Eating patterns of Australian adults: associations with blood pressure and hypertension prevalence

Association between time-of-day for eating, exercise, and sleep with blood pressure in adults with elevated blood pressure or hypertension: a systematic review

The purpose of this review is to synthesize results from studies examining the association between time-of-day for eating, exercise, and sleep with blood pressure (BP) in adults with elevated BP or hypertension. Six databases were searched for relevant publications from which 789 were identified. Ten studies met inclusion criteria. Four studies examined time-of-day for eating, five examined time-of-day for exercise, and one examined time-of-day for sleep and their associations with BP. Results suggested that later time-of-day for eating ( n  = 2/4) and later sleep mid-point ( n  = 1/1) were significantly related to higher BP in multivariable models, whereas morning ( n  = 3/5) and evening ( n  = 4/5) exercise were associated with significantly lower BP. Although this small body of work is limited by a lack of prospective, randomized controlled study designs and underutilization of 24 h ambulatory BP assessment, these results provide preliminary, hypothesis-generating support for the independent role of time-of-day for eating, exercise, and sleep with lower BP.

Temporal patterns of energy intake identified by the latent class analysis in relation to prevalence of overweight and obesity in Iranian adults

We aimed to identify temporal patterns of energy intake and investigate their association with adiposity. We performed a cross-sectional study of 775 adults in Iran. Information about eating occasions across the day was collected by three 24-h dietary recalls. Latent class analysis (LCA) was used to identify temporal eating patterns based on whether or not an eating occasion occurred within each hour of the day. We applied binary logistic regression to estimate the OR and 95 % CI of overweight and obesity (defined as BMI of 25-29·9 and ≥ 30 kg/m2, respectively) across temporal eating patterns while controlling for potential confounders. LCA grouped participants into three exclusive sub-groups named 'Conventional', 'Earlier breakfast' and 'Later lunch'. The 'Conventional' class was characterised by high probability of eating occasions at conventional meal times. 'Earlier breakfast' class was characterised by high probability of a breakfast eating occasion 1 h before the conventional pattern and a dinner eating occasion 1 h after the conventional pattern, and the 'Later lunch' class was characterised by a high probability of a lunch eating occasion 1 h after the conventional pattern. Participants in the 'Earlier breakfast' pattern had a lower likelihood of obesity (adjusted OR: 0·56, 95 % CI: 0·35, 0·95) as compared with the 'Conventional' pattern. There was no difference in the prevalence of obesity or overweight between participants in the 'Later lunch' and the 'Conventional' patterns. We found an inverse association between earlier eating pattern and the likelihood of obesity, but reverse causation may be a plausible explanation.

Interaction of Dietary Sodium-to-potassium Ratio and Dinner Energy Ratio on Prevalence of Hypertension in Inner Mongolia, China

BACKGROUND

Hypertension is one of the most common chronic diseases, and dietary factors play an important role in hypertension. We examined the interaction of dietary sodium-to-potassium (Na/K) ratio and dinner energy ratio on hypertension.

METHODS

We conducted this study using data from the cross-sectional National Survey for Nutrition and Adult Chronic Disease in 2015 in Inner Mongolia, China. Dietary data were collected using 24-hour diet records with food weights across 3 consecutive days. Logistic regression was used to determine the interaction of dinner energy ratio and dietary Na/K ratio on hypertension.

RESULTS

A total of 1,861 participants were included in this study, and 914 individuals were hypertensive (49.1%). Dinner energy ratio and high dietary Na/K ratio were independently related to high prevalence of hypertension. A formal test showed that dinner energy ratio interacted significantly with dietary Na/K ratio on hypertension (P < 0.001), with an adjusted odds ratio (OR) of 1.119 (95% confidence interval [CI], 1.040-1.203). Participants whose dinner energy ratio greater than 39.1% and dietary Na/K ratio of 3.625-6.053 had the highest OR of hypertension prevalence, with an adjusted OR of 2.984 (95% CI, 1.758-5.066), compared with participants with dinner energy ratio of 30.2-39.1%, and dietary Na/K ratio less than 2.348.

CONCLUSION

Our study highlighted the interactive effect of dinner energy ratio and dietary Na/K ratio on hypertension among adults in Inner Mongolia. We advocated a balanced diet (dinner energy ratio not small or large) and a low dietary Na/K ratio for reducing the prevalence of hypertension.

Understanding the link between frequency of eating and cardiometabolic health outcomes in Americans who "snack"

On average, Americans ages 2 yr and older eat 5 or more times per day and consume nearly a quarter of their daily energy outside of breakfast, lunch, and dinner. Frequency of eating (FOE) has been identified by both the 2020 Dietary Guidelines for Americans Scientific Advisory Committee and the American Heart Association as an important area of study to improve the dietary patterns and overall health of the American public. However, the current evidence on FOE is conflicting; it does not indicate whether eating more frequently is a healthful behavior or not. Clinical and prospective studies have shown that FOE has an inverse relationship with some cardiometabolic health markers, including total cholesterol and low-density lipoprotein cholesterol concentrations, but the relationship between FOE and other health markers such as high-density lipoprotein cholesterol concentrations, blood pressure, obesity, and coronary heart disease incidence remains unclear. Several factors may affect the relationship between FOE and cardiometabolic health including the types of foods consumed, time of day, motivation to eat, cultural background, age, sex, and food security status. Another factor affecting both the relationship between FOE and health as well as the research on FOE and health is how eating occasions are labeled. Many definitions have been proposed and used in research to delineate between meals and snacks, but a consistent definition is not currently used for "snacks," even in official dietary guidance. With the current limitations in the body of research, conclusions about the healthfulness of frequent eating cannot be drawn. In addition, conclusions cannot be drawn on the healthfulness of eating snacks (as an eating occasion) or more than 3 meals per day. More directed research is required to understand the relationships between the labels used for an eating occasion and cardiometabolic health outcomes as well as the health impacts of frequent food and beverage consumption and how and why they may vary among different population groups.

Meal Patterns of Older Adults: Results from the OUTDOOR ACTIVE Study

Eating habits have a substantial effect on health, not only because of consumed foods and nutrients, but also because of the regularity of meals. This study investigates meal patterns in older adults. Data from 1198 adults (52.8% female) aged between 65 and 75 years, who resided in Bremen, Germany, were included in this cross-sectional study. Using a self-administered questionnaire, daily meals were assessed and categorised into three meal pattern types: ‘regular eaters’ (eating at least three meals a day), ‘meal skippers’ (skipping one meal a day), and ‘irregular eaters’ (skipping more than one meal a day). Descriptive analyses were carried out, stratified by sex and meal pattern types. Most women and men were regular eaters (51.5% and 51.7%, respectively), 33.8% of women and 33.3% of men were meal skippers, and 14.7% of women and 15.0% of men were irregular eaters. Differences between meal patterns were seen with regard to socioeconomic status; self-rated health; body-mass index; hypertension; consumption of self-prepared meals; and consumption of whole-grain products, green vegetables, meat, and alcohol. The results provide first insights into possible associations between meal patterns and sociodemographic and health factors, and can benefit disease prevention and health promotion in older adults.

Association Between Na, K, and Lipid Intake in Each Meal and Blood Pressure

Cardiovascular diseases (CVDs) are one of the leading causes of death worldwide, and one of the most significant risk factors for CVDs is high blood pressure. Blood pressure is associated with various nutrients, such as sodium, potassium, and cholesterol. However, research focusing on the timing of intake of these nutrients and blood pressure has not been conducted. In this study, we used dietary data and a questionnaire asking about the sleep, physical activity, and blood pressure, collected from the food-log app “Asken” (total N = 2,402), to investigate the relationship between the dietary data of nutrient intake in the breakfast, lunch, and dinner and blood pressure. Daily total intake of various nutrients such as sodium, sodium-to-potassium ratio, total energy, lipid, carbohydrate, and saturated fat showed a significant association with blood pressure depending on the meal timing. From multiple regression analysis, eliminating the confounding factors, lunch sodium-to-potassium ratio, dinner energy, lipid, cholesterol, saturated fat, and alcohol intake were positively associated with blood pressure, whereas breakfast protein and lunch fiber intake showed a negative association with blood pressure. Our results suggest that nutrient intake timing is also an important factor in the prevention of high blood pressure. Our study provides possibilities to prevent hypertension by changing the timing of nutrient intake, especially sodium, together with potassium and lipids. However, because our research was limited to food-log app users, broader research regarding the general population needs to be conducted.

Joint temporal dietary and physical activity patterns: associations with health status indicators and chronic diseases

BACKGROUND

Diet and physical activity (PA) are independent risk factors for obesity and chronic diseases including type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). The temporal sequence of these exposures may be used to create patterns with relations to health status indicators.

OBJECTIVES

The objectives were to create clusters of joint temporal dietary and PA patterns (JTDPAPs) and to determine their association with health status indicators including BMI, waist circumference (WC), fasting plasma glucose, glycated hemoglobin, triglycerides, HDL cholesterol, total cholesterol, blood pressure, and disease status including obesity, T2DM, and MetS in US adults.

METHODS

A 24-h dietary recall and random day of accelerometer data of 1836 participants from the cross-sectional NHANES 2003-2006 data were used to create JTDPAP clusters by constrained dynamic time warping, coupled with a kernel k-means clustering algorithm. Multivariate regression models determined associations between the 4 JTDPAP clusters and health and disease status indicators, controlling for potential confounders and adjusting for multiple comparisons.

RESULTS

A JTDPAP cluster with proportionally equivalent energy consumed at 2 main eating occasions reaching ≤1600 and ≤2200 kcal from 11:00 to 13:00 and from 17:00 to 20:00, respectively, and the highest PA counts among 4 clusters from 08:00 to 20:00, was associated with significantly lower BMI (P < 0.0001), WC (P = 0.0001), total cholesterol (P = 0.02), and odds of obesity (OR: 0.2; 95% CI: 0.1, 0.5) than a JTDPAP cluster with proportionally equivalent energy consumed reaching ≤1600 and ≤1800 kcal from 11:00 to 14:00 and from 17:00 to 21:00, respectively, and high PA counts from 09:00 to 12:00.

CONCLUSIONS

The joint temporally patterned sequence of diet and PA can be used to cluster individuals with meaningful associations to BMI, WC, total cholesterol, and obesity. Temporal patterns hold promise for future development of lifestyle patterns that integrate additional temporal and contextual activities.

Joint association of meal frequency and diet quality with metabolic syndrome in Iranian adults

BACKGROUND

Metabolic syndrome (MetS) is a common complication that has been shown in various studies to be related to the frequency and timing of eating. We aimed to evaluate the relationship between meal timing and frequency with diet quality and prevalence of MetS.

STUDY DESIGN

Cross-sectional.

METHODS

We analyzed data from 850 adults (20 to 59 years) and divided the participants into different categories in terms of frequency of eating occasions (EO) (5 ≥ , 6-7 and 7 <), meal (2 ≥ and 3) and snack (2 ≥ , 3 and 4 ≤) in a day. Daily food consumption was assessed using the structured three 24-h recalls. The quality of diet we calculated using the food quality score (FQS). Metabolic syndrome was defined based on the guidelines of the national cholesterol education program adult treatment panel III (ATP III). The covariates-adjusted relationships between exposures and outcomes were investigated using a logistic regression test and two-way ANOVA.

RESULTS

The overall prevalence of MetS in participants was 34.2%. The average FQS was 28.0. Increased frequency of EOs and snacks was related to the higher prevalence of MetS ((OR, 1.72; 95% CI, 1.24, 2.37; P < 0.01) and (OR, 1.34; 95% CI, 1.07, 1.68; P, 0.01), respectively). The adjusted mean of FQS was not significantly different between the EO as well as meals and snack categories. The joint association of EO frequency and snack frequency with diet quality showed a higher chance of having MetS ( (OR, 2.36; 95% CI, 1.19, 4.66; P, 0.01 and (OR, 1.68; 95% CI, 1.06, 2.68; P,0.02), respectively). Also, we observed a higher mean of high density level cholesterol in people with the highest FQS and lowest EO frequency (P,0.02).

CONCLUSION

Our findings suggest that the EO and snack frequency may be associated with the higher chance of MetS. We also found when the frequency of EO increases, the beneficial associations of the diet quality were overshadowed. To confirm our findings, well designed randomised clinical trials are needed.

Sleep and circadian rhythms: pillars of health-a Keystone Symposia report

The human circadian system consists of the master clock in the suprachiasmatic nuclei of the hypothalamus as well as in peripheral molecular clocks located in organs throughout the body. This system plays a major role in the temporal organization of biological and physiological processes, such as body temperature, blood pressure, hormone secretion, gene expression, and immune functions, which all manifest consistent diurnal patterns. Many facets of modern life, such as work schedules, travel, and social activities, can lead to sleep/wake and eating schedules that are misaligned relative to the biological clock. This misalignment can disrupt and impair physiological and psychological parameters that may ultimately put people at higher risk for chronic diseases like cancer, cardiovascular disease, and other metabolic disorders. Understanding the mechanisms that regulate sleep circadian rhythms may ultimately lead to insights on behavioral interventions that can lower the risk of these diseases. On February 25, 2021, experts in sleep, circadian rhythms, and chronobiology met virtually for the Keystone eSymposium "Sleep & Circadian Rhythms: Pillars of Health" to discuss the latest research for understanding the bidirectional relationships between sleep, circadian rhythms, and health and disease.

Clock Time of First Eating Episode and Prospective Risk of All-Cause Mortality in US Adults

BACKGROUND

There is increasing recognition that a morning or evening preference is associated with time of eating, metabolic health, and morbidity. However, few studies have examined the association of time of eating with mortality.

OBJECTIVES

To examine the association of time of first recalled ingestive episode with the prospective risk of all-cause mortality.

METHODS

We used mortality-linked data from the NHANES conducted in 1988-1994 and 1999-2014 (n = 34,609; age ≥ 40 years). The exposure was quartiles (Q1-Q4) of clock time of first eating episode self-reported in the baseline 24-hour dietary recall. The outcome was follow-up time from the date of NHANES examination to the date of death or end of the follow-up period (31 December 2015). We used proportional hazards regression methods to determine the independent association of time of first eating episode with relative hazard of all-cause mortality, with adjustments for multiple covariates and the complex survey design. Multiple linear regression methods were used to examine the associations of time of first eating episode with baseline cardiometabolic biomarkers and dietary attributes.

RESULTS

In this national cohort, with a median age of ∼55 years (95% CI: 54.6-55.4 years) at baseline and a median follow-up of 8.3 years (IQR, 8.75 years), there were 10,303 deaths. The median times of first eating episodes in Q1-Q4 were 05:45, 07:00, 08:00, and 10:00, respectively. Covariate-adjusted relative hazards of mortality in Q1 to Q3 of the time of the first eating episode were 0.88 (95% CI: 0.81-0.96), 0.88 (95% CI: 0.81-0.95), 0.94 (95% CI: 0.87-1.02), with Q4 as the referent (P = 0.0008). Qualitative dietary attributes were inversely related with the time of the first eating episode; however, BMI and serum concentrations of glycemic biomarkers increased with later times of first eating episode (P ≤ 0.0001).

CONCLUSIONS

Recall of an earlier time of the first eating episode by ≥40-year-old US participants was suggestive of a small relative survival advantage in this observational study.

Trajectories of Energy Intake Distribution and Risk of Dyslipidemia: Findings from the China Health and Nutrition Survey (1991-2018)

Few studies have examined the secular trend of energy intake distribution. This study aims to describe trajectories of energy intake distribution and determine their association with dyslipidemia risk. Data of 2843 adult participants from the China Health and Nutrition Survey (CHNS) were analyzed. Trajectory groups of energy intake distribution were identified by multi-trajectory model over 27 years. Multilevel mixed-effects modified Poisson regression with robust estimation of variance was used to calculate risk ratio for incident dyslipidemia in a 9-year follow-up. Four trajectory groups were identified: "Energy evenly distributed group" (Group 1), "Lunch and dinner energy dominant group" (Group 2), "Dinner energy dominant group" (Group 3), "breakfast and dinner energy dominant group" (Group 4). Compared with Group 1, Group 3 was associated with higher risk of dyslipidemia (RR = 1.48, 95% CI = 1.26, 1.75), hypercholesterolemia (RR = 1.96, 95% CI = 1.37, 2.81) and high low-density lipoproteins cholesterols (LDL-C) (RR = 2.41, 95% CI = 1.82, 3.20). A U-shape was observed between cumulative average proportion of dinner energy and dyslipidemia risk (p for non-linear = 0.01), with stronger relationship at 40% and above. Energy intake distribution characterized by higher proportion of dinner energy, especially over 40% was associated with higher dyslipidemia risk in Chinese adults.

Meal Pattern Analysis in Nutritional Science: Recent Methods and Findings

There is a scarcity of dietary intake research focusing on the intake of whole meals rather than on the nutrients and foods of which those meals are composed. This growing area of research has recently begun to utilize advanced statistical techniques to manage the large number of variables and permutations associated with these complex meal patterns. The aim of this narrative review was to evaluate those techniques and the meal patterns they detect. The 10 observational studies identified used techniques such as principal components analysis, clustering, latent class analysis, and decision trees. They examined meal patterns under 3 categories: temporal patterns (relating to the timing and distribution of meals), content patterns (relating to combinations of foods within a meal and combinations of those meals over a day), and context patterns (relating to external elements of the meal, such as location, activities while eating, and the presence or absence of others). The most common temporal meal patterns were the 3 meals/d pattern, the skipped breakfast pattern, and a grazing pattern consisting of smaller but more frequent meals. The 3 meals/d pattern was associated with increased diet quality compared with the other 2 patterns. Studies identified between 7 and 12 content patterns with limited similarities between studies and no clear associations between the patterns and diet quality or health. One study simultaneously examined temporal and context meal patterns, finding limited associations with diet quality. No study simultaneously examined other combinations of meal patterns. Future research that further develops the statistical techniques required for meal pattern analysis is necessary to clarify the relations between meal patterns and diet quality and health.

Meal patterns and incident hypertension in community-dwelling middle-aged adults: an 11-year follow-up cohort study

OBJECTIVE

We aimed to examine whether meal patterns, as well as energy intake from three main meals and snacks, were associated with incident hypertension.

METHODS

We included 12 995 participants aged 18-59 years from the China Health and Nutrition Survey in the final analysis. Dietary intake was assessed using weighing methods in combination with 24-h food records. Cox proportional hazards regression models were used to examine the association of meal patterns, and energy intake from different meals with incident hypertension.

RESULTS

During a mean follow-up of 11.2 years, 4766 new hypertension cases were documented. Four meal patterns were derived according to energy intake: balanced, breakfast dominant, lunch dominant, and dinner dominant patterns. Dinner dominant meal pattern was associated with a lower risk of incident hypertension [hazard ratio (95% confidence interval): 0.90 (0.84-0.98)] compared with the balanced meal pattern. Breakfast energy intake was positively, but dinner energy intake was inversely associated with incident hypertension. The positive association between breakfast energy intake and incident hypertension was observed in rural residents only [1.22 (1.07-1.41) for rural residents, 0.98 (0.82-1.18) for urban residents; P interaction = 0.0348]. A positive association between energy intake from lunch and incident hypertension was observed in the urban residents only.

CONCLUSION

Dinner dominant meal pattern was associated with a lower risk of hypertension compared with the balanced meal pattern in Chinese adults. A relatively small breakfast and large dinner may help to prevent or delay the development of hypertension, especially in urban residents.

Aziz NS, Ambak R, Aris T. Is socio-demographic status, body mass index, and consumption of food away from home associated with high sodium intake among adults in Malaysia?: findings from the Malaysian Community Salt Survey (MyCoSS)

BACKGROUND

Studies have shown that having away from home meals contributes to high sodium intake among young people and those who lived in urban areas. This study aimed to determine the association between dietary sodium intake, body mass index, and away from home meal consumption behaviour among Malaysian adults.

METHODS

MyCoSS was a cross-sectional household survey involving 1440 adults age 18 years and above. This study utilized stratified cluster sampling to obtain a nationally representative sample. Data was collected between October 2017 and March 2018. Socio-demographic information, dietary assessment using food frequency questionnaire (FFQ), and away from home meal consumption were assessed through a face-to-face interview by trained health personnel. Descriptive analysis and logistic regression were applied to identify the association of socioeconomic status and away from home meal consumption with dietary sodium intake.

RESULTS

A total of 1032 participants completed the FFQ, with a mean age of 48.8 + 15.6 years. Based on the FFQ, slightly over half of the participants (52.1%) had high sodium intake. Results showed that 43.6% of participants consumed at least one to two away from home meals per day, while 20.8% of them had their three main meals away from home. Participants aged less than 30 years old were the strongest predictor to consume more sodium (adjusted OR: 3.83; 95%CI: 2.23, 6.58) while those of Indian ethnicity had significantly lower sodium intake. Surprisingly, having three away from home meals per day was not associated with high dietary sodium intake, although a significant association (crude OR; 1.67, 95% CI: 1.19, 2.35) was found in the simple logistic regression. Obese participants were less likely to have high dietary sodium intake compared with the normal BMI participants in the final model.

CONCLUSION

Over half of the participants consumed sodium more than the recommended daily intake, especially those who consumed three away from home meals. However, there was no significant association between high sodium intake and having three away from home meals per day. The promotion of healthy cooking methods among the public must continue to be emphasized to reduce the dietary sodium intake among Malaysian adults.

Dietary Diversity in Nepal: A Latent Class Approach

BACKGROUND

Nutritional status has important implications for labor productivity, lifetime earnings, and country-wide economic development. Dietary diversity is an important contributor to nutrition.

OBJECTIVE

To identify how patterns of food consumption are related to dietary diversity and to measure the potential for policy interventions to influence diet complexity.

METHODS

Household dietary diversity scores were constructed using data from 11 809 rural and urban households surveyed in Nepal between 2013 and 2016. Diversity scores were based on 7-day recall information on food purchases and food consumed directly from agricultural production. Reported consumption from 14 food groups was mapped into 4 distinct dietary patterns via latent class analysis. Ordered probit regressions were used to identify factors associated with observed diet patterns.

RESULTS

Diets are heterogeneous and map into 4 clusters along a continuum of complexity. Three identified diets are vegetarian and 1 is nonvegetarian. Diet complexity is associated with geography and socioeconomic features of the sample. On average, poor and agricultural households have less complex diets and households receiving remittances have more complex and higher quality diets. Road density is positively correlated with diet complexity. We find evidence of modest reductions in diet quality over the sample period.

CONCLUSIONS

Results confirm heterogeneous dietary behavior of Nepalese households. The identified patterns could be used to more effectively target policies directed at nutrition education or efforts to improve health by diversifying and improving the nutritional quality of household diets, for example, through supplemental feeding programs, home garden promotion, or targeted food assistance programs.

Association of Time-of-Day Energy Intake Patterns with Nutrient Intakes, Diet Quality, and Insulin Resistance

Evidence shows time-of-day of energy intake are associated with health outcomes; however, studies of time-of-day energy patterns and their health implication are still lacking in the Asian population. This study aims to examine the time-of-day energy intake pattern of Chinese adults and to examine its associations with nutrient intakes, diet quality, and insulin resistance. Dietary data from three 24-h recalls collected during the 2015 China Health and Nutrition Survey (CHNS) were analyzed (n = 8726, aged ≥ 18 years). Time-of-day energy intake patterns were determined by latent class analysis (LCA). General Linear Models and Multilevel Mixed-effects Logistic Regression Models were applied to investigate the associations between latent time-of-day energy intake patterns, energy-adjusted nutrient intakes, diet quality score, and insulin resistance. Three time-of-day energy intake patterns were identified. Participants in the “Evening dominant pattern” were younger, had higher proportions of alcohol drinkers and current smokers. The “Evening dominant pattern” was associated with higher daily energy intake and a higher percentage of energy from fat (%) (p < 0.001), as well as higher insulin resistance risk (OR = 1.21; 95% CI: 1.05, 1.40), after adjusting for multivariate covariates. The highest diet quality score was observed in participants with “Noon dominant pattern” (p < 0.001). A higher proportion of energy in the later of the day was associated with insulin resistance in free-living individuals.

Temporal Dietary Patterns Are Associated with Obesity in US Adults

BACKGROUND

The integration of time with dietary patterns throughout a day, or temporal dietary patterns (TDPs), have been linked with dietary quality but relations to health are unknown.

OBJECTIVE

The association between TDPs and selected health status indicators and obesity, type 2 diabetes (T2D), and metabolic syndrome (MetS) was determined.

METHODS

The first-day 24-h dietary recall from 1627 nonpregnant US adult participants aged 20-65 y from the NHANES 2003-2006 was used to determine timing, amount of energy intake, and sequence of eating occasions (EOs). Modified dynamic time warping (MDTW) and kernel k-means algorithm clustered participants into 4 groups representing distinct TDPs. Multivariate regression models determined associations between TDPs and health status, controlling for potential confounders, and adjusting for the survey design and multiple comparisons (P <0.05/6).

RESULTS

A cluster representing a TDP with evenly spaced, energy balanced EOs reaching ≤1200 kcal between 06:00 to 10:00, 12:00 to 15:00, and 18:00 to 22:00, had statistically significant and clinically meaningful lower mean BMI (P <0.0001), waist circumference (WC) (P <0.0001), and 75% lower odds of obesity compared with 3 other clusters representing patterns with much higher peaks of energy: 1000-2400 kcal between 15:00 and 18:00 (OR: 5.3; 95% CI: 2.8, 10.1), 800-2400 kcal between 11:00 and 15:00 (OR: 4.4; 95% CI: 2.5, 7.9), and 1000-2600 kcal between 18:00 and 23:00 (OR: 6.7; 95% CI: 3.9, 11.6).

CONCLUSIONS

Individuals with a TDP characterized by evenly spaced, energy balanced EOs had significantly lower mean BMI, WC, and odds of obesity compared with the other patterns with higher energy intake peaks at different times throughout the day, providing evidence that incorporating time with other aspects of a dietary pattern may be important to health status.

An eating pattern characterised by skipped or delayed breakfast is associated with mood disorders among an Australian adult cohort

BACKGROUND

Meal timing may influence food choices, neurobiology and psychological states. Our exploratory study examined if time-of-day eating patterns were associated with mood disorders among adults.

METHODS

During 2004-2006 (age 26-36 years) and 2009-2011 (follow-up, age 31-41 years), N = 1304 participants reported 24-h food and beverage intake. Time-of-day eating patterns were derived by principal components analysis. At follow-up, the Composite International Diagnostic Interview measured lifetime mood disorder. Log binomial and adjacent categories log-link regression were used to examine bidirectional associations between eating patterns and mood disorder. Covariates included sex, age, marital status, social support, education, work schedule, body mass index and smoking.

RESULTS

Three patterns were derived at each time-point: Grazing (intake spread across the day), Traditional (highest intakes reflected breakfast, lunch and dinner), and Late (skipped/delayed breakfast with higher evening intakes). Compared to those in the lowest third of the respective pattern at baseline and follow-up, during the 5-year follow-up, those in the highest third of the Late pattern at both time-points had a higher prevalence of mood disorder [prevalence ratio (PR) = 2.04; 95% confidence interval (CI) 1.20-3.48], and those in the highest third of the Traditional pattern at both time-points had a lower prevalence of first onset mood disorder (PR = 0.31; 95% CI 0.11-0.87). Participants who experienced a mood disorder during follow-up had a 1.07 higher relative risk of being in a higher Late pattern score category at follow-up than those without mood disorder (95% CI 1.00-1.14).

CONCLUSIONS

Non-traditional eating patterns, particularly skipped or delayed breakfast, may be associated with mood disorders.

Associations of Number of Daily Eating Occasions with Type 2 Diabetes Risk in the Women's Health Initiative Dietary Modification Trial

BACKGROUND

Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast consumption, time-restricted eating, and limiting daily eating occasions have been explored as behaviors for reducing T2D risk, but prior evidence is inconclusive.

OBJECTIVES

Our objectives were to examine associations between number of daily eating occasions and T2D risk in the Women's Health Initiative Dietary Modification Trial (WHI-DM) and whether associations vary by BMI, age, or race/ethnicity.

METHODS

Participants were postmenopausal women in the WHI-DM who comprised a 4.6% subsample completing 24-h dietary recalls (24HRs) at years 3 and 6 as part of trial adherence activities (n = 2159). Numbers of eating occasions per day were obtained from the year 3 24HRs, and participants were grouped into approximate tertiles as 1-3 (n = 795), 4 (n = 713), and ≥5 (n = 651) daily eating occasions as the exposure. Incident diabetes was self-reported on semiannual questionnaires as the outcome.

RESULTS

Approximately 15% (15.4%, n = 332) of the WHI-DM 24HR cohort reported incident diabetes at follow-up. Cox proportional hazards regression tested associations of eating occasions with T2D adjusted for neighborhood socioeconomic status, BMI, waist circumference, race/ethnicity, family history of T2D, recreational physical activity, Healthy Eating Index-2005, 24HR energy intake, and WHI-DM arm. Compared with women reporting 1-3 meals/d, those consuming 4 meals/d had a T2D HR = 1.38 (95% CI: 1.03, 1.84) without further increases in risk for ≥5 meals/d. In stratified analyses, associations for 4 meals/d compared with 1-3 meals/d were stronger in women with BMI <30.0 kg/m2 (HR = 1.55; 95% CI: 1.00, 2.39) and women aged ≥60 (HR = 1.61; 95% CI: 1.11, 2.33).

CONCLUSIONS

Four meals per day compared with 1-3 meals/d was associated with increased risk of T2D in postmenopausal women, but no dose-response effect was observed for additional eating occasions. Further studies are needed to understand eating occasions in relation to T2D risk.

Changes in food intake patterns during 2000-2007 and 2008-2016 in the population-based Northern Sweden Diet Database

Background

Food intake patterns provide a summary of dietary intake. Few studies have examined trends in food intake patterns over time in large, population-based studies. We examined food intake patterns and related sociodemographic and individual characteristics in the large Northern Sweden Diet Database during the two time windows 2000–2007 and 2008–2016.

Methods

In total, 100 507 participants (51% women) who had filled in a 64-item food frequency questionnaire and provided background and sociodemographic data between 2000 and 2016 were included. Food intake patterns were evaluated for women and men separately for the two time windows 2000–2007 and 2008–2016, respectively. Latent class analysis was used to identify distinct, latent clusters based on 40 food groups.

Results

Among both women and men, a greater proportion of participants were classified into food intake patterns characterized by high-fat spread and high-fat dairy during 2008–2016 compared to 2000–2007. In the earlier time window, these high-fat clusters were related to lower educational level and smoking. Simultaneously, the proportion of women and men classified into a cluster characterized by high intake of fruit, vegetables, and fibre decreased from the earlier to the later time window.

Conclusion

From a public health perspective, the increase in clusters with a high conditional mean for high-fat spread and high-fat dairy and decrease in clusters with a high conditional mean for fruit and vegetables, during the time period 2008–2016 compared to 2000–2007, is worrisome as it indicates a shift away from the recommended food habits. Subgroups of women and men with less healthy dietary patterns in the time window 2008–2016 with lower education, lower age, higher body mass index, lower levels of physical activity and more smoking were identified and future interventions may be targeted towards these groups.

Electronic supplementary material

The online version of this article (10.1186/s12937-019-0464-0) contains supplementary material, which is available to authorized users.