Meal Timing of Subtypes of Macronutrients Consumption With Cardiovascular Diseases: NHANES, 2003 to 2016

Context: Emerging evidence suggests that not only the quantity but also the quality and food sources of macronutrients plays an important role in CVD. However, limited studies have examined the association of meal timing of different quality of macronutrients with CVD risk. Objective: This study aimed to examine the association of subtypes of macronutrient consumption at dinner vs breakfast with cardiovascular diseases (CVD). Methods: A total of 27 911 participants from the National Health and Nutrition Examination Survey (2003-2016) were included. The differences of subtypes of macronutrients at dinner vs breakfast (Delta ratio) were categorized into quintiles. Multiple logistic regression models and isocaloric substitution effects of subtypes were performed. Results: After adjustment of a variety of covariates, participants in the highest quintile of the Delta ratio of low-quality carbohydrates had a higher risk of angina (odds ratio [OR]=1.63; 95% CI, 1.16-2.29) (P-for trend=.007) and heart attack (OR=1.47; 95% CI, 1.13-1.93) (P-for trend=.068) compared with the lowest quintile. The highest quintile of the Delta ratio of animal protein had a higher risk of coronary heart disease (OR=1.44; 95% CI, 1.06-1.95) (P-for trend=.014) and angina (OR=1.44; 95% CI, 1.01-2.07) (P-for trend=.047). For the Delta ratio of unsaturated fatty acid (USFA), the highest quintile of the Delta ratio of USFA was related to lower stroke risk (OR=0.76; 95% CI, 0.58-0.99) (P-for trend=.049). Isocaloric substitution of low-quality carbohydrates/animal protein by high-quality carbohydrates/plant protein at dinner reduced CVD risk by around 10%. Conclusion: This study indicated that overconsumption of low-quality carbohydrates and animal protein at dinner rather than breakfast was significantly associated with higher CVD risk and USFA consumption at dinner related to lower CVD risk among US adults. Substitution of low-quality carbohydrates or animal protein by high-quality carbohydrates or plant protein at dinner could reduce CVD risk.