女性健康倡议饮食调整试验中每日进餐次数与2型糖尿病风险的关联
Associations of Number of Daily Eating Occasions with Type 2 Diabetes Risk in the Women's Health Initiative Dietary Modification Trial.
作者信息
Neuhouser Marian L, Wertheim Betsy C, Perrigue Martine M, Hingle Melanie, Tinker Lesley F, Shikany James M, Johnson Karen C, Waring Molly E, Seguin-Fowler Rebecca A, Vitolins Mara Z, Schnall Eliezer, Snetselaar Linda, Thomson Cynthia
机构信息
Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
University of Arizona Cancer Center, Tucson, AZ, USA.
出版信息
Curr Dev Nutr. 2020 Jul 21;4(8):nzaa126. doi: 10.1093/cdn/nzaa126. eCollection 2020 Aug.
BACKGROUND
Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast consumption, time-restricted eating, and limiting daily eating occasions have been explored as behaviors for reducing T2D risk, but prior evidence is inconclusive.
OBJECTIVES
Our objectives were to examine associations between number of daily eating occasions and T2D risk in the Women's Health Initiative Dietary Modification Trial (WHI-DM) and whether associations vary by BMI, age, or race/ethnicity.
METHODS
Participants were postmenopausal women in the WHI-DM who comprised a 4.6% subsample completing 24-h dietary recalls (24HRs) at years 3 and 6 as part of trial adherence activities ( = 2159). Numbers of eating occasions per day were obtained from the year 3 24HRs, and participants were grouped into approximate tertiles as 1-3 ( = 795), 4 ( = 713), and ≥5 ( = 651) daily eating occasions as the exposure. Incident diabetes was self-reported on semiannual questionnaires as the outcome.
RESULTS
Approximately 15% (15.4%, = 332) of the WHI-DM 24HR cohort reported incident diabetes at follow-up. Cox proportional hazards regression tested associations of eating occasions with T2D adjusted for neighborhood socioeconomic status, BMI, waist circumference, race/ethnicity, family history of T2D, recreational physical activity, Healthy Eating Index-2005, 24HR energy intake, and WHI-DM arm. Compared with women reporting 1-3 meals/d, those consuming 4 meals/d had a T2D HR = 1.38 (95% CI: 1.03, 1.84) without further increases in risk for ≥5 meals/d. In stratified analyses, associations for 4 meals/d compared with 1-3 meals/d were stronger in women with BMI <30.0 kg/m (HR = 1.55; 95% CI: 1.00, 2.39) and women aged ≥60 (HR = 1.61; 95% CI: 1.11, 2.33).
CONCLUSIONS
Four meals per day compared with 1-3 meals/d was associated with increased risk of T2D in postmenopausal women, but no dose-response effect was observed for additional eating occasions. Further studies are needed to understand eating occasions in relation to T2D risk.
背景
超过2300万美国人患有2型糖尿病（T2D）。早餐摄入、限时进食和限制每日进食次数等饮食习惯已被作为降低T2D风险的行为进行研究，但先前的证据尚无定论。
目的
我们的目的是在妇女健康倡议饮食调整试验（WHI-DM）中研究每日进食次数与T2D风险之间的关联，以及这种关联是否因体重指数（BMI）、年龄或种族/族裔而异。
方法
参与者是WHI-DM中的绝经后女性，她们是作为试验依从性活动的一部分，在第3年和第6年完成24小时饮食回忆（24HRs）的4.6%的子样本（n = 2159）。每日进食次数从第3年的24HRs中获取，参与者被分为大致三分位数，即1 - 3次（n = 795）、4次（n = 713）和≥5次（n = 651）每日进食次数作为暴露因素。新发糖尿病通过半年一次的问卷调查自我报告作为结局。
结果
在WHI-DM 24HR队列中，约15%（15.4%，n = 332）的参与者在随访时报告新发糖尿病。Cox比例风险回归分析了进食次数与T2D的关联，并对邻里社会经济地位、BMI、腰围、种族/族裔、T2D家族史、休闲体育活动、健康饮食指数 - 2005、24HR能量摄入和WHI-DM分组进行了调整。与报告每日进食1 - 3次的女性相比，每日进食4次的女性患T2D的风险比（HR）= 1.38（95%置信区间：1.03，1.84），而每日进食≥5次的风险没有进一步增加。在分层分析中，与每日进食1 - 3次相比，每日进食4次的关联在BMI < 30.0 kg/m²的女性（HR = 1.55；95%置信区间：1.00，2.39）和年龄≥60岁的女性（HR = 1.61；95%置信区间：1.11，2.33）中更强。
结论
与每日进食1 - 3次相比，每日进食4次与绝经后女性患T2D的风险增加有关，但未观察到额外进食次数的剂量反应效应。需要进一步研究以了解进食次数与T2D风险的关系。
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