When, how much and what foods are eaten are related to total daily food intake

The association between breakfast frequency and diabetes incidence in middle-aged women: Results from the MTC study

BACKGROUND AND AIMS

Breakfast consumption could have a synchronizer role in chronobiological functions. Across observational studies, the assessment of breakfast frequency consumption is heterogeneous, therefore consensus on the relation between of weekly frequency of breakfast consumption and the risk of diabetes is unclear. We examined the relation between weekly breakfast frequency consumption and the incidence of diabetes in middle-age women.

METHODS AND RESULTS

Since baseline (2006-2008) we prospectively followed 71,373 women from the Mexican Teachers' Cohort. Participants were classified according to breakfast consumption frequency of 0, 1-3, 4-6, or 7 days/week. Diabetes was identified by self-report and clinical-administrative databases. We used Cox proportional hazards multivariable models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for breakfast frequency and diabetes adjusting for covariates. Stratified analyses were performed for age, birth weight, ethnicity, and physical activity. We identified 3613 new diabetes cases between baseline and 2014. The prevalence of daily breakfast consumers was 25%. The median follow-up was 2.2 years, interquartile range 1.8-3.8 years. Relative to women who skipped breakfast, those who consumed breakfast every day had a 12% lower risk of diabetes (multivariable HR = 0.88; 95% CI 0.78, 0.99; p-trend = 0.0018). One additional day per week of breakfast was associated with a lower risk of diabetes (HR = 0.98; 95% CI 0.97, 0.99). In stratified analysis, the observed inverse relation appeared to be stronger in women aged ≥40 years and in indigenous women.

CONCLUSIONS

Breakfast frequency was inversely associated with the incidence of diabetes independently of lifestyle factors. Regular breakfast consumption may be a potential component of diabetes prevention.

Distinct biophysiological effects of Ramadan fasting and traditional intermittent fasting on markers of body fat storage. A real-life study

BACKGROUND

Ramadan Intermittent fasting (RIF) exerts beneficial metabolic effects and improves gastrointestinal motility. However, a comparison between RIF and the traditional 16-hours intermittent fasting (16IF), a strategy for weight loss, is lacking.

METHODS

A total of 34 subjects (median age 32.5 years, range 18-63 years; median BMI 24.5 Kg m-1², range 18.6-37.6 Kg m-1²) were assigned to RIF (N = 18) or 16IF (N = 16) for 30 days. We measured variations in anthropometric measures (BMI, waist, and abdominal circumference), serum insulin, glucose, cortisol, non-esterified fatty acid (NEFA), body fat composition (bioelectrical impedance analysis), and the ultrasonographic measurements of liver steatosis (Hepatorenal index, HRI) and thickness of subcutaneous (SAT) and visceral (VAT) fats.

RESULTS

At baseline, BMI, rates of liver steatosis and distribution of normal weight, overweight, and obese subjects were comparable between the two groups. Body weight significantly decreased at the end of fasting in both RIF (-4.2 % vs baseline, P = 0.002) and 16IF (-2.1 % vs baseline, P = 0.002). Waist and abdominal circumferences significantly decreased only in RIF as well as the amount of body fat. In subjects with liver steatosis, SAT and VAT significantly decreased following RIF, but not 16h-IF, as well as the ultrasonographic HRI.

CONCLUSION

Both 16IF and RIF are able, during 1-month, to reduce body weight. However, RIF but not 16IF also generates marked beneficial effects in terms of reduced subcutaneous fat and liver steatosis. Further studies urge to verify the effects of different models of IF in weight-cycling and long-term management of obesity and related dysmetabolic conditions, such as ectopic fat over-storage.

Association of variabilities in body mass index and waist circumference with newly achieved remission of metabolic dysfunction-associated fatty liver disease

AIMS

Although body weight reduction is recommended to ameliorate nonalcoholic fatty liver disease, the effects of body mass index (BMI) and waist circumference (WC) variability on newly achieved remission of metabolic dysfunction-associated fatty liver disease (MAFLD) remain unclear. We aimed to investigate the longitudinal association between BMI and WC variabilities and newly achieved MAFLD remission in both sexes.

METHODS

Among 26,952 patients, 1823 with MAFLD diagnosed by ultrasonography and with >2 health checkups over >2 years from April 2014 to March 2021 were included in this observational cohort study. A generalized estimation equation model analyzed the association between BMI and WC and newly achieved MAFLD remission according to repeated measures at baseline and the most recent stage.

RESULTS

Rates of MAFLD remission in male and female patients were 7.4 % and 6.0 %, respectively. Regarding decreased BMI variability, newly achieved MAFLD remission prevalence among the subgroups differed significantly between sexes (p < 0.001). In male patients, a decrease in BMI variability of ≥1.5 kg/m2 and WC variability of ≥4.2 cm had adjusted odds ratios (ORs) of 5.215 and 2.820, respectively, for newly achieved MAFLD remission. Among female patients, regular exercise and breakfast consumption were accelerating factors for newly achieved MAFLD remission. Non-invasive liver fibrosis scores significantly differed between MAFLD and newly achieved MAFLD remission, including in the subgroups (p < 0.01 and p < 0.001, respectively).

CONCLUSIONS

Reducing BMI and WC variabilities in male patients and improving lifestyle habits in female patients may accelerate MAFLD remission.

Timing of energy intake and the therapeutic potential of intermittent fasting and time-restricted eating in NAFLD

Non-alcoholic fatty liver disease (NAFLD) represents a major public health concern and is associated with a substantial global burden of liver-related and cardiovascular-related morbidity and mortality. High total energy intake coupled with unhealthy consumption of ultra-processed foods and saturated fats have long been regarded as major dietary drivers of NAFLD. However, there is an accumulating body of evidence demonstrating that the timing of energy intake across a the day is also an important determinant of individual risk for NAFLD and associated metabolic conditions. This review summarises the available observational and epidemiological data describing associations between eating patterns and metabolic disease, including the negative effects of irregular meal patterns, skipping breakfast and night-time eating on liver health. We suggest that that these harmful behaviours deserve greater consideration in the risk stratification and management of patients with NAFLD particularly in a 24-hour society with continuous availability of food and with up to 20% of the population now engaged in shiftwork with mistimed eating patterns. We also draw on studies reporting the liver-specific impact of Ramadan, which represents a unique real-world opportunity to explore the physiological impact of fasting. By highlighting data from preclinical and pilot human studies, we present a further biological rationale for manipulating timing of energy intake to improve metabolic health and discuss how this may be mediated through restoration of natural circadian rhythms. Lastly, we comprehensively review the landscape of human trials of intermittent fasting and time-restricted eating in metabolic disease and offer a look to the future about how these dietary strategies may benefit patients with NAFLD and non-alcoholic steatohepatitis.

Breakfast Size and Prevalence of Metabolic Syndrome in the European Prospective Investigation into Cancer and Nutrition (EPIC) Spanish Cohort

BACKGROUND

Recent evidence suggest that energy distribution during the daytimecould be a potential determinant for the development of metabolic syndrome (MetS).

OBJECTIVE

To cross-sectionally assess the association between breakfast size and the prevalence of MetS in Spanish adults.

METHODS

Our study included a subset of 3644 participants from the European Prospective Investigation into Cancer and Nutrition Spain study recontacted between 2017-2018. Information on diet, sociodemographic, lifestyle, sleep quality, and chronotype was collected using standardized questionnaires, while anthropometric and blood pressure data were measured in a face-to-face personal interview by a nurse. MetS was defined according to the Adult Treatment Panel III (ATPIII) definition by measuring serum levels of total cholesterol, tryglycerides and glucose. Breakfast size was calculated as: (energy from breakfast/total energy intake) * 2000 kcal. To evaluate the association between breakfast size and MetS prevalence, a multivariable logistic regression model adjusted by potential confounders was used to estimate OR and 95% CI.

RESULTS

Prevalence of MetS in our study was 40.7%. The mean breakfast size was 306.6 * 2000 kcal (15% of the total daily energy intake), with 14 (0.4%) participants skipping breakfast. Participants in the highest quartile of breakfast size had a lower MetS prevalence compared to participants in the lowest quartile (OR_Q4vsQ1 = 0.62; 95% CI = 0.51-0.76; p-trend < 0.001). No modification of the estimated ORs by sex, breakfast time, and number of eating occasions per day were observed.

CONCLUSION

Our results suggest that higher breakfast size is associated with lower prevalence of MetS in Spanish adults, supporting the importance of a high energy breakfast. Further prospective studies are necessary to confirm these findings.

Dietary intakes and daily distribution patterns of macronutrients in youth soccer players

Introduction

There has been an abundance of dietary analysis research conducted on adult male soccer players, while studies on youth players are lacking. Furthermore, the daily distribution of energy and macronutrient intake throughout the day has been reported to influence training adaptations, but this is often not considered in the literature. This study aims to quantify daily energy and macronutrient intake and assess their distribution over 5 days, and compare daily energy intakes and predicted daily energy expenditure in under-16 male soccer players.

Methods

The sample included 25 soccer participants aged 14.8-15.7 years. Five-day self-reported food diaries were used to record the food/drink consumption. Intake was analyzed for total daily energy, macronutrient intakes, and distribution among meals (breakfast, lunch, dinner, and snacks). Daily energy expenditure was predicted by resting energy expenditure and physical activity levels developed for youth sports participants.

Results

The mean total energy intake was 1,928 ± 388 kcal∙day^-1, whereas the estimated daily energy expenditure was 3,568 kcal∙day^-1. Relative daily protein intakes were lower at breakfast, morning snack, afternoon snack, and night snack compared to lunch and dinner.

Discussion

Youth soccer players do not appear to meet energy requirements and daily CHO guidelines. Fluctuations in protein intake throughout the day were noted and may influence training adaptations (i.e., muscle protein synthesis and recovery).

Association of breakfast consumption frequency with fasting glucose and insulin sensitivity/b cells function (HOMA-IR) in adults from high-risk families for type 2 diabetes in Europe: the Feel4Diabetes Study

PURPOSE

This study aimed to investigate the association of breakfast consumption frequency (BCF) with glycemic control indices in a cross-sectional sample of adults from families at high risk for type 2 diabetes mellitus (T2DM), exploring the role of sex and socioeconomic status (SES).

METHODS

In 2370 adults (40.8 ± 5.6 years) from 6 European countries, sociodemographic, lifestyle, anthropometric and biochemical characteristics were assessed through standardized procedures. Multivariable regression models were used to examine the association between fasting glucose (FG), fasting insulin (FI), and insulin resistance (HOMA-IR) (dependent variables) with BCF (independent variable) controlling for multiple possible confounders.

RESULTS

A linear association of BCF with FG (β = -0.557, 95% CI (-0.834, -0.280)) and a quadratic association with FI and HOMA-IR with the highest point of curve observed at BCF = 2.989 (times/week) and at BCF = 2.746, respectively, independent of the used covariates. In males and in participants of high SES, BCF was linearly and inversely associated with FG, while with FI and HOMA-IR there was an association with BCF in quadratic function. In females, BCF was linearly and inversely associated with FG and HOMA-IR, and there was a quadratic association with FI. In low SES there was only a linear association with FG, yet with no statistically significant findings for FI and HOMA-IR.

CONCLUSIONS

Regular breakfast consumption, especially >3 times/week is associated with improved indices of glycemic control. This association was diminished in low SES participants in the presence of the used covariates.

Impact of the Intake of Snacks and Lifestyle Behaviors on Obesity among University Students Living in Jeddah, Saudi Arabia

Unhealthy eating habits increase the risk of obesity. This study investigated the association between obesity and the intake of snacks and lifestyle behaviors among university students in Saudi Arabia. The study included 662 students aged 18–29 years, studying at King Abdulaziz University. An online survey collected data on sociodemographic characteristics, height, and weight, to calculate body mass index (BMI), lifestyle behaviors, dietary habits, and snack intake. The prevalence of overweight and obese students was 18.6% and 12.7%, respectively. Sociodemographic characteristics and lifestyle behaviors had insignificant effects on obesity. Obese students consumed two meals daily and more cereals during breakfast. Non-obese students consumed more beverages at breakfast and had their daily meals with their families. The frequency of intake of snacks had an insignificant effect on obesity. However, obese students had a significantly higher intake of potato chips, popcorn, and biscuits, while non-obese students had a significantly higher intake of salads compared with obese students. Students consumed significantly less fruit and vegetables, chocolate, biscuits, nuts, and dairy products as snacks when inside the university compared to outside. To reduce obesity among students, universities should ensure access to healthy snacks, and provide health education programs to encourage healthy eating habits and lifestyles.

Examination of Sleep and Obesity in Children and Adolescents in the United States

PURPOSE

This study contributes to the growing literature on the association between sleep and obesity by examining the associations between hours of sleep, consistency of bedtime, and obesity among children in the US.

DESIGN

Analysis of a nationally representative sample of non-institutionalized children from the 2016-17 National Survey of Children's Health.

SETTING

US, national.

SUBJECTS

Children ages 10-17 years (n = 34,640).

MEASURES

Parent reported weeknight average hours of sleep and consistency of bedtime. Body mass index classified as underweight, normal, overweight or obesity using parent-reported child height and weight information, classified using CDC BMI-for-Age Growth Charts.

ANALYSIS

Multivariate logistic regression models were used to estimate associations between measures of sleep and body mass index weight category adjusting for individual, household and neighborhood characteristics.

RESULTS

An additional hour of sleep was associated with 10.8% lower odds of obesity, net of consistency in bedtime. After controlling for sleep duration, children who usually went to bed at the same time on weeknights had lower odds of obesity (24.8%) relative to children who always went to bed at the same time.

CONCLUSION

Sleep duration is predictive of lower odds of obesity in US children and adolescents. Some variability in weeknight bedtime is associated with lower odds of obesity, though there were no additional benefits to extensive variability in bedtime.

The impact of circadian timing on energy balance: an extension of the energy balance model

A significant proportion of the population is classified as having overweight or obesity. One framework which has attempted to explain biobehavioral mechanisms influencing the development of overweight and obesity is the energy balance model. According to this model, the body continually attempts to balance energy intake with energy expenditure. When energy intake and energy expenditure become imbalanced, there is an increase in homeostatic and allostatic pressure, generally to either increase energy intake or decrease energy expenditure, so as to restore energy homeostasis.Recent research has indicated that circadian aspects of energy intake and energy expenditure may influence energy balance. This paper provides a narrative review of existing evidence of the role of circadian timing on components of energy balance. Research on the timing of food intake, physical activity, and sleep indicates that unhealthy timing is likely to increase risk of weight gain. Public health guidelines focus on how much individuals eat and sleep, what foods are consumed, and the type and frequency of exercise, but the field of circadian science has begun to demonstrate that when these behaviors occur may also influence overweight and obesity prevention and treatment efforts.

Association between Breakfast Skipping and Body Weight-A Systematic Review and Meta-Analysis of Observational Longitudinal Studies

Globally, increasing rates of obesity are one of the most important health issues. The association between breakfast skipping and body weight is contradictory between cross-sectional and interventional studies. This systematic review and meta-analysis aims to summarize this association based on observational longitudinal studies. We included prospective studies on breakfast skipping and overweight/obesity or weight change in adults. The literature was searched until September 2020 in PubMed and Web of Science. Summary risk ratios (RRs) or β coefficients with a 95% confidence interval (CI), respectively, were estimated in pairwise meta-analyses by applying a random-effects model. In total, nine studies were included in the systematic review and three of them were included in the meta-analyses. The meta-analyses indicated an 11% increased RR for overweight/obesity when breakfast was skipped on ≥3 days per week compared to ≤2 days per week (95% CI: 1.04, 1.19, n = two studies). The meta-analysis on body mass index (BMI) change displayed no difference between breakfast skipping and eating (β = −0.02; 95% CI: −0.05, 0.01; n = two studies). This study provides minimal evidence that breakfast skipping might lead to weight gain and the onset of overweight and obesity.

Binge Eating and Binge Drinking: A Two-Way Road? An Integrative Review

Unhealthy diet and alcohol are serious health problems, especially in adolescents and young adults. "Binge" is defined as the excessive and uncontrolled consumption of food (binge eating) and alcohol (binge drinking). Both behaviors are frequent among young people and have a highly negative impact on health and quality of life. Several studies have explored the causes and risk factors of both behaviors, and the evidence concludes that there is a relationship between the two behaviors. In addition, some research postulates that binge eating is a precipitating factor in the onset and escalation of excessive alcohol consumption, while other studies suggest that alcohol consumption leads to excessive and uncontrollable food consumption. Given that no review has yet been published regarding the directionality between the two behaviors, we have set out to provide an upto- date overview of binge eating and binge drinking problems, analyzing their commonalities and differences, and their uni- and bidirectional associations. In addition, we explore the reasons why young people tend to engage in both behaviors and consider directions for future research and clinical implications.

Morning resolutions, evening disillusions: Theories of willpower affect how health behaviours change across the day

People may be more or less vulnerable to changes in self-control across the day, depending on whether they believe willpower is more or less limited. Limited willpower beliefs might be associated with steeper decreases in self-control across the day, which may result in less goal-consistent behaviour by the evening. Community members with health goals (Sample 1; N = 160; 1814 observations) and students (Sample 2; N = 162; 10,581 observations) completed five surveys per day for one to three weeks, reporting on their recent physical activity, snacking, subjective state, and health intentions. In both samples, more limited willpower beliefs were associated with less low- and moderate-intensity physical activity, particularly later in the day. Limited willpower beliefs were also associated with more snacking in the evenings (Sample 1) or overall (Sample 2). These behavioural patterns were mediated by differential changes in self-efficacy and intentions across the course of the day (in Sample 1), and the above patterns of low- and moderate-physical intensity held after controlling for related individual differences, including trait self-control and chronotype (in Sample 2). Overall, more limited willpower theories were associated with decreasing goal-consistent behaviour as the day progressed, alongside decreasing self-efficacy and weakening health-goal intentions.

Eating Timing: Associations with Dietary Intake and Metabolic Health

BACKGROUND

Emerging research indicates that eating timing may influence dietary intake and metabolic health. However, studies to date have not examined the association of multiple measures of eating timing with both dietary intake and metabolic health in adults with overweight and obesity.

OBJECTIVE

To examine the association of multiple measures of eating timing with dietary intake (ie, dietary composition, diet quality, and eating frequency) and metabolic health (ie, body composition and cardiometabolic risk).

DESIGN

This is a cross-sectional analysis of baseline data from a weight loss and maintenance intervention collected from May 2015 to January 2018.

PARTICIPANTS/SETTING

Participants were women with overweight or obesity who were dependents of active duty and retired military personnel (N = 229; mean ± standard error, BMI = 34.7 ± 0.4 kg/m², age = 40.9 ± 0.7 years). The study was conducted at military installations in Massachusetts, Connecticut, New York, Colorado, and Kentucky.

MAIN OUTCOME MEASURES

Eating timing variables examined included daily eating interval (time between first and last eating occasion), time-restricted eating (≤11 hours daily eating interval), early energy eaters (eating ≥60% of energy during the first half of time awake), and bedtime eaters (eating within 2 hours of bedtime).

STATISTICAL ANALYSIS

The main analysis was limited to those reporting plausible energy intake (64% of total sample [n = 146]). Linear, quantile, or logistic regression models were used to determine the association of eating timing with measures of dietary intake and metabolic health.

RESULTS

In individuals reporting plausible energy intake, each additional 1 hour in daily eating interval was associated with 53 kcal higher energy intake, higher glycemic load, eating frequency, and waist circumference (P < 0.05 for all). Significant associations were observed for: time-restricted eating and a lower energy intake, glycemic load, and eating frequency; early energy eating and higher carbohydrate intake; bedtime eating and a higher energy intake, glycemic load, and eating frequency.

CONCLUSIONS

These findings lend support for the mechanistic targeting of eating timing in behavioral interventions aimed at improving dietary intake and body composition.

Dietary Protein Intake and Determinants in Māori and Non-Māori Octogenarians. Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu: Life and Living in Advanced Age: A Cohort Study in New Zealand

Protein intake, food sources and distribution are important in preventing age-related loss of muscle mass and strength. The prevalence and determinants of low protein intake, food sources and mealtime distribution were examined in 214 Māori and 360 non-Māori of advanced age using two 24 h multiple pass recalls. The contribution of food groups to protein intake was assessed. Low protein intake was defined as ≤0.75 g/kg for women and ≤0.86 g/kg for men. A logistic regression model was built to explore predictors of low protein intake. A third of both women (30.9%) and men (33.3%) had a low protein intake. The main food group sources were beef/veal, fish/seafood, milk, bread though they differed by gender and ethnicity. For women and men respectively protein intake (g/meal) was lowest at breakfast (10.1 and 13.0), followed by lunch (14.5 and 17.8) and dinner (23.3 and 34.2). Being a woman (p = 0.003) and having depressive symptoms (p = 0.029) were associated with consuming less protein. In adjusted models the odds of adequate protein intake were higher in participants with their own teeth or partial dentures (p = 0.036). Findings highlight the prevalence of low protein intake, uneven mealtime protein distribution and importance of dentition for adequate protein intake among adults in advanced age.

Randomised clinical trial: the effectiveness of Gaviscon Advance vs non-alginate antacid in suppression of acid pocket and post-prandial reflux in obese individuals after late-night supper

BACKGROUND

Late-night supper increases the risk of postprandial reflux from the acid pocket especially in obesity. An alginate-based, raft-forming medication may be useful for obese patients with GERD.

AIMS

To compare the efficacy of Gaviscon Advance (Reckitt Benckiser, UK) and a non-alginate antacid in post-supper suppression of the acid pocket and post-prandial reflux among obese participants.

METHODS

Participants underwent 48 h wireless and probe-based pH-metry recording of the acid pocket and lower oesophagus, respectively, and were randomised to single post-supper (10 pm) dose of either Gaviscon Advance or a non-alginate antacid on the second night. Primary outcomes were suppression of median pH of acid pocket and lower oesophagus, measured every 10-minutes post-supper for 1 h. Secondary outcomes were suppression of % time pH < 4 at lower oesophagus and improvement in frequency and visual analogue score (VAS) of regurgitation.

RESULTS

Of the 81 screened participants, 55 were excluded and 26 (mean age 33.5 years, males 77.8% and BMI 32.8 kg/m² ) were randomised to Gaviscon Advance (n = 13) or antacid (n = 13). Median pH of the acid pocket but not the lower oesophagus was suppressed with Gaviscon Advance vs antacid (all P < 0.04) Gaviscon Advance but not antacid significantly reduced in % time pH < 4, symptom frequency and VAS on day 2 vs day 1 (all P < 0.05).

CONCLUSIONS

Among obese individuals, Gaviscon Advance was superior to a non-alginate antacid in post-supper suppression of the acid pocket. (Clinical trial registration unique identifier: NCT03516188).

Poor sleep and adolescent obesity risk: a narrative review of potential mechanisms

Poor sleep is related to increased obesity risk in adolescents, though the mechanisms of this relationship are unclear. This paper presents a conceptual framework of the various pathways that have been proposed to drive this relationship. In this framework, increased food reward, emotional reactivity, decreased inhibitory control, metabolic disturbances, poorer dietary quality, and disrupted meal timings may increase the likelihood of increasing overall energy intake. This paper further notes how poor sleep increases sedentary behavior and screen time, which likely limits overall energy expenditure. The model posits that these mechanisms result in an imbalance of energy intake and expenditure following poor sleep, intensifying the overall risk for obesity. Increases in food reward processes, decreases in insulin sensitivity, disrupted meal timing, and increases in sedentary behavior seem to be the most compelling mechanisms linking poor sleep with increased obesity risk in adolescents. Future directions and clinical implications of this framework are discussed.

The effects of exercise session timing on weight loss and components of energy balance: midwest exercise trial 2

Background/objectives

Circadian physiology has been linked to body weight regulation and obesity. To date, few studies have assessed the association between exercise timing and weight related outcomes. The aim of this secondary analysis was to explore the impact of exercise timing (i.e., 24 h clock time of exercise session) on weight loss and components of energy balance.

Subjects/methods

Overweight/obese (BMI 25.0–39.9 kg/m²), physically inactive, young adults (~51% female) completed a 10-month supervised exercise program (400 or 600 kcal/session for 5 days/week) or served as non-exercise controls (CON). Participants were categorized based on the time of day in which they completed exercise sessions (Early-Ex: >50% of sessions completed between 7:00 and 11:59 am; (n = 21), Late-Ex: >50% of sessions completed between 3:00 and 7:00 pm; (n = 25), Sporadic-Ex: <50% of sessions completed in any time category; (n = 24), and CON; (n = 18)). Body weight, energy intake (EI; digital photography), and non-exercise physical activity (NEPA; accelerometer) were assessed at baseline, 3.5, 7, and 10 months. Total daily energy expenditure (TDEE; doubly labeled water), was assessed at baseline and 10 months.

Results

At month 10, weight loss was significantly greater in both Early-EX (−7.2 ± 1.2%; p < 0.001) and Sporadic-EX (− 5.5 ± 1.2%; p = 0.01) vs CON (+0.5 ± 1.0%), and Early-EX vs Late-EX (−2.1 ± 1.0%; p < 0.001). There were no between group differences for change in TDEE, EI, and non-exercise energy expenditure (P > 0.05). A significant group × time interaction (p = 0.02) was observed for NEPA (counts/min), however, after adjusting for multiple comparisons, group effects were no longer significant.

Conclusions

Despite minimal differences in components of energy balance, Early-EX lost significantly more weight compared with Late-Ex. Although the mechanisms are unclear, the timing of exercise may be important for body weight regulation.

Appetite and Protein Intake Strata of Older Adults in the European Union: Socio-Demographic and Health Characteristics, Diet-Related and Physical Activity Behaviours

Considerable efforts have been directed towards stimulating healthy ageing regarding protein intake and malnutrition, yet large-scale consumer studies are scarce and fragmented. This study aims to profile older adults in the European Union (EU) according to appetite (poor/good) and protein intake (lower/higher) strata, and to identify dietary and physical activity behaviours. A survey with older (aged 65 years or above) adults (n = 1825) in five EU countries (Netherlands, United Kingdom, Finland, Spain and Poland) was conducted in June 2017. Four appetite and protein intake strata were identified based on simplified nutritional appetite questionnaire (SNAQ) scores (≤14 versus >14) and the probability of a protein intake below 1.0 g/kg adjusted BW/day (≥0.3 versus <0.3) based on the 14-item Pro55+ screener: "appi"-Poor appetite and lower level of protein intake (12.2%); "APpi"-Good appetite but lower level of protein intake (25.5%); "apPI"-Poor appetite but higher level of protein intake (14.8%); and "APPI"-Good appetite and higher level of protein intake (47.5%). The stratum of older adults with a poor appetite and lower level of protein intake (12.2%) is characterized by a larger share of people aged 70 years or above, living in the UK or Finland, having an education below tertiary level, who reported some or severe financial difficulties, having less knowledge about dietary protein and being fussier about food. This stratum also tends to have a higher risk of malnutrition in general, oral-health related problems, experience more difficulties in mobility and meal preparation, lower confidence in their ability to engage in physical activities in difficult situations, and a lower readiness to follow dietary advice. Two multivariate linear regression models were used to identify the behavioural determinants that might explain the probability of lower protein intake, stratified by appetite status. This study provides an overview and highlights the similarities and differences in the strata profiles. Recommendations for optimal dietary and physical activity strategies to prevent protein malnutrition were derived, discussed and tailored according to older adults' profiles.

Effect of breakfast on weight and energy intake: systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To examine the effect of regular breakfast consumption on weight change and energy intake in people living in high income countries.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Ovid Medline, and CINAHL were searched for randomised controlled trials published between January 1990 and January 2018 investigating the effect of breakfast on weight or energy intake. ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform search portal were also searched in October 2018 to identify any registered yet unpublished or ongoing trials.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials from high income countries in adults comparing breakfast consumption with no breakfast consumption that included a measure of body weight or energy intake. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Random effects meta-analyses of the effect of breakfast consumption on weight and daily energy intake were performed.

RESULTS

Of 13 included trials, seven examined the effect of eating breakfast on weight change, and 10 examined the effect on energy intake. Meta-analysis of the results found a small difference in weight favouring participants who skipped breakfast (mean difference 0.44 kg, 95% confidence interval 0.07 to 0.82), but there was some inconsistency across trial results (I²=43%). Participants assigned to breakfast had a higher total daily energy intake than those assigned to skip breakfast (mean difference 259.79 kcal/day, 78.87 to 440.71; 1 kcal=4.18 kJ), despite substantial inconsistency across trial results (I²=80%). All of the included trials were at high or unclear risk of bias in at least one domain and had only short term follow-ups (mean period seven weeks for weight, two weeks for energy intake). As the quality of the included studies was mostly low, the findings should be interpreted with caution.

CONCLUSION

This study suggests that the addition of breakfast might not be a good strategy for weight loss, regardless of established breakfast habit. Caution is needed when recommending breakfast for weight loss in adults, as it could have the opposite effect. Further randomised controlled trials of high quality are needed to examine the role of breakfast eating in the approach to weight management.

STUDY REGISTRATION

PROSPERO registration number CRD42017057687.

Prevalence and determinants of low protein intake in very old adults: insights from the Newcastle 85+ Study

PURPOSE

The very old (aged ≥ 85 years), fastest growing age group in most western societies, are at especially high risk of muscle mass and strength loss. The amount, sources and timing of protein intake may play important roles in the aetiology and management of sarcopenia. This study investigated the prevalence and determinants of low protein intake in 722 very old adults participating in the Newcastle 85+ Study.

METHODS

Protein intake was estimated with 2 × 24-h multiple pass recalls (24 h-MPR) and contribution (%) of food groups to protein intake was calculated. Low protein intake was defined as intake < 0.8 g of protein per adjusted body weight per day. A backward stepwise multivariate linear regression model was used to explore socioeconomic, health and lifestyle predictors of protein intake.

RESULTS

Twenty-eight percent (n = 199) of the community-living very old in the Newcastle 85+ Study had low protein intake. Low protein intake was less likely when participants had a higher percent contribution of meat and meat products to total protein intake (OR 0.97, 95% CI 0.95, 1.00) but more likely with a higher percent contribution of cereal and cereal products and non-alcoholic beverages. Morning eating occasions contributed more to total protein intake in the low than in the adequate protein intake group (p < 0.001). Being a woman (p < 0.001), having higher energy intake (p < 0.001) and higher tooth count (p = 0.047) was associated with higher protein intake in adjusted models.

CONCLUSION

This study provides novel evidence on the prevalence of low protein intake, diurnal protein intake patterns and food group contributors to protein intake in the very old.

Time-related eating patterns and chronotype are associated with diet quality in pregnant women

Animal studies strongly suggest that timed feeding can have beneficial physiological effects, including protection against the obesogenic and metabolic consequences of a high-fat diet. However, the relationship between variables related to the timing of eating and diet quality in pregnancy women, which is considered as a period of nutritional vulnerability, is still poorly described in the literature. Therefore, the aim of the present study was to investigate the associations between time-related eating patterns and chronotype with diet quality of pregnant women. This cross-sectional study was conducted with 100 pregnant women in the first gestational trimester (≤12 weeks of gestation). The information regarding food intake was obtained by three 24-Hour Dietary Recall (24HR). Time-related eating patterns, i.e., the interval between the first and the last meal (eating duration), nightly fasting, time of the first and last meals, and number of meals eating on a day were determined. Chronotype was derived using the mid-sleep time on free days on weekends, with a further correction for calculated sleep debt. Diet quality was evaluated using the Brazilian Healthy Eating Index-Revised (BHEI-R), validated for the Brazilian population. Linear regression modeling analyses adjusted for confounders were used to investigate the association between time-related eating patterns and chronotype with diet quality. The BHEI-R total score was negatively associated with time of the first meal (β =  -0.355; p = 0.002; r² adjusted = 0.141), and positively associated with eating duration (β = 0.262; p = 0.024; r² adjusted = 0.086) and number of meals (β = 0.273; p = 0.019; r² adjusted = 0.091). In addition, the score of total fruit component was negatively associated with chronotype (β = -0.236; p = 0.033; r² adjusted = 0.078), time of the first meal (β = -0.393; p = 0.001; r² adjusted = 0.171), and positively associated with eating duration (β = 0.259; p = 0.022; r² adjusted = 0.087) and number of meals (β = 0.376; p = 0.001; r² adjusted = 0.159). The score for whole fruit component was negatively associated with time of the first meal (β = -0.388; p = 0.001; r² adjusted = 0.152), and positively associated with number of meals (β = 0.403; p = 0.001; r² adjusted = 0.164). A longer eating duration, earlier time of the first meal, higher number of meals and morningness tendency are associated with a better diet quality in the first gestational trimester - higher scores of the total BHEI-R and/or fruit components. We suggest that nutritional guidelines should consider time-related eating patterns and chronotype to ensure good diet quality of pregnant women since the beginning of gestation, contributing on prevention of metabolic-nutritional complications.

Identifying usual food choices at meals in overweight and obese study volunteers: implications for dietary advice

Understanding food choices made for meals in overweight and obese individuals may aid strategies for weight loss tailored to their eating habits. However, limited studies have explored food choices at meal occasions. The aim of this study was to identify the usual food choices for meals of overweight and obese volunteers for a weight-loss trial. A cross-sectional analysis was performed using screening diet history data from a 12-month weight-loss trial (the HealthTrack study). A descriptive data mining tool, the Apriori algorithm of association rules, was applied to identify food choices at meal occasions using a nested hierarchical food group classification system. Overall, 432 breakfasts, 428 lunches, 432 dinners and 433 others (meals) were identified from the intake data (n 433 participants). A total of 142 items of closely related food clusters were identified at three food group levels. At the first sub-food group level, bread emerged as central to food combinations at lunch, but unprocessed meat appeared for this at dinner. The dinner meal was characterised by more varieties of vegetables and of foods in general. The definitions of food groups played a pivotal role in identifying food choice patterns at main meals. Given the large number of foods available, having an understanding of eating patterns in which key foods drive overall meal content can help translate and develop novel dietary strategies for weight loss at the individual level.

A Clear Difference Emerges in Hormone Patterns Following a Standard Midday Meal in Young Women Who Regularly Eat or Skip Breakfast

BACKGROUND

Multiple hormones are involved in the regulation of food intake and glucose metabolism. Past intervention studies showed a benefit of eating breakfast on satiety, but this was possibly confounded by the disruption of habitual meal patterns.

OBJECTIVE

The objective of this study was to compare hormonal responses, including insulin, leptin, glucagon-like peptide-1, ghrelin, peptide YY (PYY3-36), and cholecystokinin (CCK), between habitual breakfast eaters (Br-Es) and habitual skippers (Br-Ss) to a standard midday meal.

METHODS

Thirty-two women [mean ± SD age: 22.6 ± 3.3 y; body mass index (in kg/m2): 21.8 ± 2.0] participated in a cross-sectional study that consisted of a 3-h test protocol that included a standard test meal served at 1230 with pre- and postmeal blood sampling. The protocol required that Br-Es eat a typical breakfast between 0700 and 1000, whereas Br-Ss had no breakfast meal and had fasted for 12 h. Blood was drawn 35 and 5 min prelunch and 5, 20, 35, 50, and 110 min postlunch.

RESULTS

Repeated-measures ANOVA revealed a group difference for PYY3-36 (P = 0.001), with the Br-E group exhibiting 50-90% higher concentrations throughout the test period. Leptin tended to be different (P = 0.08) between groups, with higher mean ± SD values for the Br-S group (27.6 ± 29.6 ng/mL) compared with the Br-E group (11.5 ± 9.8 ng/mL). Partial least squares regression analysis confirmed that these 2 hormones were important contributors to the patterns of the hormones, anthropometric, clinical, and behavioral variables that differed between groups; insulin and CCK were important as well.

CONCLUSION

We found differences between the Br-E and Br-S groups in circulating gut and adipose-derived hormones measured midday, indicating that the breakfast habit is associated with the hormonal milieu before and after a midday meal. The different patterns may be short-lived or may impact metabolism later in the day. This report is a secondary analysis of a trial registered at clinicaltrials.gov as NCT01427556.

Higher Energy Intake Variability as Predisposition to Obesity: Novel Approach Using Interquartile Range

OBJECTIVE

It is known that total energy intake and its distribution during the day influences human anthropometric characteristics. However, possible association between variability in total energy intake and obesity has thus far remained unexamined. This study was designed to establish the influence of energy intake variability of each daily meal on the anthropometric characteristics of obesity.

METHODS

A total of 521 individuals of Czech Caucasian origin aged 16–73 years (390 women and 131 men) were included in the study, 7-day food records were completed by all study subjects and selected anthropometric characteristics were measured. The interquartile range (IQR) of energy intake was assessed individually for each meal of the day (as a marker of energy intake variability) and subsequently correlated with body mass index (BMI), body fat percentage (%BF), waist-hip ratio (WHR), and waist circumference (cW).

RESULTS

Four distinct models were created using multiple logistic regression analysis and backward stepwise logistic regression. The most precise results, based on the area under the curve (AUC), were observed in case of the %BF model (AUC=0.895) and cW model (AUC=0.839). According to the %BF model, age (p<0.001) and IQR-lunch (p<0.05) seem to play an important prediction role for obesity. Likewise, according to the cW model, age (p<0.001), IQR-breakfast (p<0.05) and IQR-dinner (p <0.05) predispose patients to the development of obesity. The results of our study show that higher variability in the energy intake of key daily meals may increase the likelihood of obesity development.

CONCLUSIONS

Based on the obtained results, it is necessary to emphasize the regularity in meals intake for maintaining proper body composition.

Eveningness is associated with skipping breakfast and poor nutritional intake in Brazilian undergraduate students

Some studies have proposed that self-reported eveningness, which reflects the preference of performing activities in the evening, may harm nutritional health and influence the eating behavior and nutritional status of individuals. However, the relationship between these variables (eveningness and nutritional status) and the consumption of breakfast, which is currently considered a marker of health, has been insufficiently explored by studies. The aim of this study was to investigate, in undergraduate students, the association between diurnal preference, being overweight, and food consumption (with special focus on breakfast). The study included 721 undergraduate students from a Brazilian public university. Dietary intake was assessed by 24-hour food recall, and the usual time for breakfast was identified. Body weight, height, and waist circumference were measured by trained researchers. Diurnal preference was determined by the Horne and Ostberg questionnaire validated for the Brazilian population, and the participants were classified into three categories: evening (coefficient: 16-41), intermediate type (coefficient: 42-58) or morning type (coefficient: 59-86). The prevalence of skipping breakfast was higher among the evening types (p = 0.02), when compared with morning and intermediate types. A negative association between the diurnal preference coefficient and total caloric (coefficient -0.25, p = 0.007, r² adjusted = 0.12), carbohydrate (coefficient -0.19, p = -0.04, r² adjusted = 0.04) and lipid intake (coefficient -0.18, p = 0.04, r² adjusted = 0.05) was also found in the breakfast skippers but not in breakfast eaters. In other words, breakfast skippers with diurnal preference values indicative of eveningness consumed more calories, carbohydrates and fats. Evening types presented significant odds of skipping breakfast (OR = 1.7, CI = 1.1-2.9, p = 0.02) when compared with morning and intermediate chronotypes. We conclude that eveningness is associated with skipping breakfast and a higher consumption of calories, carbohydrates and fats in breakfast skippers. These eating behaviors may predispose these individuals to being overweight.

The addition of peanuts to habitual diets is associated with lower consumption of savory non-core snacks by men and sweet non-core snacks by women

Snacking is associated with intakes of non-core foods which may predispose to obesity. Peanuts have potential satiety benefits and may assist with weight management; we hypothesized that peanut consumption would reduce intake of non-core snack foods due to compensation. We investigated the effects of adding peanuts to a habitual diet on snacking habits and energy intake. Sixty-one healthy participants (65±7years, body mass index 31±4kg/m²) consumed their habitual diet with or without peanuts (56g/d for 32 women, 84g/d for 29 men) for 12weeks each in a randomized crossover design. Food diaries were analyzed at baseline and after each 12-week period for meal and snack content and timing. Total energy intake was higher (17% for men [P<.001], 9% for women [P<.001]) during the peanut phase. Body weight was 0.5±0.2kg (P=.010) greater during the peanut phase. Snacking occasions increased during the peanut phase (53% for men [P=.001], 14% for women [P=.01]). Servings of other snack foods did not change during the peanut phase (P=.6) compared with control. However, sex-specific analysis revealed that men and women consumed less savory (P<.001) and sweet (P=.01) non-core snacks, respectively, during the peanut phase. Despite increased energy intake and snacking frequency, peanuts may improve the diet through sex-specific reductions of non-core foods; for optimal energy balance, peanuts should be substituted rather than added to the diet.

Dietary patterns associated with overweight and obesity among Brazilian schoolchildren: an approach based on the time-of-day of eating events

Several studies reported that the timing of eating events has critical implications in the prevention of obesity, but dietary patterns regarding the time-of-day have not been explored in children. The aim of this study was to derive latent food patterns of daily eating events and to examine their associations with overweight/obesity among schoolchildren. A population-based cross-sectional study was conducted with 7–10-year-old Brazilian schoolchildren (n 1232) who completed the Previous Day Food Questionnaire, illustrated with twenty-one foods/beverages in six daily eating events. Latent class analysis was used to derive dietary patterns whose association with child weight status was evaluated by multivariate multinomial regression. Four mutually exclusive latent classes of dietary patterns were identified and labelled according to the time-of-day of eating events and food intake probability (FIP): (A) higher FIP only at lunch; (B) lower FIP at all eating events; (C) higher FIP at lunch, afternoon and evening snacks; (D) lower FIP at breakfast and at evening snack, higher FIP at other meals/snacks. The percentages of children within these classes were 32·3, 48·6, 15·1 and 4·0 %, respectively. After controlling for potential confounders, the mean probabilities of obesity for these classes were 6 % (95 % CI 3·0, 9·0), 13 % (95 % CI 9·0, 17·0), 12 % (95 % CI 6·0, 19) and 11 % (95 % CI 5·0, 17·0), in the same order. In conclusion, the children eating traditional lunch with rice and beans as the main meal of the day (class A) had the lowest obesity risk, thus reinforcing the importance of both the food type and the time-of-day of its intake for weight status.

Dietary energy density and obesity: how consumption patterns differ by body weight status

PURPOSE

Recent public health messages have advised consumers to lower dietary energy density (ED) for weight management, but it is not known whether the proportion of the diet from low-ED foods is related to weight status. In a nationally representative sample of US adults, we evaluated whether the proportions of dietary energy intake contributed by low- and high-ED foods are associated with body mass index (BMI) and waist circumference (WC).

METHODS

Data were from a cross-sectional sample of 9551 adults ≥18 years in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). ED (kcal/g) was calculated for each food item reported during a 24-h dietary recall; individual foods were divided into five ED categories: very low ED (<0.6 kcal/g), low ED (0.6-1.5 kcal/g), medium ED (1.51-2.25 kcal/g), high ED (2.26-4.0 kcal/g), and very high ED (>4.0 kcal/g). The percentages of total energy and the food weight from each category were evaluated by BMI and WC after controlling for total energy intake and other covariates.

RESULTS

Men classified as lean (BMI < 25 kg/m²) reported consuming a greater proportion of total energy from very low- and low-ED foods (7.2 %_{very low} and 23.3 %_low), compared to men considered obese ((BMI > 30 kg/m²); 5.2 %_{very low} and 20.1_low %; p-trends <0.001_{very low}, 0.002_low). Similarly, women classified as lean reported intakes of very low-ED foods of 7.8 % (vs. 6.4 % for women with obesity) of total energy and low-ED foods of 24.7 % (vs. 21.5 % for women with obesity) of total energy (p-trends 0.007_{very low}, 0.004_low). Men and women with obesity reported greater proportions of energy from high-ED foods (45.9 %_{men with obesity} vs. 42.4 %_{lean men}, 44.2 %_{women with obesity} vs. 39.9 %_{lean women}) with significant statistical trends (men = 0.008, women = 0.0005). Similar patterns were observed for intakes of proportions of very low-, low-, and high-ED foods and WC.

CONCLUSION

Higher proportions of energy intake and food weight contributed by very low- and low-ED foods are associated with lower BMI (and WC).

Impact of Breakfast Skipping and Breakfast Choice on the Nutrient Intake and Body Mass Index of Australian Children

Recent data on breakfast consumption among Australian children are limited. This study examined the impact of breakfast skipping and breakfast type (cereal or non-cereal) on nutrient intakes, likelihood of meeting nutrient targets and anthropometric measures. A secondary analysis of two 24-h recall data from the 2007 Australian National Children’s Nutrition and Physical Activity Survey was conducted (2–16 years; n = 4487) to identify (a) breakfast skippers and (b) breakfast consumers, with breakfast consumers further sub-divided into (i) non-cereal and (ii) cereal consumers. Only 4% skipped breakfast and 59% of skippers were 14–16 years. Breakfast consumers had significantly higher intakes of calcium and folate, and significantly lower intakes of total fat than breakfast skippers. Cereal consumers were more likely to meet targets and consume significantly higher fibre, calcium, iron, had significantly higher intakes of folate, total sugars and carbohydrate, and significantly lower intakes of total fat and sodium than non-cereal consumers. The prevalence of overweight was lower among breakfast consumers compared to skippers, and among cereal consumers compared to-cereal consumers (p < 0.001), while no significant differences were observed for mean body mass index (BMI), BMI z-score, waist circumference and physical activity level across the categories. Breakfast and particularly breakfast cereal consumption contributes important nutrients to children’s diets.

Meal irregularity and cardiometabolic consequences: results from observational and intervention studies

Studying irregular meal patterns fits in with the latest research focusing not only on what people eat but also when they eat, also called chrono-nutrition. Chrono-nutrition involves studying the impact of nutrition on metabolism via circadian patterns, including three aspects of time: (ir)regularity, frequency and clock time. The present paper aimed to narratively review research on irregular meal patterns and cardiometabolic consequences. Only few cross-sectional studies and prospective cohort studies were identified, and most of these suggested that eating meals irregularly is associated with a higher risk of the metabolic syndrome and cardiometabolic risk factors, including BMI and blood pressure. This was supported by two randomised controlled intervention studies showing that consuming meals regularly for 2 weeks v. an irregular meal pattern, led to beneficial impact on cardiometabolic risk factors as lower peak insulin, lower fasting total and LDL-cholesterol, both in lean and obese women. In conclusion, the limited evidence on meal regularity and cardiometabolic consequences supports the hypothesis that consuming meals irregularly is adversely associated with cardiometabolic risk. However, it also highlights the need for more large-scale studies, including detailed dietary assessment to further advance the understanding of the impact of chrono-nutrition on public health.

Snacking Among US Children: Patterns Differ by Time of Day

OBJECTIVE

Evaluate foods and beverages consumed, and energy and nutrient densities that constitute morning, afternoon, and evening snacking periods among children in the US.

DESIGN

Evaluate snacking behavior using the National Health and Nutrition Examination Survey, 2009-2012.

PARTICIPANTS

Children aged 4-8 and 9-13 years (n = 3,647).

VARIABLES MEASURED

Self-reported foods and beverages reported as snacks were aggregated into morning (0:00-12:00 hours), afternoon (12:00-18:00 hours), and evening (18:00-24:00 hour) snacking periods.

ANALYSIS

Intakes and amounts consumed during different snacking periods were analyzed from per capita weighted averages using SAS 9.2 and SUDAAN software. Statistical differences were detected using Student t test for means and chi-square test for prevalence data.

RESULTS

Snacking contributed 25% of daily energy in both age groups, with the morning snacking period contributing the least energy. The most frequently consumed food groups across all snacking periods were water, snacks and sweets, nonalcoholic beverages, milk and dairy, and fruit. Nutrient densities varied among different snacking periods; the morning snack period for 4- to 8-year-olds was the most nutrient dense.

CONCLUSIONS AND IMPLICATIONS

Snacking is an important contributor to energy and nutrients in children's diets, but foods and beverages selected vary by time of day and age. Modifying snacking choices, especially in the afternoon, could improve the nutritional quality of children's diets.

Irregularity of energy intake at meals: prospective associations with the metabolic syndrome in adults of the 1946 British birth cohort

Irregularity in eating patterns could be a potential cardiometabolic risk factor. We aimed to study the associations of irregular intake of energy at meals in relation to cardiometabolic risk factors 10 and 17 years later. Variability of energy intake data – derived from 5-d estimated diet diaries of cohort members of the National Survey for Health and Development collected at ages 36 (n1416), 43 (n1505) and 53 years (n1381) – was used as a measure for irregularity. Associations between meal irregularity scores with cardiometabolic risk factors measured 10 and 17 years later were investigated using linear mixed models and logistic regression models. The results showed that irregularity scores changed significantly over the years (P<0·05). At age 36 years, subjects with a more irregular intake of energy at lunch (OR 1·42; 95 % CI 1·05, 1·91) and between meals (OR 1·35; 95 % CI 1·01, 1·82) had an increased risk for the metabolic syndrome 17 years later; at lunch was also associated with an increased waist circumference (OR 1·58; 95 % 1·27, 1·96) and TAG levels (OR 1·33; 95 % CI 1·02, 1·72). At age 43 years, subjects with a more irregular intake at breakfast had an increased risk of the metabolic syndrome 10 years later (OR 1·53; 95 % CI 1·15, 2·04), as well as an increased BMI (OR 1·66; 95 % CI 1·31, 2·10), waist circumference (OR 1·53; 95 % CI 1·23, 1·90) and diastolic blood pressure (OR 1·42; 95 % CI 1·13, 1·78). In conclusion, subjects with a more irregular intake of energy, mostly at breakfast and lunch, appeared to have an increased cardiometabolic risk 10 and 17 years later.

Higher proportion of total and fat energy intake during the morning may reduce absolute intake of energy within the day. An observational study in free-living Japanese adults

BACKGROUND

Although the distribution of energy intake throughout the day appears to impact overall daily energy intake, little is known about the ad libitum distribution of energy intake.

OBJECTIVE

Our aim was to investigate associations between the distribution of energy intake during the day and subsequent or overall energy intake, and food choice in free-living adults.

DESIGN

A total of 119 women and 116 men completed 16-day semi-weighed dietary records. The longitudinal dietary intake data for each participant were analyzed using a mixed model to examine the effect of energy intake at various times of day on subsequent or overall energy intake.

RESULTS

Mean proportion of total energy intake in the morning (4:00 a.m.-10:29 a.m.), afternoon (10:30 a.m.-4:59 p.m.) and evening (5:00 p.m.-3:59 a.m.) meal was 22.6%, 33.8% and 43.6% in men, and 24.7%, 36.5%, 38.8% in women, respectively. Proportion of energy intake (%) in the morning meal was significantly and negatively associated with energy intake (kcal) in the subsequent afternoon and evening meals, and consequently in the whole day in both sexes. This significant and negative association was also observed for proportion of energy intake (%) of fat, but not of carbohydrate or protein, in both sexes. Proportion of energy intake (%) in the morning meal was negatively associated with overall energy intake (kcal) from the group of meats, fish, and eggs in both sexes, and from the group of confectioneries and soft drinks in women.

CONCLUSIONS

More energy in the morning meal may reduce energy intake, especially that from fat, in the subsequent meals, and consequently in the whole day.

Contribution of daily and seasonal biorhythms to obesity in humans

While the significance of obesity as a serious health problem is well recognized, little is known about whether and how biometerological factors and biorhythms causally contribute to obesity. Obesity is often associated with altered seasonal and daily rhythmicity in food intake, metabolism and adipose tissue function. Environmental stimuli affect both seasonal and daily rhythms, and the latter are under additional control of internal molecular oscillators, or body clocks. Modifications of clock genes in animals and changes to normal daily rhythms in humans (as in shift work and sleep deprivation) result in metabolic dysregulation that favours weight gain. Here, we briefly review the potential links between biorhythms and obesity in humans.

The Influence of Portion Size and Timing of Meals on Weight Balance and Obesity

This review focuses on the influence of portion size and temporal distribution of food intake on weight balance and obesity in adults. The inconsistency of definitions in the area of meal patterns is also discussed. The conclusion is that regular eating habits might facilitate weight balance, while unplanned snacking as well as consuming the major part of the energy intake at the end of the day seem to be unfavourable. Altogether, the research suggests that large portions promote over-consumption and, therefore, limiting portion size of energy dense foods and drinks with added sugar could be recommended. Even if more research is needed, these factors should be taken into consideration in recommendations for obesity prevention.

The time-varying association between perceived stress and hunger within and between days

OBJECTIVE

Examine the association between perceived stress and hunger continuously over a week in free-living individuals.

METHODS

Forty five young adults (70% women, 30% overweight/obese) ages 18 to 24 years (Mean = 20.7, SD = 1.5), with BMI between 17.4 and 36.3 kg/m(2) (Mean = 23.6, SD = 4.0) provided between 513 and 577 concurrent ratings of perceived stress and hunger for 7 days via hourly, text messaging assessments and real-time eating records. Time-varying effect modeling was used to explore whether the within-day fluctuations in stress are related to perceived hunger assessed on a momentary basis.

RESULTS

A generally positive stress-hunger relationship was confirmed, but we found that the strength of the relationship was not linear. Rather, the magnitude of the association between perceived stress and hunger changed throughout the day such that only during specific time intervals were stress and hunger significantly related. Specifically, the strength of the positive association peaked during late afternoon hours on weekdays (β = 0.31, p < .05) and it peaked during evening hours on weekend days (β = 0.56, p < .05).

CONCLUSION

This is the first empirical study to demonstrate potentially maladaptive, nonlinear stress-hunger associations that peak in the afternoon or evening hours. While we are unable to infer causality from these analyses, our findings provide empirical evidence for a potentially high-risk time of day for stress-induced eating. Replication of these findings in larger, more diverse samples will aid with the design and implementation of real-time intervention studies aimed at reducing stress-eating.

Impact of snacking pattern on overweight and obesity risk in a cohort of 11- to 13-year-old adolescents

OBJECTIVES

The association between snacking habits and overweight in adolescents is unclear. We evaluated the relation between snacking patterns and overweight/obesity in a cohort of 11- to 13-year-old Italian adolescents.

METHODS

The dietary habits of 400 randomly selected adolescents were evaluated; those with body mass index ≥ 85 th percentile were considered as overweight/obese. Participants were classified based on the percentage of caloric intake from snacks (<15%, 15%-20%, >20%), snacking frequency (1, 2, ≥ 3), and timing of consuming the most caloric snack (morning, afternoon, evening).

RESULTS

A minority of participants (13/400, 3.3%) did not consume any snacks; 5/13 (38.5) of them were overweight/obese. Among snackers (387/400), overweight/obesity prevalence was 10.4%, 14.4%, 20.5%, respectively, in those consuming <15%, 15% to 10%, and >20% of their energy intake from snacks. In a Poisson regression model, the overweight/obesity relative risks (RRs) were 1.35 (95% confidence interval [CI] 0.58-3.15) and 2.32 (1.10-4.89) for 15% to 20% and >20% calories/day from snacks, respectively. Overweight/obesity prevalence (from 9.6% to 22.6%) was correlated with snacking frequency (RR 2.20, 95% CI 0.92-5.27, and RR 4.17, 95% CI 1.60-10.9, for 2 and ≥ 3 snacks per day, respectively). The most caloric snacks were consumed in the morning (180/387) and afternoon (179/387); 28.6% of the predominantly evening snackers (28/387) were overweight/obese (RR 3.12, 95% CI 1.17-8.34).

CONCLUSIONS

Increased snacking calories, frequency, and evening snacking are independently associated with overweight/obesity in Italian middle-school adolescents.

Consuming more of daily caloric intake at dinner predisposes to obesity. A 6-year population-based prospective cohort study

BACKGROUND/OBJECTIVES

It has been hypothesized that assuming most of the caloric intake later in the day leads to metabolic disadvantages, but few studies are available on this topic. Aim of our study was to prospectively examine whether eating more of the daily caloric intake at dinner leads to an increased risk of obesity, hyperglycemia, metabolic syndrome, and non-alcoholic fatty liver disease (NAFLD).

SUBJECTS/METHODS

1245 non-obese, non-diabetic middle-aged adults from a population-based cohort underwent a 3-day food record questionnaire at enrollment. Anthropometric values, blood pressure, blood metabolic variables, and estimated liver fat were measured at baseline and at 6-year follow-up.

DESIGN

Prospective cohort study.

RESULTS

Subjects were divided according to tertiles of percent daily caloric intake at dinner. A significant increase in the incidence rate of obesity (from 4.7 to 11.4%), metabolic syndrome (from 11.1 to 16.1%), and estimated NAFLD (from 16.5 to 23.8%) was observed from the lower to higher tertile. In a multiple logistic regression model adjusted for multiple covariates, subjects in the highest tertile showed an increased risk of developing obesity (OR = 2.33; 95% CI 1.17-4.65; p = 0.02), metabolic syndrome (OR = 1.52; 95% CI 1.01-2.30; p = 0.04), and NAFLD (OR = 1.56; 95% CI 1.10-2.22; p = 0.01).

CONCLUSIONS

Consuming more of the daily energy intake at dinner is associated with an increased risk of obesity, metabolic syndrome, and NAFLD.

The benefits of breakfast cereal consumption: a systematic review of the evidence base

There have been no comprehensive reviews of the relation of breakfast cereal consumption to nutrition and health. This systematic review of all articles on breakfast cereals to October 2013 in the Scopus and Medline databases identified 232 articles with outcomes related to nutrient intake, weight, diabetes, cardiovascular disease, hypertension, digestive health, dental and mental health, and cognition. Sufficient evidence was available to develop 21 summary evidence statements, ranked from A (can be trusted to guide practice) to D (weak and must be applied with caution). Breakfast cereal consumption is associated with diets higher in vitamins and minerals and lower in fat (grade B) but is not associated with increased intakes of total energy or sodium (grade C) or risk of dental caries (grade B). Most studies on the nutritional impact are cross-sectional, with very few intervention studies, so breakfast cereal consumption may be a marker of an overall healthy lifestyle. Oat-, barley-, or psyllium-based cereals can help lower cholesterol concentrations (grade A), and high-fiber, wheat-based cereals can improve bowel function (grade A). Regular breakfast cereal consumption is associated with a lower body mass index and less risk of being overweight or obese (grade B). Presweetened breakfast cereals do not increase the risk of overweight and obesity in children (grade C). Whole-grain or high-fiber breakfast cereals are associated with a lower risk of diabetes (grade B) and cardiovascular disease (grade C). There is emerging evidence of associations with feelings of greater well-being and a lower risk of hypertension (grade D), but more research is required.

Potential Association between Breakfast Skipping and Concomitant Late-Night-Dinner Eating with Metabolic Syndrome and Proteinuria in the Japanese Population

Skipping breakfast is considered to be an unhealthy eating habit linked to predispositions to obesity and type 2 diabetes. Because eating dinner late at night can elicit subsequent breakfast skipping, we investigated if skipping breakfast concomitant with late-night-dinner eating (LNDE) was associated with metabolic syndrome (MetS) and proteinuria in the general Japanese population. We examined self-reported habitual breakfast skipping and LNDE, MetS (modified ATP-III criteria), and proteinuria in a cross-sectional study of 60,800 Japanese adults aged 20-75 years. A total of 14,068 subjects (23.1%) skipped breakfast, of whom approximately half (52.8%) skipped breakfast alone (without LNDE). The percentages of subjects who skipped breakfast showed a J-shaped relationship with body mass index (BMI). Multivariate logistic regression analysis showed that skipping breakfast concomitant with LNDE (n = 6,645) was significantly associated with MetS and proteinuria, even after adjusting for relevant confounders (odds ratio (95% CI), 1.17 (1.08-1.28), P = 0.0003, and 1.37 (1.24-1.52), P < 0.0001, resp.). Skipping breakfast alone and LNDE alone were not associated with MetS and proteinuria, respectively. In conclusion, habitual breakfast skipping concomitant with LNDE may represent poorer eating behavior than skipping breakfast alone, associated with MetS, asymptomatic proteinuria, obesity, and low body weight in the general Japanese population.

Dietary habits and behaviors associated with nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent causes of health problems in Western (industrialized) countries. Moreover, the incidence of infantile NAFLD is increasing, with some of these patients progressing to nonalcoholic steatohepatitis. These trends depend on dietary habits and life-style. In particular, overeating and its associated obesity affect the development of NAFLD. Nutritional problems in patients with NAFLD include excess intake of energy, carbohydrates, and lipids, and shortages of polyunsaturated fatty acids, vitamins, and minerals. Although nutritional therapeutic approaches are required for prophylaxis and treatment of NAFLD, continuous nutrition therapy is difficult for many patients because of their dietary habits and lifestyle, and because the motivation for treatment differs among patients. Thus, it is necessary to assess the nutritional background and to identify nutritional problems in each patient with NAFLD. When assessing dietary habits, it is important to individually evaluate those that are consumed excessively or insufficiently, as well as inappropriate eating behaviors. Successful nutrition therapy requires patient education, based on assessments of individual nutrients, and continuing the treatment. In this article, we update knowledge about NAFLD, review the important aspects of nutritional assessment targeting treatment success, and present some concrete nutritional care plans which can be applied generally.