The Association of Energy and Macronutrient Intake at Dinner Versus Breakfast With Disease-Specific and All-Cause Mortality Among People With Diabetes: The US National Health and Nutrition Examination Survey, 2003-2014

OBJECTIVE This study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes. RESEARCH DESIGN AND METHODS A total of 4,699 people with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrient intake was measured by a 24-h dietary recall. The differences (Delta) in energy and macronutrient intake between dinner and breakfast (Delta = dinner - breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between Delta and diabetes, cardiovascular disease (CVD), and all-cause mortality. RESULTS Among the 4,699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quintile of Delta in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (hazard ratio [HR](Delta energy)1.92, 99% CI 1.08-3.42; HR(Delta protein)1.92, 99% CI 1.06-3.49) and CVD (HR(Delta energy)1.69, 99% CI 1.02-2.80; HR(Delta protein)1.96, 99% CI 1.14-3.39). The highest quintile of Delta total fat was related to CVD mortality (HR 1.67, 99% CI 1.01-2.76). Isocalorically replacing 5% of total energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR 0.96, 95% CI 0.94-0.98) and CVD (HR 0.95, 95% CI 0.93-0.97) mortality, respectively. CONCLUSIONS Higher intake of energy, total fat, and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes.