Eating frequency is inversely associated with BMI, waist circumference and the proportion of body fat in Korean adults when diet quality is high, but not when it is low: analysis of the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV)

Meal Frequency Does Not Affect Weight Loss in Overweight/Obese Women but Affects the Body Composition: A Randomized Controlled Trial

OBJECTIVES

Studies showing the relationship between meal frequency, weight loss and anthropometric measurements are contradictory. This study aims to determine the effect of meal frequency on weight loss, anthropometric measurements, and body composition.

METHODS

This is a parallel designed randomized control trial that was conducted with 40 female volunteers between the ages of 19-64 years, with a Body Mass Index (BMI) ≥27 who applied to a private clinic. Participants were randomized in two treatment arms (3 meals + 3 snacks/day (n = 20) vs 3 meals/day (n = 20)) and same dietary energy restriction (-500kcal) was applied for 3 months. Food consumption was questioned with 3 day food records, and anthropometric measurements and body composition were measured before the study and repeated each week till the end of the study by the researcher.

RESULTS

All of the participants completed the study period. Body weight (kg), BMI (kg/m2), total body fat (kg), body fat percentage (%), fat free mass (kg) and waist circumference (cm) decreased, while fat free mass percentage (%) increased significantly in both of the groups at the end of the study (p < 0.05). The rate of difference for body weight, BMI (kg/m2) and waist circumference (cm) were similar among the groups. When difference in body composition analyses was examined, the rate of reduction in total body fat (-18.82 ± 4.97% vs -14.87 ± 7.44%) and body fat percentage (%)(-10.79 ± 4.63% vs -7.68 ± 7.04%) and the rate of increase in fat free mass percentage (%)(7.65 ± 3.16% vs 5.04 ± 3.44%) were significantly higher in 3 meals + 3 snacks group (p < 0.05).

CONCLUSION

When energy restricted and balanced weight loss programs are applied, alteration in body weight, BMI and waist circumference is not affected from meal frequency, but body composition does.

CLINICAL TRIAL NUMBER

NCT05581862 (Date of Trial Registration: 13/10/2022).

Association between daily eating frequency and mortality in people with diabetes: Findings from NHANES 1999-2014

Background

Previous studies have shown that increasing the frequency of eating is beneficial in terms of cardiovascular metabolic risk factors; however, limited evidence is available for the association between daily eating frequency and mortality, especially in people with diabetes. Therefore, we aimed to explore the association between eating frequency and long-term mortality in populations with diabetes.

Methods

We selected 4,924 individuals suffering from diabetes (mean age: 57.77 years; 51.3% men) from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2014. Daily eating frequency was used as the exposure factor in this study. We extracted the mortality data from the National Death Index records and matched them with the population of NHANES. All participants were followed up from the date of getting enrolled in NHANES to 31 December 2015. Multivariate Cox proportional hazards regression, Kaplan-Meier survival curves, and restricted cubic spline were used to assess the associations between eating frequency and all-cause and cause-specific mortality among people with diabetes.

Results

During 34,950 person-years of follow-up, 1,121 deaths were documented, including 272 cardiovascular disease (CVD)-related deaths and 156 cancer-related deaths. After adjusting for confounding factors, the daily eating frequency was linearly inversely associated with all-cause and CVD-related mortality, and the HR (95% CIs) for per one-time increment of eating frequency was 0.88 (0.80-0.98) and 0.77 (0.63-0.93), respectively. Sensitivity analyses showed that the main results and statistical significance were still stable.

Conclusion

Higher eating frequency was independently related to lower all-cause and CVD-related mortality in people with diabetes, which can be used as a potential strategy for daily-diet management among populations suffering from diabetes.

Eating frequency has an inverse correlation with adiposity measures and non-invasive arterial stiffness parameters in healthy adult people

BACKGROUND

Lifestyle modifications have been recommended as an essential treatment approach for cardiovascular diseases. Recent studies have shown that eating frequency (EF) correlates with hypertension and related risk of organ damage. This study aimed to examine critical clinical implications to evaluate the association of EF with arterial stiffness parameters as an early marker of atherosclerosis manifestations.

METHODS

A cross-sectional descriptive study was performed on 658 participants of the PERSIAN Organizational Cohort study in Mashhad, aged 30-70 years. Arterial stiffness was assessed by measurement markers of arteriosclerosis, including arterial age, augmentation index (AIx), augmentation pressure (AP), carotid-femoral pulse wave velocity (Cf-PWV), and central blood pressure. Differences in anthropometric indices, blood indices, and arterial stiffness parameters were evaluated across EF groups.

RESULTS

Our data demonstrate that EF was positively correlated with total daily energy intake, and favourable profiles of adiposity and blood lipids. Subjects with an increased EF, had significantly lower AIx, AP, Arterial Age and Central blood pressure (P for trend<0.001) as compared to Lowest EF and not significant with PWV (P for trend, 0.19). Arterial stiffness was also significantly lower in those with increased EF compared with subjects with low EF. By Linear regression analysis, after adjustment for Confounding factors, except PWV, EF showed the associations with all of the non-invasive arterial stiffness parameters.

CONCLUSION

Increased EF is associated with a lower wave reflection and blood pressure in the central arteries.

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.

A narrative review of nutrient based indexes to assess diet quality and the proposed total nutrient index that reflects total dietary exposures

A priori dietary indices provide a standardized, reproducible way to evaluate adherence to dietary recommendations across different populations. Existing nutrient-based indices were developed to reflect food/beverage intake; however, given the high prevalence of dietary supplement (DS) use and its potentially large contribution to nutrient intakes for those that use them, exposure classification without accounting for DS is incomplete. The purpose of this article is to review existing nutrient-based indices and describe the development of the Total Nutrient Index (TNI), an index developed to capture usual intakes from all sources of under-consumed micronutrients among the U.S. population. The TNI assesses U.S. adults' total nutrient intakes relative to recommended nutrient standards for eight under-consumed micronutrients identified by the Dietary Guidelines for Americans: calcium, magnesium, potassium, choline, and vitamins A, C, D, E. The TNI is scored from 0 to 100 (truncated at 100). The mean TNI score of U.S. adults (≥19 y; n = 9,954) based on dietary data from NHANES 2011-2014, was 75.4; the mean score for the index ignoring DS contributions was only 69.0 (t-test; p < 0.001). The TNI extends existing measures of diet quality by including nutrient intakes from all sources and was developed for research, monitoring, and policy purposes.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1967872.

Eating Speed, Eating Frequency, and Their Relationships with Diet Quality, Adiposity, and Metabolic Syndrome, or Its Components

Excess body weight is a major global health concern, particularly due to its associated increased health risks. Several strategies have been proposed to prevent overweight and obesity onset. In the past decade, it has been suggested that eating speed/rate and eating frequency might be related to obesity. The main aim of this narrative review was to summarize existing evidence regarding the impact of eating speed/rate and eating frequency on adiposity, metabolic syndrome (MetS), or diet quality (DQ). For this purpose, a literature search of observational and interventional trials was conducted between June and September 2020 in PubMed and Web of Sciences databases, without any data filters and no limitations for publication date. Results suggest that children and adults with a faster eating speed/rate may be associated with a higher risk of developing adiposity, MetS or its components. Furthermore, a higher eating frequency could be associated with diet quality improvement, lower adiposity, and lower risk of developing MetS or its components. Further interventional trials are warranted to clarify the mechanism by which these eating behaviors might have a potential impact on health.

Meal and snack frequency in relation to diet quality in Japanese adults: a cross-sectional study using different definitions of meals and snacks

Epidemiological evidence on the association between eating frequency and overall diet quality does not represent a consistent picture. This cross-sectional study examined the associations of meal frequency and snack frequency with diet quality, using different definitions of meals and snacks. Based on 4-d weighed dietary record data obtained from 639 Japanese adults aged 20-81 years, all eating occasions were divided into meals or snacks based on either the participant-identified or time-of-day definitions. Diet quality was assessed by the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3). One additional meal per d increased the HEI-2015 total score by 3·6 and 1·3 points based on the participant-identified and time-of-day definitions, respectively. A higher meal frequency was also associated with higher values of some of the HEI-2015 component scores (total vegetables, greens and beans, and total protein foods), irrespective of how meals were defined. Additionally, one additional participant-identified snack per d increased the HEI-2015 total score by 0·7 points. The frequency of participant-identified snacks also showed positive associations with some of the HEI-2015 component scores (total fruits, whole fruits, total vegetables, greens and beans, dairy products, and Na). However, the frequency of time-of-day defined snacks was not associated with the total scores of HEI-2015, although there were some associations for its components. Similar findings were obtained when the NRF9.3 was used. In conclusion, higher meal frequency was consistently associated with higher diet quality, while associations between snack frequency and diet quality varied depending on the definition of snacks.

The impact of a higher eating frequency on the diet quality and nutritional status of women with breast cancer undergoing chemotherapy

The present study investigated the association between eating frequency (EF), diet quality and nutritional status of fifty-five women with breast cancer (BC) undergoing chemotherapy (CT), with three follow-ups, before the first cycle (T0), after the intermediate cycle (T1) and after the last cycle of CT (T2). Dietary data were obtained by nine 24-h dietary recalls (24HR), and the Brazilian Healthy Eating Index Revised (BHEI-R) was used for qualitative analysis of diet. The average EF was established by adding the number of daily eating episodes in the three 24HR of each time. Anthropometric variables were obtained at three times. Women who reported higher EF (equal to or above median value (T0 and T1: 4·67; T2: 4·33 eating episodes)) presented better anthropometric parameters, in T0 and T1, as well as higher scores for BHEI-R specific groups and BHEI-R Total score in T1 and T2. In generalised linear models, the continuous variable EF was negatively associated with all the anthropometric variables in T0 and with the waist:height ratio in T1. There were positive associations for the BHEI-R groups at the three times: Total Fruit; Whole Fruit; Total Vegetables; Dark Green and Orange Vegetables and Legumes. At T1 and T2 the EF was positively associated with the BHEI-R Total score, and also with Whole Grains in T1. The results suggest that a higher EF was associated with a better diet quality during CT in women with BC. In contrast, an inverse association was observed between EF and anthropometric parameters before the first cycle of treatment.