Eating patterns and type 2 diabetes risk in older women: breakfast consumption and eating frequency

Abstract

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

Objective: The objective was to examine prospectively associations between regular breakfast consumption, eating frequency, and T2D risk in women.

Design: Eating pattern was assessed in 2002 in a cohort of 46,289 US women in the Nurses' Health Study who were free of T2D, cardiovascular disease, or cancer and were followed for 6 y. We used Cox proportional hazards analysis to evaluate associations with incident T2D.

Results: We documented 1560 T2D cases during follow-up. After adjustment for known risk factors for T2D-except for body mass index (BMI), a potential mediator-women who consumed breakfast irregularly (0-6 times/wk) were at higher risk of T2D than were women who consumed breakfast daily (RR: 1.28; 95% CI: 1.14, 1.44). This association was moderately attenuated after adjustment for BMI (RR: 1.20; 95% CI: 1.07, 1.35). In comparison with women who ate 3 times/d, the RRs were 1.09 (0.84, 1.41) for women who ate 1-2 times/d, 1.13 (1.00, 1.27) for women who ate 4-5 times/d, and 0.99 (0.81, 1.21) for women who ate ≥6 times/d. Among irregular breakfast consumers, women with a higher eating frequency (≥4 times/d) had a significantly greater T2D risk (RR: 1.47; 95% CI: 1.23, 1.75) than did women who consumed breakfast daily and ate 1-3 times/d. Adjustment for BMI attenuated this association (RR: 1.24; 95% CI: 1.04, 1.48).

Conclusion: Irregular breakfast consumption was associated with a higher T2D risk in women, which was partially but not entirely mediated by BMI.

FIGURE 1.

Breakfast consumption and Alternative Healthy Eating Index 2010 in relation to risk of type 2 diabetes in the B and No B groups. Values are RRs derived from Cox proportional hazards models (P-interaction = 0.51). All multivariate models were adjusted for age (in mo), family history of type 2 diabetes (yes or no), alcohol intake (0 to <5, 5 to <15, or ≥15 g/d), physical activity (1 to <3, 3 to <9, 9 to <18, 18 to <27, or ≥27 metabolic equivalent h/wk or missing category), menopausal status and hormone use (premenopausal, postmenopausal and never used hormones, postmenopausal and current hormone users, or postmenopausal and past hormone users), smoking status (never, past, current 1–14 cigarettes/d, current 15–24 cigarettes/d, current ≥25 cigarettes/d, or missing category), energy intake (kcal/d, continuous), cereal fiber intake (quintiles, g/d), and Alternative Healthy Eating Index 2010 (quintiles or missing category). B, regular breakfast consumers (7 times/wk); No B, irregular breakfast consumers (0–6 times/wk).