ArticleThe American journal of clinical nutrition2026
The timing of macronutrient and major food group intake and associations with mortality among United States adults, 1999‒March 2020: a serial cross-sectional study.
Article in The American journal of clinical nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEating timing has been increasingly linked to health, yet national trends in macronutrient/food group timing and their health implications remain unclear.
objectivesTo characterize trends in the timing of energy, macronutrient, and food group intake among United States adults and examine their associations with mortality.
methodsIn this serial cross-sectional study of adults aged ≥20 y with ≥1 valid 24-h dietary recall (National Health and Nutrition Examination Survey, 1999‒March 2020), we examined secular trends in timing of energy, macronutrients, and major food group intake. Associations with mortality (through December 2019) were examined using Cox models.
resultsAmong 50,264 adults, evening (18:00-22:00) accounted for the highest daily energy intake (weighted mean proportions across years, 31.9%‒33.3%), followed by noon (10:00-14:00, 24.7%‒26.8%), afternoon (14:00-18:00, 19.9%‒21.8%), morning (06:00-10:00, 13.5%‒14.9%), and overnight (22:00-06:00, 5.6%‒6.5%); midnight (22:00-02:00) eating occurred in 23.4%‒28.0% of the population. Macronutrient and food groups followed similar patterns, except whole grain (peaked in the morning) and fruit, egg, and dairy intake (more evenly distributed). Over the years, noon and midnight energy intake proportions declined, whereas the afternoon proportion increased; secular trends varied by macronutrients/food groups. Fasting started at 20:34-20:51 and ended at 08:41-08:51; intake midpoint was 14:37-14:48; intake duration was 11.9‒12.2 h. Male, non-Hispanic Black, and socioeconomically disadvantaged groups had greater midnight intake proportions and later intake midpoints. Reallocating 5% of daily energy to midnight was associated with higher cardiovascular mortality (hazard ratio: 1.09; 95% confidence interval: 1.02,1.17), driven by carbohydrates; reallocating 5% to predawn (02:00-06:00) was associated with higher cancer mortality (hazard ratio: 1.22; 95% confidence interval: 1.05, 1.41), driven by proteins. Each 1-h delay in fasting and intake midpoint was associated with an 8%‒9% higher cardiovascular mortality.
conclusionsOvernight intake and delayed eating timing are prevalent among United States adults, especially between socioeconomically disadvantaged groups, and were associated with higher mortality, particularly for specific macronutrients/foods, supporting eating timing recommendations integrating food composition.
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