Food Consumption Timing Could Impact CVD Mortality Risk in Diabetes

Using data from the National Health and Nutrition Examination Survey (NHANES), researchers uncovered an association between food consumption time with cardiovascular disease (CVD) and all-cause mortality among patients with diabetes. Findings were published in The Journal of Clinical Endocrinology & Metabolism.

Although diet has been extensively investigated as a modifiable behavior affecting prevention and therapy of diabetes, less research has been conducted assessing the association of consumption time of different foods with long-term survival in this patient population, authors explained.

“The intake time of specific foods may provide more acceptable guidance than the current knowledge for people to select appropriate food at appropriate times to improve their long-term survival,” they added.

NHANES contains a nationally representative sample of the civilian population in the United States; individuals over the age of 18 with diabetes and who participated in NHANES between 2003 and 2014 were included in the current analysis. All individuals also recorded a dietary energy intake ranging from 500 to 5000 kcal/day.

A total of 4642 participants (2390 men, 2252 women) were included in the study. Dietary intake was assessed via 2 nonconsecutive 24-hour dietary recall interviews. Investigators used the Department of Agriculture’s Food and Nutrient Database and MyPyramid Equivalent Database 2.0 to assess 18 food groups.

Food groups were then split into different consumption periods: forenoon (breakfast plus snack between breakfast and lunch), afternoon (lunch plus snack between lunch and dinner), and evening (dinner plus snack after dinner).

CVD and all-cause mortality were determined using the National Death Index up until December 31, 2015.

“Compared to diabetes patients who did not die or died of non-CVD, patients with CVD mortality were more likely to be men, non-Hispanic White; have higher age and prevalence of hypertension; and have lower BMI, education level, family annual income, diet quality, energy, and macronutrient intake (P < .05),” the researchers found.

Their analyses revealed:

• In the forenoon, compared with participants in the lowest quantile of potato and starchy vegetable, participants in the highest quantile had lower mortality risk of CVD (HR_potato, 0.46; 95% CI, 0.24-0.89; HR_{starchy-vegetable}, 0.32; 95% CI, 0.15-0.72)
• In the afternoon, participants who consumed whole grain had lower mortality from CVD (HR_{whole grain}, 0.67; 95% CI, 0.48-0.95)
• In the evening, the highest quantile of dark vegetable and milk intake is related to lower mortality risk of CVD (HR_{dark vegetable}, 0.55; 95% CI, 0.35-0.87; HR_milk, 0.56; 95% CI, 0.36-0.88) and all-cause mortality (HR_milk, 0.71; 95% CI, 0.54-0.92), whereas participants in the highest quantile of intakes of processed meat are more likely to die due to CVD (HR_{processed-meat}, 1.74; 95% CI, 1.07-2.82)
• Isocalorically switching 0.1 serving of potato or starchy vegetable consumed in the afternoon or evening to the forenoon, 0.1 serving of a dark vegetable consumed in the afternoon to the evening, and 0.1 serving of whole grains consumed in the forenoon to the afternoon reduced the risk of CVD mortality

Overall, “we observed that eating potatoes in the morning, whole grains in the afternoon, greens and milk in the evening, and less processed meat in the evening was associated with better long-term survival in people with diabetes,” said study author Qingrao Song, MD.

“Nutritional guidelines and intervention strategies for diabetes should integrate the optimal consumption times for foods in the future,” Song added.

Studies have shown insulin sensitivity in hepatic and peripheral tissues, and insulin secretion in general, have biological rhythms with high levels seen in the afternoon and a gradual decrease from day to night.

Thus, fluctuation of glucose after high intakes of certain food at certain times “are likely more [in] accordance with the biological rhythm of insulin sensitivity and insulin secretion across a day, probably aiding in the glucose control, which is a possible reason for explaining the beneficial effect of their optimal intake time among people with diabetes,” the authors explained.

Gut microbes also have internal circadian patterns, meaning intake of certain foods can be aligned with the bacteria’s rhythm, ultimately promoting nutritional metabolic processing.

Due to the observational nature of the study, measurement error may have been present, while unmeasured confounding factors could have influenced the results. Researchers were also unable to distinguish diabetes type based on the dataset, marking a further limitation.

Reference

Jiang W, Song Q, Zhang J, et al. The association of consumption time for food with cardiovascular disease and all-cause mortality among diabetic patients. J Clin Endocrinol Metab. Published online March 15, 2022. doi:10.1210/clinem/dgac069