Starchy snacks after any meal were associated with at least a 50% increased risk of mortality and a 44%-57% increased risk of cardiovascular disease (CVD) related death, according to the study published in the Journal of the American Heart Association.
Conversely, eating fruits, vegetables or dairy at specific meals is associated with a reduced risk of death from cardiovascular disease, cancer or any cause.
“People are increasingly concerned about what they eat as well as when they eat,” said Professor Ying Li, lead study author from the department of nutrition and food hygiene at Harbin Medical University School of Public Health in China. “Our team sought to better understand the effects different foods have when consumed at certain meals.”
Li and colleagues analysed the results of 21,503 participants in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2014 in the US to assess dietary patterns across all meals: 51% of participants were women and all participants were aged 30 or older at the start of the study. To determine patient outcomes, researchers used the US Centers for Disease Control and Prevention's National Death Index to note participants who died through to December 31, 2015, due to CVD, cancer or any cause.
Researchers categorised participants' dietary patterns by analysing what types of food they ate at different meals. For the main meals, three main dietary patterns were identified for the morning meal: Western breakfast, starchy breakfast and fruit breakfast. Western lunch, vegetable lunch and fruit lunch were identified as the main dietary patterns for the midday meal. Western dinner, vegetable dinner and fruit dinner were identified as the main dietary patterns for the evening meal.
For snacks, grain snack, starchy snack, fruit snack and dairy snack were identified as the main snack patterns in between meals. Additionally, participants who did not fit into specific meal patterns were analysed as a reference group. The researchers noted that the Western dietary pattern has higher proportions of fat and protein, which is similar to many North American meals.
Participants in the Western lunch group consumed the most servings of refined grain, solid fats, cheese, added sugars and cured meat. Participants in the fruit-based lunch group consumed the most servings of whole grain, fruits, yogurt and nuts. Participants in the vegetable-based dinner group consumed the most servings of dark vegetables, red and orange vegetables, tomatoes, other vegetables and legumes. Participants who consumed starchy snacks consumed the most servings of white potatoes.
According to their findings:
Eating a Western lunch (typically containing refined grains, cheese, cured meat) was associated with a 44% increased risk of CVD death;
Eating a fruit-based lunch was associated with a 34% reduced risk of CVD death;
Eating a vegetable-based dinner was associated with a 23% and 31% reduction in CVD and all-cause mortality, respectively; and
Consuming a snack high in starch after any meal was associated with a 50%-52% increased risk of all-cause mortality and a 44%-57% increased risk in CVD-related mortality.
"Our results revealed that the amount and the intake time of various types of foods are equally critical for maintaining optimal health," said Li. "Future nutrition guidelines and interventional strategies could integrate optimal consumption times for foods across the day."
Limitations to this study include that dietary data was self-reported by participants, which may lead to recall bias. And, although the researchers controlled for potential confounders, other unmeasured confounding factors cannot be ruled out.
Study details
Association of Meal and Snack Patterns With Mortality of All‐Cause, Cardiovascular Disease, and Cancer: The US National Health and Nutrition Examination Survey, 2003 to 2014
Authors: Wei Wei , Wenbo Jiang , Jiaxin Huang , Jiaxu Xu , Xuanyang Wang , Xitao Jiang , Yu Wang , Guili Li , Changhao Sun , Ying Li , and Tianshu Han
Published in the Journal of the American Heart Association, 23 June 2021
Abstract
Background
Although accumulating evidence has demonstrated that consumption time of energy and macronutrients plays an important role in maintaining health, the association between consumption time of different foods and cardiovascular disease, cancer, and all‐cause mortalities is still largely unknown.
Methods and results
A non-institutionalised household population of the US 21 503 participants from National Health and Nutrition Examination Survey was included. Meal patterns and snack patterns throughout a whole day were measured using 24‐hour dietary recall. Principal component analysis was performed to establish dietary patterns. Cox proportional hazards models were used to evaluate the association between dietary patterns across meals and cardiovascular disease (CVD), cancer, and all‐cause mortalities.
During the 149 875-people years of follow-up, 2192 deaths, including 676 deaths because of CVD and 476 because of cancer, were documented. After adjusting for potential confounders, participants consuming fruit‐lunch had lower mortality risks of all‐cause (hazard ratio [HR], 0.82; 95% CI, 0.72–0.92) and CVD (HR, 0.66; 95% CI, 0.49–0.87); whereas participants who consumed Western lunch were more likely to die because of CVD (HR, 1.44; 95% CI, 1.10–1.89).
Participants who consumed vegetable dinners had lower mortality risks of all‐cause, CVD, and cancer (HRall‐cause, 0.69; 95% CI, 0.60–0.78; HRCVD, 0.77; 95% CI, 0.61–0.95; HRcancer, 0.63; 95% CI, 0.48–0.83).
For the snack patterns, participants who consumed fruit‐snack after breakfast had lower mortality risks of all‐cause and cancer (HRall‐cause, 0.78; 95% CI, 0.66–0.93; HRcancer, 0.55; 95% CI, 0.39–0.78), and participants who consumed dairy snacks after dinner had lower risks of all‐cause and CVD mortalities (HRall‐cause, 0.82; 95% CI, 0.72–0.94; HRCVD, 0.67; 95% CI, 0.52–0.87). Participants who consumed a starchy snack after main meals had greater mortality risks of all‐cause (HRafter‐breakfast, 1.50; 95% CI, 1.24–1.82; HRafter‐lunch, 1.52; 95% CI, 1.27–1.81; HRafter‐dinner, 1.50; 95% CI, 1.25–1.80) and CVD (HRafter‐breakfast, 1.55; 95% CI, 1.08–2.24; HRafter‐lunch, 1.44; 95% CI, 1.03–2.02; HRafter‐dinner, 1.57; 95% CI, 1.10–2.23).
Conclusions
Fruit snacks after breakfast, fruit lunch, vegetable dinner, and dairy snacks after dinner was associated with lower mortality risks of CVD, cancer, and all‐cause; whereas Western lunches and starchy snacks after main meals had greater CVD and all‐cause mortalities.
Full study in Journal of the American Heart Association
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