Skipping Meals, Fasting and Eating Meals Too Closely Together May Be Linked to Increased Mortality Risk

Summary: A new study links daily eating to mortality risk. Those over 40 who eat one meal a day have a higher mortality risk. Those who skip breakfast are at an increased risk of cardiovascular disease-associated death, and those who eat meals less than 4.5 hours apart have increased mortality risks.

Source: Elsevier

Eating only one meal per day is associated with an increased risk of mortality in American adults 40 years old and older, according to a new study in the Journal of the Academy of Nutrition and Dietetics.

Skipping breakfast is associated with higher risk of cardiovascular disease mortality and missing lunch or dinner with all-cause mortality.

Even among individuals who eat three meals daily, eating two adjacent meals less than or equal to 4.5 hours apart is associated with a higher all-cause death risk.

“At a time when intermittent fasting is widely touted as a solution for weight loss, metabolic health, and disease prevention, our study is important for the large segment of American adults who eat fewer than three meals each day. Our research revealed that individuals eating only one meal a day are more likely to die than those who had more daily meals.

Among them, participants who skip breakfast are more likely to develop fatal cardiovascular diseases, while those who skip lunch or dinner increase their risk of death from all causes,” noted lead author Yangbo Sun, MBBS, Ph.D., Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis. TN, U.S.. “Based on these findings, we recommend eating at least two to three meals spread throughout the day.”

The investigators analyzed data from a cohort of more than 24,000 American adults 40 years old and older who participated in the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2014. An ongoing, nationally representative health survey of the non-institutionalized US population, NHANES collects a wide range of health-related data to assess diet, nutritional status, general health, disease history, and health behaviors every two years.

Mortality status and cause of the 4,175 deaths identified among this group were ascertained from the NHANES Public-use Linked Mortality File. The investigators observed a number of common characteristics among participants eating fewer than three meals per day (around 40% of respondents)—they are more likely to be younger, male, non-Hispanic Black, have less education and lower family income, smoke, drink more alcohol, be food insecure, and eat less nutritious food, more snacks, and less energy intake overall.

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Dr. Bao explained that skipping meals usually means ingesting a larger energy load at one time, which can aggravate the burden of glucose metabolism regulation and lead to subsequent metabolic deterioration. Image is in the public domain

“Our results are significant even after adjustments for dietary and lifestyle factors (smoking, alcohol use, physical activity levels, energy intake, and diet quality) and food insecurity,” said the study’s senior investigator Wei Bao, MD, Ph.D., Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, U.S.. He noted, “Our findings are based on observations drawn from public data and do not imply causality. Nonetheless, what we observed makes metabolic sense.”

Dr. Bao explained that skipping meals usually means ingesting a larger energy load at one time, which can aggravate the burden of glucose metabolism regulation and lead to subsequent metabolic deterioration. This can also explain the association between a shorter meal interval and mortality, as a shorter time between meals would result in a larger energy load in the given period.

Dr. Bao commented, “Our research contributes much-needed evidence about the association between eating behaviors and mortality in the context of meal timing and duration of the daily prandial period.”

Meal frequency, skipping, and intervals were not addressed by the 2020-2025 Dietary Guidelines for Americans because the Dietary Guidelines Advisory Committee “was unable to find sufficient evidence on which to summarize the evidence between frequency of eating and health.”

Previous dietary studies and Dietary Guidelines for Americans have focused mainly on dietary components and food combinations.

About this diet research news

Author: Press Office
Source: Elsevier
Contact: Press Office – Elsevier
Image: The image is in the public domain

Original Research: Open access.
Meal Skipping and Shorter Meal Intervals Are Associated with Increased Risk of All-Cause and Cardiovascular Disease Mortality among US Adults” by Yangbo Sun et al. Journal of the Academy of Nutrition and Dietetics


Meal Skipping and Shorter Meal Intervals Are Associated with Increased Risk of All-Cause and Cardiovascular Disease Mortality among US Adults


Previous dietary studies and current dietary guidelines have mainly focused on dietary intake and food patterns. Little is known about the association between eating behaviors such as meal frequency, skipping and intervals, and mortality.


The objective was to examine the associations of meal frequency, skipping, and intervals with all-cause and cardiovascular disease (CVD) mortality.


This was a prospective study.


A total of 24,011 adults (aged ≥40 years) who participated in the National Health and Nutrition Examination Survey 1999-2014 were included in this study. Eating behaviors were assessed using 24-hour recall. Death and underlying causes of death were ascertained by linkage to death records through December 31, 2015.

Main outcome measures

The outcomes were all-cause and CVD mortality.

Statistical analyses performed

Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) of all-cause and CVD mortality.


During 185,398 person-years of follow-up period, 4,175 deaths occurred, including 878 cardiovascular deaths. Most participants ate three meals per day. Compared with participants eating three meals per day, the multivariable-adjusted HRs for participants eating one meal per day were 1.30 (95% CI 1.03 to 1.64) for all-cause mortality, and 1.83 (95% CI 1.26 to 2.65) for CVD mortality. Participants who skipped breakfast have multivariable-adjusted HRs 1.40 (95% CI 1.09 to 1.78) for CVD mortality compared with those who did not. The multivariable-adjusted HRs for all-cause mortality were 1.12 (95% CI 1.01 to 1.24) for skipping lunch and 1.16 (95% CI 1.02 to 1.32) for skipping dinner compared with those who did not. Among participants eating three meals per day, the multivariable-adjusted HR for participants with an average interval of ≤4.5 hours in two adjacent meals was 1.17 (95% CI 1.04 to 1.32) for all-cause mortality, comparing with those having a meal interval of 4.6 to 5.5 hours.


In this large, prospective study of US adults aged 40 years or older, eating one meal per day was associated with an increased risk of all-cause and CVD mortality. Skipping breakfast was associated with increased risk of CVD mortality, whereas skipping lunch or dinner was associated with increased risk of all-cause mortality. Among participant with three meals per day, a meal interval of ≤4.5 hours in two adjacent meals was associated with higher all-cause mortality.

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  1. This journal is funded by Multinational Food Corporations, BigAg etc.

    Of course they are going to recommend a continuation of the SAD which had led to the level of disease and illness we see today. Because it keeps a healthy bottom line.

    Really wish we could trust these journals, but the internet has poked so many holes in their integrity it’s sad.

  2. If you get to the referenced article, you’ll find this great tidbit, “[…] participants eating fewer than three meals per day were more likely to be younger, men, non-Hispanic Black, with less education and lower family income, current smokers, heavy alcohol drinkers, higher physical activity levels, lower total energy intake and lower diet quality, food insecure, and higher frequency of snacks.”

    1. Not surprising, I guess neuroscience news gotta publish this. They live off ads, ads comes from centres that can afford it that keep pushing the same nonsensical propaganda bs.

  3. LMMAO who would believe this crap!

    A study based on a cheap survey proves nothing. Correlation is not causation!

  4. One week intermittent fasting is the healthiest thing you can do. The next week, it’ll kill you. Who knows what to believe anymore? I would like to know who funded this “study”.

  5. More bullshit from the medical field….after the Plandemic you fools are losing credit by the day! Funny no mention of what one eats or of overeating…in my view less of good stuff is better than more of crap! Yet another stupid useless ” study ” !

  6. How many participants die after your results of your study and how many live longer than your expectations?

  7. This is crazy…Who funded your research?? Just a saying when people adopt interminant fasting and good health practices…they become healthier. When people get healthy..only the drug companies get unhappy about it…

  8. What a bogus study; We all know who funded this; what a bogus point it is ‘they tend to eat more after fasting’ those who follow daily fasting know after fasting there is no more eating comparing to the rest of the associates portion of meals; what a hoax study this is

  9. This was a SURVEY. Not an actual clinical study, where things are, you know, actually recorded down. Like that actual count of calories, food type and content, and underlying health issues of the volunteers. A survey only takes what people say they do. What people say they do and what they actually do are two separate things. This article is a farce, appearing as some sophisticated and technical study when it’s just a survey.

  10. Cohort studies are far from being considered scientific evidence; neither is prospective research. Great illustration of flawed research methods. It does call for additional studies though.

  11. What a garbage study. We looked at a bunch of fat, unhealthy people trying to lose weight and found they die slightly more often than people who have no need to lose weight. We make a subtle claim that it was their diet that killed them. There isn’t an ounce of cause in this study because the difference in morality rate is not caused by skipping a meal.

    In a similar study, we determined that people who have cancer are more likely to die of cancer than people who don’t have cancer. But we’re unsure of the cause *rolleyes*

  12. This study seems very very wrong. Intermittent fasting and eating less often works extremely well with humans and animals for longevity and health.

    You have to include quality food, wholefoods, nutrient dense, high fibre…
    Testing a group eating trash processed foods really doesn’t count

    Intermittent fasting on some days is EXCEPTIONAL

  13. This has to be the most ridiculous article I have ever read. What nonsense! So they are saying that skipping breakfast caused these people to die younger and not the fact that they had an unhealhty diet, drank, smoked, (likely also did drugs) and also high stress due to low income, etc. I wonder how much the breakfast industry paid them for this “research”. Shameful!

    1. If you look at the actual study, they controlled for effects of “…age, gender, and race and ethnicity…. education, income, smoking status, alcohol intake, physical activity levels, total energy intake, HEI-2010 score, household adult food insecurity status, and snacks frequency…. baseline diabetes, hypertension, hypercholesterolemia, CVD, cancer, and BMI status, because these variables may be mediators between meal frequency, intervals and timing, and mortality.”

  14. In other words those who ate less often were found to have poor diets…go figure they die sooner smh

  15. Absolute nonsense. Not enough context to draw any sort of conclusion that would lead you to make eating decisions.

  16. Can you provide if the subjects had any underlying health issues such as type 2 diabetes, hypertension/high blood pressure, high cholesterol, etc. We’re
    the subjects completely healthy individuals? This study and overall findings seem very flawed.

    1. Is this the famous Mr Anton made famous by Thiel? I’m a huge fan of yours! Nice to see you in the comments. I have opposite eating habits than you ( I cram food in my mouth and am very unsophisticated). However, we think alike. I rarely comment but had to since this article reeked of CCP flat out lies. Looks like everyone else called their bullshit as well. Lead author MRS. Sun is CCP all the way. Somebody please prove me wrong.

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