Time-varying eating behaviors and long-term risk of incident hypertension in a Japanese cohort.

Hypertension is a leading modifiable risk factor for cardiovascular disease. However, the long-term association of eating behaviors with incident hypertension remains insufficiently studied. The present study aimed to examine whether time-varying eating behaviors are associated with the long-term risk of incident hypertension. Data on 236,343 adults participating in an annual health check-up program between 2009 and 2023 were analyzed. Eating behaviors, including breakfast skipping, eating speed, and bedtime eating, were assessed and modeled as 1-year-lagged time-varying exposures. Marginal structural models with inverse probability weighting were used to account for time-dependent confounding. Cumulative incidence of hypertension was estimated over 14 years, and absolute risk differences (RD) and risk ratios (RR) were calculated. After applying eligibility criteria, the analytic samples comprised 86,157 to 86,241 participants depending on the eating behavior examined. At 14 years, breakfast skipping was associated with a higher hypertension risk compared with not skipping breakfast (55.3% vs. 49.5%; RD, 5.8%; 95% CI, 4.3%-7.3%; RR, 1.12; 95% CI, 1.09-1.15). Fast eating was also associated with higher risk compared with slow eating (50.7% vs. 46.6%; RD, 4.1%; 95% CI, 1.7%-6.4%; RR, 1.09; 95% CI, 1.03-1.14). In contrast, bedtime eating showed minimal association (50.3% vs. 50.1%; RD, 0.2%; 95% CI, -0.9% to 1.5%; RR, 1.00; 95% CI, 0.98-1.03). These findings suggest that breakfast skipping and fast eating are potentially important and modifiable behavioral targets for hypertension prevention, and highlight the value of advanced longitudinal analytical approaches in lifestyle research.