Cohort studyindependent cross-checkabstract checked★ key study I-FAST-116 in-depth review

One meal a day and death risk

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

Overview

Sun Y et al.. J Acad Nutr Diet 2023 · PMID 35964910 · DOI 10.1016/j.jand.2022.08.119

US adults who ate only one meal a day had a higher death rate, but this type of study cannot prove the meal pattern caused it.

Does the study support the specific claim? No · Methodological quality: moderate

Study explained simply

What did the researchers want to find out?: Link meal patterns to mortality.
How was the study done?: Cohort of 24,011 adults followed for deaths.
How many people, animals or samples were studied?: US adults aged 40+.
What was actually found?: HR 1.30 all-cause, 1.83 CVD for one meal/day.
How large was the observed effect?: HR 1.30 (1.03-1.64).
What do the results mean in everyday life?: No evidence that one meal a day is healthier; possibly the opposite.
What are the study's limitations?: Diet recorded once; confounding.
What does it say about Elawady's specific claim?: Contradicts 'the healthy way to eat', at low certainty.
Do the results apply to Germany and Europe?: Applies; same physiology.
What can explicitly not be concluded from this study?: Causation.

Authors: Sun Y et al.
Journal: J Acad Nutr Diet
Year: 2023
Identifier: PMID 35964910 DOI 10.1016/j.jand.2022.08.119
Verification: verified – PubMed efetch 2026-10-26; Crossref update-to/updated-by check
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: not stated in abstract

Are meal frequency, skipping and intervals associated with mortality?

Study design: Cohort study – Prospective cohort (NHANES 1999-2014 linked to death records)
Population: US adults aged >=40
Country: USA
Period: 1999-2014; mortality to 2015
Sample size: 24,011; 4,175 deaths (878 CVD)
Inclusion and exclusion criteria: not stated in abstract

Exposure / intervention: One meal/day; meal skipping; meal intervals (24-h recall)
Comparator: Three meals/day
Endpoints: All-cause and CVD mortality
Statistical methods: Multivariable Cox models

Results: One meal/day vs three: all-cause mortality HR 1.30 (95% CI 1.03-1.64), CVD mortality HR 1.83 (1.26-2.65). Breakfast skipping CVD HR 1.40 (1.09-1.78); lunch skipping all-cause HR 1.12 (1.01-1.24); dinner skipping 1.16 (1.02-1.32).
Absolute risks: Whole cohort 22.5 deaths per 1,000 person-years (calculated); group-specific absolute risks not reported.
Authors' conclusion: Eating one meal per day was associated with increased all-cause and CVD mortality.

CIs log-symmetric; association only, cannot show causation; see stats/I-FAST-116_meal_skipping.py.

Observational signal of harm for habitual one-meal-a-day eating; does not prove causation.

Universal biology; applies in Europe and Egypt.

Low-certainty contradicting evidence; must not be overstated.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	moderate
Risk of bias	high
Precision of results	moderate
Directness	direct
Reproducibility	not replicated
Consistency with the overall evidence	unknown
Regional transferability	moderate
Adequacy of the interpretation (by the archive)	not applicable