Cardiovascular disease (CVD) remains the leading cause of death and imposes enormous social burdens worldwide, including in Japan. Over the past decades, numerous risk factors for CVD have been identified. Most previous studies have mainly focused on metabolic factors including glucose level, blood pressure, and lipid profile. Since the mid-2000s, reports on the association between eating behaviors, including skipping breakfast,1, 2, 3, 4, 5, 6, 7 fast eating,8, 9, 10 and snacking after dinner,11, 12, 13, 14 and cardiometabolic risk factors or CVD have become more common. However, studies on Western subjects have preceded those on Japanese subjects. Japanese people have a lower BMI than Westerners, and tend to develop atherosclerotic diseases without obesity.15, 16, 17 Owing to differences in genetic, environmental, and cultural factors, in nonobese Japanese, the effects of eating behaviors on CVD may differ from those in Westerners.

There is a lack of evidence on common eating behaviors to support the association with CVD in Japanese people. As for research on Japanese subjects, several small studies showed that fast eating is associated with incident type 2 diabetes, an important risk factor for CVD.10,18 Cross-sectional studies also showed an association between skipping breakfast or eating snacks after dinner and type 2 diabetes or overweight.14,19 Only 1 large study showed that skipping breakfast or snack after dinner was associated with coronary artery disease (CAD), stroke, and heart failure in general Japanese population, but this study had a very short observation period.11 Further, it did not consider cardiovascular death.

Therefore, a large-scale long-term study of the Japanese population, which includes nonobese individuals, is required to evaluate the association between eating behaviors and CVD. The purpose of our study was to examine the association of eating behaviors with incident CVD, and cardiovascular death in a large and long-term cohort in Japanese people.