Meal Timing of Subtypes of Macronutrients Consumption With Cardiovascular Diseases: NHANES, 2003 to 2016

Abstract

Context Emerging evidence suggests that not only the quantity but also the quality and food sources of macronutrients plays an important role in CVD. However, limited studies have examined the association of meal timing of different quality of macronutrients with CVD risk. Objective This study aimed to examine the association of subtypes of macronutrient consumption at dinner vs breakfast with cardiovascular diseases (CVD). Methods A total of 27 911 participants from the National Health and Nutrition Examination Survey (2003-2016) were included. The differences of subtypes of macronutrients at dinner vs breakfast (Δratio) were categorized into quintiles. Multiple logistic regression models and isocaloric substitution effects of subtypes were performed. Results After adjustment of a variety of covariates, participants in the highest quintile of the Δratio of low-quality carbohydrates had a higher risk of angina (odds ratio [OR] = 1.63; 95% CI, 1.16-2.29) (Pfor trend = .007) and heart attack (OR = 1.47; 95% CI, 1.13-1.93) (Pfor trend = .068) compared with the lowest quintile. The highest quintile of the Δratio of animal protein had a higher risk of coronary heart disease (OR = 1.44; 95% CI, 1.06-1.95) (Pfor trend = .014) and angina (OR = 1.44; 95% CI, 1.01-2.07) (Pfor trend = .047). For the Δratio of unsaturated fatty acid (USFA), the highest quintile of the Δratio of USFA was related to lower stroke risk (OR = 0.76; 95% CI, 0.58-0.99) (Pfor trend = .049). Isocaloric substitution of low-quality carbohydrates/animal protein by high-quality carbohydrates/plant protein at dinner reduced CVD risk by around 10%. Conclusion This study indicated that overconsumption of low-quality carbohydrates and animal protein at dinner rather than breakfast was significantly associated with higher CVD risk and USFA consumption at dinner related to lower CVD risk among US adults. Substitution of low-quality carbohydrates or animal protein by high-quality carbohydrates or plant protein at dinner could reduce CVD risk.

Multiple Metrics of Carbohydrate Quality Place Starchy Vegetables Alongside Non-starchy Vegetables, Legumes, and Whole Fruit

“…The present analyses point to a discrepancy between a priori assignments of CF quality ( 4 , 5 ) and CF quality metrics. Based on the percent of items meeting CQI criteria, starchy vegetables were more likely to meet those criteria compared to refined grains, snacks and sweets, candy and desserts, and sweet beverages.…”

“…These foods were selected using What We Eat in America 4-digit codes and included grains, snacks and sweets, sugar sweetened beverages, 100% fruit juices, vegetables, and fruit. Of these, 36% were pre-classified as “higher quality” and 64% as “lower quality” carbohydrates following published papers ( 4 , 5 ). Figure 1A shows the distribution of FNNDS carbohydrate foods by WWEIA food subgroup.…”

“…The present goal was to compare published assignments of CF quality ( 4 , 5 ) against 4 published carbohydrate quality index (CQI) metrics ( 3 ). Table 3 shows how many “higher” and “lower” quality carbohydrates met the published CQI criteria.…”

“…Following past studies ( 4 , 5 ), refined grains, snacks and sweets, 100% fruit juices, sweetened beverages, and starchy vegetables were defined as “lower quality” CF. Based on WWEIA codes, refined grains were cooked grains, breads and rolls, quick breads, RTE cereals, and cooked cereals.…”

“…Many starchy vegetables are important sources of dietary fiber ( 9 , 10 ). Nonetheless, some studies have placed starchy vegetables and white and sweet potatoes alongside sweetened beverages, candy, and sweet bakery goods ( 4 , 5 ).…”