Associations between chrono-nutrition and glucose metabolism across levels of glucose impairment: The Maastricht Study

Chrono-nutrition, defined as the timing, frequency, and regularity of food intake, may influence glucose metabolism and the risk of type 2 diabetes mellitus (T2DM) through its interaction with circadian rhythms. We examined cross-sectional associations of meal frequency, irregularity, and length of the eating window with glucose metabolism in individuals with normal glucose metabolism, prediabetes, and T2DM. Data were derived from 3,467 participants of a population-based cohort enriched with T2DM. Glucose metabolism status (normal, prediabetes, T2DM) was determined by oral glucose tolerance test and use of glucose-lowering medication. Fasting plasma glucose, 2 h post-load glucose, and HbA1c were measured in venous plasma. Chrono-nutrition was assessed by questionnaire. Multinomial logistic regression estimated odds ratios for prediabetes and T2DM versus normal glucose metabolism. Linear regression models assessed associations with glycemic markers, stratified by glucose metabolism status. Analyses were adjusted for sociodemographic, lifestyle, and clinical factors, including diet quality and caloric intake. A longer eating window was associated with higher odds of prediabetes (OR per hour: 1.07, 95% CI 1.01–1.13). In normal glucose metabolism (N = 2264), breakfast skipping showed higher fasting glucose (β: 0.09 mmol/L, 0.04–0.14), while in participants with prediabetes (N = 604) breakfast skipping was associated with lower 2 h post-load glucose (β: −0.50 mmol/L, −0.96, −0.05). In prediabetes, higher meal irregularity was associated with higher fasting glucose (β: 0.07, 0.03–0.12) and HbA1c (Q4 vs. Q1: β: 1.46 mmol/mol, 0.15–2.77). In T2DM (N = 599), higher meal irregularity was associated with elevated HbA1c levels (Q4 vs. Q1: β: 3.28, 0.19–6.37). These findings highlight the potential role of chrono-nutrition in glucose regulation, warranting further research for confirmation.