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.
Objective
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 body mass index (BMI), age, or race/ethnicity.
Methods
Participants were postmenopausal women in the WHI-DM who comprised a 4.6% subsample completing 24-hour dietary recalls (24HR) at years 3 and 6 as part of trial adherence activities (n = 2,159). Numbers of eating occasions/day were obtained from the year 3 24HR 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 semi-annual questionnaires as the outcome. WHI-DM is registered at clinicaltrials.gov (NCT00000611).
Results
Fifteen % (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 (NSES), BMI, waist circumference, race/ethnicity, family history of T2D, recreational physical activity, Healthy Eating Index (HEI)-2005, 24HR energy intake and WHI-DM arm. Compared to women reporting 1–3 meals/day, those consuming 4 meals/day had a T2D HR = 1.38 (95%CI 1.03–1.84) without further increases in risk for ≥ 5 meals/day. In stratified analyses, associations for 4 meals/day compared to 1–3 meals/day were stronger in women with BMI < 30.0 kg/m2 (HR = 1.55, 95% CI 1.00–2.39) and women ≥ age 60 (HR = 1.61, 95% CI 1.11–2.33).
Conclusions
4 daily meals/day compared to 1–3 meals/day 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.