The association of energy and macronutrient intake at dinner vs breakfast with the incidence of type 2 diabetes mellitus in a cohort study: The China Health and Nutrition Survey, 1997-2011

Background This study aims to investigate the association of energy and macronutrient intake at dinner vs breakfast with the incidence of type 2 diabetes mellitus (T2DM). Methods A total of 11 153 adults, including 811 with T2DM, completed a questionnaire about energy and macronutrient intake in the China Health and Nutrition Survey (1997-2011). The differences (Delta) in energy and macronutrient intake between dinner and breakfast (Delta = dinner - breakfast) were categorized into quintiles. Cox proportional hazards regression models were performed to explore the association between Delta and the risk of T2DM and to investigate the change of the risk when 5% total energy or energy provided by macronutrients at dinner was substituted with total energy or energy provided by macronutrients at breakfast by isocaloric substitution models. Results After adjustment for potential confounders, compared with participants in the lowest quintile, participants in the highest quintile were more likely to develop T2DM (hazard ratio [HR](Delta energy) 1.46, 95% CI 1.13-1.87; HR Delta fat 1.85, 95% CI 1.43-2.41; HR Delta protein 1.37, 95% CI 1.06-1.78). Isocalorically replacing 5% energy at dinner with energy at breakfast was associated with a 7% lower T2DM risk. Replacing 5% energy provided by fat at dinner with energy provided by carbohydrate, protein, and fat at breakfast was associated with a 9%, 5%, and 7% lower T2DM risk, respectively. Replacing 5% energy provided by protein at dinner with energy provided by carbohydrate or protein at breakfast was associated with a 5% lower T2DM risk. Conclusions Higher intake of energy, protein, and fat at dinner than at breakfast increased the risk of T2DM.