Quantity and meal timing of dietary cholesterol intake and cerebrovascular disease mortality

Background: Recent guidelines have removed specific limitations of dietary cholesterol, which has raised considerable debate regarding the significance of cholesterol in the context of cerebrovascular disease (CBD). Furthermore, the relationship between the quantity and meal timing of dietary cholesterol intake and CBD mortality remains unclear. This study aims to explore the relationships between the quantity and meal timing of dietary cholesterol intake and CBD mortality among older adults using the U.S. National Health and Nutrition Examination Survey (NHANES) (2003-2018). Methods: In this prospective study of 7906 older adults aged over 50 years in the National Health and Nutrition Examination Survey (2003-2018), dietary intake was divided into quintiles, and meal timing was evaluated using two days of 24-hour dietary recall. Serum cholesterol levels were measured. The relationship between the quantity and meal timing of dietary cholesterol and mortality was examined with survey-weighted Cox regression models. Results: During a follow-up of 15 years, 107 participants died of CBD. Compared with participants with the lowest quintile of total cholesterol intake (CHO-T) and cholesterol at breakfast (CHO-B), no significant association between CHO-T and CHO-B and mortality (HRCHO-T 0.48; 95%CI 0.18-1.23 and HRCHO-B 0.98; 95%CI 0.37-2.47) was observed. For the difference of cholesterol at dinner (CHO-D) minus CHO-B (ΔCHO), which was related to lower CBD mortality (HR 0.45; 95%CI 0.21-0.97), 29-142 mg of ΔCHO was associated with lower CBD mortality in a non-linear manner and 29-112 mg of ΔCHO was associated with lower TC and LDL-C levels. Conclusions: Moderate consumption of dietary cholesterol at dinner rather than breakfast was associated with a lower risk of CBD mortality in a nonlinear manner, whereas the total quantity of dietary cholesterol throughout the day was not associated with CBD mortality.