Article Text
Abstract
Objective This study aimed to investigate the association between the trajectories of energy consumption at dinner versus breakfast and the risk of type 2 diabetes (T2D).
Design Cohort study.
Setting The study was conducted in China.
Participants A total of 10 727 adults, including 5239 men and 5488 women, with a mean age of 42.7±11.2 years and a mean follow-up time of 9.1 years, met the study criteria and completed a questionnaire about energy intake and diabetes status from the China Health and Nutrition Survey in 1997–2011.
Primary outcome measures Participants were divided into subgroups based on the trajectories of the ratio of energy consumption at dinner versus breakfast. Cox multivariate regression models were used to explore the associations between different trajectories and the risk of T2D after adjustment for confounders and their risk factors. Mediation analysis was performed to explore the intermediary effect of triacylglycerol (TG), total cholesterol (TC), uric acid (UA) and apolipoprotein B (ApoB) between the trajectories and the risk of T2D.
Results For energy consumption at dinner versus breakfast, compared with a low-stable trajectory, the adjusted HR of T2D in low-increasing from early-stage trajectory was 1.29 (95% CI 1.04 to 1.60). TG, TC, UA and ApoB were significantly higher in low-increasing from early-stage trajectory than other trajectories and play partial regulation roles between trajectories and T2D.
Conclusions This study emphasised the harmful effect of a gradual increase in the ratio of energy consumption at dinner versus breakfast from early stage on the development of T2D and partially mediated by TG, TC, UA and ApoB, highlighting that it is necessary to intake more energy at breakfast compared with dinner to prevent T2D in adults.
- epidemiology
- nutrition & dietetics
- general diabetes
Data availability statement
Data are available in a public, open access repository. Data from China Health and Nutrition Survey was used in this study, which can be downloaded at www.cpc.unc.edu/projects/china.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available in a public, open access repository. Data from China Health and Nutrition Survey was used in this study, which can be downloaded at www.cpc.unc.edu/projects/china.
Supplementary materials
Supplementary Data
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Footnotes
Contributors CS and TH conceived the idea. XR and JG designed the study. XR analysed and interpreted the data and wrote the original manuscript. All authors read and approved the final manuscript.
Funding This study was supported by National Key R&D Program of China (2017YFC1307401 to Changhao Sun),Young Elite Scientists Sponsorship Program by CAST (2019QNRC001 to Tianshu Han) and the National Natural Science Foundation (81803227 to Tianshu Han).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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