The association of energy and macronutrients intake at dinner versus breakfast with disease-specific and all-cause mortality among people with diabetes: the US National Health and Nutrition Examination Survey, 2003-2014

<b>Objective </b>This study aims<b> </b>to evaluate the association of energy and macronutrients intake at dinner vs. breakfast with disease-specific and all-cause mortality in people with diabetes. <div><p><b>Methods </b>4699 peoples with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrients intake were measured by a 24h dietary-recall. The Differences(△) in energy and macronutrients intake between dinner and breakfast (△=dinner minus 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 △ and diabetes, cardiovascular-disease (CVD) and all-cause mortality. </p> <p><b>Results</b> Of the 4699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjusting 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 (HR_Δenergy=1.92, 99% CI:1.08-3.42; HR_Δprotein=1.92, 99% CI:1.06-3.49) and CVD (HR_Δenergy=1.69, 99% CI:1.02-2.80; HR_Δprotein=1.96, 99% CI:1.14-3.39). The highest quintile of Δ from total-fat was related with 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.</p> <p><b>Conclusions</b> 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. <b></b></p><b></b></div>