Temporal patterns of energy intake and cognitive function and its decline: a community-based cohort study in China

To our knowledge, this study is one of the few population-based studies that explore the association of TPEI and cognitive decline, although accumulating studies have linked TPEI to health outcomes, including obesity [8], hypertension [9], and cardiovascular health [10]. Emerging studies suggested that meal timing is associated with cognitive function. An experimental study showed that evenly spreading the same amount of energy into four meals can improve short-term cognitive performance than that of two meals [11]. Another meta-analysis [12] including 34 experimental studies showed that breakfast skipping is related to worse acute cognitive function among healthy adults than breakfast consumers. Our findings were generally consistent with prior evidence, showing that breakfast skipping was associated with exceptionally faster cognitive decline than other TPEIs, corroborated by the secondary finding that higher energy intakes in the morning were associated with better cognitive function and slower decline. For snack intake, we observed that only snacks consumed after dinner exhibited a potentially beneficial role, most likely resulting from the fact that people who consumed snacks at night usually used to be brain workers with higher education levels and tended to have a better cognitive function. Our findings should be placed in the context of China's rapid transitions in eating habits, where accessibility of food choices as snacks may vary significantly across populations. In conclusion, we observed that maintaining balanced energy intake across three major meals was associated with significantly better cognitive function than the other five unevenly-distributed patterns. In particular, breakfast skipping was associated with significantly worse cognitive function and faster cognitive decline over time. The observed associations were similar across major prespecified subgroups. Further studies are needed to confirm our findings in different populations and reveal the underlying mechanisms. If proven causal, these findings will add to the evidence for future public health recommendations on balanced temporal pattern of energy intake for primary prevention of cognitive decline in the aging population.