Dairy cow efficiency is increasingly important for future breeding decisions. The efficiency is determined mostly by dry matter intake (DMI). Reducing DMI seems to increase efficiency if milk yield remains the same, but resulting negative energy balance (EB) may cause health problems, especially in early lactation. Objectives of this study were to examine relationships between DMI and liability to diseases. Therefore, cow effects for DMI and EB were correlated with cow effects for 4 disease categories throughout lactation. Disease categories were mastitis, claw and leg diseases, metabolic diseases, and all diseases. In addition, this study presents relative percentages of diseased cows per days in milk (DIM), repeatability, and cow effect correlations for disease categories across DIM. A total of 1,370 German Holstein (GH) and 287 Fleckvieh (FV) primiparous and multiparous dairy cows from 12 dairy research farms in Germany were observed over a period of 2 yr. Farm staff and veterinarians recorded health data. We modeled health and production data with threshold random regression models and linear random regression models. From DIM 2 to 305 average daily DMI was 22.1 kg/d in GH and 20.2 kg/d in FV. Average weekly EB was 2.8 MJ of NE L /d in GH and 0.6 MJ of NE L /d in FV. Most diseases occurred in the first 20 DIM. Multiparous cows were more susceptible to diseases than primiparous cows. Relative percentages of diseased cows were highest for claw and leg diseases, followed by metabolic diseases and mastitis. Repeatability of disease categories and production traits was moderate to high. Cow effect correlations for disease categories were higher for adjacent lactation stages than for more distant lactation stages. Pearson correlation coefficients between cow effects for DMI, as well as EB, and disease categories were estimated from DIM 2 to 305. Almost all correlations were negative in GH, especially in early lactation. In FV, the course of correlations was similar to GH, but correlations were mostly more negative in early lactation. For the first 20 DIM, correlations ranged from −0.31 to 0.00 in GH and from −0.42 to −0.01 in FV. The results illustrate that future breeding for dairy cow efficiency should focus on DMI and EB in early lactation to avoid health problems.