• Kyriaki Apergi, Kalliopi Karatzi, Kyriakos Reppas, Christina Mavrogianni, Samiah Shadid, Flores-Barrantes P, Pilar De Miguel-Etayo, Yuliya Bazdarska, Sándorné Radó, Imre Rurik, Katja Wikström, Tsvetalina Tankova, Greet Gardon, Violeta Iotova, Yannis Manios, and Konstantinos Makrilakis.
• National and Kapodistrian, University of Athens Medical School, 11527 Athens, Greece. Electronic address: kiapergi@med.uoa.gr.
• Nutrition. 2022 Mar 1; 95: 111566.

ObjectiveThe aim of this study was to examine the association between the number of times one eats daily (termed eating occasions [EO]) with indices of glycemic control and insulin resistance (IR) in a large sample of adults from families at high risk for type 2 diabetes mellitus (T2DM) from six European countries. The study also considered sex and socioeconomic status (SES).MethodsStandardized questionnaires and procedures were used to assess sociodemographic characteristics, dietary intake, sedentary behavior, and anthropometric and biochemical indices. Univariate analysis of variance was used to investigate associations of daily EOs with fasting glucose (FG), fasting insulin (FI), and IR.ResultsIn 1552 adults (41.6 ± 7.2 y), three to four daily EOs rather than less than three were inversely associated with FG (β = -2.598; 95% confidence interval [CI], -4.521 to -0.675), independent of age, body mass index (BMI), dietary quality, and sedentary time. In women, three to four EOs per day were also associated with FG (β = -3.071; 95% CI to -5.573 to -0.570) independently of the mentioned confounders. In high SES participants, having more than four EOs per day had an inverse association with FI (β = -1.348; 95% CI to -2.583 to -0.114). No such associations were observed in men or in low SES participants.ConclusionIn adults at high risk for T2DM, and especially in women, having three to four daily EOs was inversely associated with FG, whereas in high SES participants, more than four EOs was associated with FI. Future studies should further elucidate the underlying mechanisms and offer insight into the optimum number of daily EOs for the prevention of T2DM especially in men and in adults with low SES where the number of daily EOs was not found to be significantly related to glycemic indices.Copyright © 2021 Elsevier Inc. All rights reserved.

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