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. 2021 Oct 1;13(10):3488.
doi: 10.3390/nu13103488.

Trajectories of Energy Intake Distribution and Risk of Dyslipidemia: Findings from the China Health and Nutrition Survey (1991-2018)

Xiaoyun Song  1 , Huijun Wang  1 , Chang Su  1 , Zhihong Wang  1 , Wenwen Du  1 , Feifei Huang  1 , Jiguo Zhang  1 , Xiaofang Jia  1 , Hongru Jiang  1 , Yifei Ouyang  1 , Li Li  1 , Jing Bai  1 , Xiaofan Zhang  1 , Gangqiang Ding  1 , Bing Zhang  1
Affiliations

Trajectories of Energy Intake Distribution and Risk of Dyslipidemia: Findings from the China Health and Nutrition Survey (1991-2018)

Xiaoyun Song et al. Nutrients. .

Abstract

Few studies have examined the secular trend of energy intake distribution. This study aims to describe trajectories of energy intake distribution and determine their association with dyslipidemia risk. Data of 2843 adult participants from the China Health and Nutrition Survey (CHNS) were analyzed. Trajectory groups of energy intake distribution were identified by multi-trajectory model over 27 years. Multilevel mixed-effects modified Poisson regression with robust estimation of variance was used to calculate risk ratio for incident dyslipidemia in a 9-year follow-up. Four trajectory groups were identified: "Energy evenly distributed group" (Group 1), "Lunch and dinner energy dominant group" (Group 2), "Dinner energy dominant group" (Group 3), "breakfast and dinner energy dominant group" (Group 4). Compared with Group 1, Group 3 was associated with higher risk of dyslipidemia (RR = 1.48, 95% CI = 1.26, 1.75), hypercholesterolemia (RR = 1.96, 95% CI = 1.37, 2.81) and high low-density lipoproteins cholesterols (LDL-C) (RR = 2.41, 95% CI = 1.82, 3.20). A U-shape was observed between cumulative average proportion of dinner energy and dyslipidemia risk (p for non-linear = 0.01), with stronger relationship at 40% and above. Energy intake distribution characterized by higher proportion of dinner energy, especially over 40% was associated with higher dyslipidemia risk in Chinese adults.

Keywords: cohort; dyslipidemia; energy intake; multi-trajectory model.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Estimated trajectory groups of energy intake distribution among Chinese adults. EI%, proportion of energy intake.
Figure 2
Figure 2
Exposure-response relationships between energy intake proportion at main meals and risk of dyslipidemia by restricted cubic spline for adjusted modified Poisson regression model with robust (sandwich) estimation of variance; EI%, energy intake proportion; (a) breakfast energy intake proportion and risk for dyslipidemia; (b) lunch energy intake proportion and risk for dyslipidemia; (c) dinner energy intake proportion and risk for dyslipidemia.
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