Department of Nutrition and Food Hygiene, National Key Discipline, School of Public Health, Harbin Medical University, Harbin, China.
Department of Endocrinology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Diabetes Care. 2020 Jul;43(7):1442-1448. doi: 10.2337/dc19-2289. Epub 2020 Apr 30.
This study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes.
A total of 4,699 people with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrient intake was measured by a 24-h dietary recall. The differences (Δ) in energy and macronutrient intake between dinner and breakfast (Δ = dinner - breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between Δ and diabetes, cardiovascular disease (CVD), and all-cause mortality.
Among the 4,699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quintile of Δ in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (hazard ratio [HR] 1.92, 99% CI 1.08-3.42; HR 1.92, 99% CI 1.06-3.49) and CVD (HR 1.69, 99% CI 1.02-2.80; HR 1.96, 99% CI 1.14-3.39). The highest quintile of Δtotal fat was related to CVD mortality (HR 1.67, 99% CI 1.01-2.76). Isocalorically replacing 5% of total energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR 0.96, 95% CI 0.94-0.98) and CVD (HR 0.95, 95% CI 0.93-0.97) mortality, respectively.
Higher intake of energy, total fat, and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes.
本研究旨在评估晚餐与早餐的能量和宏量营养素摄入与糖尿病患者的疾病特异性和全因死亡率之间的关联。
本研究共纳入了 2003 年至 2014 年参加国家健康和营养调查的 4699 名糖尿病患者。通过 24 小时膳食回忆法测量能量和宏量营养素的摄入。晚餐与早餐之间能量和宏量营养素摄入的差异（Δ）分为五分位数。从国家死亡指数获得死亡信息，直至 2015 年。采用 Cox 比例风险回归模型评估Δ与糖尿病、心血管疾病（CVD）和全因死亡率之间的生存关系。
在 4699 名参与者中，记录了 913 例死亡，包括 269 例糖尿病死亡和 314 例 CVD 死亡。在调整了潜在混杂因素后，与能量和蛋白质总摄入量最低五分位数的参与者相比，最高五分位数的参与者死于糖尿病（风险比 [HR] 1.92，99%CI 1.08-3.42；HR 1.92，99%CI 1.06-3.49）和 CVD（HR 1.69，99%CI 1.02-2.80；HR 1.96，99%CI 1.14-3.39）的可能性更高。Δ总脂肪最高五分位数与 CVD 死亡率相关（HR 1.67，99%CI 1.01-2.76）。用早餐替代晚餐 5%的总能量与糖尿病（HR 0.96，95%CI 0.94-0.98）和 CVD（HR 0.95，95%CI 0.93-0.97）死亡率降低 4%和 5%相关。
晚餐摄入的能量、总脂肪和蛋白质比早餐多与糖尿病患者的糖尿病、CVD 和全因死亡率增加有关。
