Does nibbling or grazing protect the peripheral arteries from atherosclerosis?

It has been suggested that frequent food intake is metabolically advantageous. We investigated whether meal frequency was associated with the development of peripheral arterial disease among smokers.

Hospital-based case-control study of smokers, recruited from outpatient clinics and inpatient wards at two London teaching hospitals.

Two-hundred and ninety-one smokers, newly referred with peripheral arterial disease (cases) and 828 age- and sex-matched smokers without smoking-related disorders and with negative Rose questionnaire responses for intermittent claudication (controls) were recruited. All cases and controls completed a validated questionnaire concerning dietary habits. Odds ratios for peripheral arterial disease in association with several dietary variables were calculated, after adjustment for confounding variables.

After adjustment for age, sex, pack-years of smoking, diabetes, hypertension and body mass index, the odds ratio for peripheral arterial disease among those smokers eating between meals (grazing) compared with those who did not, was 0.54 (95% confidence interval 0.42-0.83; P < 0.001). Among cases and controls, grazing was also associated with significantly lower plasma cholesterol concentrations (median 5.67 mmol/l in grazers compared with 6.08 mmol/l in non-grazers; P < 0.001) in those with apparently similar overall fat intakes. Neither plasma lipoprotein (a) nor fibrinogen concentrations varied with meal frequency.

In smokers, grazing was associated with a reduced risk of developing symptomatic peripheral atherosclerosis. This is the first study to demonstrate the apparent benefits of grazing on a cardiovascular end-point.