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The Association Between Eating Frequency and Risk of Type 2 Diabetes: The Women's Health Initiative Dietary Modification Trial
Author(s) -
Clowry Catherine M,
Beatty Sarah J,
Thomson Cynthia A,
Wertheim Betsy C,
Neuhouser Marian L
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.789.12
Subject(s) - medicine , women's health initiative , demography , waist , type 2 diabetes , hazard ratio , cohort , socioeconomic status , gerontology , body mass index , diabetes mellitus , environmental health , population , confidence interval , endocrinology , observational study , sociology
Objective The relationship between eating frequency (EF) and health is uncertain. We investigated the association between EF and incident diabetes in postmenopausal women participating in the Women's Health Initiative Dietary Modification Trial (WHI‐DM). The WHI‐DM was a low‐fat dietary intervention trial; 24‐hour dietary recalls were administered in year 3 of the trial as part of trial adherence activities. For this analysis, the recall data were used to examine the relationship between number of daily eating occasions and risk for diabetes. Outcomes data were collected by annual self‐report. Methods This prospective cohort study included 2,159 post‐menopausal women aged 50 to 79 y, of diverse socioeconomic and ethnic backgrounds and represented a subset of WHI‐DM participants. Participants were categorized into groups according to their reported meal frequency: 1–3 meals per day, 4 meals per day, and ≥5 meals per day. Cox proportional hazard regression was used to investigate the relationship of eating frequency with risk of Type 2 diabetes. All models were adjusted for socio‐economic status, race/ethnicity, BMI, waist circumference, energy intake from the recall, time between study enrollment and recall administration and clinical trial arm assignment. Further analyses were stratified by baseline BMI, race/ethnicity, and age. Results Most women reported intake of 1–3 meals or 4 meals (n=795 and 713, respectively); only 86 women reported EF >5 servings/day. Eating frequency was inversely associated with age and positively associated with income, BMI and energy intake. Multivariate models indicated that eating 4 meals per day was associated with an increased risk for incident diabetes (HR = 1.36, 95% CI: 1.04–1.79) as compared to eating 1–3 meals per day. No significant association was observed between the highest (5+ meals/day) and lowest (1–3 meals/day) groups. The increased risk observed for the group eating 4 meals per day did not differ across BMI groups or by race/ethnicity; however associations were stronger in those > 60 y. Conclusion This study showed that women eating 4 versus 1–3 meals per day experienced a greater risk for diabetes. Potential underlying mechanisms include increased number of glucose and insulin excursions with more frequent meal consumption. Since diabetes is one of the most common and serious chronic diseases facing postmenopausal women, identification of strategies for prevention is an important public health goal. Additional large‐scale studies are warranted to confirm these associations. Support or Funding Information The WHI Dietary Modification Trial was funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.