Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy


Rehabilitation and Movement Science

First Advisor

Salvatore Carbone


Introduction: Promising associations have been demonstrated between delayed last eating occasion and cardiorespiratory fitness in patients with heart failure (HF), however, it is unknown if time of eating is associated with clinical outcomes such as mortality. The aims of this manuscript were to examine the associations between time of eating variables and all-cause and cardiovascular mortality in the National Health and Nutrition Examination Survey (NHANES) and to assess which cardiometabolic risk factors may mediate any observed associations.

Methods: During interviews, participants self-identified as having HF. Two dietary recalls were obtained and categorical variables for time of eating were created placing participants above or below the mean values for time of first eating occasion (8:31 AM), last eating occasion (7:33 PM) and eating window (11:01 hours). Mortality outcomes were obtained through NHANES linkage to the National Death Index. Covariate-adjusted Cox proportional hazard models were performed examining the association between time of eating and all-cause and cardiovascular mortality. Logistic and linear regression were performed to examine the associations betweentime of eating variables found to be significantly associated with mortality and cardiometabolic risk factors which could serve as potential mediators of these associations.

Results: When Cox proportional hazard regression models were fully adjusted for time of eating variables and all other covariates, extending the eating window ≥ 11:01 hours was associated with an decreased risk of cardiovascular (HR 0.368 [95% CI 0.169-0.803]), but not all-cause, mortality vs. a shorter eating window. Time of first and last eating occasion were not associated with all-cause nor cardiovascular mortality in the final, fully-adjusted models. Extending the eating window was also associated with increasing self-reported physical activity, appendicular lean mass and fat mass indices.

Conclusions: In patients with HF, an extended eating window is favorably associated with cardiovascular mortality risk. Randomized controlled trials should be performed to examine if extending the eating window can improve prognostic indicators such as cardiorespiratory fitness in patients with HF and whether other cardiometabolic risk factors, such as changes in physical activity and body composition, play an important mediating role.


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Available for download on Tuesday, April 11, 2028