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Background: There is increasing recognition that morning or evening preference is associated with time of eating, metabolic health, and morbidity. However, few studies have examined the association of time of eating with mortality.

Objective: To examine the association of time of first recalled ingestive episode with prospective risk of all-cause mortality.

Design: We used mortality-linked data from the National Health and Nutrition Examination Surveys (NHANES) conducted in 1988-1994 and 1999-2014 (n=34609; age >40 y). Quartiles (Q1-Q4) of clock time of first eating episode self-reported in the baseline 24-h dietary recall was the exposure. Follow-up time from date of NHANES examination to date of death or end of the follow-up period (12/31/2015) was the outcome. We used proportional hazards regression methods to determine the independent association of time of first eating episode with relative hazard of all-cause mortality with adjustment for multiple covariates and complex survey design. Multiple linear regression methods were used to examine the association of time of first eating episode and baseline cardiometabolic biomarkers and dietary attributes.

Results: In this national cohort, median age ~55 y (95% CI 54.6, 55.4) at baseline, median follow-up of 8.3 y (IQR 8.75), there were 10, 303 deaths. The median time (military time) of first eating episode in Q1-Q4 was 0545, 0700, 0800, and 1000. Covariate-adjusted relative hazard of mortality in Q1 to Q3 of time of first eating episode was 0.88 (95% CI 0.81-0.96), 0.88 (0.81-19 0.95), 0.94 (0.87, 1.02), with Q4 as the referent (P=0.0008). Qualitative dietary attributes were inversely related with time of first eating episode; however, BMI and serum concentrations of glycemic biomarkers increased with later time of first eating episode (P

Conclusion: Recall of an earlier time of the first eating episode by US >40-y-olds was suggestive of a small relative survival advantage in this observational study.


This is a pre-copyedited, author-produced version of an article accepted for publication in The Journal of Nutrition following peer review. The version of record:

Kant, Ashima K. and Barry I. Graubard. "Clock Time of First Eating Episode and Prospective Risk of All-Cause Mortality in US Adults." The Journal of Nutrition. October 27, 2021, nxab327.

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