Food Consumption Time-of-Day and CVD Death in Patients with Diabetes

Among people with diabetes, eating a potato or starchy vegetables for breakfast, whole grains for lunch, and dark vegetables and milk for dinner but less processed meat for dinner decreased the risk of death from cardiovascular disease, according to study findings published in The Journal of Clinical Endocrinology & Metabolism.

Circadian effects affect ingestion and digestion time. Diet is a modifiable factor to prevent or treat many illnesses, including diabetes. Previous studies have found that popular diet-ideas, such as avoiding breakfast, eating more meals, eating more calories at dinner, and eating late at night, may lead to obesity, heart-health problems, and type 2 diabetes. Researchers seek to investigate the association between the time-of-day food groups are eaten and cardiovascular disease (CVD) and all-cause death in people with diabetes.

To accomplish this, they conducted a retrospective review of the National Health and Nutrition Examination Survey (NHANES), a stratified multistage study of 4642 adult participants (48.5% women) aged older than 18 years, with diabetes, eating 500 to 5000 kcal/day between 2003 and 2014. Death due to CVD occurred in 307 participants (aged 70.2±10.6 years; 41.4% women; 51.1% non-Hispanic White; 17.3% still smoking; 55.4% still drinking; 29.1±8.7 BMI; 17.6% regular exercise ;100% family history of diabetes), compared with the other 4335 participants (aged 60.6±13.8 years; 49.0% women; 37.3% non-Hispanic White; 19.0% still smoking; 59.7% still drinking; 32.0±8.1 BMI; 16.2% regular exercise; 3.0% family history of diabetes), of whom 307 died of CVD.

Participants who ate the most potatoes and starchy vegetables for breakfast had a lower risk of CVD related death than those who ate the least potatoes and starchy vegetables for breakfast (hazard ratio [HR], 0.46; 95% CI, 0.24-0.89; HR, 0.32; 95% CI, 0.15-0.72). Participants who ate more whole grains for lunch had a lower risk of CVD related death than those who ate the least whole grains for lunch (HR, 0.67; 95% CI, 0.48-0.95). Participants who ate more dark vegetables and drank more milk for dinner had a lower risk of CVD related death than those who ate the least dark vegetables and drank the least milk for dinner (HR, 0.55; 95% CI, 0.35-0.87; HR, 0.56; 95% CI, 0.36-0.88). The patients who drank milk at dinner time also had a lower risk of all-cause mortality (HR, 0.71; 95% CI, 0.54-0.92).

Participants who ate the most processed meat for dinner had a greater risk of CVD-related death (HR, 1.74; 95% CI, 1.07-2.82). Switching the times foods were consumed (potatoes and starchy vegetables for breakfast instead of later in the day; dark vegetables for dinner instead of lunch; whole grains for lunch instead of breakfast) reduced the risk of death related to CVD.

Study limitations included self-reporting food-intake bias, unmeasured confounding factors, and no distinction between type 1 and type 2 diabetes.

Researchers concluded that the time of day certain foods are consumed is as significant as the amount and quality of those foods. Choosing the time of day to eat those foods might benefit people with diabetes. They said diabetics should eat, “more potatoes and starchy vegetables in the forenoon and more dark vegetables in the evenings, as well as less refined grains and processed meat in the evening, which was associated with better long-term survival.”


Jiang W, Song Q, Zhang J, et al. The association of consumption time for food with cardiovascular disease and all-cause mortality among diabetic patients. J Clin Endocrinol Metab. Published online March 15, 2022. doi:10.1210/clinem/dgac069

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