Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking

Background: Little is known about the association between eating patterns and type 2 diabetes (T2D) risk. Objective: The objective of this study was to prospectively examine associations between breakfast omission, eating frequency, snacking, and T2D risk in men. Design: Eating patterns were assessed in 1992 in a cohort of 29,206 US men in the Health Professionals Follow-Up Study who were free of T2D, cardiovascular disease, and cancer and were followed for 16 y. We used Cox proportional hazards analysis to evaluate associations with incident T2D. Results: We documented 1944 T2D cases during follow-up. After adjustment for known risk factors for T2D, including BMI, men who skipped breakfast had 21% higher risk of T2D than did men who consumed breakfast (RR: 1.21; 95% CI: 1.07, 1.35). Compared with men who ate 3 times/d, men who ate 1-2 times/d had a higher risk of T2D (RR: 1.25; 95% Cl: 1.08, 1.45). These findings persisted after stratification by BMI or diet quality. Additional snacks beyond the 3 main meals (breakfast, lunch, and dinner) were associated with increased T2D risk, but these associations were attenuated after adjustment for BMI. Conclusions: Breakfast omission was associated with an increased risk of T2D in men even after adjustment for BMI. A direct association between snacking between meals and T2D risk was mediated by BMI. Am J Clin Nutr 2012;95:1182-9.