Associations between temporal meal patterns, cardiovascular risk factors and cardiovascular disease in Swedish adults: cross-sectional and nested case-control analyses

PURPOSE: Temporal meal patterns are suggested to influence cardiometabolic health, but existing evidence is limited, inconclusive, and largely cross-sectional. This study aimed to examine associations between temporal meal patterns and cardiovascular risk factors, and whether meal timing is associated with incident cardiovascular disease (CVD). METHODS: The study included 3812 participants (18-75 years) in the Malmö Offspring Study who completed 4-day web-based dietary records and provided fasting blood samples. Cross-sectional analyses assessed associations between temporal meal patterns and risk factors, while a nested case-control study evaluated associations with incident CVD. RESULTS: Meal frequency was nonlinearly associated with HDL-cholesterol, with the highest HDL levels observed at 4.7 meals/day. Each additional eating occasion was associated with 15% lower odds of metabolic syndrome (MS). Breakfast skipping was associated with higher total cholesterol (0.12 mmol/L 95% CI: 0.04, 0.21) and, among men, higher LDL-cholesterol (0.15 mmol/L 95% CI: 0.03, 0.26) but not with MS. Each additional hour of the eating window was associated with lower total and LDL-cholesterol (- 0.03 mmol/L 95% CI: - 0.05, - 0.01, and - 0.04, - 0.01) and a 7% (95% CI: 0.88, 0.98) reduction in odds of MS. A later first meal of the day, was associated with higher odds of MS (9% per hour, 95% CI: 1.01, 1.16). Prospectively, a later energy midpoint was associated with 31% higher odds of CVD (95% CI: 1.00, 1.74). CONCLUSION: Starting to eat early in the day, regular breakfast consumption, an earlier energy midpoint, higher meal frequency, and a longer eating window may be associated with favourable cardiometabolic health.