scholarly journals Association of Oily and Nonoily Fish Consumption and Fish Oil Supplements With Incident Type 2 Diabetes: A Large Population-Based Prospective Study

2021 ◽  
Author(s):  
Guo-Chong Chen ◽  
Rhonda Arthur ◽  
Li-Qiang Qin ◽  
Li-Hua Chen ◽  
Zhendong Mei ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fish Oil ◽  
Fish Consumption ◽  
Lower Risk ◽  
Large Population ◽  
Incident Type ◽  
Incident Type 2 Diabetes ◽  
Oily Fish ◽  
Incident Cases

<b>OBJECTIVE </b> <p>To evaluate associations of oily and non-oily fish consumption and fish oil supplements with incident type 2 diabetes (T2D).</p> <p><b>RESEARCH DESIGN AND METHODS </b></p> <p>We included<a> 392,287 middle-aged and older participants </a>(55.0% women) in the UK Biobank who were free of diabetes, major cardiovascular disease, and cancer, and had information on habitual intake of major food groups and use of fish oil supplements at baseline (<a>2006-2010</a>). Of these, <a>163,706</a> participated in 1-5 rounds of 24-h dietary recalls during 2009-2012. </p> <p><b>RESULTS</b></p> <p>During a median 10.1 years of follow-up, <a>7,262</a> incident cases of T2D were identified. As compared with participants who reported never consumption of oily fish, the multivariable-adjusted hazard ratios (95% CI) of T2D were 0.84 (0.78-0.91), 0.78 (0.72-0.85), and 0.78 (0.71-0.86) for those who reported <1 serving/week, weekly, and ≥2 servings/week of oily fish consumption, respectively (P-trend <0.001). Consumption of non-oily fish was not associated with risk of T2D (P-trend = 0.45). Participants who reported regular fish oil use at baseline had a 9% (95% CI: 4%-14%) lower risk of T2D as compared with non-users. Baseline regular users of fish oil who also reported fish oil use during at least one of the 24-h dietary recalls had an 18% (95% CI: 8%-27%) lower risk of T2D when compared with constant non-users.</p> <p><b>CONCLUSIONS</b></p> Our findings suggest that consumption of oily fish, but not non-oily fish, was associated with a lower risk of T2D. Use of fish oil supplements, especially constant use over time, was also associated with a lower risk of T2D.

scholarly journals Association of Oily and Nonoily Fish Consumption and Fish Oil Supplements With Incident Type 2 Diabetes: A Large Population-Based Prospective Study

2021 ◽  
Author(s):  
Guo-Chong Chen ◽  
Rhonda Arthur ◽  
Li-Qiang Qin ◽  
Li-Hua Chen ◽  
Zhendong Mei ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fish Oil ◽  
Fish Consumption ◽  
Lower Risk ◽  
Large Population ◽  
Incident Type ◽  
Incident Type 2 Diabetes ◽  
Oily Fish ◽  
Incident Cases

<b>OBJECTIVE </b> <p>To evaluate associations of oily and non-oily fish consumption and fish oil supplements with incident type 2 diabetes (T2D).</p> <p><b>RESEARCH DESIGN AND METHODS </b></p> <p>We included<a> 392,287 middle-aged and older participants </a>(55.0% women) in the UK Biobank who were free of diabetes, major cardiovascular disease, and cancer, and had information on habitual intake of major food groups and use of fish oil supplements at baseline (<a>2006-2010</a>). Of these, <a>163,706</a> participated in 1-5 rounds of 24-h dietary recalls during 2009-2012. </p> <p><b>RESULTS</b></p> <p>During a median 10.1 years of follow-up, <a>7,262</a> incident cases of T2D were identified. As compared with participants who reported never consumption of oily fish, the multivariable-adjusted hazard ratios (95% CI) of T2D were 0.84 (0.78-0.91), 0.78 (0.72-0.85), and 0.78 (0.71-0.86) for those who reported <1 serving/week, weekly, and ≥2 servings/week of oily fish consumption, respectively (P-trend <0.001). Consumption of non-oily fish was not associated with risk of T2D (P-trend = 0.45). Participants who reported regular fish oil use at baseline had a 9% (95% CI: 4%-14%) lower risk of T2D as compared with non-users. Baseline regular users of fish oil who also reported fish oil use during at least one of the 24-h dietary recalls had an 18% (95% CI: 8%-27%) lower risk of T2D when compared with constant non-users.</p> <p><b>CONCLUSIONS</b></p> Our findings suggest that consumption of oily fish, but not non-oily fish, was associated with a lower risk of T2D. Use of fish oil supplements, especially constant use over time, was also associated with a lower risk of T2D.

scholarly journals Association of Oily and Nonoily Fish Consumption and Fish Oil Supplements With Incident Type 2 Diabetes: A Large Population-Based Prospective Study

Diabetes Care ◽  
2021 ◽  
Vol 44 (3) ◽  
pp. 672-680
Author(s):  
Guo-Chong Chen ◽  
Rhonda Arthur ◽  
Li-Qiang Qin ◽  
Li-Hua Chen ◽  
Zhendong Mei ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Prospective Study ◽  
Fish Oil ◽  
Fish Consumption ◽  
Large Population ◽  
Population Based ◽  
Incident Type ◽  
Incident Type 2 Diabetes

Abstract MP05: Leisure-Time Running and Incident Type 2 Diabetes

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Duck-chul Lee ◽  
Carl J. Lavie ◽  
Timothy S. Church ◽  
Xuemei Sui ◽  
Steven N. Blair
Keyword(s):  
Type 2 Diabetes ◽  
Lower Risk ◽  
Leisure Time ◽  
Cox Regression ◽  
Smoking Status ◽  
Physical Activities ◽  
Incident Type ◽  
Incident Type 2 Diabetes

Introduction: There is still little evidence on the dose-response relation between leisure-time running and incident type 2 diabetes (T2D). Hypothesis: We examined the hypothesis that running reduces the risk of developing T2D. Methods: Participants were 19,347 adults aged 18 to 100 years (mean age, 44) who received an extensive preventive medical examination during 1974-2006 in the Aerobics Center Longitudinal Study. Participants were free of cardiovascular disease, cancer, and T2D at baseline. Running and other physical activities were assessed on the medical history questionnaire by self-reported leisure-time activities during the past 3 months. We defined T2D as fasting glucose ≥126 mg/dl, insulin use, or physician-diagnosis during follow-up medical examinations. Cox regression was used to quantify the association between running and T2D after adjusting for baseline age, sex, examination year, body mass index, smoking status, heavy alcohol drinking, abnormal electrocardiogram, hypertension, hypercholesterolemia, and levels of other physical activities. Results: During an average follow-up of 6.5 years, 1,015 adults developed T2D. Approximately 30% of adults participated in leisure-time running. Runners had a 29% lower risk of developing T2D compared with non-runners. The hazard ratios (95% confidence intervals) of T2D were 0.97 (0.74-1.27), 0.66 (0.49-0.89), 0.62 (0.45-0.85), 0.78 (0.58-1.03), and 0.57 (0.42-0.79) across quintiles (Q) of running time (minutes/week); 0.99 (0.76-1.30), 0.60 (0.44-0.82), 0.72 (0.55-0.94), 0.65 (0.47-0.90), and 0.63 (0.47-0.86) across Q of running distance (miles/week); 1.08 (0.83-1.40), 0.67 (0.50-0.90), 0.70 (0.53-0.93), 0.61 (0.45-0.83), and 0.53 (0.36-0.76) across Q of running frequency (times/week); 0.95 (0.73-1.24), 0.70 (0.52-0.94), 0.62 (0.45-0.84), 0.73 (0.55-0.97), and 0.58 (0.42-0.80) across Q of total amount of running (MET-minutes/week); and 0.95 (0.71-1.28), 0.76 (0.59-0.99), 0.59 (0.42-0.83), 0.66 (0.51-0.85), and 0.62 (0.43-0.90) across Q of running speed (mph), respectively, compared with no running after adjusting for confounders including levels of other physical activities. Conclusions: Participating in leisure-time running is associated with markedly lower risk of developing T2D in adults. Except for those in the very lowest Q for running doses, even relatively low running doses (starting with Q 2) were associated with marked reductions in T2D risk over time, supporting the prescription of running to reduce T2D.

scholarly journals Role of HDL Cholesterol and Estimates of HDL Particle Composition in Future Development of Type 2 Diabetes in the General Population: The PREVEND Study

2013 ◽  
Vol 98 (8) ◽  
pp. E1352-E1359 ◽  
Author(s):  
Ali Abbasi ◽  
Eva Corpeleijn ◽  
Ron T. Gansevoort ◽  
Rijk O. B. Gans ◽  
Hans L. Hillege ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
High Density ◽  
High Density Lipoproteins ◽  
Particle Composition ◽  
Incident Type ◽  
Incident Type 2 Diabetes ◽  
Incident Cases

Background and Aims: High-density lipoproteins (HDLs) may directly stimulate β-cell function and glucose metabolism. We determined the relationships of fasting high-density lipoprotein cholesterol (HDL-C), plasma apolipoprotein (apo) A-I and apoA-II, and HDL-C–to–apoA-I and HDL-C–to–apoA-II ratios, as estimates of HDL particle composition, with incident type 2 diabetes mellitus. Methods: A prospective study was carried out in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort after exclusion of subjects with diabetes at baseline (n = 6820; age, 28–75 years). The association of HDL-related variables with incident type 2 diabetes was determined by multivariate logistic regression analyses. Results: After a median follow-up of 7.7 years, 394 incident cases of type 2 diabetes mellitus were ascertained (5.8%). After adjustment for age, sex, family history of diabetes, body mass index, hypertension, alcohol, and smoking, odd ratios (ORs) for diabetes were 0.55 (95% confidence interval [CI], 0.47–0.64; P &lt; .001), 0.81 (0.71–0.93; P = .002), 0.02 (0.01–0.06; P &lt; .001), and 0.03 (0.01–0.060; P &lt; .001) per 1-SD increase in HDL-C and apoA-I and in the HDL-C–to–apoA-I and the HDL-C–to–apoA-II ratios, respectively. In contrast, apoA-II was not related to incident diabetes (OR = 1.02; 95% CI, 0.90–1.16; P=0.71). The relationships of HDL-C and the ratios of HDL-C to apoA-I and HDL-C to apoA-II remained significant after further adjustment for baseline glucose and triglycerides (ORHDL = 0.74 [95% CI, 0.61–0.88], ORHDL/APO A-I = 0.14 [0.04–0.44], and ORHDL/APOA-II = 0.12 [0.04–0.36]; all P ≤ .001). Conclusions: Higher HDL-C, as well as higher HDL-C–to–apoA-I and HDL-C–to–apoA-II ratios are strongly and independently related to a lower risk of future type 2 diabetes.

scholarly journals Greater Adherence to the Portfolio Diet Is Associated with Lower Incidence of Type 2 Diabetes in the Women's Health Initiative

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1034-1034
Author(s):  
Andrea Glenn ◽  
Kenneth Lo ◽  
David Jenkins ◽  
Beatrice Boucher ◽  
Anthony Hanley ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Women's Health ◽  
Postmenopausal Women ◽  
Lower Risk ◽  
Incident Type ◽  
Health Initiative ◽  
Incident Type 2 Diabetes ◽  
Diet Score ◽  
The Women’S Health Initiative

Abstract Objectives To assess the association of the plant-based cholesterol-lowering diet, the Portfolio Diet, with incident type 2 diabetes in women. Methods We followed 147,732 postmenopausal women initially free of diabetes in the Women's Health Initiative (WHI) Clinical Trials and Observational Study from 1993 through 2017. Adherence to the Portfolio Diet was assessed using an a priori diet index based on six food categories (high in plant protein [soy & pulses], nuts, viscous fiber, plant sterols and monounsaturated fat, and low in saturated fat) that were previously found to lower cardiovascular risk factors in the Portfolio Diet trials. We used Cox proportional-hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of the association of adherence to a Portfolio Diet score with incident type 2 diabetes, adjusting for potential confounders (demographics, lifestyle behaviors, and medical history). The Portfolio Diet score was cumulatively assessed at baseline and year three using a validated food frequency questionnaire. Type 2 diabetes diagnosis was ascertained by self-reported medication use. Results There were 14,096 cases of incident type 2 diabetes over a mean follow-up of 14.3 years. In the fully adjusted models, adherence to the Portfolio Diet score was associated with a lower risk of incident type 2 diabetes (HR, 0.88, CIs, 0.83, 0.93; P for trend &lt; 0.001), comparing the highest to lowest quartiles of adherence. Results remained similar across subgroup analyses (age, body mass index, family history of diabetes, and ethnicity) and several sensitivity analyses. Conclusions Among postmenopausal women, higher adherence to the Portfolio Diet was associated with lower incident type 2 diabetes. These findings are the first to show that the Portfolio Diet may be associated with a lower risk of type 2 diabetes and warrants further investigation. Funding Sources The WHI was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and the U.S. Department of Health and Human Services. AJG was supported by the Banting & Best Diabetes Centre Tamarack Graduate Award in Diabetes Research, the Peterborough K.M. Hunter Charitable Foundation Graduate Award, and an Ontario Graduate Scholarship. JLS was funded by a Diabetes Canada Clinician Scientist Award.

scholarly journals Opposing associations of NT-proBNP with risks of diabetes and diabetes-related complications

2020 ◽  
Author(s):  
Anna Birukov ◽  
Fabian Eichelmann ◽  
Olga Kuxhaus ◽  
Elli Polemiti ◽  
Andreas Fritsche ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Vascular Complications ◽  
Diabetes Risk ◽  
Macrovascular Complications ◽  
Incident Type ◽  
Incident Type 2 Diabetes ◽  
Design And Methods ◽  
Incident Cases ◽  
Healthy Participants

<b>Objective:</b> Circulating N-terminal pro b-type natriuretic peptide (NT-proBNP) is a classic diagnostic and prognostic marker for heart failure. However, it is inversely associated with diabetes risk. We aimed to investigate relationships of NT-proBNP with risk of diabetes-related complications in initially healthy individuals. <p><b>Research Design and Methods:</b> <a>We performed a case-cohort study within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort including a random subcohort (n=1294) and incident cases of type 2 diabetes (n=649) and cardiovascular diseases (CVD, n=478). Incident cases of type 2 diabetes (n=545) were followed up for micro- (n=133) and macrovascular (n=50) complications. Plasma NT-proBNP was measured at baseline in initially healthy participants.</a></p> <p><b>Results: </b><a></a><a>In multivariable models, NT-proBNP was linearly inversely associated with incident type 2 diabetes, HR (95% CI) per doubling in NT-proBNP: 0.91 (0.86; 0.98). The association was only observable in women, HR (95%CI): 0.80 (0.72; 0.90), compared to 0.98 (0.91; 1.07) in men. Among persons with incident diabetes, NT-proBNP was positively associated with diabetes complications, HR (95% CI): 1.31 (1.13; 1.53) for overall, 1.20 (1.01; 1.43) for micro- and 1.37 (1.03; 1.83) for macrovascular complications. </a></p> <b>Conclusions: </b><a>Although higher NT-proBNP levels are associated with lower diabetes risk, in persons who develop diabetes NT-proBNP is a biomarker for vascular complications independent of potential confounders. </a><a>Thus, NT-proBNP might be informative to monitor risk for diabetes-related micro- and macrovascular complications, which should be further explored in future prospective studies.</a>

Abstract MP32: Muscular Strength and Type 2 Diabetes Prevention

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Duck-chul Lee ◽  
Angelique Brellenthin ◽  
Xuemei Sui ◽  
Steven Blair
Keyword(s):  
Type 2 Diabetes ◽  
Cardiorespiratory Fitness ◽  
Diabetes Prevention ◽  
Lower Risk ◽  
Muscular Strength ◽  
Incident Type ◽  
Type 2 Diabetes Prevention ◽  
Incident Type 2 Diabetes ◽  
History Of

Introduction: There is little evidence on the effects of muscular strength, independent of cardiorespiratory fitness, on the development of type 2 diabetes. Hypothesis: We hypothesised that muscular strength, independent of cardiorespiratory fitness, has significant benefits in type 2 diabetes prevention. Methods: Participants were 5,578 men and women aged 18 to 100 years (mean age, 44) who received preventive medical examinations during 1980-2006 in the Aerobics Center Longitudinal Study. Participants were free of myocardial infarction, stroke, cancer, and diabetes at baseline. Total body muscular strength was quantified by combining 1 repetition maximum (1-RM) measures for leg and bench presses and categorized into three groups, lower (weak), middle, and upper (strong), based on the tertiles (thirds) of muscular strength. Cardiorespiratory fitness was measured by a maximal treadmill exercise test. Type 2 diabetes was defined as a fasting plasma glucose level of ≥126 mg/dl, a history of diabetes, or current insulin therapy. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident type 2 diabetes by muscular strength after adjusting for baseline age, sex, examination year, body mass index (BMI), current smoking, heavy alcohol drinking, parental history of diabetes, hypertension, hypercholesterolemia, glucose level, and maximum treadmill test time. Results: During an average follow-up of 8 years, 270 (4.8%) individuals developed type 2 diabetes. Compared with the individuals in the lower third of muscular strength, individuals in the middle third had a 30% lower risk of developing type 2 diabetes (HR: 0.70, 95% CI: 0.51-0.95), whereas no significant benefit was found in individuals in the upper third (HR: 1.16, 95% CI: 0.86-1.57) after adjusting for potential confounders and cardiorespiratory fitness. We found similar results in men and women, young (<50 years) and old (≥50 years), and normal (BMI <25 kg/m 2 ) and overweight/obese (BMI ≥25 kg/m 2 ) individuals. In the combined analysis of muscular strength and cardiorespiratory fitness, we also found similar results that individuals in the middle third of muscular strength showed lower risks of developing type 2 diabetes in both low (lower 50%) and high (upper 50%) cardiorespiratory fitness, compared with individuals in the lower third of muscular strength and low cardiorespiratory fitness. Conclusions: We found that a moderate level of muscular strength, independent of cardiorespiratory fitness, is associated with a lower risk of developing type 2 diabetes. Additional studies on the dose-response relationship of muscular strength and incident type 2 diabetes are warranted.

P2493Change in cardiovascular health and incident type 2 diabetes and prediabetes: The Whitehall II Study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Climie ◽  
T T Van Sloten ◽  
M C Perier ◽  
M Tafflet ◽  
A Fayosse ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Health ◽  
Heart Association ◽  
Single Measure ◽  
Incident Type ◽  
Ideal Metrics ◽  
Incident Type 2 Diabetes ◽  
Fasting Glycaemia ◽  
Incident Cases

Abstract Background Most previous studies on cardiovascular health (CVH) and incident type 2 diabetes (T2D) used a single measure of CVH and none investigated the association with incident prediabetes. This study aimed to examine whether changes in CVH are associated with incident T2D and prediabetes. Methods Within the prospective Whitehall II study, CVH was examined serially every 5 years from 1991/93 until 2015/16. Subjects with 0–2, 3–4 and 5–6 ideal metrics of CVH from the American Heart Association (non-smoking, and ideal levels of body mass index, physical activity, diet, blood pressure, and total cholesterol, fasting glycaemia was not considered),were categorized as having low, moderate or high CVH. Results There were 6234 participants without prior cardiovascular disease and T2D (mean age 49.8±6.0 years, 70% male) including 5015 who were additionally free of prediabetes (49.6±6.0 years, 67% male) at baseline. Over a median follow-up of 24.8 (IQR 24.0 to 25.2) years, 895 and 1703 incident cases of T2D and prediabetes occurred respectively. Change in CVH between 1991/93 and 2002/04 was calculated among 4470 participants without CVD and T2D in the interval, and among 2798 participants additionally free of prediabetes. In multivariate analysis, compared to those with stable low CVH, risk of T2D was lower in those with initially high CVH (HR=0.23; 0.09, 0.56), those who had persistently moderate CVH or changed from moderate to high CVH (moderate-moderate/high; HR=0.42; 0.33, 0.54), low-moderate/high (HR=0.50; 0.36, 0.69) and moderate-low (HR=0.63; 0.48, 0.83). Results were similar for prediabetes, but effect sizes were smaller. Conclusions Among participants without previous CVD, T2D or prediabetes, change in CVH was related to the risk of incident T2D and prediabetes.

scholarly journals Associations of circulating very-long-chain saturated fatty acids and incident type 2 diabetes: a pooled analysis of prospective cohort studies

2019 ◽  
Vol 109 (4) ◽  
pp. 1216-1223 ◽  
Author(s):  
Amanda M Fretts ◽  
Fumiaki Imamura ◽  
Matti Marklund ◽  
Renata Micha ◽  
Jason H Y Wu ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fatty Acids ◽  
Lower Risk ◽  
Saturated Fatty Acids ◽  
Pooled Analysis ◽  
Incident Diabetes ◽  
Incident Type ◽  
Incident Type 2 Diabetes ◽  
Long Chain

ABSTRACT Background Saturated fatty acids (SFAs) of different chain lengths have unique metabolic and biological effects, and a small number of recent studies suggest that higher circulating concentrations of the very-long-chain SFAs (VLSFAs) arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0) are associated with a lower risk of diabetes. Confirmation of these findings in a large and diverse population is needed. Objective We investigated the associations of circulating VLSFAs 20:0, 22:0, and 24:0 with incident type 2 diabetes in prospective studies. Methods Twelve studies that are part of the Fatty Acids and Outcomes Research Consortium participated in the analysis. Using Cox or logistic regression within studies and an inverse-variance-weighted meta-analysis across studies, we examined the associations of VLSFAs 20:0, 22:0, and 24:0 with incident diabetes among 51,431 participants. Results There were 14,276 cases of incident diabetes across participating studies. Higher circulating concentrations of 20:0, 22:0, and 24:0 were each associated with a lower risk of incident diabetes. Pooling across cohorts, the RR (95% CI) for incident diabetes comparing the 90th percentile to the 10th percentile was 0.78 (0.70, 0.87) for 20:0, 0.84 (0.77, 0.91) for 22:0, and 0.75 (0.69, 0.83) for 24:0 after adjustment for demographic, lifestyle, adiposity, and other health factors. Results were fully attenuated in exploratory models that adjusted for circulating 16:0 and triglycerides. Conclusions Results from this pooled analysis indicate that higher concentrations of circulating VLSFAs 20:0, 22:0, and 24:0 are each associated with a lower risk of diabetes.

Meal frequency and incidence of type 2 diabetes: a prospective study

2021 ◽  
pp. 1-6
Author(s):  
Xiaowen Wang ◽  
Yonghua Hu ◽  
Li-Qiang Qin ◽  
Jia-Yi Dong
Keyword(s):  
Type 2 Diabetes ◽  
Lower Risk ◽  
Dietary Habits ◽  
Community Dwelling ◽  
Meal Frequency ◽  
Incident Type ◽  
Incident Type 2 Diabetes ◽  
A Prospective Study ◽  
Baseline Bmi

Abstract Dietary habits play an important role in the development of obesity and type 2 diabetes. However, evidence on association between diet frequency and type 2 diabetes was limited and inconclusive. We aimed to examine the association between meal frequency and risk of type 2 diabetes. The cohort study used data from China Health and Retirement Longitudinal Study of 8874 community-dwelling people aged over 45 years. Participants were classified as eating two meals per day, three meals per day and four meals per day. Multiple Poisson regression models were used to examine risk of 4-year incident type 2 diabetes among people who ate more or less than three meals per day compared with people who ate three meals per day. We documented 706 type 2 diabetes cases during follow-up. After adjustment for known risk factors for type 2 diabetes, except for BMI, participants who ate four meals per day were at a lower risk of type 2 diabetes than those who ate three meals per day (relative risk(RR) = 0·73 (0·58, 0·92)). After further adjustment for baseline BMI, the association was slightly attenuated but remained statistically significant (RR = 0·76 (0·60, 0·97)). Subgroup analysis showed that the fully adjusted RR of type 2 diabetes for people eating four meals per day were 0·66 (0·48, 0·91) and 0·93 (0·65, 1·34) among those had a BMI < 25 and ≥ 25 kg/m2, respectively. Eating four meals per day, compared with eating three meals per day was associated with lower risk of developing type 2 diabetes in a Chinese population, particularly in those with a BMI < 25 kg/m2.

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