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. 2012 May;95(5):1182-9.
doi: 10.3945/ajcn.111.028209. Epub 2012 Mar 28.

Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking

Rania A Mekary  1 , Edward Giovannucci, Walter C Willett, Rob M van Dam, Frank B Hu
Affiliations

Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking

Rania A Mekary et al. Am J Clin Nutr. 2012 May.

Abstract

Background: Little is known about the association between eating patterns and type 2 diabetes (T2D) risk.

Objective: The objective of this study was to prospectively examine associations between breakfast omission, eating frequency, snacking, and T2D risk in men.

Design: Eating patterns were assessed in 1992 in a cohort of 29,206 US men in the Health Professionals Follow-Up Study who were free of T2D, cardiovascular disease, and cancer and were followed for 16 y. We used Cox proportional hazards analysis to evaluate associations with incident T2D.

Results: We documented 1944 T2D cases during follow-up. After adjustment for known risk factors for T2D, including BMI, men who skipped breakfast had 21% higher risk of T2D than did men who consumed breakfast (RR: 1.21; 95% CI: 1.07, 1.35). Compared with men who ate 3 times/d, men who ate 1-2 times/d had a higher risk of T2D (RR: 1.25; 95% CI: 1.08, 1.45). These findings persisted after stratification by BMI or diet quality. Additional snacks beyond the 3 main meals (breakfast, lunch, and dinner) were associated with increased T2D risk, but these associations were attenuated after adjustment for BMI.

Conclusions: Breakfast omission was associated with an increased risk of T2D in men even after adjustment for BMI. A direct association between snacking between meals and T2D risk was mediated by BMI.

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Figures

FIGURE 1.
FIGURE 1.
Breakfast consumption and Western dietary pattern in relation to T2D risk. Filled circles represent the RR for No B, and the open circles represent the RR for B. Values are RRs from Cox proportional hazards models (P-interaction = 0.03). All multivariate models were adjusted for age (mo), family history of T2D (yes or no), energy intake (kcal/d, continuous), alcohol intake (g/d, continuous), cereal fiber intake (g/d, Qs), physical activity (1 to <3, 3 to <9, 9 to <18, 18 to <27, and ≥27 metabolic equivalent task hours/wk), smoking status (never, past, or currently 1–14, 15–24, or ≥25 cigarettes/d), prudent dietary pattern (Qs), glycemic load (continuous), and eating frequency (1–2, 3, 4, or 5–8 meals/d). B, breakfast consumers; No B, breakfast skippers; Q, quintile; ref, reference; T2D, type 2 diabetes.
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