(P03-002-25) Association Between Daily Calorie Distribution Patterns and Mortality Among US Adults: NHANES 2005–2018

Objectives: The study aimed to use group-based trajectory modeling to identify distinct daily calorie intake patterns among U.S. adults and evaluate their association with mortality, offering insights into feasible alternatives to extreme fasting diets that lack robust evidence on long-term outcomes in humans.

Methods: 28,425 US adults (aged >19y) from NHANES (Cycles 2005-2018) were included. First, we calculated calorie intake at 6-hour intervals within a day via 24-hour food recalls. Then, group-based trajectory analysis was performed, and four distinct patterns of daily calorie intake were identified: “Skewed to Morning”, “Skewed to Midday”, “Skewed to Evening”, and “Midday-evening Balance”. All-cause and cause-specific mortality was ascertained through December 2019 using the National Death Index. Survey-weighted Cox proportional hazards regression was used to determine the association between daily calorie intake trajectory groups and mortality, adjusting for sociodemographic, lifestyle, and dietary factors, BMI, sleep, health status, and recall days of week.

Results: Among participants, 17% had Morning-skewed, 22% Midday-skewed, 22% Evening-skewed calorie intake patterns, and 39% had balanced calorie intake between midday and evening. During a median follow-up of 7.5 years, 2,989 participants died. In the unadjusted model, all skewed calorie intake trajectories were associated with higher all-cause mortality compared to the Midday-evening Balance reference group (p < 0.05). After multivariable adjustment, Skewed to Morning (HR=1.18; 95%CI, 1.01-1.38) and Skewed to Evening (HR=1.23; 1.03-1.47) patterns remained significantly associated with higher all-cause mortality. These risks were particularly greater among older adults, women, and White individuals. There was a suggestion of Skewed to Morning associating with 42% higher CVD mortality, but it did not reach statistical significance (p=0.079).

Conclusions: Our analysis suggests that patterns of calorie intake skewed toward morning or evening may be associated with increased all-cause mortality risk compared to more balanced daily intake. These findings highlight the potential importance of timing in dietary recommendations and suggest that further research is needed to confirm these relationships and explore underlying mechanisms.

Funding Sources: NIA