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

Abstract 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.