Associations of Number of Daily Eating Occasions with Type 2 Diabetes Risk in the Women's Health Initiative Dietary Modification Trial. Academic Article uri icon


  • 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 (n=2159). Numbers of eating occasions per day were obtained from the year 3 24HRs, and participants were grouped into approximate tertiles as 1-3 (n=795), 4 (n=713), and5 (n=651) daily eating occasions as the exposure. Incident diabetes was self-reported on semiannual questionnaires as the outcome. RESULTS: Approximately 15% (15.4%, n=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 for5 meals/d. In stratified analyses, associations for 4 meals/d compared with 1-3 meals/d were stronger in women with BMI<30.0kg/m2 (HR=1.55; 95% CI: 1.00, 2.39) and women aged60 (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.

published proceedings

  • Curr Dev Nutr

author list (cited authors)

  • Neuhouser, M. L., Wertheim, B. C., Perrigue, M. M., Hingle, M., Tinker, L. F., Shikany, J. M., ... Thomson, C.

citation count

  • 4

complete list of authors

  • 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

publication date

  • August 2020