional day of breakfast skipping, but the curve reached a plateau at 4-5 d/wk, showing an increased risk of 55% (summary RR: 1.55; 95% CI: 1.41, 1.71). No further increase in risk of type 2 diabetes was observed after 5 d of breakfast skipping/wk (P for nonlinearity = 0.08). Conclusions: This meta-analysis provides evidence that breakfast skipping is associated with an increased risk of type 2 diabetes, and the association is partly mediated by BMI.

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August 2019

Aurélie Ballon · Manuela Neuenschwander · Sabrina Schlesinger

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Unexpectedly High Prevalence of Breakfast Skipping in Low Body-Weight Middle-Aged Men: Results of the Kanagawa Investigation of Total Checkup Data from the National Data Base-7 (KITCHEN-7)

Article

Full-text available

Dec 2020

Breakfast skipping (BS) has been considered to be associated with obesity, particularly among younger generations. However, few studies have addressed this issue in a middle-aged population considering sex and the conditions prior to breakfast. Therefore, we investigated clinical parameters, self-reported BS, late-night dinner (LND) eating, and late-night snacking (LNS) in ten body mass index (BMI) categories in a cross-sectional study of 892,578 non-diabetic people aged 40–74 years old who underwent a checkup. BS and LND were more prevalent in men (20.7% and 40.5%, respectively) than women (10.9% and 17.4%), whereas LNS was more prevalent in women (15.0%) than men (12.2%; all p < 0.0001). The overall prevalence of BS increased linearly with increasing BMI. However, when subjects were divided into men and women, the prevalence of BS showed a U-shaped relationship with BMI in men (n = 479,203). When male subjects were restricted to those in their 40s or those reporting LND, the prevalence of BS further increased, maintaining a U-shaped form. Logistic regression analysis also showed a U-shaped relationship in the adjusted odds ratios of BMI categories for BS in men and a J-shaped curve in women. In conclusion, our study revealed an unexpectedly high prevalence of BS in middle-aged low-body-weight men.

Association of breakfast consumption frequency with fasting glucose and insulin sensitivity/b cells function (HOMA-IR) in adults from high-risk families for type 2 diabetes in Europe: the Feel4Diabetes Study

Article

Full-text available

May 2022

Purpose This study aimed to investigate the association of breakfast consumption frequency (BCF) with glycemic control indices in a cross-sectional sample of adults from families at high risk for type 2 diabetes mellitus (T2DM), exploring the role of sex and socioeconomic status (SES). Methods In 2370 adults (40.8 ± 5.6 years) from 6 European countries, sociodemographic, lifestyle, anthropometric and biochemical characteristics were assessed through standardized procedures. Multivariable regression models were used to examine the association between fasting glucose (FG), fasting insulin (FI), and insulin resistance (HOMA-IR) (dependent variables) with BCF (independent variable) controlling for multiple possible confounders. Results A linear association of BCF with FG (β = −0.557, 95% CI (−0.834, −0.280)) and a quadratic association with FI and HOMA-IR with the highest point of curve observed at BCF = 2.989 (times/week) and at BCF = 2.746, respectively, independent of the used covariates. In males and in participants of high SES, BCF was linearly and inversely associated with FG, while with FI and HOMA-IR there was an association with BCF in quadratic function. In females, BCF was linearly and inversely associated with FG and HOMA-IR, and there was a quadratic association with FI. In low SES there was only a linear association with FG, yet with no statistically significant findings for FI and HOMA-IR. Conclusions Regular breakfast consumption, especially >3 times/week is associated with improved indices of glycemic control. This association was diminished in low SES participants in the presence of the used covariates.

The association of skipping breakfast with cancer-related and all-cause mortality in a national cohort of United States adults

Article

Full-text available

May 2021
CANCER CAUSE CONTROL

Purpose Many lifestyle and dietary factors have been recognized as risk factors for cancer morbidity and mortality. However, investigations of the association of the frequency of breakfast consumption and cancer are limited. This study aimed to examine the association of skipping breakfast with all-cause and cancer-related mortality in a national cohort of United States men and women. Methods Data were from 7,007 adults aged ≥ 40 years who participated in the third National Health and Nutrition Examination Survey (1988–1994) and had follow-up information on mortality up until 31 December 2015. Cox proportional hazards regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results The mean age of participants was 55.4 years, with 54.4% and 79% being women and non-Hispanic whites, respectively. Approximately, 16% of participants rarely consumed breakfast, 23.0% consumed breakfast some days, and 61% consumed breakfast every day. During a median follow-up of 22.2 years, 3,573 deaths occurred with 795 being related to cancer. In models adjusting for sociodemographic factors, smoking, physical activity, body mass index, hypertension, diabetes, cholesterol levels, total energy intake and diet quality, persons who rarely consumed breakfast had a higher risk of cancer-related mortality (HR = 1.52; CI:1.06–2.18) and all-cause (HR = 1.69; CI: 1.42–2.02) compared to those who took breakfast every day. Conclusion In this nationally representative sample, skipping breakfast was associated with elevated risks for all-cause and cancer-related mortality. This study provides evidence for the benefits of regular breakfast consumption in reducing the risk of all-cause and cancer mortality.

Influence of sleep and chrononutrition on hypertension and diabetes: a population-based study

Article

Full-text available

Jul 2022
CAD SAUDE PUBLICA

The objective is to evaluate the influence of sleep and chrononutrition on hypertension and diabetes in the adult population (18 years or older) in a municipality in Southern Brazil. This is a population-based cross-sectional study, developed in Criciúma, State of Santa Catarina, in 2019. The exposure variables were sleep duration and quality, and two of the main aspects of chrononutrition, the number of daily meals and the presence of breakfast. The outcomes studied were diabetes mellitus and systemic arterial hypertension. Crude and adjusted Poisson regression with robust variance was used to evaluate the associations between exposures and outcomes. For all analyses, the effect of the sample design was considered, and the significance level adopted was 5%. In total, 820 patients were evaluated. The prevalence of diabetes and hypertension was of 19.9% and 44.1%, respectively. Individuals with worse sleep quality had a higher prevalence of 33% for diabetes and 17% for hypertension, compared to those with good quality of sleep. Those who had four or more meals per day had a 16% lower prevalence of hypertension, when compared to those who had less than four meals. We concluded that the quality of sleep and the number of daily meals, a feeding behavior related to chrononutrition, were related to hypertension and diabetes. These results highlight the importance of public health actions that address new strategies for coping with these diseases focused on sleep quality and chrononutrition.

Formation and Validation of the Healthy Diet Index (HDI) for Evaluation of Diet Quality in Healthcare

Article

Full-text available

Feb 2021
Int J Environ Res Publ Health

Lack of tools to evaluate the quality of diet impedes dietary counselling in healthcare. We constructed a scoring for a validated food intake questionnaire, to measure the adherence to a healthy diet that prevents type 2 diabetes (T2D). The Healthy Diet Index (HDI) consists of seven weighted domains (meal pattern, grains, fruit and vegetables, fats, fish and meat, dairy, snacks and treats). We studied the correlations of the HDI with nutrient intakes calculated from 7-day food records among 52 men and 25 women, and associations of HDI with biomarkers and anthropometrics among 645 men and 2455 women. The HDI correlated inversely with total fat (Pearson’s r = −0.37), saturated fat (r = −0.37), monounsaturated fat (r = −0.37), and the glycaemic index of diet (r = −0.32) and positively with carbohydrates (r = 0.23), protein (r = 0.25), fibre (r = 0.66), magnesium (r = 0.26), iron (r = 0.25), and vitamin D (r = 0.27), (p < 0.05 for all). In the linear regression model adjusted for BMI and age, HDI is associated inversely with waist circumference, concentrations of fasting and 2-h glucose and triglycerides in men and women, total and LDL cholesterol in women, and fasting insulin in men (p < 0.05 for all). The HDI proved to be a valid tool to measure adherence to a health-promoting diet and to support individualised dietary counselling.

Energy and macronutrient intakes at breakfast and cognitive declines in community-dwelling older adults: a 9-year follow-up cohort study

Article

Mar 2021
AM J CLIN NUTR

Background: It is unclear whether breakfast consumption and breakfast composition are independently associated with changes in cognition over a long-term period in older adults. Objectives: We aimed to examine the associations between energy and macronutrient intakes at breakfast and cognitive declines. Methods: We included 2935 participants aged 55-93 y at baseline from the China Health and Nutrition Survey in our analysis. Cognition was assessed in 1997, 2000, 2004, 2006, and 2015. Dietary intake was assessed using weighing methods in combination with 24-h food records. Results: Breakfast contributed to 25.9% of total energy intake of the day and percentages of breakfast energy intake from protein, fat, and carbohydrates were 12.8%, 11.5%, and 75.7%, respectively. During a median follow-up of 9 y, the β values for changes in global cognitive z-scores for Quintile 5 of protein and fat intakes at breakfast, with Quintile 1 as the reference, were 0.13 (95% CI: 0.01-0.25) and 0.17 (95% CI: 0.04-0.30), respectively. Substitution of 5% energy from carbohydrates with equivalent energy from protein (β, 0.06; 95% CI: 0.01-0.11) or fat (β, 0.05; 95% CI: 0.02-0.08) at breakfast was positively associated with the change in the global cognitive z-score. Energy intake at breakfast was not significantly associated with the global cognitive z-score. Similar results were found for the verbal memory z-score. The positive association of breakfast fat intake and the inverse association of breakfast carbohydrate intake with cognitive declines were stronger in urban residents. Conclusions: Higher intakes of protein and fat and lower intake of carbohydrates at breakfast were associated with a lower rate of cognitive decline in older adults. Substitution of carbohydrates with protein or fat intake at breakfast may help to delay or prevent cognitive declines.

An Intermittent Fasting Mimicking Nutrition Bar Extends Physiologic Ketosis in Time Restricted Eating: A Randomized, Controlled, Parallel-Arm Study

Article

Full-text available

Apr 2021

There has been increasing interest in time-restricted eating to attain intermittent fasting's metabolic benefits. However, a more extended daily fast poses many challenges. This study was designed to evaluate the effects of a 200-calorie fasting-mimicking diet (FMD) energy bar formulated to prolong ketogenesis and mitigate fasting-associated side effects. A randomized, controlled study was conducted comparing the impact of consuming an FMD bar vs. continued water fast, after a 15-h overnight fast. Subjects in the FMD group showed a 3-h postprandial beta-hydroxybutyrate (BHB) level and 4-h postprandial BHB area under the curve (AUC0-4) that were non-inferior to those who continued with the water fast (p = 0.891 and p = 0.377, respectively). The postprandial glucose AUC0-4 in the FMD group was non-inferior to that in the water fast group (p = 0.899). A breakfast group served as a control, which confirmed that the instrument used in home glucose and ketone monitoring functioned as expected. The results indicate that FMD bar consumption does not interfere with the physiological ketogenesis associated with overnight fasting and could be used to facilitate the practice of time-restricted eating or intermittent fasting.

Effects of Diet, Lifestyle, Chrononutrition and Alternative Dietary Interventions on Postprandial Glycemia and Insulin Resistance

Article

Full-text available

Feb 2022

As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.

Shared Genetic Basis and Causal Relationship Between Television Watching, Breakfast Skipping and Type 2 Diabetes: Evidence From a Comprehensive Genetic Analysis

Article

Full-text available

Mar 2022

Background Epidemiological investigations have established unhealthy lifestyles, such as excessive leisurely sedentary behavior (especially TV/television watching) and breakfast skipping, increase the risk of type 2 diabetes (T2D), but the causal relationship is unclear. We aimed to understand how single nucleotide variants contribute to the co-occurrence of unhealthy lifestyles and T2D, thereby providing meaningful insights into disease mechanisms. Methods Combining summary statistics from genome-wide association studies (GWAS) on TV watching ( N = 422218), breakfast skipping ( N = 193860) and T2D ( N = 159208) in European pedigrees, we conducted comprehensive pairwise genetic analysis, including high-definition likelihood (HDL-method), cross-phenotype association studies (CPASSOC), GWAS-eQTL colocalization analysis and transcriptome-wide association studies (TWAS), to understand the genetic overlap between them. We also performed bidirectional two-sample Mendelian randomization (MR) analysis for causal inference using genetic instrumental variables, and two-step MR mediation analysis was used to assess any effects explained by body mass index, lipid traits and glycemic traits. Results HDL-method showed that T2D shared a strong genetic correlation with TV watching ( r g = 0.26; P = 1.63×10 ⁻²⁹ ) and skipping breakfast ( r g = 0.15; P =2.02×10 ⁻⁶ ). CPASSOC identifies eight independent SNPs shared between T2D and TV watching, including one novel shared locus. TWAS and CPASSOC showed that shared genes were enriched in lung, esophageal, adipose, and thyroid tissues and highlighted potential shared regulatory pathways for lipoprotein metabolism, pancreatic β-cell function, cellular senescence and multi-mediator factors. MR showed TV watching had a causal effect on T2D (β IVW = 0.629, P IVW = 1.80×10 ⁻¹⁰ ), but no significant results were observed between breakfast skipping and T2D. Mediation analysis provided evidence that body mass index, fasting glucose, hemoglobin A1c and high-density lipoprotein are potential factors that mediate the causal relationship between TV and T2D. Conclusions Our findings provide strong evidence of shared genetics and causation between TV watching and T2D and facilitate our identification of common genetic architectures shared between them.

Trajectories of energy intake distribution and subsequent risk of hyperglycemia among Chinese adults: findings from the China Health and Nutrition Survey (1997–2018)

Article

Full-text available

Apr 2022
EUR J NUTR

Aims Few studies have examined the secular trend of the energy intake distribution, and its effect on future risk of hyperglycemia. This study aims to describe trajectories of energy intake distribution over 12 years and relate them to subsequent risk of hyperglycemia over 9 years of follow-up. Methods Our study used ten waves of data from the CHNS survey, a population-based longitudinal survey in China, ongoing since 1989. We examined a cohort of adult participants who were free from diabetes but had at least three waves of dietary data from 1997 to 2009. We assessed energy intake using three consecutive 24 h recalls. We used these data to identify trajectory groups of energy intake distribution by multi-trajectory model based on energy intake proportions of breakfast, lunch, and dinner. We followed up participants for hyperglycemia, diabetes, and impaired fasting glucose for 9 years from 2009 to 2018. Outcomes were ascertained with fasting glucose, serum HbA1c, and self-report of diabetes and/or glucose-lowering medication. We estimated relative risk (RR) for hyperglycemia, diabetes, and impaired fasting glucose by identified trajectory groups using multilevel mixed-effects modified Poisson regression with robust (sandwich) estimation of variance. Gender difference was additionally examined. Results A total of 4417 participants were included. Four trajectory groups were identified, characterized and labeled by “Energy evenly distributed with steady trend group” (Group 1), “Dinner and lunch energy dominant with relatively steady trend group” (Group 2), “Dinner energy dominant with increasing trend and breakfast energy with declining trend group” (Group 3), and “breakfast and dinner energy dominant with increasing trend group” (Group 4). During 48,091 person-years, 1053 cases of incident hyperglycemia occurred, 537 cases of incident diabetes occurred, and 516 cases of impaired fasting glucose occurred. Compared with Group 1, Group 3 was associated with higher subsequent risk of incident hyperglycemia in 9 years of follow-up (RR = 1.28, 95% CI = 1.02, 1.61). No association was found for incident diabetes and impaired fasting glucose. Among males, Group 3 was associated with higher risk of incident hyperglycemia in 9 years of follow-up (RR = 1.44, 95% CI = 1.07, 1.94). No relationship was found in females. Conclusions Energy intake distribution characterized by over 40% of energy intake from dinner with a rising trend over years was associated with higher long-term risk of hyperglycemia in Chinese adults.

Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: a cohort study

Article

Full-text available

Jun 2022
BMC PUBLIC HEALTH

Background Changes in Swedish university students’ lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex. Methods Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June–September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations. Results 1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex. Conclusions Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before. Trial registration ClinicalTrials.gov, NCT04465435. 10/07/2020.

Meal frequency and incidence of type 2 diabetes: A prospective study

Article

Aug 2021

Dietary habits play an important role in the development of obesity and type 2 diabetes. However, evidence on association between diet frequency and type 2 diabetes was limited and inconclusive. We aimed to examine the association between meal frequency and risk of type 2 diabetes. The cohort study used data from China Health and Retirement Longitudinal Study of 8874 community-dwelling people aged over 45 years. Participants were classified as eating 2 meals/d, 3 meals/d and 4 meals/d. Multiple Poisson regression models were used to examine risk of 4-year incident type 2 diabetes among people who ate more or less than 3 meals/d compared with people who ate 3 meals/d. We documented 706 type 2 diabetes cases during follow-up. After adjustment for known risk factors for type 2 diabetes, except for body mass index (BMI), participants who ate 4 meals/d were at a lower risk of type 2 diabetes than those who ate 3 meals/d (RR = 0.73 [0.58, 0.92]). After further adjustment for baseline BMI, the association was slightly attenuated but remained statistically significant (RR = 0.76 [0.60, 0.97]). Subgroup analysis showed that the fully-adjusted RRs of type 2 diabetes for people eating 4 meals/day were 0.66 (0.48, 0.91) and 0.93 (0.65, 1.34) among those had a BMI < 25 and ≥ 25 kg/m ² , respectively. Eating 4 meals/day, compared with eating 3 meals/day, was associated with lower risk of developing type 2 diabetes in a Chinese population, particularly in those with a BMI < 25 kg/m ² .

Novel trends and concepts in the nutritional management of glycemia in type 2 diabetes mellitus—beyond dietary patterns: a narrative review

Article

Aug 2021

A variety of eating patterns are recommended by international guidelines to help people with type 2 diabetes mellitus (T2DM) achieve general health and glycemia goals. Apart from eating patterns, there is evidence that other approaches related to the everyday application of dietary advice, such as meal frequency, breakfast consumption, daily carbohydrate distribution, and order of food consumption during meals, have significant effects on glycemia management. The aims of this review were to examine published diabetes nutrition guidelines concerning specific recommendations with regard to the above approaches, as well as to review evidence from studies that have investigated their effect on glycemia in T2DM. The data suggest that eating breakfast regularly, consuming most carbohydrates at lunch, avoiding large dinners late at night, and applying the carbohydrate-last meal pattern are effective practices towards better nutritional management of T2DM.

nutrients-14-02657

Article

Full-text available

Jun 2022

Ryohei Yamamoto

Frequency of alcohol drinking is a potential predictor of binge drinking of alcohol, a serious social problem for university students. Although previous studies have identified skipping breakfast as a predictor of various health-compromising behaviors and cardiometabolic diseases, few studies have assessed the association between skipping breakfast and the incidence of frequent alcohol drinking. This retrospective cohort study included 17,380 male and 8799 female university students aged 18–22 years admitted to Osaka universities between 2004 and 2015. The association between breakfast frequency (eating every day, skipping occasionally, and skipping often/usually) and the incidence of frequent alcohol drinking, defined as drinking ≥4 days/week, was assessed using multivariable-adjusted Cox proportional hazards models. During the median observational period of 3.0 years, 878 (5.1%) men and 190 (2.2%) women engaged in frequent alcohol drinking. Skipping breakfast was significantly associated with the incidence of frequent alcohol drinking (adjusted hazard ratios [95% confidence interval] of eating every day, skipping occasionally, and skipping often/usually: 1.00 [reference], 1.02 [0.84–1.25], and 1.48 [1.17–1.88] in men; 1.00 [reference], 1.60 [1.03–2.49], and 3.14 [1.88–5.24] in women, respectively). University students who skipped breakfast were at a higher risk of frequent alcohol drinking than those who ate breakfast every day.

The Effect of CKD on Associations between Lifestyle Factors and All-cause, Cancer, and Cardiovascular Mortality: A Population-based Cohort Study

Article

Full-text available

Feb 2021

Objective Results from previous studies on the dose-dependent effect of adhering to multiple lifestyle factors on all-cause mortality in patients with chronic kidney disease (CKD) are inconsistent, despite the reported dose-dependent effect in the general population. This study aimed to examine whether CKD modifies the dose-dependent effect of adhering to multiple lifestyle factors on mortality. Methods This population-based prospective cohort study targeted 262,011 men and women aged 40-74 years at baseline. Of these, 18.5% had CKD, which was defined as GFR <60 ml/min/1.73 m², ≥1+ proteinuria on urinalysis, or both. The following lifestyle behaviors were considered healthy: no smoking, body mass index <25 kg/m², moderate or lower alcohol consumption, regular exercise, and healthy eating habits. Healthy lifestyle scores were calculated by adding the total number of lifestyle factors for which each participant was at low risk. Cox proportional hazards models were used to examine associations between healthy lifestyle scores and all-cause, cancer, and cardiovascular mortality, and whether CKD modified these associations. Results During a median follow-up of 4.7 years, 3,471 participants died. The risks of all-cause and cancer mortality decreased as the number of five healthy lifestyle factors that were adhered to increased, irrespective of the CKD status. The risk of cardiovascular mortality, however, was modified by CKD (interaction p=0.07), and an unhealthy lifestyle and CKD synergistically increased cardiovascular mortality. Conclusion A healthy lifestyle can reduce the risk of all-cause and cancer death in patients with or without CKD, while the prevention of CKD is essential for reducing the risk of cardiovascular death.

Is the Indian Dietary Pattern Associated WithType 2 Diabetes? A Pan-India Randomized Cluster Sample Study

Article

Full-text available

Jun 2021

Background Diabetes is associated strongly with many neurodegenerative diseases and is also a lifestyle disorder. A good glycemic status depends on diet management and physical activity. There are several studies available on the relationship between diet habits and impact on diabetes. Purpose The objective of this study was to check the association of different dietary factors with glucose levels and lipid values in type 2 diabetes from a part of a large nationwide trial. Methods This was the data fromapan-India multicentered cluster randomized controlled study covering 60 states and 4 union territories; 17,285 individuals were surveyed for dietary factors. Amongst them, data of 12,500 individuals were analyzed.Males were 54% and 60% individuals were from urban areas. Results The analysis of the results showed that consumption (usual/often) of milk(odds ratio, OR = 7.180), meat (OR = 6.81), less fiber (OR = 17.77), and less fruits (OR = 14.71) was strongly and positively associated with fasting blood glucose ( P<.001). The postprandial blood glucose (PPBG) in diabetes individuals also had a strong positive association ( P<.001) with consumption (usual/often) of meat (OR = 22.82) and milk (OR = 17.19). In prediabetes individuals, milk was significantly ( P<.001) associated with fasting blood glucose (OR = 2.74). In nondiabetes individuals also, milk was significantly associated with postprandial blood glucose (OR = 2.56). Consumption of meat was associated with high cholesterol (OR = 1.465). Consumption of junk food was associated significantly ( P <.001)with the status of known diabetes (OR = 1.345) and known hypertension (OR = 1.247). Conclusion Consumption of milk, meat, less vegetables, less fruits, and junk food has a significant effect on the glycemic status and cholesterol levels, and also on the status of known diabetes and hypertension.

Breakfast skipping

Article

Full-text available

Jun 2021

Hyder Mirghani

ntroduction There is an increasing awareness regarding the effects of chrono-nutrition on glycemic control and weight regulation. Therefore, this study aimed to determine the relationship between breakfast skipping and late�night eating to body mass index and glycemic control among patients with type 2 diabetes. Subjects and methods This cross-sectional study was conducted among 310 patients with diabetes in Tabuk City, Saudi Arabia during the period from December 2020 to April 2021. A structured questionnaire was used to interview the participants, the following were reported: demographic data, breakfast skipping, late-night eating, smoking, level of exercise, family history of diabetes, and diabetes complications. Weight and height were measured to calculate the body mass index (BMI), and the last glycated hemoglobin was collected to estimate the degree of glycemic control. Statistical Package for Social Sciences (SPSS Statistics, IBM Corp., Armonk, USA) was used for data analysis. The ethical committee of the University of Tabuk approved the research. Results Out of 310 patients with diabetes (54.8% women), nearly half (45.2%) were breakfast-skippers and 20% eat late at night. Breakfast skipping was correlated with BMI (Wald, 5.481, 95% CI, 0.154-0.847, P-value, 0.019). A positive direct correlation was evident between late dinner intake, BMI, and HbA1c (Wald, 4.210, 95% CI, 0.743-0.993, P-value, 0.04 for HbA1c, and Wald, 6.777, 95% CI, 1.0221-1.165, P-value, 0.009 for BMI). Conclusion Breakfast skipping and late dinner intake were associated with obesity, while only late dinner consumption was associated with poor glycemic control. Further larger multi-center studies investigating the chronotype and glycemic index are recommended.

Eating architecture in adults at increased risk of type 2 diabetes: associations with body fat and glycaemic control

Article

Aug 2021
BRIT J NUTR

Eating architecture is a term that describes meal frequency, meal timing, and meal size and the daily variation in each of these. The aim of this study was to determine the relationship between components of eating architecture on body fat and markers of glycaemic control in healthy adults at increased risk of type 2 diabetes (T2DM). Participants (N=73, 39 males, age 58.8 [8.1] years, BMI 33.4 [4.4] kg/m2) recorded food intake and wore accelerometers and continuous glucose monitors (CGM) for 7-14 days under free-living conditions. Body fat and glycated haemoglobin (HbA1c) were also measured. The mean and day-to-day variation (calculated as the standard deviation during the monitoring period) of each component of eating architecture were calculated. Multivariable linear regression models were constructed for three separate outcome variables (body fat mass, mean CGM glucose, and HbA1c) for each component of eating architecture before and after adjustment for confounders. Higher variability in the time of first meal consumption was associated with increased body fat mass after adjusting for confounders (β=0.227, 95% CI: 0.019, 0.434, p=0.033). Increased variability in the time lag from waking to first meal consumption was also positively associated with increased HbA1c after adjustment (β=0.285, 95%CI: 0.040, 0.530, p=0.023). Low day-to-day variability in first meal consumption was associated with lower body fat and improved glucose control in adults at increased risk of T2DM. Routine consumption of meals may optimise temporal regulation to anticipate and respond appropriately to a glucose challenge.

Periodic and Intermittent Fasting in Diabetes and Cardiovascular Disease

Article

Full-text available

Dec 2020
Curr Diabetes Rep

Purpose of Review Cardiovascular disease (CVD) is one of the leading causes of death globally. Nutrition plays a central role in CVD risk by affecting aging, adiposity, glycemia, blood pressure, cholesterol, inflammation, and other risk factors and can affect CVD risk not only based on calorie intake and dietary composition but also the timing and range of meals. This review evaluates the effects of fasting, fasting-mimicking diets, and time-restricted eating on the reduction of CVD risk factors and provides initial data on their potential to serve as CVD prevention and treatment therapies. Recent Findings Intermittent fasting (IF), time-restricted eating (TRE), prolonged fasting (PF), and fasting-mimicking diets (FMD) show promise in the reduction of CVD risk factors. Summary Results on IF, TRE, PF, and FMD on CVD risk factors are significant and often independent of weight loss, yet long-term studies on their effect on CVD are still lacking. Coupling periodic and prolonged, or intermittent and more frequent cycles of fasting or fasting-mimicking diets, designed to maximize compliance and minimize side effects, has the potential to play a central role in the prevention and treatment of CVD and metabolic syndrome.

Parental insulin resistance is associated with unhealthy lifestyle behaviours independently of body mass index in children: The Feel4Diabetes study

Article

Full-text available

Jun 2022
Eur J Pediatr

Parental health is associated with children’s health and lifestyles. Thus, the aim of the present study was to assess lifestyle behaviours of children of parents with insulin resistance (IR) and at risk of type 2 diabetes. 2117 European families from the Feel4Diabetes-study were identified as being at risk for diabetes with the FINDRISC questionnaire and included in the present study. One parent and one child per family were included. Parental IR was considered when homeostasis model assessment (HOMA) was equal or higher than 2.5. Children’s screen-time, physical activity and diet were assessed and clustered by K -means. Weight and height were measured and children’s body mass index (BMI) was calculated. For children, a Healthy Diet Score (HDS) was calculated. Linear regression and multilevel logistic regression analyses were performed to assess the associations between parental IR and children’s lifestyle behaviours in 2021. Children of parents with IR had higher BMI ( p < 0.001) and spent more screen time ( p = 0.014) than those of non-IR parents. Children of parents with IR had a lower value in the breakfast and vegetable components of the HDS ( p = 0.008 and p = 0.05). Four lifestyle clusters were found. Children of IR parents had higher odds of being in a non-healthy cluster (OR: 1.19; 95%CI: 1.001–1.437). Conclusion : Having an IR parent was associated with a high screen time and an increased probability of having an unhealthy lifestyle pattern in children. These data point out that children’s lifestyles should be assessed in families with IR parents to provide tailored interventions. What is Known: • Children with diabetic or insulin-resistant parents could also develop this condition. • Unhealthy lifestyles are directly related with insulin resistance even in children. What is New: • Children from parents with insulin resistance have higher chances of unhealthy lifestyles. • A higher BMI was found for those children with an insulin-resistant parent.

Meal patterns and incident hypertension in community-dwelling middle-aged adults: an 11-year follow-up cohort study

Article

Jan 2021
J Hypertens

Objective: We aimed to examine whether meal patterns, as well as energy intake from three main meals and snacks, were associated with incident hypertension. Methods: We included 12 995 participants aged 18-59 years from the China Health and Nutrition Survey in the final analysis. Dietary intake was assessed using weighing methods in combination with 24-h food records. Cox proportional hazards regression models were used to examine the association of meal patterns, and energy intake from different meals with incident hypertension. Results: During a mean follow-up of 11.2 years, 4766 new hypertension cases were documented. Four meal patterns were derived according to energy intake: balanced, breakfast dominant, lunch dominant, and dinner dominant patterns. Dinner dominant meal pattern was associated with a lower risk of incident hypertension [hazard ratio (95% confidence interval): 0.90 (0.84-0.98)] compared with the balanced meal pattern. Breakfast energy intake was positively, but dinner energy intake was inversely associated with incident hypertension. The positive association between breakfast energy intake and incident hypertension was observed in rural residents only [1.22 (1.07-1.41) for rural residents, 0.98 (0.82-1.18) for urban residents; P interaction = 0.0348]. A positive association between energy intake from lunch and incident hypertension was observed in the urban residents only. Conclusion: Dinner dominant meal pattern was associated with a lower risk of hypertension compared with the balanced meal pattern in Chinese adults. A relatively small breakfast and large dinner may help to prevent or delay the development of hypertension, especially in urban residents.

The Future of Shift Work: Circadian Biology Meets Personalised Medicine and Behavioural Science

Article

Full-text available

Aug 2020

Shift work is commonplace in modern societies, and shift workers are predisposed to the development of numerous chronic diseases. Disruptions to the circadian systems of shift workers are considered important contributors to the biological dysfunction these people frequently experience. Because of this, understanding how to alter shift work and zeitgeber (time cue) schedules to enhance circadian system function is likely to be key to improving the health of shift workers. While light exposure is the most important zeitgeber for the central clock in the circadian system, diet and exercise are plausible zeitgebers for circadian clocks in many tissues. We know little about how different zeitgebers interact and how to tailor zeitgeber schedules to the needs of individuals; however, in this review we share some guidelines to help shift workers adapt to their work schedules based on our current understanding of circadian biology. We focus in particular on the importance of diet timing and composition. Going forward, developments in phenotyping and "envirotyping" methods may be important to understanding how to optimise shift work. Non-invasive, multimodal, comprehensive phenotyping using multiple sources of time-stamped data may yield insights that are critical to the care of shift workers. Finally, the impact of these advances will be reduced without modifications to work environments to make it easier for shift workers to engage in behaviours conducive to their health. Integrating findings from behavioural science and ergonomics may help shift workers make healthier choices, thereby amplifying the beneficial effects of improved lifestyle prescriptions for these people.

Evaluation of Knowledge of Type 2 Diabetes among University Students in Punjab, Pakistan

Article

Full-text available

Sep 2021

The aim of the study was to evaluate the level of knowledge of university students about risk factors, signs and symptoms, and impact of diabetes in Punjab, Pakistan. A cross-sectional study design was used for this study. Population of the study was students who were enrolled in public and private universities in Punjab. A multistage sampling method was used for this study. Total 1260 students were selected randomly among which 1087 respondents completed the self-administered questionnaire. Descriptive statistics and the Chi-square test were used through Statistical Package of Social Science (SPSS) version 20.0. The results of the study showed that 544 (50%) respondents were females, most respondents 617 (56.7%) were between 20-23 years old, 589 (54.2%) respondents were studying at undergraduate level, 435 (40%) respondents had poor economic status, 1006 (92.5%) respondents were single, 813 (4.8%) respondents never got their sugar level checked, and 696 (64%) respondents had family history of diabetes. Findings of the study also indicated that most of the respondents 77.9% had inadequate knowledge about risk factors of type 2 diabetes, 73.4% respondents had inadequate knowledge of signs and symptoms of type 2 diabetes, and 72.2% respondents had inadequate knowledge of impact of diabetes. Chi-square test showed that level of knowledge of diabetes was associated with gender (p < .001), education (p < .001), marital status (p < .001), ever checking of sugar (p < .001), and family history of diabetes (p < .001). The study concluded that majority of the respondents had inadequate knowledge of diabetes. Therefore, there is a need of educational programs and awareness sessions for university students. It will be helpful in enhancing students’ knowledge and reducing the prevalence of diabetes in the future of Pakistan.

Chrono‐nutrition: From molecular and neuronal mechanisms to human epidemiology and timed feeding patterns

Article

Full-text available

Dec 2020

The circadian timing system governs daily biological rhythms, synchronising physiology and behaviour to the temporal world. External time cues, including the light‐dark cycle and timing of food intake, provide daily signals for entrainment of the central, master circadian clock in the hypothalamic suprachiasmatic nuclei (SCN), and of metabolic rhythms in peripheral tissues, respectively. Chrono‐nutrition is an emerging field building on the relationship between temporal eating patterns, circadian rhythms, and metabolic health. Evidence from both animal and human research demonstrates adverse metabolic consequences of circadian disruption. Conversely, a growing body of evidence indicates that aligning food intake to periods of the day when circadian rhythms in metabolic processes are optimised for nutrition may be effective for improving metabolic health. Circadian rhythms in glucose and lipid homeostasis, insulin responsiveness and sensitivity, energy expenditure, and postprandial metabolism, may favour eating patterns characterised by earlier temporal distribution of energy. This review details the molecular basis for metabolic clocks, the regulation of feeding behaviour, and the evidence for meal timing as an entraining signal for the circadian system in animal models. The epidemiology of temporal eating patterns in humans is examined, together with evidence from human intervention studies investigating the metabolic effects of morning compared to evening energy intake, and emerging chrono‐nutrition interventions such as time‐restricted feeding. Chrono‐nutrition may have therapeutic application for individuals with and at‐risk of metabolic disease and convey health benefits within the general population.

Dietary Protein Intake Patterns and Inadequate Protein Intake in Older Adults from Four Countries

Article

Full-text available

Oct 2020

Recent interest in protein intake per meal is observed in studies that have reported the protein intake patterns in different countries; however, comparisons of these data are lacking. We aimed to compare protein intake patterns and the percentage of inadequate protein intake (IPI) per day and meal in older adults from different countries. We acquired data of protein intake in older adults from four countries (Mexico, United States of America, Germany, and United Kingdom). We compared protein intake (per day and meal), IPI per day and meal, and the number of meals with an adequate protein content among countries. The IPI per day significantly differed among countries for <0.8 and <1.0 (both p < 0.001), but not for <1.2 g/kg/d (p = 0.135). IPI per meal (<30 g/meal) did not differ among countries at breakfast (p = 0.287) and lunch (p = 0.076) but did differ at dinner (p < 0.001). Conversely, IPI per meal (<0.4 g/kg/meal) significantly differed among countries at breakfast, lunch, and dinner (all p < 0.001). The percentage of participants that ate ≥30 g/meal or ≥0.4 g/kg/meal at zero, one, and two or three meals per day significantly differed among countries (all p < 0.05). IPI at breakfast and lunch (<30 g/meal) was a common trait in the analyzed samples and might represent an opportunity for nutritional interventions in older adults in different countries.

Effects of regular breakfast habits on metabolic and cardiovascular diseases: A protocol for systematic review and meta-analysis

Article

Full-text available

Nov 2021
MEDICINE

Background: Breakfast, which is considered as an important meal of the day, is being ignored by an increasing number of people as the pace of modern life accelerates. Although a large number of previous studies have reported the relationship between skipping breakfast and type 2 diabetes mellitus, most of them were cross-sectional studies. It remains unclear how skipping breakfast affects such specific cardio-metabolic diseases as hypertension, strokes and hypercholesterolemia. Methods: The protocols and reports of this meta-analysis are based on a meta-analysis of observational studies in epidemiological guidelines (MOOSE). Relevant studies were systematically retrieved from PubMed, Embase, Web of Science and the Cochrane Library, and were restricted to English from the inception to May 10, 2019. All the results were obtained by RRs, and outcomes of interests should include the occurrence of cardiovascular and metabolic diseases. Results: Fourteen cohort studies in total were eventually included. Compared with people having breakfast frequency≦3times/week, those with a frequency>3 times/week have reduced the risk of type 2 diabetes mellitus, obesity, Metabolic Syndrome, Low high-density lipoprotein cholesterolemia, Cardiovascular Diseases, cardiovascular Mortality, hypertension and strokes, with (RR = 0.8 [95% CI: 0.7-0.91], P = .142, I2 = 37.6%), (RR = 0.74 [95% CI: 0.59-0.94], P < .001, I2 = 89%), (RR = 0.86 [95% CI:0.75-0.99], P = .512, I2 = 0%), (RR = 0.75 [95% CI:0.61-0.93], P = .643, I2 = 0%), (RR = 0.87 [95% CI:0.81-0.93], P = .479, I2 = 0%), (RR = 0.63 [95% CI:0.51-0.78], P = .396, I2 = 0%), (RR = 0.92 [95% CI:0.86-0.98], P = .419, I2 = 0.7%), and (RR = 0.89 [95% CI:0.79-0.99], P = .238, I2 = 29%), respectively. Conclusions: A regular daily breakfast habit benefits the cardio-metabolism to a great extent, reducing the risk of Cardiovascular Diseases, type 2 diabetes mellitus, obesity, hypertension, strokes, Metabolic Syndrome, cardiovascular Mortality, Low high-density lipoprotein cholesterolemia, and Abdominal obesity, while it is not significantly related to hypercholesterolemia and coronary heart disease regardless of gender. Nevertheless, skipping breakfast once a week may greatly reduce the benefits of cardio-metabolism. Therefore, public institutions should promote and encourage citizens to cultivate regular daily breakfast habits.

Chrononutrition in Cardiometabolic Health

Article

Full-text available

Jan 2022

In recent years, a healthy balanced diet together with weight reduction has risen to the forefront of minimizing the impact of cardiovascular disease. There is evidence that metabolic processes present circadian rhythmicity. Moreover, the timing of food consumption exerts a powerful influence on circadian rhythms. In this context, the subject of chrononutrition, described as the alignment of timing of food intake to the rhythms imposed by the circadian clock, has attracted considerable interest for possible beneficial effects on cardiovascular health. Current human studies suggest that chrononutrition-based dietary interventions could reduce the risk for cardiovascular disease by improving weight control, hypertension, dyslipidemia, and diabetes. However, meta-analysis of randomized control trials in this topic present varying and somehow conflicting results. Even the traditional association of breakfast skipping with adverse cardiovascular outcomes is nowadays controversial. Therefore, long-term and fairly consistent studies on the effect of chrononutrition on cardiovascular outcomes are needed. The purpose of this review is to provide concise evidence of the most recent literature involving the effects of chrononutrition and the specific chrononutrition-based dietary interventions, in particular time-restricted eating, on body weight and other cardiovascular disease risk factors.

The impact of Movement Control Order during the COVID-19 pandemic on lifestyle behaviours and body weight changes: Findings from the MyNutriLifeCOVID-19 online survey

Article

Full-text available

Jan 2022
PLOS ONE

Background The COVID-19 pandemic lockdowns have affected daily lives of the communities worldwide. This study aims to determine the lifestyle behaviours and their associations with body weight changes among Malaysian adults during the Movement Control Order (MCO) due to COVID-19 pandemic. Methods A total of 1319 Malaysian adults participated in this cross-sectional online survey. Information on anthropometric data including body weight and height, and lifestyle behaviours including eating pattern, physical activity, and sleep pattern were self-reported by the respondents. A multivariable generalised linear mixed model was used to assess the associations between lifestyle behaviours and body weight changes with adjustment of confounding factors; namely, age, sex, ethnicity, and body weight status before MCO. Results During MCO, 41.2% of the respondents perceived that their eating patterns were healthier, but 36.3% reduced their physical activities, and 25.7% had a poorer sleep quality. Further, the proportion of adults who reported having lose weight (32.2%) was almost similar to those who reported having gained weight (30.7%). Lifestyle behaviours including less frequent practice of healthy cooking methods and lunch skipping were associated with weight gain, while less frequent consumption of high fat foods, more frequent physical activity, and good sleep latency were associated with lower risk of weight gain. In contrast, practicing healthy eating concept, skipped lunch, and more frequent physical activity were significantly associated with weight loss. Conclusion Lifestyle behaviours were associated with body weight changes during MCO. While the COVID-19 pandemic lockdown is necessary to prevent further spread of the disease, promoting healthy lifestyle practices during lockdown should be implemented for a healthy weight and better health.

Skipping Breakfast and Its Association with Health Risk Behaviour and Mental Health Among University Students in 28 Countries

Article

Full-text available

Aug 2020

Introduction: The study aimed to investigate the associations between skipping breakfast and various health risk behaviours and mental health in university students in 28 countries. Methods: Using a cross-sectional study design, 21,972 university students with a median age of 20 years from 28 countries in Africa, the Americas and Asia, replied to self-reported measures of breakfast consumption, health compromising behaviours, mental health measures and protective factors. Results: In adjusted logistic regression analysis, infrequent and/or frequent breakfast skipping was associated with inadequate fruit and vegetable intake, frequent soft drink intake, not avoiding fat and cholesterol, current binge drinking, current tobacco use, gambling, not always wearing a seatbelt, inadequate physical activity, inadequate tooth brushing, not seeing a dentist in the past year and having been in a physical fight. In addition, infrequent and/or frequent breakfast skipping was associated with depression, lower happiness, posttraumatic stress disorder, loneliness, short sleep, long sleep, sleep problem, restless sleep, sleep problem due to traumatic event, and poor academic performance. Discussion: We found evidence that skipping breakfast was associated with 10 of 15 health risk behaviours, all of nine poor mental health indicators and poor academic performance.

Skipping Breakfast Is Associated with Hypertension in Adults: A Meta-Analysis

Article

Full-text available

Mar 2022

Previous studies evaluating the association between skipping breakfast and hypertension in adult population showed inconsistent results. We performed a meta-analysis to systematically evaluate the association. Observational studies which evaluated the relationship between skipping breakfast and hypertension in adult population with multivariate analyses were identified by systematic search of PubMed, Embase, and Web of Science databases. A random-effect model which incorporated the potential intrastudy heterogeneity was used for the meta-analysis. A total of six observational studies with 14189 adults were included, and 3577 of them were breakfast skippers. Pooled results showed that skipping breakfast was independently associated with hypertension in these populations (adjusted odds ratio (OR): 1.20, 95% confidence interval: 1.08 to 1.33, P < 0.001 ) with no significant heterogeneity (I2 = 0%). Sensitivity by excluding one study at a time showed consistent results (OR: 1.18 to 1.22, all P <0.01). Subgroup analyses showed that the association between skipping breakfast and hypertension in adults was consistent in the general population and in patients with type 2 diabetes, in studies from different countries, in cohort and cross-sectional studies, in breakfast skippers defined as taking breakfast ≤3 days/week and as self-reported habitual breakfast skipping, and in studies with and without adjustment of body mass index ( P for subgroup difference, all P >0.10). In conclusion, skipping breakfast is associated with hypertension in the adult population.

Associations of Number of Daily Eating Occasions with Type 2 Diabetes Risk in the Women's Health Initiative Dietary Modification Trial

Article

Full-text available

Jul 2020

Background: Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast consumption, time-restricted eating, and limiting daily eating occasions have been explored as behaviors for reducing T2D risk, but prior evidence is inconclusive. Objectives: Our objectives were to examine associations between number of daily eating occasions and T2D risk in the Women's Health Initiative Dietary Modification Trial (WHI-DM) and whether associations vary by BMI, age, or race/ethnicity. Methods: Participants were postmenopausal women in the WHI-DM who comprised a 4.6% subsample completing 24-h dietary recalls (24HRs) at years 3 and 6 as part of trial adherence activities (n = 2159). Numbers of eating occasions per day were obtained from the year 3 24HRs, and participants were grouped into approximate tertiles as 1-3 (n = 795), 4 (n = 713), and ≥5 (n = 651) daily eating occasions as the exposure. Incident diabetes was self-reported on semiannual questionnaires as the outcome. Results: Approximately 15% (15.4%, n = 332) of the WHI-DM 24HR cohort reported incident diabetes at follow-up. Cox proportional hazards regression tested associations of eating occasions with T2D adjusted for neighborhood socioeconomic status, BMI, waist circumference, race/ethnicity, family history of T2D, recreational physical activity, Healthy Eating Index-2005, 24HR energy intake, and WHI-DM arm. Compared with women reporting 1-3 meals/d, those consuming 4 meals/d had a T2D HR = 1.38 (95% CI: 1.03, 1.84) without further increases in risk for ≥5 meals/d. In stratified analyses, associations for 4 meals/d compared with 1-3 meals/d were stronger in women with BMI <30.0 kg/m2 (HR = 1.55; 95% CI: 1.00, 2.39) and women aged ≥60 (HR = 1.61; 95% CI: 1.11, 2.33). Conclusions: Four meals per day compared with 1-3 meals/d was associated with increased risk of T2D in postmenopausal women, but no dose-response effect was observed for additional eating occasions. Further studies are needed to understand eating occasions in relation to T2D risk.

Meal Patterns of Older Adults: Results from the OUTDOOR ACTIVE Study

Article

Full-text available

Jul 2022

Eating habits have a substantial effect on health, not only because of consumed foods and nutrients, but also because of the regularity of meals. This study investigates meal patterns in older adults. Data from 1198 adults (52.8% female) aged between 65 and 75 years, who resided in Bremen, Germany, were included in this cross-sectional study. Using a self-administered questionnaire, daily meals were assessed and categorised into three meal pattern types: ‘regular eaters’ (eating at least three meals a day), ‘meal skippers’ (skipping one meal a day), and ‘irregular eaters’ (skipping more than one meal a day). Descriptive analyses were carried out, stratified by sex and meal pattern types. Most women and men were regular eaters (51.5% and 51.7%, respectively), 33.8% of women and 33.3% of men were meal skippers, and 14.7% of women and 15.0% of men were irregular eaters. Differences between meal patterns were seen with regard to socioeconomic status; self-rated health; body-mass index; hypertension; consumption of self-prepared meals; and consumption of whole-grain products, green vegetables, meat, and alcohol. The results provide first insights into possible associations between meal patterns and sociodemographic and health factors, and can benefit disease prevention and health promotion in older adults.

Associations between breakfast consumption from childhood to adulthood and cardiometabolic health: A systematic review

Article

Dec 2020

Aim Breakfast consumption may be associated favourably with cardiometabolic health. Most studies only measure breakfast consumption at one timepoint, whereas repeated measures allow for associations to be explored from a life course perspective. This systematic review assessed evidence from cohort studies on associations between breakfast consumption from childhood to adulthood and cardiometabolic health. Methods Seven databases were searched; eligible records included analyses assessing breakfast consumption in childhood and adulthood, and type 2 diabetes, cardiovascular disease, obesity or associated clinical risk factors. Risk of bias was assessed using the Joanna Briggs Institute checklist for cohort studies. Results Six eligible articles were reviewed, representing four cohort studies from two countries. Body composition was the only outcome investigated by five articles; the sixth article investigated body composition as well as a metabolic syndrome score and serum cardiometabolic risk markers. Most articles found significant associations between breakfast consumption in childhood and adulthood and cardiometabolic benefits, however the quality of evidence was poor. Childhood and adulthood breakfast consumption were each associated with cardiometabolic benefits, and breakfast consumption over both life stages was associated with greater benefits. An increase in breakfast consumption from childhood to adulthood was also associated with cardiometabolic benefits. Conclusions We evaluated the available literature and found limited studies of low quality to suggest that more frequent breakfast consumption across both childhood and adulthood may be associated with the greatest cardiometabolic benefits. Further research is needed to develop an understanding of the relationship between breakfast and cardiometabolic health from a cross‐lifestage perspective.

Association of breakfast skipping with cardiovascular outcomes and cardiometabolic risk factors: an updated review of clinical evidence

Article

Sep 2020
CRIT REV FOOD SCI

"Eat breakfast like a king, lunch like a prince and dinner like a pauper" (Adelle Davis, 1904-1974) is a concept that appears to align with some contemporary evidence concerning the appropriate proportioning of daily meals. At the same time, with the popular and scientific dissemination of the concepts of intermittent fasting and time-restricted feeding, well-controlled clinical trials have emerged showing the safety or even possible benefits of skipping breakfast. In this comprehensive literature review, we discuss recent evidence regarding breakfast intake, cardiovascular outcomes and cardiovascular risk markers. Overall, breakfast omission appears to be associated with a higher risk for atherosclerotic and adverse cardiovascular outcomes. However, caution should be employed when deciphering these data as many complex, unmeasured confounders may have contributed. Unfortunately, long-term randomized, clinical trials with detailed dietary control that have assessed clinical outcomes are sparse. Notwithstanding the observational findings, current trials conducted so far-albeit apparently smaller number-have shown that breakfast addition in subjects who do not habitually consume this meal may increase body weight, particularly fat mass, through caloric excess, whereas skipping breakfast may be a feasible strategy for some people aiming for calorie restriction. To date, definitive benefits of breakfast omission or consumption are not supported by the best evidence-based research, and the question of whether skipping breakfast per se is causally associated with cardiovascular outcomes remains unresolved.

Frequency of Breakfast, Lunch, and Dinner and Incidence of Proteinuria: A Retrospective Cohort Study

Article

Full-text available

Nov 2020

Although multiple studies have revealed a close association of skipping breakfast with cardiometabolic diseases, few studies have reported its association with chronic kidney disease (CKD). Furthermore, there is scant reporting on the clinical impacts that skipping lunch and dinner has on cardiometabolic diseases and CKD. This retrospective cohort study, including 5439 female and 4674 male workers of a national university in Japan who underwent annual health checkups between January 2005 and March 2013, aimed to assess an association of frequencies of breakfast, lunch, and dinner with incidence of proteinuria (dipstick urinary protein ≥1+). The incidence of proteinuria was observed in 763 (14.0%) females and 617 (13.2%) males during the median 4.3 and 5.9 years of the observational period, respectively. In females, skipping breakfast as well as skipping dinner, but not lunch, were associated with the incidence of proteinuria (adjusted hazard ratios of breakfast frequency of “every day”, “sometimes”, and “rarely”: 1.00 (reference), 1.35 (1.09–1.66), and 1.54 (1.22–1.94), respectively; those of dinner frequency of “every day” and “≤sometimes”: 1.00 (reference) and 1.31 (1.00–1.72), respectively). However, no association was observed in male workers. Skipping breakfast and skipping dinner were identified as risk factors of proteinuria in females, but not in males.

Prospective Study of Skipping Meals to Lose Weight as a Predictor of Incident Type 2 Diabetes With Potential Modification by Cardiometabolic Risk Factors: The Canadian 1995 Nova Scotia Health Survey

Article

Sep 2020

Background Skipping meals is an increasingly common practice to lose weight among North American adults. However, the long-term effect of this practice on incident type 2 diabetes mellitus (T2DM) remains unknown. We assessed whether skipping meals to lose weight is associated with T2DM risk and whether this association is modified by cardiometabolic risk factors. Methods Skipping meals to lose weight was assessed by questionnaire in 2,288 adults from the 1995 Nova Scotia Health Survey and was linked to administrative health databases to determine T2DM incidence in the following 23 years. Multivariable-adjusted Cox proportional hazards models estimated hazard ratios (aHRs) and 95% confidence intervals (CIs) for T2DM. Results During follow up, 378 T2DM cases were diagnosed. Compared with participants who did not skip meals to lose weight, those who did (2.2%) had a 125% higher risk of T2DM (aHR, 2.25; 95% CI, 1.31 to 3.86). This association was no longer present after further adjustment for baseline body mass index (BMI) (aHR, 1.66; 95% CI, 0.96 to 2.85). Skipping meals to lose weight was associated with T2DM among participants who were men (n=1,135; aHR, 2.09; 95% CI, 1.09 to 4.02) or had a BMI <30 kg/m² (n=1,676; aHR, 2.64, 95% CI, 1.15 to 6.06), elevated cholesterol (n=1,146; aHR, 2.11; 95% CI, 1.06 to 4.22), high blood pressure (n=1,133; aHR, 2.10; 95% CI, 1.10 to 4.01) and restless sleep (n=1,186; aHR, 2.19; 95% CI, 1.13 to 4.25), but not among women, those with a BMI of ≥30 kg/m² and those without elevated cholesterol, high blood pressure or restless sleep. Conclusions Skipping meals to lose weight may be a predictive modifiable risk factor for developing T2DM over time, potentially working in connection with other T2DM risk factors.

Prävention, Remission oder Verzögerung der Typ-2-Diabetes-Manifestation – Teil 1

Article

Oct 2020

Rüdiger Landgraf

Prevalence and incidence of diabetes and especially type 2 diabetes are worldwide growing dramatically. In 2019 around 463 million people suffered from diabetes with an enormous increase to 700 million up to the year 2045. Realistic estimates report even a doubling of the prevalence when considering the undiagnosed cases. In Germany the prevalence of diabetes is around 10 %, of undiagnosed cases 2 % and of people with prediabetes (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] or both) 21 %. Diabetes and its complications account for at least 10-12 % of the total health expenditures in Germany. Prevention of type 2 diabetes together with other non-communicable diseases is therefore paramount to curtail this already existing health crisis. Drawing on the evidence from high quality randomized controlled trials, systematic reviews and meta-analyses lifestyle interventions are effective to prevent or delay the manifestation in high risk populations (i. e. prediabetes), which have to be identified by evaluated screening tools like the FINDRISK questionnaire and/or blood glucose parameters plus HbA 1c. The strategies for a successful prevention are attacking multiple risk factors for the development of type 2 diabetes (f. e. obesity/fatty liver, physical inactivity, unhealthy eating and drinking including alcohol as well as coffee and tea consumption, smoking, sleeping disorders, depression) with non-pharmacological behavioural prevention which will be discussed in this evidence-based review (part 1 of this CME paper). Part 2 deals with important aspects of a setting-based/environmental prevention. Both behavioural and environmental prevention strategies have closely work together in order to achieve long-lasting successes in diabetes prevention.

Relationships among Local Agricultural Product Purchases, Self-Cooked Meal Consumption, and Healthy Eating Habits: A Cross-Sectional Study in a Town in Gunma, Japan

Article

Aug 2022

This study examined whether the frequency of purchasing local agricultural products and the intake frequency of self-cooked meals were related to healthy eating habits. A cross-sectional study was conducted using anonymized data from the “Survey on health promotion and food-and-nutritional education” conducted in 2021 in Tamamura, Gunma, Japan, targeting residents aged 20–65. Logistic regression analyses were conducted using the purchasing frequency of local agricultural products (often/sometimes/rarely) and the intake frequency of self-cooked meals (almost every day/not every day) as independent variables. The dependent variables were the frequencies of breakfast (every day/not every day), balanced meal (two times/day or more/fewer than two times/day), and vegetable intake (two times/day or more/fewer than two times/day). The purchasing frequency of local agricultural products was positively related to the frequency of balanced meal and vegetable intake. Additionally, the intake frequency of self-cooked meals was positively related to the frequencies of breakfast, balanced meal, and vegetable intake. In conclusion, significant positive relationships of the purchasing frequency of local agricultural products and the intake frequency of self-cooked meals with healthy eating habits were confirmed.

Türkiye Nüfusunun Şehirlerin Gelişimi Üzerindeki Etkilerinin Coğrafi Ağırlıklandırılmış Regresyon Yöntemiyle İncelenmesi

Conference Paper

Full-text available

Apr 2021

Cities, whose emergence dates back to ancient times and whose formation has accelerated with the settlement, are the largest settlements where human communities live. Cities develop from the past to the present, and this is caused by more than one factor. Some of these factors are considered as natural factors such as landforms and climatic conditions, and some as human factors such as agriculture, industry and service sectors. Factors in both groups are determinant in the population of cities, and all of these play an important role in the development of cities from the past to the present. Considering a city developed in terms of human factors; It is seen that there are many jobs and other opportunities and these increase the attractiveness of the city. This situation causes migration to occur and the population to increase. The increasing population, on the other hand, creates some needs and progress is being made in areas such as industry, trade and education in order to meet these needs. Considering all these, it is obvious that the population factor is directly related to the development of the city and many parameters that affect this factor can be mentioned. Demographic factors are taken into consideration, evaluated the development level of cities in Turkey. In this case, it is understood that the effect degree of many parameters that the population factor depends on may differ from city to city. In order to examine this situation, it may be possible to handle the changes that occur depending on the location of the parameters and to map the resulting distribution by using spatial analysis techniques. Using Geographically Weighted Regression (GWR) method in this context, which can work in integration with Geographical Information Systems (GIS), will allow spatial relationships to be explored and modeled. In this study, Geographically Weighted Regression method was used. GWR, one of the spatial statistical methods; It enables the location-dependent relationships of a situation to be investigated and the effects of factors affecting this situation to be predicted positionally. The method uses a weighting scheme for each of the factors considered; It enables the determination of which parameters are determinative on the situation to be investigated and to observe the effects of these parameters depending on the location on the studied area by modeling them. Population factor, which determines the development of cities, as dependent variable; Factors such as migration, industry, tourism, agriculture, education, health, transportation, employment were determined as independent variables. In order to examine how the dependent variable is affected by the independent variables, it is aimed to create a model using the GWR method. The results obtained with the model, the effects of the independent variables on the dependent variables was investigated on all cities in Turkey spatially. At the same time, it is purposed to obtain the spatial pattern of these variables in the cities of our country. Using with GWR method in this study , the determining factors on Turkey’s population have been identified. Then, with these factors, the most suitable model representing the country’s population was created. The influence level of the factors in the created model on each city is modeled spatially. The development levels of the cities were examined with the results. Results are presented with maps produced using Geographical Information Systems via ArcGIS software. It is thought that the results will add a different perspective to the studies on spatial analysis.

A practical approach to obesity prevention: Healthy home habits

Article

Jan 2021

Families have the potential to foster a healthy home environment aimed at reducing the risk of overweight and obesity. Establishing habits associated with reduced risk of obesity and overweight early in childhood can have lasting effects into adulthood. Nurse practitioners can encourage families to participate in healthy habits by addressing areas of growth for obesity prevention within the home. A review of the most recent literature, approximately over the past decade, was used to provide a consolidated source of reference for healthy home habits for the nurse practitioner. The search included terms such as "obesity," "overweight," "healthy habits," "physical activity," "obesogenic behaviors," "family meals," "screen time," "depression," "sugary beverages," and "portion sizes." The information was synthesized into three content areas: nutrition and consumption, patterns of activity, and stress within the home. Establishing healthy habits early in life can protect against the development of overweight and obesity. Nurse practitioners can serve a vital role in the prevention of pediatric, adolescent, and adult obesity. Equipped with the unique role of assisting those from a diverse patient base, nurse practitioners can inform patients how to improve healthy habits to decrease the likelihood of obesity or overweight. Encouraging behavior change related to the healthy habits associated with the prevention of overweight and obesity can have a long-term impact on the health of an entire family.

Beneficial Gut Microbiome Remodeled During Intermittent Fasting in Humans

Article

May 2021

Intermittent fasting (IF) is the practice of restricting food intake for 12 to 48 hours per fasting cycle over a prolonged period of time. Previous work shows beneficial health effects such as weight loss and lower risk for cardiometabolic diseases. Although reduced calorie intake may account for some of the observed benefits of intermittent fasting, exact mechanisms are still unclear. Recent evidence indicates that intermittent fasting may lead to remodeling and increased taxonomic diversity in the human gut microbiome. In particular, the Lachnospiraceae family of anaerobic bacteria increased during fasting. This family, in the order Clostridiales, promotes butryogenesis in the gut, a process that is associated with healthful metabolic and prolongevity effects. IF-associated alterations to the microbiome may play a key role in the metabolic and potential healthspan-enhancing benefits of IF and dietary restriction.

Thirty obesity Myths, Misunderstandings, and/or oversimplifications: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Article

Aug 2022

Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) is intended to provide clinicians an overview of 30 common obesity myths, misunderstandings, and/or oversimplifications. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS discusses 30 common obesity myths, misunderstandings, and/or oversimplifications, utilizing referenced scientific publications such as the integrative use of other published OMA CPSs to help explain the applicable physiology/pathophysiology. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on 30 common obesity myths, misunderstandings, and/or oversimplifications is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Knowledge of the underlying science may assist the obesity medicine clinician improve the care of their patients with obesity.

Association of Employees’ Meal Skipping Patterns with Workplace Food Purchases, Dietary Quality, and Cardiometabolic Risk: A Secondary Analysis from the ChooseWell 365 Trial

Article

Aug 2021

Background Employed adults may skip meals due to time or financial constraints, challenging work schedules, or limited workplace food choices. Little is known about the relationship between employees’ meal skipping patterns and workplace dietary choices and health. Objective To examine whether hospital employees’ meal skipping patterns were associated with workplace food purchases, dietary quality, and cardiometabolic risk factors (obesity, hypertension, pre-diabetes/diabetes). Design This is a secondary cross-sectional analysis of baseline data from the ChooseWell 365 randomized controlled trial. Employees reported meal skipping frequency in a baseline survey. The healthfulness of workplace food purchases was determined with a validated Healthy Purchasing Score (HPS; range 0-100, higher=healthier purchases) calculated using sales data for participants’ purchases in the 3 months before study enrollment. Dietary quality was measured with the 2015 Healthy Eating Index (HEI-2015; range 0-100, higher=healthier diet) from two 24-hour recalls. Cardiometabolic risk factors were ascertained from clinic measurements. Participants/setting Participants were 602 hospital employees who regularly visited workplace cafeterias and enrolled in ChooseWell 365, a workplace health promotion study in Boston, Massachusetts in 2016-2018. Main outcome measures Primary outcomes were HPS, HEI-2015, and cardiometabolic risk factors. Statistical analyses Regression analyses examined differences in HPS, HEI-2015, and cardiometabolic variables by meal skipping frequency, adjusting for demographics. Results Participants’ mean age was 43.6 (SD:12.2) years and 478 (79%) were female. Overall, 45.8% skipped breakfast, 36.2% skipped lunch, and 24.9% skipped dinner ≥1 day/week. Employees who skipped breakfast ≥3 days/week (N=102) had lower HPS (65.1 vs 70.4, p<0.01) and HEI-2015 score (55.9 vs 62.8, p<0.001) compared to those who never skipped. Skipping lunch ≥3 days/week and dinner ≥1 day/week were associated with significantly lower HPS compared to never skipping. Employees who worked non-standard shifts skipped more meals than those who worked standard shifts. Meal skipping was not associated with obesity or other cardiometabolic variables. Conclusions Skipping meals was associated with less healthy food purchases at work, and skipping breakfast was associated with lower dietary quality. Future research to understand employees’ reasons for skipping meals may inform how employers could support healthier dietary intake at work.

Maternal meal irregularities during pregnancy and lifestyle correlates

Article

Oct 2021
APPETITE

Meal regularity can influence metabolic health. However, habits of skipping and delaying meals are rarely studied among pregnant women. This study examined the incidence of maternal meal skipping and meal delaying, and their associated lifestyle patterns during pregnancy. Pregnant women in the second trimester (18-24 weeks' gestation; n = 90) were recruited from the antenatal clinics in KK Women's and Children's Hospital, Singapore, 2019-2020. Data on sociodemographic, lifestyle and dietary habits were collected. Firstly, principal component analysis was used to identify lifestyle patterns. Subsequently, multiple logistic regression model was used to examine the association of lifestyle patterns with meal skipping and delaying. In total, 32 (35.6%) women had irregular meals, in which 25 (27.8%) and 26 (28.9%) women reported meal skipping and meal delaying for at least 3 times a week, respectively. Women with 'poor sleep and emotion' pattern as characterized by higher scores for poor sleep, depression, anxiety, and stress symptoms were associated with higher odds of meal skipping (OR 1.99; 95% CI 1.13, 3.53) and meal delaying (2.50; 1.31, 4.79). 'Sedentary' pattern, as characterized by greater daily time spent on television and screen electronic devices, and 'weight and inactivity' pattern, as characterized by higher BMI and physical inactivity level, were not associated with meal regularity. In this study, almost one-third of women reporting meal irregularities during pregnancy. 'Poor sleep and emotion' pattern is associated with a higher incidence of meal skipping and delaying. These findings suggest the need to address sleep and emotional health in interventions promoting healthy nutrition specifically regular eating in pregnancy.

Kentsel Açık Yeşil Alanların ve Yapılı Çevrenin İklim Değişikliği Üzerine Etkilerinin Karşılaştırılması

Conference Paper

Full-text available

Apr 2021

İklim Değişikliği

Prospective study of breakfast frequency and timing and the risk of incident type 2 diabetes in community-dwelling older adults: The Cardiovascular Health Study

Article

Apr 2022

Background No evidence-based recommendations regarding optimal breakfast frequency and timing and type 2 diabetes mellitus (T2DM) exist for older adults due to limited studies. Objective We sought to prospectively assess relationships between breakfast frequency and timing and T2DM risk among older adults and determine whether these depended on gender or cardiometabolic risk factors. Methods Weekly breakfast frequency and usual daily breakfast time were assessed by questionnaire at baseline in 3,747 older adults (aged ≥65 years) from the Cardiovascular Health Study (CHS) who were free of cancer and T2DM and followed for 17.6 years. Multivariable-adjusted hazard ratios (aHR) with 95% confidence intervals (CI) estimated from Cox proportional hazards models were used to quantify associations with T2DM. Results Most CHS participants (median age: 74 years; interquartile range: 71, 78) consumed breakfast daily (85.5%), and 73% had their first daily eating occasion between 07:00-09:00 hours, which were associated with higher socioeconomic status, factors that are indicative of a healthier lifestyle, and lower levels of cardiometabolic risk indicators at baseline. During follow-up, 547 T2DM cases were documented. No strong evidence was observed between breakfast frequency and risk of T2DM. Compared to participants whose breakfast timing (first eating occasion of the day) was 07:00-09:00, those who broke fast after 09:00 had an aHR for T2DM of 0.71 (95% CI: 0.51, 0.99). This association was present in participants with impaired fasting glucose at baseline (0.61; 0.39, 0.95) but not in those without (0.83; 0.50, 1.38)). No associations between eating frequency or timing and T2DM were observed within other pre-specified subgroups. Conclusions Eating breakfast daily was not associated with either higher or lower risk of T2DM in this cohort of older adults, while a later (after 09:00) daily first eating occasion time was associated with lower T2DM risk in participants with impaired fasting glucose at baseline.

Relationship between protein intake in each meal and physical activity level: Cross-sectional Study (Preprint)

Article

Dec 2021

Background: Protein intake plays an important role in the synthesis and maintenance of skeletal muscles for the prevention of health risks. It is also widely known that physical activity influences muscle function. However, no large-scale studies have examined the relationship between daily dietary habits, especially the timing of protein intake, and daily physical activity. Objective: The purpose of this cross-sectional study was to investigate how protein intake and composition (involving the 3 major nutrients protein, fat, and carbohydrate) in the 3 traditional meals (breakfast, lunch, and dinner) are associated with physical activity. Methods: Using daily dietary data accumulated in the smartphone food log app "Asken" and a web-based cross-sectional survey involving Asken users (N=8458), we analyzed nutrient intake and composition, as well as daily activity levels. As very few individuals skipped breakfast (1102/19,319 responses, 5.7%), we analyzed data for 3 meals per day. Results: Spearman rank correlation analysis revealed that breakfast and lunch protein intakes had higher positive correlations with daily physical activity among the 3 major macronutrients (P<.001). These findings were confirmed by multivariate logistic regression analysis with confounding factors. Moreover, participants with higher protein intake and composition at breakfast or lunch tended to exhibit significantly greater physical activity than those with higher protein intake at dinner (P<.001). Conclusions: Among the 3 macronutrients, protein intake during breakfast and lunch was closely associated with daily physical activity.

Healthy eating for healthy aging: What and when to eat as an older adult

Article

Jun 2022
AM J CLIN NUTR

Not only diet quality and physical activity but also snacking and skipping meals could be related with menstrual disorders in PCOS

Article

Aug 2022

The aim of this study was to clarify the associations between menstrual cycle disorders, food frequency intake, dietary habits, and physical activity levels in women with and without Polycystic Ovary Syndrome (PCOS). 114 women with PCOS and 341 without PCOS (CONTROL) participated in the study. They were also divided into women with menstrual disorders(MD), and those with regular cycle (RC). Each of them completed a medical and Kompan questionnaires. In women with PCOS and menstrual disorders (PCOS-MD), intake of wholemeal products, meat and meat products, fats and alcoholic beverages was higher in comparison to those in the control group with menstrual disorders (CONTROL-MD). Women in the PCOS-MD group also reported significantly more frequent snacking between meals, higher Pro-Healthy Diet Index (pHDI-14), and a lower level of physical activity at leisure time than CONTROL-MD. Women with PCOS differed from those in CONTROL due to a higher consumption of meat and meat products, fats, fruits and vegetables, juices and alcoholic beverages, and a lower intake of whitemeal products, sweets, and fruits. Women with PCOS more frequently snacked, but the number of their meals was also lower. In women with PCOS, menstrual disorders may be related not only with diet quality and physical activity but also with snacking and skipping meals.

Time-restricted eating and circadian rhythms: the biological clock is ticking

Article

Full-text available

Jul 2020

Meal timing may be a critical modulator of health outcomes due to complex interactions between circadian biology, nutrition and human metabolism. As such, approaches that aim to align food consumption with endogenous circadian rhythms are emerging in recent years. Time-restricted eating (TRE) consists of limiting daily nutrient consumption to a period of 4 to 12 hours in order to extend the time spent in the fasted state. TRE can induce positive effects on the health of individuals with overweight and obesity, including sustained weight loss, improvement in sleep patterns, reduction in blood pressure and oxidative stress markers and increased insulin sensitivity. However, it is not fully clear whether positive effects of TRE are due to reduced energy intake, body weight or the truncation of the daily eating window. In addition, null effects of TRE in some populations and on some parameters of cardiometabolic health have been documented. Some evidence indicates that greater promotion of health via TRE may be achieved if the nutrient intake period occurs earlier in the day. Despite some promise of this dietary strategy, the effects of performing TRE at different times of the day on human cardiometabolic health, as well as the safety and efficacy of this dietary approach in individuals with cardiometabolic impairments, need to be evaluated in additional controlled and long-term studies.

Breakfast quality and cardiometabolic risk profiles in an upper middle-aged German population

Article

Full-text available

Jul 2017
EUR J CLIN NUTR

Background/objectives: Little is known about relation of overall breakfast quality with cardiometabolic risk factors. Therefore, this study aimed to explore sex-specific associations between breakfast quality and cardiometabolic risk profiles in a sample of an upper middle-aged German population. Subjects/methods: Cardiometabolic profiles of 339 men and 329 women were cross-sectionally assessed using an overall biomarker score (BScore), glycated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), blood pressure, body mass index (BMI) and waist circumference (WC). Overall breakfast quality was assessed by using (i) an a-priori defined breakfast quality score (BQS) and (ii) data-driven breakfast patterns based on principal component analysis (PCA). Multiple linear regression models for association of breakfast quality with all outcomes were adjusted for all potential confounders including overall diet quality. Results: After adjustment for all potential confounders the BQS was inversely associated with the BScore (regression beta with 95% Confidence Interval: -0.29 (052-0.06)) and HbA1c (-0.12 (-0.21, -0.04)) in men; whereas no such associations were observed in women. Four breakfast (B) patterns were identified: B-processed-food pattern, B-cereal pattern, B-high fat pattern and B-dairy &cereal pattern. The B-processed-food pattern was positively associated with HbA1c (0.09(0.01, 0.18)), BMI (0.16 (0.06, 0.26)), and WC (0.17 (0.8, 0.26)) in men, and BMI (0.13 (0.1, 0.25)) and WC (0.11(0.01.0.22)) in women. The B-cereal pattern was inversely associated with BScore (-0.23 (-0.45, -0.01)) and BMI (-0.11 (-0.20, -0.01)) in men and WC(-0.16 (-0.27, -0.05)) in women. The B-dairy &cereal pattern was also inversely associated with BScore (-0.26 (-0.48, -0.04)) in men but not in women. Conclusions: The overall breakfast quality was cross-sectionally associated with a healthier cardiometabolic profile, especially in upper-middle age men, independent of overall dietary quality. Such analyses should be supplemented by studies investigating the circadian sequence of food intake and metabolic consequences including hard disease endpoints.European Journal of Clinical Nutrition advance online publication, 26 July 2017; doi:10.1038/ejcn.2017.116.

Food groups and risk of type 2 diabetes mellitus: a systematic review and meta-analysis of prospective studies

Article

Full-text available

May 2017
EUR J EPIDEMIOL

The aim of this systematic review and meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups and risk of type 2 diabetes (T2D). We conducted a systematic search in PubMed, Embase, Medline (Ovid), Cochrane Central, and Google Scholar for prospective studies investigating the association between whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages (SSB) on risk of T2D. Summary relative risks were estimated using a random effects model by contrasting categories, and for linear and non-linear dose–response relationships. Six out of the 12 food-groups showed a significant relation with risk of T2D, three of them a decrease of risk with increasing consumption (whole grains, fruits, and dairy), and three an increase of risk with increasing consumption (red meat, processed meat, and SSB) in the linear dose–response meta-analysis. There was evidence of a non-linear relationship between fruits, vegetables, processed meat, whole grains, and SSB and T2D risk. Optimal consumption of risk-decreasing foods resulted in a 42% reduction, and consumption of risk-increasing foods was associated with a threefold T2D risk, compared to non-consumption. The meta-evidence was graded “low” for legumes and nuts; “moderate” for refined grains, vegetables, fruit, eggs, dairy, and fish; and “high” for processed meat, red meat, whole grains, and SSB. Among the investigated food groups, selecting specific optimal intakes can lead to a considerable change in risk of T2D. Electronic supplementary material The online version of this article (doi:10.1007/s10654-017-0246-y) contains supplementary material, which is available to authorized users.

Meal Timing and Frequency: Implications for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association

Article

Full-text available

Jan 2017

Eating patterns are increasingly varied. Typical breakfast, lunch, and dinner meals are difficult to distinguish because skipping meals and snacking have become more prevalent. Such eating styles can have various effects on cardiometabolic health markers, namely obesity, lipid profile, insulin resistance, and blood pressure. In this statement, we review the cardiometabolic health effects of specific eating patterns: skipping breakfast, intermittent fasting, meal frequency (number of daily eating occasions), and timing of eating occasions. Furthermore, we propose definitions for meals, snacks, and eating occasions for use in research. Finally, data suggest that irregular eating patterns appear less favorable for achieving a healthy cardiometabolic profile. Intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiometabolic risk factor management.

Relative and Absolute Availability of Fast Food Restaurants in Relation to the Development of Diabetes: A Population-Based Cohort Study

Article

Full-text available

Oct 2016

Consumption of Meals Prepared at Home and Risk of Type 2 Diabetes: An Analysis of Two Prospective Cohort Studies

Article

Full-text available

Jul 2016
PLOS MED

Background: There has been a trend towards increased dining out in many countries. Consuming food prepared out of the home has been linked to poor diet quality, weight gain, and diabetes risk, but whether having meals prepared at home (MPAH) is associated with risk of type 2 diabetes (T2D) remains unknown. Methods and findings: We followed 58,051 women (from 1986 to 2012) and 41,676 men (from 1986 to 2010) in two prospective cohort studies of health professionals. Frequencies of consuming midday or evening MPAH were assessed at baseline and during follow-up. Incident T2D was identified through self-report and confirmed using a validated supplementary questionnaire. During 2.1 million person-years of follow-up, 9,356 T2D cases were documented. After adjusting for demographic, socioeconomic, and lifestyle factors, hazard ratios (HRs) and 95% confidence intervals (95% CIs) of T2D were 1 (reference), 0.93 (0.88-0.99), 0.96 (0.90-1.03), and 0.86 (0.81-0.91) for those eating 0-6, 7-8, 9-10, and 11-14 MPAH (p-trend < 0.001) per week, respectively. Participants eating 5-7 midday MPAH had 9% lower T2D risk than those with 0-2 midday MPAH, and participants having 5-7 evening MPAH had 15% lower risk than those with 0-2 evening MPAH (both p-trend < 0.001). In the first 8 y of follow-up, women and men who consumed 11-14 MPAH per week had 0.34 kg (95% CI: 0.15-0.53; p < 0.001) and 1.23 kg (95% CI: 0.92-1.54) less weight gain than those with 0-6 MPAH, respectively. Among participants who were nonobese (body mass index [BMI] < 30 kg/m2) at baseline, pooled HR (95% CI) of developing obesity (BMI ≥ 30 kg/m2) was 0.86 (0.82-0.91; p-trend < 0.001) when extreme MPAH groups (11-14 MPAH versus 0-6 MPAH) were compared. When midday and evening MPAH were analyzed separately, HRs comparing extreme groups (5-7 MPAH versus 0-2 MPAH) were 0.93 (95% CI: 0.89-0.97, p-trend = 0.003) for midday MPAH and 0.76 (95% CI: 0.70-0.83; p-trend < 0.001) for evening MPAH. Further adjusting for BMI during follow-up attenuated the association between MPAH and T2D risk: the HR (95% CI) for participants with 11-14 MPAH was 0.95 (0.89-1.01, p-trend = 0.13). The main limitations of our study were that it lacked assessments on individual foods constituting the MPAH and that the findings were limited to health professionals with a relatively homogeneous socioeconomic status. Conclusions: In two large prospective cohort studies, frequent consumption of MPAH is associated with a lower risk of developing T2D, and this association is partly attributable to less weight gain linked with this dining behavior.

Relative and absolute availability of fast-food restaurants in relation to the development of diabetes: A population-based cohort study

Article

Full-text available

Jun 2016

Objectives: To determine whether residents living in areas with a high proportion of fast-food restaurants (FFR) relative to all restaurants are more likely to develop diabetes and whether the risk varies according to the volume of FFR. Methods: The study cohort consisted of adult respondents (20-84 years) to the Canadian Community Health Survey (cycles 2005, 2007/2008, 2009/2010) who resided within walking distance (720 m) of at least one restaurant in Toronto, Brampton, Mississauga or Hamilton, ON. The development of diabetes was established by linking participants to the Ontario Diabetes Database. Cox proportional hazards models were used to estimate hazard ratios (HRs) of incident diabetes associated with relative and absolute measures of restaurant availability. Results: During a median follow-up of 5 years, 347 of 7,079 participants (4.6%) developed diabetes. Among younger adults (20-65 years, n = 5,806), a greater proportion of fast-food relative to all restaurants was significantly associated with incident diabetes after adjustment for a range of individual and area-level covariates, but only in areas with high volumes of fast-food retailers (3+ outlets) (HR = 1.79, 95% confidence interval: 1.03-3.12, across the interquartile range). Adjusting for body mass index rendered this association non-significant. No significant associations were observed in areas with low volumes of FFR or among older adults (65-84 years, n = 1,273). Absolute availability (number) of fast-food and other restaurants was generally unrelated to incident diabetes. Conclusion: Areas with the double burden of a high volume of FFR and few dining alternatives may represent an adverse environment for the development of diabetes.

Prediction of metabolic syndrome by a high intake of energy-dense nutrient-poor snacks in Iranian children and adolescents

Article

Full-text available

Dec 2015
Pediatr Res

Background: Our aim was to investigate the relationship between metabolic syndrome (MetS) and energy-dense nutrient-poor solid snack intakes during 3.6 years of follow-up among children and adolescents. Method: This population-based longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study, on 424 MetS free subjects, aged 6-18 years. Data on consumption of energy-dense nutrient-poor solid snacks, sweet and salty snacks, was collected at baseline (2006-2008). Logistic regression, adjusted for age, sex, total energy intake, physical activity, dietary fiber, family history of diabetes, and BMI, was used to assess the relationship between snacks and incident MetS. Results: After adjustment for confounders, compared to the lowest quartile of total energy-dense nutrient-poor solid snacks, odds ratios of incident MetS in the highest quartile was 3.04 (95%CI:1.11-8.49); for sweet snacks this was 2.88(95%CI:1.00-8.32) and for salty ones it was 2.85(95%CI:1.09-7.43). The risk of incident hypertension in the highest, compared to the lowest quartile of total and salty snacks, was 2.99(95%CI:1.00-8.93) and 3.35(95%CI:1.10-10.17), respectively. Conclusion: Energy-dense nutrient-poor solid snacks, both salty and sweet, may have undesirable effects on the incidence of MetS, with salty snacks having the potential to increase risk of incident hypertension in children and adolescents as well.Pediatric Research (2015); doi:10.1038/pr.2015.270.

Dietary fibre and incidence of type 2 diabetes in eight European countries: The EPIC-InterAct Study and a meta-analysis of prospective studies

Article

Full-text available

May 2015

Aims/hypothesis: Intake of dietary fibre has been associated with a reduced risk of type 2 diabetes, but few European studies have been published on this. We evaluated the association between intake of dietary fibre and type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study and in a meta-analysis of prospective studies. Methods: During 10.8 years of follow-up, 11,559 participants with type 2 diabetes were identified and a subcohort of 15,258 participants was selected for the case-cohort study. Country-specific HRs were estimated using Prentice-weighted Cox proportional hazards models and were pooled using a random effects meta-analysis. Eighteen other cohort studies were identified for the meta-analysis. Results: In the EPIC-InterAct Study, dietary fibre intake was associated with a lower risk of diabetes (HRQ4 vs Q1 0.82; 95% CI 0.69, 0.97) after adjustment for lifestyle and dietary factors. Similar inverse associations were observed for the intake of cereal fibre and vegetable fibre, but not fruit fibre. The associations were attenuated and no longer statistically significant after adjustment for BMI. In the meta-analysis (19 cohorts), the summary RRs per 10 g/day increase in intake were 0.91 (95% CI 0.87, 0.96) for total fibre, 0.75 (95% CI 0.65, 0.86) for cereal fibre, 0.95 (95% CI 0.87, 1.03) for fruit fibre and 0.93 (95% CI 0.82, 1.05) for vegetable fibre. Conclusions/interpretation: The overall evidence indicates that the intake of total and cereal fibre is inversely related to the risk of type 2 diabetes. The results of the EPIC-InterAct Study suggest that the association may be partially explained by body weight.

Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: Systematic review, meta-analysis, and estimation of population attributable fraction

Article

Full-text available

Jul 2015
Br Med J Int Ed

Objectives To examine the prospective associations between consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice with type 2 diabetes before and after adjustment for adiposity, and to estimate the population attributable fraction for type 2 diabetes from consumption of sugar sweetened beverages in the United States and United Kingdom. Design Systematic review and meta-analysis. Data sources and eligibility PubMed, Embase, Ovid, and Web of Knowledge for prospective studies of adults without diabetes, published until February 2014. The population attributable fraction was estimated in national surveys in the USA, 2009-10 (n=4729 representing 189.1 million adults without diabetes) and the UK, 2008-12 (n=1932 representing 44.7 million). Synthesis methods Random effects meta-analysis and survey analysis for population attributable fraction associated with consumption of sugar sweetened beverages. Results Prespecified information was extracted from 17 cohorts (38 253 cases/10 126 754 person years). Higher consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, by 18% per one serving/day (95% confidence interval 9% to 28%, I2 for heterogeneity=89%) and 13% (6% to 21%, I2=79%) before and after adjustment for adiposity; for artificially sweetened beverages, 25% (18% to 33%, I2=70%) and 8% (2% to 15%, I2=64%); and for fruit juice, 5% (−1% to 11%, I2=58%) and 7% (1% to 14%, I2=51%). Potential sources of heterogeneity or bias were not evident for sugar sweetened beverages. For artificially sweetened beverages, publication bias and residual confounding were indicated. For fruit juice the finding was non-significant in studies ascertaining type 2 diabetes objectively (P for heterogeneity=0.008). Under specified assumptions for population attributable fraction, of 20.9 million events of type 2 diabetes predicted to occur over 10 years in the USA (absolute event rate 11.0%), 1.8 million would be attributable to consumption of sugar sweetened beverages (population attributable fraction 8.7%, 95% confidence interval 3.9% to 12.9%); and of 2.6 million events in the UK (absolute event rate 5.8%), 79 000 would be attributable to consumption of sugar sweetened beverages (population attributable fraction 3.6%, 1.7% to 5.6%). Conclusions Habitual consumption of sugar sweetened beverages was associated with a greater incidence of type 2 diabetes, independently of adiposity. Although artificially sweetened beverages and fruit juice also showd positive associations with incidence of type 2 diabetes, the findings were likely to involve bias. None the less, both artificially sweetened beverages and fruit juice were unlikely to be healthy alternatives to sugar sweetened beverages for the prevention of type 2 diabetes. Under assumption of causality, consumption of sugar sweetened beverages over years may be related to a substantial number of cases of new onset diabetes.

Breakfast Skipping is Positively Associated With Incidence of Type 2 Diabetes Mellitus: Evidence From the Aichi Workers’ Cohort Study

Article

Full-text available

Mar 2015
J EPIDEMIOL

Skipping breakfast has been suspected as a risk factor for type 2 diabetes (T2DM), but the associations are not entirely consistent across ethnicities or sexes, and the issue has not been adequately addressed in the Japanese population. We followed 4631 participants (3600 men and 1031 women) in a work-site cohort of participants aged 35-66 years in 2002 through 2011 for T2DM development. Frequency of eating breakfast was self-reported and was subsequently dichotomized to breakfast skippers, who eat breakfast 3-5 times/week or less, and to eaters. Cox proportional hazards models were used to adjust for potential confounding factors, including dietary factors, smoking and other lifestyles, body mass index (BMI), and fasting blood glucose (FBG) at baseline. During 8.9 years of follow-up, 285 T2DM cases (231 men and 54 women) developed. Compared to participants who reported eating breakfast every day, maximally-adjusted hazard ratios and 95% confidence intervals (CI) of those with the frequency of almost every day and 3-5, 1-2, and 0 days/week were: 1.06 (95% CI, 0.73-1.53), 2.07 (95% CI, 1.20-3.56), 1.37 (95% CI, 0.82-2.29), and 2.12 (95% CI, 1.19-3.76), respectively. In a dichotomized analysis, breakfast skipping was positively associated with T2DM incidence (maximally-adjusted hazard ratio 1.73; 95% CI, 1.24-2.42). The positive associations were found in both men and women, current and non-current smokers, normal weight and overweight (BMI ≥25 kg/m(2)), and normal glycemic status and impaired fasting glycemic status (FBG 110 to <126 mg/dL) individuals at baseline (Ps for interaction all >0.05). The present study in middle-aged Japanese men and women suggests that skipping breakfast may increase the risk of T2DM independent of lifestyles and baseline levels of BMI and FBG.

Is the number of fast-food outlets in the neighbourhood related to screen-detected type 2 diabetes mellitus and associated risk factors?

Article

Full-text available

Oct 2014

Objective We investigated whether a higher number of fast-food outlets in an individual’s home neighbourhood is associated with increased prevalence of type 2 diabetes mellitus and related risk factors, including obesity. Design Cross-sectional study. Setting Three UK-based diabetes screening studies (one general population, two high-risk populations) conducted between 2004 and 2011. The primary outcome was screen-detected type 2 diabetes. Secondary outcomes were risk factors for type 2 diabetes. Subjects In total 10 461 participants (mean age 59 years; 53 % male; 21 % non-White ethnicity). Results There was a higher number of neighbourhood (500 m radius from home postcode) fast-food outlets among non-White ethnic groups ( P <0·001) and in socially deprived areas ( P <0·001). After adjustment (social deprivation, urban/rural, ethnicity, age, sex), more fast-food outlets was associated with significantly increased odds for diabetes (OR=1·02; 95 % CI 1·00, 1·04) and obesity (OR=1·02; 95 % CI 1·00, 1·03). This suggests that for every additional two outlets per neighbourhood, we would expect one additional diabetes case, assuming a causal relationship between the fast-food outlets and diabetes. Conclusions These results suggest that increased exposure to fast-food outlets is associated with increased risk of type 2 diabetes and obesity, which has implications for diabetes prevention at a public health level and for those granting planning permission to new fast-food outlets.

Relationship between skipping breakfast and impaired fasting glucose along with cardiovascular and pre-diabetes condition risk factors in apparently healty subjects

Article

Full-text available

Oct 2011

Regular food intake plays a pivotal role in normal glucose homeostasis. However, few studies have evaluated the level of fasting glu-cose in individuals with skipping breakfast, which theoretically means lack of supplemen-tary energy and increased risk of subsequent hypoglycemia. We examined the prevalence of suspected habitual skipping breakfast (SHSB) (skipping at least three times /week), roughly assessed with a simple question, and fasting plasma glucose level, cardiovascular risk fac-tors, and lifestyle factors in a cross-sectional study of 2,331 asymptomatic adults who had never been treated with insulin or oral medica-tions for diabetes. The overall prevalence of SHSB was 16.3% (men 20.1%, women 9.4%, P<0.0001, χ 2 test). Compared with normal fast-ing glucose, impaired fasting glucose (IFG) (100-125 mg/dl), but not high fasting glucose (≥126 mg/dL), was significantly associated with SHSB and this association remained after adjustment for relevant confounders [Odds Ratio (95% CI): 1.75 (1.33-2.30) and 2.10 (0.93-4.71), respectively]. Age (inversely), current smoking, late dinner before sleeping, infre-quent exercise, and high C-reactive protein (≥1.8 mg/L) were simultaneously associated with SHSB independently of each other. In a subgroup of subjects who underwent a 75g oral glucose tolerance test (n=1,315) of pre-diabetes groups, isolated IFG (n=272) was only signifi-cantly associated with SHSB. Current results suggest that IFG, subtle inflammatory state, and unfavorable lifestyle factors may be associated with the habit of skipping breakfast in asympto-matic adults. Causality and detailed mecha-nisms remain to be clarified in further studies.

Fast Food Consumption and Gestational Diabetes Incidence in the SUN Project

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Sep 2014
PLOS ONE

Background Gestational diabetes prevalence is increasing, mostly because obesity among women of reproductive age is continuously escalating. We aimed to investigate the incidence of gestational diabetes according to the consumption of fast food in a cohort of university graduates. Methods The prospective dynamic “Seguimiento Universidad de Navarra” (SUN) cohort included data of 3,048 women initially free of diabetes or previous gestational diabetes who reported at least one pregnancy between December 1999 and March 2011. Fast food consumption was assessed through a validated 136-item semi-quantitative food frequency questionnaire. Fast food was defined as the consumption of hamburgers, sausages, and pizza. Three categories of fast food were established: low (0–3 servings/month), intermediate (>3 servings/month and ≤2 servings/week) and high (>2 servings/week). Non-conditional logistic regression models were used to adjust for potential confounders. Results We identified 159 incident cases of gestational diabetes during follow-up. After adjusting for age, baseline body mass index, total energy intake, smoking, physical activity, family history of diabetes, cardiovascular disease/hypertension at baseline, parity, adherence to Mediterranean dietary pattern, alcohol intake, fiber intake, and sugar-sweetened soft drinks consumption, fast food consumption was significantly associated with a higher risk of incident gestational diabetes, with multivariate adjusted OR of 1.31 (95% conficence interval [CI]:0.81–2.13) and 1.86 (95% CI: 1.13–3.06) for the intermediate and high categories, respectively, versus the lowest category of baseline fast food consumption (p for linear trend: 0.007). Conclusion Our results suggest that pre-pregnancy higher consumption of fast food is an independent risk factor for gestational diabetes.

Caffeinated and Decaffeinated Coffee Consumption and Risk of Type 2 Diabetes: A Systematic Review and a Dose-Response Meta-analysis

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Feb 2014

OBJECTIVE Previous meta-analyses identified an inverse association of coffee consumption with the risk of type 2 diabetes. However, an updated meta-analysis is needed because new studies comparing the trends of association for caffeinated and decaffeinated coffee have since been published.RESEARCH DESIGN AND METHODS PubMed and Embase were searched for cohort or nested case-control studies that assessed the relationship of coffee consumption and risk of type 2 diabetes from 1966 to February 2013. A restricted cubic spline random-effects model was used.RESULTSTwenty-eight prospective studies were included in the analysis, with 1,109,272 study participants and 45,335 cases of type 2 diabetes. The follow-up duration ranged from 10 months to 20 years. Compared with no or rare coffee consumption, the relative risk (RR; 95% CI) for diabetes was 0.92 (0.90-0.94), 0.85 (0.82-0.88), 0.79 (0.75-0.83), 0.75 (0.71-0.80), 0.71 (0.65-0.76), and 0.67 (0.61-0.74) for 1-6 cups/day, respectively. The RR of diabetes for a 1 cup/day increase was 0.91 (0.89-0.94) for caffeinated coffee consumption and 0.94 (0.91-0.98) for decaffeinated coffee consumption (P for difference = 0.17).CONCLUSIONS Coffee consumption was inversely associated with the risk of type 2 diabetes in a dose-response manner. Both caffeinated and decaffeinated coffee was associated with reduced diabetes risk.

Breakfast Frequency and Development of Metabolic Risk

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Jun 2013

OBJECTIVE The relation of breakfast intake frequency to metabolic health is not well studied. The aim of this study was to examine breakfast intake frequency with incidence of metabolic conditions.RESEARCH DESIGN AND METHODS Analysis of 3,598 participants from the community-based Coronary Artery Risk Development in Young Adults (CARDIA) study who were free of diabetes in the year 7 examination when breakfast and dietary habits were assessed (1992-1993) and participated in at least one of the five subsequent follow-up examinations over 18 years.RESULTSRelative to infrequent breakfast consumption (0-3 days/week), participants who reported eating breakfast daily gained 1.9 kg less weight over 18 years (P = 0.001). In a Cox regression analysis, there was a stepwise decrease in risk across conditions in frequent breakfast consumers (4-6 days/week) and daily consumers. The results for incidence of abdominal obesity, obesity, metabolic syndrome, and hypertension remained significant after adjustment for baseline measures of adiposity (waist circumference or BMI) in daily breakfast consumers. Hazard ratios (HRs) and 95% CIs for daily breakfast consumption were as follows: abdominal obesity HR 0.78 (95% CI 0.66-0.91), obesity 0.80 (0.67-0.96), metabolic syndrome 0.82 (0.69-0.98), and hypertension 0.84 (0.72-0.99). For type 2 diabetes, the corresponding estimate was 0.81 (0.63-1.05), with a significant stepwise inverse association in black men and white men and women but no association in black women. There was no evidence of differential results for high versus low overall dietary quality.CONCLUSIONS Daily breakfast intake is strongly associated with reduced risk of a spectrum of metabolic conditions.

Meta-analysis of Observational Studies in EpidemiologyA Proposal for Reporting

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Apr 2000

Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.

Dietary patterns and odds of Type 2 diabetes in Beirut, Lebanon: A case--control study

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Dec 2012
NUTR METAB

Background In Lebanon, Type 2 diabetes (T2D) has a major public health impact through high disease prevalence, significant downstream pathophysiologic effects, and enormous financial liabilities. Diet is an important environmental factor in the development and prevention of T2D. Dietary patterns may exert greater effects on health than individual foods, nutrients, or food groups. The objective of this study is to examine the association between dietary patterns and the odds of T2D among Lebanese adults. Methods Fifty-eight recently diagnosed cases of T2D and 116 population-based age, sex, and place of residence matched control participants were interviewed. Data collection included a standard socio-demographic and lifestyle questionnaire. Dietary intake was evaluated by a semi-quantitative 97-item food frequency questionnaire. Anthropometric measurements including weight, height, waist circumference, and percent body fat were also obtained. Dietary patterns were identified by factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of extracted patterns with T2D. Pearson correlations between these patterns and obesity markers, energy, and nutrient intakes were also examined. Results Four dietary patterns were identified: Refined Grains & Desserts, Traditional Lebanese, Fast Food and Meat & Alcohol. While scores of the “Refined Grains & Desserts” had the highest correlations with energy (r = 0.74) and carbohydrates (r = 0.22), those of the “Fast Food” had the highest correlation with fat intake (r = 0.34). After adjustment for socio-demographic and lifestyle characteristics, scores of the Refined Grains & Desserts and Fast Food patterns were associated with higher odds of T2D (OR: 3.85, CI: 1.13-11.23 and OR: 2.80, CI: 1.14-5.59; respectively) and scores of the Traditional Lebanese pattern were inversely associated with the odds of T2D (OR: 0.46, CI: 0.22-0.97). Conclusions The findings of this study demonstrate direct associations of the Refined Grains & Desserts and Fast Food patterns with T2D and an inverse association between the Traditional Lebanese pattern and the disease among Lebanese adults. These results may guide the development of nutrition interventions for the prevention and management of T2D among Lebanese adults.

The relationship of breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome in young adults. The National Health and Nutrition Examination Survey (NHANES): 1999–2006

Article

Full-text available

Oct 2012
PUBLIC HEALTH NUTR

Objective: To examine the association between breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome (MetS). Design: Cross-sectional. Three breakfast groups were identified, breakfast skippers (BS), ready-to-eat-cereal (RTEC) consumers and other breakfast (OB) consumers, using a 24 h dietary recall. Risk factors were compared between the breakfast groups using covariate-adjusted statistical procedures. Setting: The 1999–2006 National Health and Nutrition Examination Survey, USA. Subjects: Young adults (20–39 years of age). Results: Among these young adults (n 5316), 23.8% were BS, 16.5% were RTEC consumers and 59.7% were OB consumers. Relative to the BS, the RTEC consumers were 31%, 39%, 37%, 28%, 23%, 40% and 42% less likely to be overweight/obese or have abdominal obesity, elevated blood pressure, elevated serum total cholesterol, elevated serum LDL-cholesterol, reduced serum HDL-cholesterol or elevated serum insulin, respectively. Relative to the OB consumers, the BS were 1.24, 1.26 and 1.44 times more likely to have elevated serum total cholesterol, elevated serum LDL-cholesterol or reduced serum HDL-cholesterol, respectively. Relative to the OB consumers, the RTEC consumers were 22%, 31% and 24% less likely to be overweight/ obese or have abdominal obesity or elevated blood pressure, respectively. No difference was seen in the prevalence of the MetS by breakfast skipping or type of breakfast consumed. Conclusions: Results suggest that consumption of breakfast, especially that included an RTEC, was associated with an improved cardiometabolic risk profile in U.S. young adults. Additional studies are needed to determine the nature of these relationships.

Effects of healthy dietary pattern and other lifestyle factors on incidence of diabetes in a rural Japanese population

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Sep 2012

This study assessed the effects of dietary habits and other lifestyle factors on the incidence of diabetes in a rural Japanese population. This 10.3-year study investigated a cohort of 1,995 men and 3,670 women aged 40-69 years without diabetes at baseline who underwent health check-ups between April 1990 and March 1992. Participants were followed up until diabetes was confirmed or until the end of 2006. The incidence of diabetes was determined from fasting and random levels of plasma glucose, HbA1c levels or being under medical treatment for diabetes. Principal component analysis identified a major dietary pattern characterized by more frequent consumption of vegetables, potatoes, seaweeds, fruits and soybean products that we labeled "healthy". Diabetes developed in 446 of the participants during 58,151 person-years of follow-up. Consuming a healthy diet was associated with a lower risk of diabetes (multivariable-adjusted hazard ratio for highest vs lowest quartiles, 0.78 [95% CI, 0.61- 0.95]. In addition, scores for a healthy diet were associated with a lower risk for diabetes among persons who consumed regular meals (0.76 [0.58-0.96]), persons with an exercise habit (0.65 [0.44-0.96]) and non- and exsmokers (0.72 [0.53-0.96]). Our findings suggest that consuming a healthy diet is associated with a lower risk for diabetes among the Japanese, particularly among those who eat regularly, those who habitually exercise and nonand ex-smokers.

Health Risk Assessment for Diabetes Mellitus Based on Longitudinal Analysis of MHTS Database

Article

Full-text available

Feb 1998

This study was designed with a follow up of 16 years to provide the epidemiological model evaluating the risk of developing diabetes mellitus in Japan. A cohort of 2573 subjects (1851 males and 722 females) from a MHTS in Tokyo, who were nondiabetic (fasting blood glucose (FBS) less than 110 mg/dl) in the initial year, were selected. This cohort was followed every year to identify the occurrence of diabetes mellitus. Diabetes Mellitus was defined as fasting blood glucose over 110 mg/dl, or the initiation of diabetic therapy. We compared two prognosis groups (a normal group and a diabetic group) in terms of age, examination findings, and prevalence of health risks (lifestyle, stress, and working form). We also assessed family history of diabetes and past histories including hypertension, hypercholesterolemia, and hyperuricemia. After assessing each variable by univariate analysis(t-test, 2 test), we employed Cox''s proportional hazards model analysis. We used stepwise model adopting risk factors. The diabetic group had significant differences compared to the normal group in age, BMI (body mass index), FBS, smoking, drinking, not eating breakfast, dairy intake, hypertension, hypercholesterolemia, hyperuricemia, and family history by univariate analysis. According to proportional hazards model analysis, FBS, age, family history, hypertension, smoking, and BMI were incorporated into significant risk factors for diabetes in males, and not eating breakfast, FBS, age, drinking, and hypertension were incorporated in females. Diabetes seemed to be related to fixed factors (age), or genetic factors (family history and FBS) in males. For females, lifestyle (not eating breakfast and drinking habit) seemed to play an important role. It will be worthwhile to assess the risks of developing diabetes mellitus by this epidemiological model.

Bias in Meta-Analysis Detected by a Simple, Graphical Test

Article

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Sep 1997

Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30

Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

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