AHA: Late Meals Linked to HTN, Prediabetes

Risks seen in study of Hispanic and Latino Americans

by Ashley Lyles

CHICAGO -- Eating a late dinner may contribute to cardiometabolic risk in American Hispanics and Latinos, a population-based study found.

People who consumed at least 30% of their energy after 6 pm had 23% higher odds of hypertension (OR 1.23, 95% CI 1.05-1.44) and 19% higher odds of prediabetes (OR 1.19, 95% CI 1.03-1.37) compared with those who ate less in the evening.

But eating in the evening was not associated with overweight, obesity, or central adiposity in the study by Nour Makarem, PhD, of Columbia University in New York City, and colleagues slated for presentation here at the American Heart Association's Scientific Sessions, which begin Saturday.

Late eaters had higher levels of the following, compared with other participants:

  • Fasting glucose (93.7 versus 93.0 mg/dL; P=0.001)
  • Insulin levels (12.4 versus 11.6 mU/L; P=0.003)
  • Score on the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR; 2.9 versus 2.7; P=0.001)
  • Systolic blood pressure (BP; 118.7 versus 117.5 mm Hg; P=0.004)
  • Diastolic BP (72.2 versus 71.0 mm Hg; P<0.0001)

These data are from "the first population-based study to demonstrate that consuming a larger proportion of energy in the evening may be associated with reduced glycemic control and higher odds of prediabetes and hypertension in US Hispanics [and] Latinos," the investigators noted.

Emerging data have highlighted "that eating at unconventional circadian times is associated with adverse metabolic effects," the researchers emphasized.

Clinicians have long known that "what you eat and how much you eat is critically important -- not only in the treatment and management of diabetes but, quite frankly, in the treatment and management other cardiovascular risk factors. This is a study that suggests that when you eat may matter," commented Eduardo Sanchez, MD, MPH, chief medical officer for prevention and chief of the Center for Health Metrics and Evaluation at the American Heart Association, who was not involved in the study.

The researchers evaluated 12,708 participants with an age range of 18 to 76 years from the Hispanic Community Health/Study of Latinos. None of the participants had cancer or diabetes. Of these participants, the average daily energy was 35.7% after 6 pm, and more than half reported eating at least 30% of energy after 6 pm.

The researchers gathered evening eating data using time-stamped 24-hour food recall information by evaluating average proportion of energy consumed after 6 pm.

Makarem's group used a multivariable linear and logistic regression model to determine the relationships between evening caloric intake and cardiometabolic risk. The investigators used models that considered sample weights and design effects and were also adjusted for variables like lifestyle and medical and socio-demographic covariates.

The findings showed that each 1% increase in energy intake after 6 pm was associated with the following:

  • Higher fasting glucose: (Beta=0.02; P<0.0001)
  • Insulin: (Exp[Beta]=1.001; P=0.004)
  • HOMA-IR: (Exp[Beta]=1.001; P=0.001)

When advising patients to make "healthy lifestyle choices, we often talk about how much and what we eat, but we should also consider when we eat. We should eat smaller evening meals, avoid consuming a lot of calories in the evening, and reduce night time eating," Makarem said to MedPage Today.

The study had its limitations. It is an observational study, that cannot draw causative conclusions, noted Sanchez.

While the findings are probably generalizable to all populations, that can't be concluded based on this study, Sanchez cautioned. Still, he noted, "It's critical to think about Latinos and other subpopulations because diabetes is not an equal opportunity 'burdener' of disease."

Going forward, "randomized trials are needed to determine whether changing meal-timing behaviors can reduce CVD risk via improvements in glucoregulation and BP," the researchers concluded.

Makarem did not report any disclosures.

Primary Source

American Heart Association Scientific Sessions

Source Reference: Makarem N, et al “Circadian timing of food intake is associated with cardiometabolic risk in US hispanics/latinos: Results from the hispanic community health study/study of latinos” AHA Scientific Session 2018.

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Comments

— AES
Well, it can't get much more impressive than that, can it?
FBG 93.7 vs 93
Insulin level 12.4 vs 11.6
Insulin resistance score 2.9 vs 2.7
Systolic BP 118.7 vs 117.5
Diastolic BP 72.2 vs 71.0

Yes, very impressive indeed. So where did the headline come from? Are these even statistically significant?

 

— Susanna Levin, NP
I'd like to see a f/u study w/ other demographic populations, as well as later night snacking (but not a full meal).

 

— Thomas Loker
If this is true then Spain should have higher incidence of HTN and diabetes. But, it doesnt. Why?

Does the study take into account the normal bedtime hours? Late shift workers or those with skewed circadian cycles may respond differently. I wonder?

 

— Dr. JP
Headlines like this followed by the data (which, for instance, shows an increase in systolic and diastolic BP of 1 mm but still UNDER what even the most ridiculous cutoffs would assign to “pre-HTN” are irresponsible, diseasemongering. Not good.

— Joy Jurena
Shocking. Not the data - the AHA. It seems almost a desperate attempt to gain validity. We the people need some explaining from the AHA.

Dietary Saturated fat is not the culprit in Heart disease or anything else. Dr.Lundberg in Medscape had a significant article - It's not the fat that makes us unhealthy in Medscape with one reference. Why saturated fat cannot raise LDL. Well, I read that article by a Scottish MD, and went further to an Irish Engineer, Ivor Cummins and found out so much more, watched a tEDx talk by Diabetes MD from Purdue who tells her patients outright that to fix diabetes II ditch the guidelines and don't eat GPS - grains, potatoes and sugar and read about a vegan keto diet reversing CFS in a Belgium nutritionist - lots of coconut milk/oil - saturated fat, monounsaturated fat and Omega 3.

For your information AHA, it is fat that makes us unhealthy but not exogenous fat. It is the endogenous liver made fat from excess high glycemic food.

I fear we will not be able to improve our healthcare defacto system until the AHA stops saying we should not eat saturated fat and should eat Omega 6 oils - like corn oil (pro-inflammatory. It is this and the high glycemic food that has caused the US obesity epidemic. European countries far ahead of us it cleaning up their data and providing the real cause of of chronic conditions.

— Robert Shearin M.D., M.S
Amen to the skeptics' (critical thinkers') comments above! Since when is "after 6PM" "late"? Another published paper that should have perished on a conscious editor's computer.

— JS
AES, yes!! Statistical significance due to generous sample sizes vs. clinical significance. p-values are over-rated!

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