Regular meal frequency creates more appropriate insulin sensitivity and lipid profiles compared with irregular meal frequency in healthy lean women

Association of chrononutrition patterns with biological aging: evidence from a nationally representative cross-sectional study

Previous studies mostly focused on the benefits of caloric restriction and fasting on longevity. However, whether the timing and frequency of eating affect aging remains unclear. Here, we investigated the associations between chrononutrition patterns and biological aging, and explored whether and to what extent dietary inflammation mediated this association. 16 531 adults aged 20 to 84 years from the National Health and Nutrition Examination Survey were collected. Chrononutrition patterns were determined with two 24-hour dietary recalls. Phenotypic age was calculated to reflect the biological aging status. The dietary inflammatory index (DII) was used to assess the dietary inflammation. After adjustment of the survey weight and multiple covariates including total energy intake, participants in the third tertile of the time of the first meal (mean 10 : 26) exhibited more advanced biological age (β 0.64; 95% CI, 0.26-1.00) and a higher incidence of accelerated aging (odds ratio (OR) 1.25; 95% CI, 1.06-1.47) compared to those of the first tertile (mean 6 : 14). Higher eating frequency was associated with delayed biological aging in both multivariable linear (β -0.31; 95% CI, -0.44 to -0.19) and logistic regression model (OR 0.90; 95% CI, 0.85-0.95). Furthermore, we found that DII rather than metabolic factors mediated the inverse association between eating frequency and biological aging (mediation proportion 24.67%; 95% CI, 19.83%-32.00%). Our findings demonstrated the association between chrononutrition patterns and biological aging among the US general population and the potential role of dietary inflammation in this association, suggesting that modifying chrononutrition patterns may be a practical and cost-effective strategy for combating aging.

The association between diet quality and chrononutritional patterns in young adults

PURPOSE

Young adults eat erratically and later in the day which may impact weight and cardiometabolic health. This cross-sectional study examined relationships between chrononutritional patterns and diet quality in two young adult populations: a university and community sample.

METHODS

Three days of dietary data were collected including food images captured using wearable cameras. Chrononutritional variables were extracted: time of first and last eating occasions, caloric midpoint (time at which 50% of daily energy was consumed), number of eating occasions per day, eating window, day-to-day variability of the above metrics, and evening eating (≥20:00h). The Healthy Eating Index for Australian Adults scored diet quality. Statistical analyses controlled for gender, body mass index, and socio-economic status.

RESULTS

No significant associations between chrononutritional patterns and diet quality were found for all participants (n = 95). However, differences in diet quality were found between university (n = 54) and community (n = 41) samples with average diet quality scores of 59.1 (SD 9.7) and 47.3 (SD 14.4), respectively. Of those who extended eating ≥20:00 h, university participants had better diet quality (62.9±SE 2.5 vs. 44.3±SE 2.3, p < 0.001) and discretionary scores (7.9±SE 0.9 vs. 1.6±SE 0.6, p < 0.001) than community participants. University participants consumed predominately healthful dinners and fruit ≥20:00h whereas community participants consumed predominately discretionary foods.

CONCLUSION

For the general young adult population, meal timing needs to be considered. Food choices made by this cohort may be poorer during evenings when the desire for energy-dense nutrient-poor foods is stronger. However, meal timing may be less relevant for young adults who already engage in healthy dietary patterns.

The effects of meal patterns on liver steatosis, fibrosis, and biochemical factors in patients with nonalcoholic fatty liver disease: a randomized controlled clinical trial

Background

This study was designed to compare the effects of four meal patterns on liver steatosis, fibrosis, and biochemical factors in patients with Nonalcoholic fatty liver disease (NAFLD).

Methods

The 12-week intervention was performed on 123 patients with NAFLD who were randomly allocated into four groups: "3-meals", "skipping breakfast", "skipping dinner", and " 3 meals and 3 snacks per day." group. The assessment of liver steatosis, fibrosis, biochemical factors, and anthropometrical evaluation were performed at baseline and at end of the study.

Results

A significant improvement was found in the liver steatosis and fibrosis among the patients who consumed 3 meals, 3 snacks compared to the other groups (P < 0.001). In addition, a higher reduction was observed in serum levels of alanine amino transferase (ALT) (20.93 ± 23.37 mg/dl, P < 0.001), aspartate aminotransferase (AST) (17.15 ± 16.48 mg/dl, P < 0.001), gamma-glutamyl transferase(GGT) (13.43 ± 13.41 mg/dl; P < 0.001), and alkaline phosphatase (ALK) (47.19 ± 60.51 mg/dl; P = 0.004) in patients who consumed 3 meals, 3 snacks, while the concentration of liver enzymes in patients who consumed 3 meals increased significantly. At the end of the study, there was a significant increase in the fasting blood sugar (FBS) concentration in the "skipping breakfast" group (17.51 ± 38.85 mg/dl; P = 0.011) and "3-meals" group (17.51 ± 38.85 mg/dl, P = 0.03).

Conclusion

Consuming 3 meals, 3 snack per day significantly improves disease severity and biochemical factors in NAFLD patients. Further studies are warranted.

Trial registration number

: IRCT20201010048982N2. Name of the registry: Urmia University of Medical Sciences. Date of registration: 2021-08-22, 1400/05/31. URL of trial registry record: https://www.irct.ir/search/result?query=IRCT20201010048982N2.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01375-2.

No Effect of High Eating Frequency Compared with Low Eating Frequency on Appetite and Inflammation Biomarkers: Results from a Randomized Crossover Clinical Trial

BACKGROUND

Eating frequency (EF) focuses on the total number of eating occasions per day and may influence metabolic health.

OBJECTIVES

We sought to examine the effect of high compared with low EF on appetite regulation and inflammatory biomarkers among healthy adults.

METHODS

Data are from a randomized, crossover trial (the Frequency of Eating and Satiety Hormones study). Participants (n = 50) completed 2 isocaloric 21-d study periods of low EF (3 eating occasions/d) and high EF (6 eating occasions/d) in random order with a 14-d washout period in between. Participants were free-living and consumed their own food, using study-directed, structured meal plans with identical foods and total energy in both study periods. On days 1 and 21 of each EF period, fasting blood was collected during in-person clinic visits to assess plasma concentrations of ghrelin, leptin, adiponectin, and high-sensitivity C-reactive protein (hs-CRP). Linear mixed models with EF, diet sequence, and period as fixed effects and participant as random effect were used to estimate the intervention effect. Interaction effects between EF and body fat percentage were examined.

RESULTS

Among the 50 participants who completed the trial, 39 (78%) were women, 30 (60%) were Non-Hispanic White, and 40 (80%) had a body mass index of <25 kg/m2, and the mean age was 32.1 y. The differences between high and low EF in fasting ghrelin (geometric mean difference: 17.76 ng/mL; P = 0.60), leptin (geometric mean difference: 2.09 ng/mL; P = 0.14), adiponectin (geometric mean difference: 381.7 ng/mL; P = 0.32), and hs-CRP (geometric mean difference: -0.018 mg/dL; P = 0.08) were not statistically significant. No significant interaction was observed between EF and body fat percentage on appetite regulation and inflammatory biomarkers.

CONCLUSIONS

No differences was observed in fasting ghrelin, leptin, adiponectin, and hs-CRP comparing high and low EF. Future studies are needed to understand the physiology of EF and appetite as they relate to metabolic health. This trial was registered at clinicaltrials.gov as NCT02392897.

A psychobioecological model to understand the income-food insecurity-obesity relationship

Food insecurity, defined by unpredictable access to food that may not meet a person's nutritional needs, is associated with higher BMI (kg/m2) and obesity. People with food insecurity often have less access to food, miss meals and go hungry, which can lead to psychological and metabolic changes that favor energy conservation and weight gain. We describe a conceptual model that includes psychological (food reinforcement and delay discounting) and physiological (thermic effect of food and substrate oxidation) factors to understand how resource scarcity associated with food insecurity evolves into the food insecurity-obesity paradox. We present both animal and human translational research to describe how behavioral and metabolic adaptations to resource scarcity based on behavioral ecology theory may occur for people with food insecurity. We conclude with ideas for interventions to prevent or modify the behaviors and underlying physiology that characterize the income-food insecurity-obesity relationship.

Chronomedicine Insights: Evaluating the Impact of Time-Restricted Meal Intake on Lipid Profile Parameters Among Individuals With Type 2 Diabetes in Northern India

INTRODUCTION

Time-restricted meal intake (TRM) has shown potential benefits such as enhanced insulin sensitivity, lowered blood sugar levels, and possible weight loss in individuals with type 2 diabetes mellitus (T2DM). Our study aimed to investigate the impact of TRM on lipid profile parameters such as total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) in fasting conditions in T2DM patients.

METHODS

In total, 400 patients from the endocrinology department at King George's Medical University (KGMU), Lucknow were enrolled in this study, adhering to the guidelines of the American Diabetes Association (ADA). Male and female patients with recently diagnosed T2DM (in the past five years), aged between 25 to 60 years, on oral anti-diabetic therapy excluding insulin, expressing willingness to provide written consent and to adhere to TRM were included in the TRM group. It was a longitudinal study as diabetic dyslipidemia is primarily caused by insulin resistance and nutritional reasons and we wanted to assess the effect of TRM on lipid profile in T2DM patients. Patients were enrolled via simple random sampling using the random number table method (computerized). The TRM group had an early dinner at 7 pm whereas the control group was of non-TRM/late-night eaters. TRM group was given comprehensive guidance including strategies to manage hunger, permissible beverage options (water and prescribed medication) during the fasting period, and daily maintenance of a diary documenting their timing, type, and quantity of food intake which they were requested to bring fortnightly. Emphasis was placed on recording even minor dietary items consumed throughout the day. The TRM group consumed food ad libitum during a 12-hour eating window from breakfast at 7 am to dinner at 7 pm. Data distribution was non-parametric. Mann-Whitney U test compared TRM and control group using mean values at baseline and follow-ups. Analysis used GraphPad Prism 9.2.0 software (GraphPad Inc., La Jolla, CA). A p-value less than 0.05 (p < 0.05) was considered statistically significant.

RESULTS

A total of 127 patients were lost to follow-up, resulting in 273 patients who completed the study. The mean value of TC in the TRM and non-TRM groups using the Mann-Whitney U test registered a highly significant p-value <0.0001 at 18 months, with a decrease of 14.17% from baseline in the TRM group and a decrease of 1.53% from baseline in the non-TRM group. The TRM group had a decrease of 24.75% in TG from a baseline value of 145.4±41.9, whereas the non-TRM group showed a decrease of 2.2% from a baseline value of 154.7±37.30 (p-value <0.0001). The TRM group showed an increase of 9.25% in HDL from a baseline value of 50.14±8.58; the non-TRM group showed an increase of 0.82% from a baseline value of 48.62±9.31 (p-value <0.0001). TRM group showed a decrease of 8.62% in LDL from a baseline value of 68.20±16.2 while the non-TRM group showed an increase of 1.54% from a baseline value of 65.38±19.3 (p-value <0.0002). The TRM group showed a decrease of 13.97% in VLDL from a baseline value of 32.20±18.7; the non-TRM group showed an increase of 4% from a baseline value of 30.16±24.2 (p-value <0.0001).

CONCLUSION

Our study's promising results underscore the potential of TRM as an effective strategy for managing dyslipidemia in individuals with T2DM, even over prolonged periods.

Chrononutrition in traditional European medicine-Ideal meal timing for cardiometabolic health promotion

Meal timing plays a crucial role for cardiometabolic health, given the circadian regulation of cardiometabolic function. However, to the best of our knowledge, no concept of meal timing exists in traditional European medicine (TEM). Therefore, in this narrative review, we aim to define the optimal time slot for energy intake and optimal energy distribution throughout the day in a context of TEM and explore further implications. By reviewing literature published between 2002 and 2022, we found that optimal timing for energy intake may be between 06:00 and 09:00, 12:00 and 14:00, and between 15:00 and 18:00, with high energy breakfast, medium energy lunch and low energy dinner and possibly further adjustments according to one's chronotype and genetics. Also, timing and distribution of energy intake may serve as a novel therapeutic strategy to optimize coction, a concept describing digestion and metabolism in TEM. Please cite this article as: Eberli NS, Colas L, Gimalac A. Chrononutrition in traditional European medicine-Ideal meal timing for cardiometabolic health promotion. J Integr Med. 2024; 22(2);115-125.

Relationship between circadian eating behavior (daily eating frequency and nighttime fasting duration) and cardiovascular mortality

BACKGROUND

Knowledge regarding the health impacts of daily eating frequency (DEF) and nighttime fasting duration (NFD) on mortality is very limited.

OBJECTIVE

This study aimed to examine whether DEF and NFD are associated with CVD and all-cause mortality.

METHODS

This was a prospective cohort study of a nationally representative sample from the United States, including 30,464 adults who participated in the National Health and Nutrition Examination Survey 2003-2014. Using 24-h dietary recall, DEF was assessed by the number of eating episodes, and NFD was calculated by the first and last eating time across a day. Death information was obtained from the National Death Index up to 2019. Weighted Cox proportional hazards regression models were used to assess survival relationships of DEF and NFD with mortality.

RESULTS

During 307,686 person-years of follow-up, 4560 deaths occurred, including 1824 CVD cases. After adjustment for confounders, compared to DEF at 4-6 times, participants whose DEF was less than 3 times had greater CVD [hazard-ratio (HR) = 1.33, 95% confidence-interval (CI): 1.06-1.67] and all-cause (HR = 1.16, 95% CI: 1.01-1.33) mortality risks. Furthermore, compared to NFD of 10 to 11 h, participants whose NFD was shorter than 10 h had HRs of 1.30 (95% CI: 1.08-1.55) for CVD mortality and 1.23 (95% CI: 1.08-1.39) for all-cause mortality. NFD longer than 14 h was also related to CVD mortality (HR = 1.37, 95% CI: 1.12-1.67) and all-cause mortality (HR = 1.36, 95% CI: 1.19-1.54). Similar results for the association of NFD and DEF with heart-specific and stroke-specific mortality were observed.

CONCLUSION

This study found that DEF less than 3 times and NFD shorter than 10 h or longer than 14 h were independently associated with greater cardiovascular and all-cause mortality.

A systematic review of associations between day-to-day variability in meal pattern and body weight, components of the metabolic syndrome and cognitive function

BACKGROUND

Meal pattern is a potential health determinant. Previously, mean values for properties of meal pattern, such as daily meal frequency, have been considered. Means, however, obscure variability between-day (irregular or chaotic eating). This systematic review aimed to identify and critique published methods used to characterise between-day variability in meal pattern, and to explore relationships between this and obesity, as well as associated health outcomes.

METHODS

Using relevant databases, a systematic search was undertaken for studies with adults and children in which between-day variability in meal pattern was measured, and related to body weight, metabolic syndrome components and cognitive function.

RESULTS

In 34 papers identified (28 observational and six intervention studies), between-day variability in meal pattern was characterised by a variety of methods. These ranged from single questions about intake regularity to more complex methods quantifying the degree of variability. Assumptions were made, such as there being three main meals, resulting in dissociation from the "clock time" of eating. In 24 of the papers, between-day variability in meal pattern was associated with negative weight and health outcomes including higher weight, reduced thermogenic response to meals and poorer academic achievement.

CONCLUSIONS

Between-day variability in meal pattern is a promising research area that might inform low-cost public health interventions. However, current methods of characterising between-day variability tend to make assumptions and be inconsistent in the meal pattern properties considered. Well controlled dietary intervention studies are required to confirm causation.

Chrononutrition and metabolic health in children and adolescents: a systematic review and meta-analysis

CONTEXT

Obesity has emerged as a global health issue for the pediatric population, increasing the need to investigate physiopathological aspects to prevent the appearance of its cardiometabolic complications. Chrononutrition is a field of research in nutritional sciences that investigates the health impact of 3 different dimensions of feeding behavior: regularity of meals, frequency, and timing of food intake.

OBJECTIVE

We carried out a systematic review and meta-analysis to investigate the association between chrononutrition in children and adolescents and the risk of overweight/obesity or a cluster of metabolic abnormalities related to glucose and lipid metabolism, blood pressure, and cardiovascular disease risk.

DATA EXTRACTION

A literature search was performed using PubMed, EMBASE, and The Cochrane Library for relevant articles published before August 2022.

DATA ANALYSIS

A total of 64 articles were included in the narrative synthesis (47 cross-sectional and 17 cohort studies), while 16 studies were included in the meta-analysis. Meta-analysis showed that non-daily breakfast consumers (≤6 d/wk) had a higher risk of overweight/obesity (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.08-1.82] compared with daily breakfast eaters (7 d/wk). Similarly, irregular breakfast consumption (only 0-to-3 times/wk) increased the risk of abdominal obesity (waist-to-height ratio ≥ 0.5) compared with regular consumption (5-to-7 times/wk) (OR, 1.38; 95% CI, 1.26-1.49). There was evidence to suggest that a regular frequency of meal consumption (≥4 times/d) is preventive against overweight/obesity development compared with fewer meals (≤3 times/d) (OR, 0.83; 95% CI, 0.70-0.97). In the narrative synthesis, snacking habits showed controversial results, while food timing was the most understudied dimension.

CONCLUSION

Overall, our data indicate a potential implication of chrononutrition in affecting pediatric metabolic health; however, the evidence of this association is limited and heterogeneous. Further prospective and intervention studies with a consistent approach to categorize the exposure are needed to elucidate the importance of chrononutrition for pediatric metabolic health.

Association between breakfast frequency and metabolic syndrome among young adults in South Korea

Skipping breakfast is highly prevalent but it is not clear whether breakfast frequency is associated with metabolic syndrome in young adults. We aimed to assess the association between breakfast frequency and metabolic syndrome in Korean young adults. This cross-sectional study was based on health check-up data of university students aged 18-39 years between 2016 and 2018. Participants were stratified into three groups by breakfast frequency (non-skipper, skipper 1-3 days/week, skipper 4-7 days/week). Multivariable-adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of metabolic syndrome. Out of 12,302 participants, 56.8% skipped breakfast at least 4 days/week. Metabolic syndrome prevalence was higher in those skipping breakfast for 4 or more days/week compared to non-skipper. (3.1% vs 1.7%) In the age- and sex-adjusted model, individuals skipping breakfast for 4-7 days per week had a higher OR of metabolic syndrome (OR 1.73, 95% CI 1.21-2.49) compared to non-skipper. Although this association became insignificant (OR 1.49, 95% CI 0.99-2.23) after a fully adjusted multivariable model, trends of positive association between frequency of breakfast skipping and metabolic syndrome was significant (P for trend = 0.038). Frequent breakfast skipping was associated with higher odds of metabolic syndrome in young adults. Further longitudinal studies in the long term are needed to understand the association of meal patterns with metabolic syndrome.

Food insecurity is associated with glycemic markers, and socioeconomic status and low-cost diets are associated with lipid metabolism in Mexican mothers

The association between socioeconomic status (SES) and chronic disease has recently become more evident in middle- and low-income countries. We hypothesized that poor socioeconomic conditions, such as food insecurity, low educational level, or low SES, may restrict access to a healthy diet and may be associated with cardiometabolic risk independently of body fat. This study examined the relation between socioeconomic indicators, body fat, and cardiometabolic disease risk markers in a random sample of mothers living in Queretaro, Mexico. Young and middle-aged mothers (n = 321) answered validated questionnaires to determine SES, food insecurity, and educational level and a semiquantitative food frequency questionnaire to determine dietary patterns and the cost of individual diet. Clinical measurements included anthropometry, blood pressure, lipids profile, glucose, and insulin. Obesity was present in 29% of the participants. Women with moderate food insecurity had higher waist circumference, glucose, insulin, and homeostasis model assessment of insulin resistance than women with food security. High triglyceride concentration and lower levels of high-density lipoprotein and low-density lipoprotein cholesterol were associated with lower SES and lower educational level. Women who consumed a lower carbohydrate diet had higher SES, higher education, and better cardiovascular risk markers. The higher carbohydrate diet profile was the least expensive diet. There was an inverse association between the cost and energy-density of foods. In conclusion, food insecurity was associated with glycemic control markers, and lower SES and education were related to a low-cost, higher carbohydrate diet and to a greater cardiovascular risk. The influence of the social environment on obesity and cardiovascular diseases needs to be further explored.

Circadian clock and temporal meal pattern

The central circadian clock in the brain controls the time-of-the-day variations in acute meal responses, with a low glycemic response but a high satiety/thermogenic response to meals consumed at waking compared to other time points. Consistently, studies show that consuming a significant proportion of calories, particularly carbohydrates, in breakfast is beneficial for the chronic management of obesity and its associated metabolic syndrome, compared to consuming identical meals at dinner. Conversely, breakfast skipping or/and late dinner can have unfavorable metabolic outcomes. It remains controversial how meal frequency affects metabolic health. In contrast, irregular meals, especially irregular breakfasts, show consistent adverse metabolic consequences. Time-restricted feeding (TRF), with all calories consumed within less than 12-h per day, can improve metabolism and extend lifespan. A major component of TRF in humans is caloric restriction, which contributes significantly to the beneficial effects of TRF in humans. By comparison, TRF effects in rodents can be independent of caloric restriction and show day/night phase specificity. TRF could alleviate metabolic abnormalities due to circadian disruption, but its effects appear independent of the circadian clock in rodents. Understanding neuroendocrine mechanisms underlying clock-mediated metabolic regulation will shed light on the metabolic effects of temporal meal patterns.

Association between meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents

BACKGROUND

This study aimed to assess the association of meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents.

METHODS

In this national survey, 14,880 students with 6-18 years of age were selected by stratified multistage sampling method from urban and rural regions of 30 provinces of Iran. Meal frequency was assessed by a questionnaire prepared based on global school-based student health survey. Physical measurements included height, weight, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP).

RESULTS

The participation rate was 90.6% including 49.24% girls and 75.5% urban residents. Skipping breakfast and dinner were more frequent in girls than in boys (71.6% vs. 64.1%, 91.2% vs. 86.9%, respectively, P<0.05). Overweight, obesity, and abdominal obesity were more prevalent in those who had two meals, one meal, or very low intake (P<0.001) than those had three meals. There were no significant differences in SBP, DBP, and blood pressure across to different meal frequency groups (P>0.05). Students who had very low intake and one meal per week had a higher risk of abdominal obesity compared with those who had three meals (OR 1.7, 95% CI: 1.3-2.3, and OR 1.6, 95% CI: 1.4-2.0, respectively).

CONCLUSIONS

An inverse significant association between higher meal frequency and anthropometric indices was observed. Therefore, encouraging children and adolescents for regular meal intake should be considered as a health priority in the pediatric population.

Association of Eating and Sleeping Intervals With Weight Change Over Time: The Daily24 Cohort

Background We aim to evaluate the association between meal intervals and weight trajectory among adults from a clinical cohort. Methods and Results This is a multisite prospective cohort study of adults recruited from 3 health systems. Over the 6-month study period, 547 participants downloaded and used a mobile application to record the timing of meals and sleep for at least 1 day. We obtained information on weight and comorbidities at each outpatient visit from electronic health records for up to 10  years before until 10 months after baseline. We used mixed linear regression to model weight trajectories. Mean age was 51.1 (SD 15.0) years, and body mass index was 30.8 (SD 7.8) kg/m²; 77.9% were women, and 77.5% reported White race. Mean interval from first to last meal was 11.5 (2.3) hours and was not associated with weight change. The number of meals per day was positively associated with weight change. The average difference in annual weight change (95% CI) associated with an increase of 1 daily meal was 0.28 kg (0.02-0.53). Conclusions Number of daily meals was positively associated with weight change over 6 years. Our findings did not support the use of time-restricted eating as a strategy for long-term weight loss in a general medical population.

Association of self-rated chewing function and oral health status with metabolic syndrome

PURPOSE

The study aimed to examine the association of self-rated chewing function, the number of teeth and periodontal status with metabolic syndrome.

METHODS

The participants were 11,119 adults aged 40-74 years who underwent specific health checkups, including an oral health examination, in 2018 in Japan. This study used the standard questions of the specific health checkups to obtain information on self-rated chewing function. A multinomial logistic regression analysis was performed with metabolic syndrome status as the dependent variable, and age, sex, lifestyle questions, self-rated chewing function, number of teeth, and periodontal status as the independent variables.

RESULTS

Number of teeth and periodontal status were significantly associated with metabolic syndrome after adjusting for confounding variables. Self-rated chewing function was significantly associated with metabolic syndrome in the crude analysis, but not after adjustment for confounding variables. Both number of teeth and periodontal status were significantly associated with self-rated chewing function.

CONCLUSION

There was no significant direct association between self-rated chewing function and metabolic syndrome. Self-rated chewing function may be an indicator of poor oral condition that links to metabolic syndrome.

Wearable Cameras Reveal Large Intra-Individual Variability in Timing of Eating among Young Adults

Studies have shown that young adults follow less structured eating patterns compared with older cohorts. This may have implications for dietary assessment methods which rely on memory and structured meal patterns. Our aim was to describe the intra-individual variation of eating times in young adults aged 18−30 years. Participants (n = 41) wore an Autographer camera that captured first-person perspective images every 30 s for three consecutive days. All images were timestamped and those showing food consumption were used to extract data such as the timing of the first and last eating occasions (EOs), number of EOs per day, and length of eating window. Intra-individual variability was calculated from these data using composite phase deviation (CPD) and coefficient of variation (CV). The number of individuals with high or very high variability was 28 and 18 for timing of first and last EOs, respectively (CPD > 1.70), and 27 and 17 for number of EOs and eating window, respectively (CV > 20%). In this sample of young adults, the lack of regularity in eating patterns should be considered when selecting a dietary assessment method.

Eating patterns in a nationwide sample of Japanese aged 1-79 years from MINNADE study: eating frequency, clock time for eating, time spent on eating and variability of eating patterns

OBJECTIVE

Although there is growing evidence suggesting that eating patterns are important determinants of health status, comprehensive information on patterning of eating behaviours is almost lacking. The aim of this cross-sectional study was to describe eating patterns in Japan.

DESIGN

Information on actual eating behaviours was collected using 2-d dietary record in each season over a year (total 8 d). Eating occasions were defined as any discrete intake occasion (with a discrete start clock time and name) except for eating occasions consisting of water only, which were excluded.

SETTING

Japan.

PARTICIPANTS

A nationwide sample of 4032 Japanese aged 1-79 years.

RESULTS

The mean value of eating frequency of meals (i.e. breakfast, lunch and dinner), snacks and total eating occasions was 2·94, 1·74 and 4·68 times/d, respectively. The mean clock time for the start of breakfast, lunch and dinner was 07.24, 12.29 and 19.15 h, respectively. The mean time spent consuming breakfast, lunch, dinner and snacks was 19, 25, 34 and 27 min/d, respectively. On average, variability (i.e. average of absolute difference from mean) of meal frequency was small compared with that of snack frequency and total eating frequency. Both mean variability of clock time for the start of eating (<1 h) and mean variability of time spent on meals (<10 min/d) were also small. Conversely, mean variability of time spent on snacks was large (>18 min/d).

CONCLUSION

The present findings serve as both a reference and an indication for future research on patterning of eating behaviours.

Effects of Diet, Lifestyle, Chrononutrition and Alternative Dietary Interventions on Postprandial Glycemia and Insulin Resistance

As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.

Impact of isoenergetic intake of irregular meal patterns on thermogenesis, glucose metabolism, and appetite: a randomized controlled trial

BACKGROUND

Evidence is emerging that interdaily meal pattern variability potentially affects response such as thermic effect of food (TEF), macronutrient metabolism, and appetite.

OBJECTIVES

To investigate the effect of irregular meal pattern on TEF, glucose, insulin, lipid profile, and appetite regulation in women who are overweight or with obesity and confirmed insulin resistance.

DESIGN

In a randomized crossover trial, 9 women [mean ± SD BMI (in kg/m2): 33.3 ± 3.1] with confirmed insulin resistance consumed a regular (14 d; 6 meals/d) and an irregular (14 d; 3-9 meals/d) meal pattern separated by a 14-d washout interval. Identical foods were provided during the interventions, and at the start and end of each meal pattern, participants attended the laboratory after an overnight fast. Energy expenditure, glucose, insulin, lipids, adiponectin, leptin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and ghrelin were measured at baseline and for 3 h after consumption of a test drink, after which an ad libitum test meal was offered. Subjective appetite ratings were recorded before and after the test drink, after the ad libitum meal, and during the intervention. Continuous interstitial glucose monitoring was undertaken for 7 consecutive days during each intervention.

RESULTS

TEF (over 3 h) was significantly lower postirregular intervention compared with postregular (97.7 ± 19.2 kJ*3 h in postregular visit and 76.7 ± 35.2 kJ*3 h in postirregular visit, paired t test, P = 0.048). Differences in HOMA-IR between the 2 interventions (3.3 ± 1.7 and 3.6 ± 1.6 in postregular and postirregular meal pattern, respectively) were not significant. Net incremental AUC for GLP-1 concentrations (over 3 h) for the postregular meal pattern were higher (864.9 ± 456.1 pmol/L*3 h) than the postirregular meal pattern (487.6 ± 271.7 pmol/L*3 h, paired t test, P = 0.005).

CONCLUSIONS

Following a 14-d period of an irregular meal pattern, TEF was significantly less than following a regular meal pattern, potentially compromising weight management if sustained long term. This study was registered at www.clinicaltrials.gov as NCT02582606.

Feeding frequency affects glucose and lipid metabolism through SIRT1/AMPK pathway in growing pigs with the same amount of daily feed

Eating patterns are associated with obesity and metabolic health. However, the regulating mechanism of different eating patterns on body metabolism are not fully cleare. In this study, a pig model was used to evaluate the effects of feeding frequency on glucose and lipid metabolism and reveal its regulating mechanism. Twenty-four growing barrows were randomly allocated to 1-meal (M1), 3-meal (M3), or 5-meal (M5) per day groups with the same amount of daily feed. GSEA was conducted on the liver to investigate the pathways of different feeding frequencies on the metabolism. The serum glucose, NEFA, VLDL-C levels were higher for M1 group than for M3 and M5 groups, however, the hepatic TRIG level was lower. Liver transcriptome showed that glycolysis/gluconeogenesis and fatty acid metabolism pathways were suppressed with the increase of feeding frequency. The increase of gluconeogenic substrates (glycerol and lactate) and enzymes (PEPCK1 and G6Pase) in liver indicated that hepatic gluconeogenesis was enhanced in the M1 group. AMPK/PPARα signaling associated genes were positively correlated with NEFA and β-HB levels in M1 group, which promoted fatty acid oxidation and ketogenesis in liver. Moreover, compared with M3 and M5 groups, the higher NAD⁺/NADH ratio in the liver of M1 group activated SIRT1, which stimulated the AMPK signaling associated pathways by up-regulating the LKB1 gene. These findings provide evidence for the regulating roles of feeding frequency on glucose and lipid metabolism through SIRT1/AMPK pathway, which greatly contributes to the regulation of energy metabolism through daily eating patterns in animals.

Content Validation of a Chrononutrition Questionnaire for the General and Shift Work Populations: A Delphi Study

Unusual meal timing has been associated with a higher prevalence of chronic disease. Those at greater risk include shift workers and evening chronotypes. This study aimed to validate the content of a Chrononutrition Questionnaire for shift and non-shift workers to identify temporal patterns of eating in relation to chronotype. Content validity was determined using a Delphi study of three rounds. Experts rated the relevance of, and provided feedback on, 46 items across seven outcomes: meal regularity, times of first eating occasion, last eating occasion, largest meal, main meals/snacks, wake, and sleep, which were edited in response. Items with greater than 70% consensus of relevance were accepted. Rounds one, two, and three had 28, 26, and 24 experts, respectively. Across three rounds, no outcomes were irrelevant, but seven were merged into three for ease of usage, and two sections were added for experts to rate and comment on. In the final round, all but one of 29 items achieved greater than 70% consensus of relevance with no further changes. The Chrononutrition Questionnaire was deemed relevant to experts in circadian biology and chrononutrition, and could represent a convenient tool to assess temporal patterns of eating in relation to chronotype in future studies.

Systematic Review and Meta-Analysis on the Effect of Portion Size and Ingestive Frequency on Energy Intake and Body Weight among Adults in Randomized Controlled Feeding Trials

Energy intake is the product of portion size (PS)-the energy content of an ingestive event-and ingestive frequency (IF)-the number of ingestive events per unit time. An uncompensated alteration in either PS or IF would result in a change in energy intake and body weight if maintained over time. The objective of this meta-analysis was to assess the independent effects of PS and IF on energy intake and body weight among healthy adults in randomized controlled trials (RCTs). A total of 9708 articles were identified in PubMed, Web of Science, Cochrane, and CINAHL databases. The articles were divided among 10 researchers; each article was screened for eligibility by 2-3 independent reviewers. Exclusion criteria included: populations <19 y and >65 y, unhealthy populations (i.e. participants with an acute or chronic disease), assessments <24 h and <4 wk in duration for trials investigating energy intake or body weight, respectively. Controlled feeding trials (i.e. fixed energy intake) that manipulated IF and PS in the same study intervention (IF/PS) were evaluated separately and for the body weight outcome only. Twenty-two studies (IF = 4, PS = 14, IF/PS = 4) met the inclusion criteria. There was an insufficient number of studies to assess the effect of IF, PS, or IF/PS on body weight. There was heterogeneity in the effect sizes among all comparisons (I2 ≥75%). Consuming larger portion sizes was associated with higher daily energy intake [295 kcal (202, 388), n = 24; weighted mean differences (WMD) (95% CI), n = comparisons], and increased frequency of ingestive events was associated with higher energy intake [203 kcal (76, 330), n = 10]. Results from RCTs support that larger PS and greater IF are both associated with higher energy consumption. However, there is insufficient information to determine chronic effects on body weight. This protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42018104757.

Effects of consuming later evening meal v. earlier evening meal on weight loss during a weight loss diet: a randomised clinical trial

Previous evidence confirms a relationship between the timing of food intake and weight loss. We aimed to evaluate the effect of late v. early evening meal (EEM) consumption on weight loss and cardiometabolic risk factors in women during a weight loss programme. Eighty-two healthy women (BMI 27-35 kg/m2; age 18-45 years) were randomly assigned to two groups: EEM group (eating at 19.00-19.30 hours) or late evening meal (LEM) group (eating at 22.30-23.00 hours), for 12 weeks. Compared with the LEM group, the EEM group had a greater mean reduction in weight (EEM: -6·74 (sd 1·92) kg; LEM: -4·81 (sd 2·22) kg; P < 0·001), BMI (EEM: -2·60 (sd 0·71) kg/m2; LEM: -1·87 (sd 0·85) kg/m2; P < 0·001), waist circumference (EEM: -8 (sd 3·25) cm; LEM: -6 (sd 3·05) cm, P = 0·007), total cholesterol (EEM: -0·51 (sd 0·19) mmol/l, LEM: -0·43 (sd 0·19) mmol/l, P = 0·038), TAG (EEM: -0·28 (sd 0·10) mmol/l, LEM: -0·19 (sd 0·10) mmol/l, P < 0·001) and homoeostasis model assessment of insulin resistance (EEM: -0·83 (sd 0·37); LEM: -0·55 (sd 0·28), P < 0·001) after 12 weeks. In conclusion, eating an earlier evening meal resulted in favourable changes in weight loss and plasma cardiometabolic risk markers during a weight loss programme.

Irregular daily energy intake and diet quality in Iranian adults

The present cross-sectional study aimed to assess the association of daily irregularity in energy intake and diet quality among apparently healthy adults in Iran. The research was conducted on 850 adult men and women (age range: 20-59 years) who attended health care centres in Tehran. Dietary intake was assessed by three, 24-h dietary recalls. Diet quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) diet score and Healthy Eating Index-2015 (HEI-2015). An irregularity score of daily energy intake was calculated based on the deviation from the 3-d mean energy intake, with a higher score indicating more fluctuations in daily energy intake. Multiple linear regression analysis was used to assess the association of irregularity score of daily energy intake with food group intakes and DASH diet score and HEI-2015, controlling for age, sex, BMI, physical activity, education level and occupation status. The range of irregularity score was 0·55-133·3 (22·4 (sd 19·0)). Higher irregularity score of daily energy intake was significantly associated with a lower consumption of fruit, vegetables, legumes, low-fat dairy products and poultry, higher consumption of soft drinks, processed meat and nuts, and lower overall DASH diet score and HEI-2015. Overall, our findings showed that more day-to-day variations in energy intake may be correlated with a lower diet quality. More research is needed to confirm the associations observed in the present study and to clarify potential mechanisms explaining these associations.

Dietary Aspects to Incorporate in the Creation of a Mobile Image-Based Dietary Assessment Tool to Manage and Improve Diabetes

Diabetes is the seventh leading cause of death in United States. Dietary intake and behaviors are essential components of diabetes management. Growing evidence suggests dietary components beyond carbohydrates may critically impact glycemic control. Assessment tools on mobile platforms have the ability to capture multiple aspects of dietary behavior in real-time throughout the day to inform and improve diabetes management and insulin dosing. The objective of this narrative review was to summarize evidence related to dietary behaviors and composition to inform a mobile image-based dietary assessment tool for managing glycemic control of both diabetes types (type 1 and type 2 diabetes). This review investigated the following topics amongst those with diabetes: (1) the role of time of eating occasion on indicators of glycemic control; and (2) the role of macronutrient composition of meals on indicators of glycemic control. A search for articles published after 2000 was completed in PubMed with the following sets of keywords “diabetes/diabetes management/diabetes prevention/diabetes risk”, “dietary behavior/eating patterns/temporal/meal timing/meal frequency”, and “macronutrient composition/glycemic index”. Results showed eating behaviors and meal macronutrient composition may affect glycemic control. Specifically, breakfast skipping, late eating and frequent meal consumption might be associated with poor glycemic control while macronutrient composition and order of the meal could also affect glycemic control. These factors should be considered in designing a dietary assessment tool, which may optimize diabetes management to reduce the burden of this disease.

Rest-activity rhythms in emerging adults: implications for cardiometabolic health

Emerging adulthood (18-25 years) represents a window of opportunity to modify the trajectory of cardiometabolic disease risk into older adulthood. Not known is the extent to which rest-activity rhythms (RAR) may be related to biomarkers of cardiometabolic health in this population. In this cross-sectional, observational study, 52 healthy emerging adults wore wrist accelerometers (14 consecutive days; 24 h/day) for assessment of nonparametric RAR metrics, including interdaily stability (IS; day-to-day RAR consistency), intradaily variability (IV; within-day RAR fragmentation), and relative amplitude (RA; robustness of RAR), as well as autocorrelation (correlation of rest/activity levels at 24-h lag-times). Cardiometabolic biomarkers, including body mass index (BMI), body fat percentage, blood pressure (BP), fasting lipids, glucose, and C-reactive protein (CRP) were assessed. Additional measures including physical activity, sleep duration, and habitual caffeine and alcohol consumption were also evaluated. A series of multivariable regression models of cardiometabolic biomarkers were used to quantify associations with RAR metrics. On average, participants were 20 ± 1 years of age (21 males, 31 females), non-obese, and non-hypertensive. All were nonsmokers and free of major diseases or conditions. In separate models, which adjusted for sex, BMI, moderate-vigorous physical activity, sleep duration, caffeine, and alcohol consumption, IS was inversely associated with total cholesterol (p ≤ 0.01) and non-HDL cholesterol (p < .05), IV was positively associated with CRP (p < .05), and autocorrelation was inversely associated with total cholesterol (p < .05) and CRP (p < .05). Conversely, associations between RA and cardiometabolic biomarkers were nonsignificant after adjustment for BMI, alcohol, and caffeine consumption. In conclusion, RAR metrics, namely, a higher IS, lower IV, and higher autocorrelation, emerged as novel biomarkers associated with more favorable indices of cardiometabolic health in this sample of apparently healthy emerging adults.

Dietary Association with Glycemic Status Among Adults Clinically Diagnosed with Type 2 Diabetes in Malawi

We elucidated diet and its association with glycemic status among adults clinically diagnosed with type 2 diabetes mellitus (T2DM) through across-sectional study in Malawi. Glycosylated hemoglobin (A1C) and dietary intakes were assessed. Consumption of cereals, roots, and tubers and sweet, sugary food, including sweetened beverages, was significantly higher among participants with A1C≥8%. Fruit and vegetable intake were disproportionately low overall. Consuming adiet high in carbohydrates (OR: 1.167; CI = 1.107-1.231; p < .001) and having <3 meals/day (OR: 2.680; CI = 1.445-4.970; p = .002) were both associated with A1C≥8%. Therefore, dietary interventions for T2DM focusing on carbohydrate counting, total dietary quality, and meal planning are needed in Malawi.

Time-Restricted Eating: Benefits, Mechanisms, and Challenges in Translation

Eating out of phase with daily circadian rhythms induces metabolic desynchrony in peripheral metabolic organs and may increase chronic disease risk. Time-restricted eating (TRE) is a dietary approach that consolidates all calorie intake to 6- to 10-h periods during the active phase of the day, without necessarily altering diet quality and quantity. TRE reduces body weight, improves glucose tolerance, protects from hepatosteatosis, increases metabolic flexibility, reduces atherogenic lipids and blood pressure, and improves gut function and cardiometabolic health in preclinical studies. This review discusses the importance of meal timing on the circadian system, the metabolic health benefits of TRE in preclinical models and humans, the possible mechanisms of action, the challenges we face in implementing TRE in humans, and the possible consequences of delaying initiation of TRE.

Personality, Chrono-nutrition and Cardiometabolic Health: A Narrative Review of the Evidence

Growing evidence suggests that personality traits play a role in obesity and cardiometabolic health. In addition, irregularity of food intake has emerged as a potential risk factor for obesity, cardiovascular disease, and metabolic syndrome. Recent studies suggest that when we eat, termed "chrono-nutrition," may be as important to what we eat. This concept covers 3 aspects: 1) irregularity of energy intake in meals (varying amounts of energy intake throughout the day and at different times from one day to the next), 2) frequency (number of meals per day), and 3) timing of food intake (actual time of day). A narrative review was conducted to identify literature evaluating the effect of personality on chrono-nutrition and subsequently obesity and cardiometabolic health. The search focused on research published since 2000 in MEDLINE using the search terms "personality," "chrono-nutrition," "cardiometabolic," "BMI," "obesity," and "metabolic rate." Findings indicate an inverse relation between conscientiousness and obesity, with people who are more conscientious having a lower risk of obesity. Furthermore, time of day of energy intake has been linked to obesity, since meals consumed in the evening have been associated with lower resting metabolic rate. Inconsistent timing and frequency of meals have also been linked to increased body weight and worse cardiometabolic health. Together, the data indicate that eating meals at the same time every day at regular intervals might be the reason why those who score high in conscientiousness are able to maintain a healthier weight. Despite the reviewed observational evidence, there is an apparent gap in the existing literature on the interplay between personality, chrono-nutrition, and obesity and particularly on how dietary interventions should be designed considering different personality traits. Future research is needed to clarify this association and how it interacts with other factors, thus elucidating the role of chrono-nutrition in health.

Effects of Shift Work on the Eating Behavior of Police Officers on Patrol

Recent studies indicate that the timing of food intake can significantly affect metabolism and weight management. Workers operating at atypical times of the 24-h day are at risk of disturbed feeding patterns. Given the increased risk of weight gain, obesity and metabolic syndrome in shift working populations, further research is required to understand whether their eating behavior could contribute to these increased metabolic risks. The objective of this study was to characterize the dietary patterns of police officers across different types of shifts in their natural environments. Thirty-one police officers (six women; aged 32.1 ± 5.4 years, mean ± SD) from the province of Quebec, Canada, participated in a 28- to 35-day study, comprising 9- to 12-h morning, evening, and night shifts alternating with rest days. Sleep and work patterns were recorded with actigraphy and diaries. For at least 24 h during each type of work day and rest day, participants logged nutrient intake by timestamped photographs on smartphones. Macronutrient composition and caloric content were estimated by registered dieticians using the Nutrition Data System for Research database. Data were analyzed with linear mixed effects models and circular ANOVA. More calories were consumed relative to individual metabolic requirements on rest days than both evening- and night-shift days (p = 0.001), largely sourced from increased fat (p = 0.004) and carbohydrate (trend, p = 0.064) intake. Regardless, the proportions of calories from carbohydrates, fat, and protein did not differ significantly between days. More calories were consumed during the night, between 2300 h and 0600 h, on night-shift days than any other days (p < 0.001). Caloric intake occurred significantly later for night-shift days (2308 h ± 0114 h, circular mean ± SD) than for rest days (1525 h ± 0029 h; p < 0.01) and was dispersed across a longer eating window (13.9 h ± 3.1 h vs. 11.3 h ± 1.8 h, mean ± SD). As macronutrient proportions were similar and caloric intake was lower, the finding of later meals times on night-shift days versus rest days is consistent with emerging hypotheses that implicate the biological timing of food intake—rather than its quantity or composition—as the differentiating dietary factor in shift worker health.

The Effects of Meal Timing and Frequency, Caloric Restriction, and Fasting on Cardiovascular Health: an Overview

Cardiovascular disease (CVD), which is the leading cause of death worldwide, is strongly affected by diet. Diet can affect CVD directly by modulating the composition of vascular plaques, and indirectly by affecting the rate of aging. This review summarizes research on the relationships of fasting, meal timing, and meal frequency with CVD incidence and progression. Relevant basic research studies, epidemiological studies, and clinical studies are highlighted. In particular, we discuss both intermittent and periodic fasting interventions with the potential to prevent and treat CVD.

Eating Competence Is Associated with Lower Prevalence of Obesity and Better Insulin Sensitivity in Finnish Adults with Increased Risk for Type 2 Diabetes: The StopDia Study

A healthy diet prevents type 2 diabetes but is often difficult to adhere to. This cross-sectional study aimed to investigate whether eating competence is associated with diet or risk factors and prevalence of type 2 diabetes in individuals screened for type 2 diabetes risk. Eating competence is an indicator of food acceptance, positive attitudes, internal regulation and contextual skills related to food and eating. In total, 3147 Finnish adults aged 18-74 at an increased risk for type 2 diabetes identified via online risk screening participated in the baseline examinations of the Stop Diabetes (StopDia) study. The participants filled out the digital questionnaire on food intake, physical activity and sleep, and the Satter Eating Competence Inventory 2.0^TM (ecSI 2.0^TM). In addition, anthropometric and laboratory measurements were performed at primary healthcare centres. Eating competent individuals (37%, classified by ecSI 2.0^TM) had a better quality of diet (p < 0.05 for all). Additionally, eating competence was associated with a lower prevalence of previously undiagnosed type 2 diabetes, abdominal obesity, metabolic syndrome and hypertriglyceridaemia, and with better insulin sensitivity (p < 0.05 for all). However, these associations, except for metabolic syndrome, were at least partly mediated by body mass index. Eating competence is associated with a healthy diet and could, thus, in the long term, support the prevention of type 2 diabetes.

Dietary Habits of Students Enrolled in Faculties of Health Sciences: A Cross-sectional Study

Introduction It is often presumed that students of health sciences are more vigilant about their diet. This study assessed the prevalence of unhealthy dietary habits and identified its associated factors among students enrolled at a large university for health sciences in the Middle East. Methods A cross-sectional study, using a set of pre-validated and anonymous dietary tools, was conducted in 2018. The self-reported students' characteristics and prevalence of 10 unhealthy dietary habits were collected. Results Males were significantly more likely have irregular meal times (β = 0.425, adjusted [adj.] odds ratio [OR] = 1.5) and insufficient seafood consumption (β = 0.55, adj. OR = 1.7) compared to females, adj. P = 0.046 and adj. P = 0.012, respectively. Students in their third year and above (β = 0.857, adj. OR = 2.2) reported more insufficient water intake compared to students in the first and second years, adjusted P = 0.003. Obesity in students was a significant associated factor with fast food consumption (β = 0.48, adj. OR = 1.8), night-eating habits (β = 0.27, adj. OR = 1.3) and skipping meals (β = 0.41, adj. OR = 1.5) compared to normal weight students, adjusted P = 0.002, adj. P = 0.004, and adj. P = 0.003, respectively. Conclusions Compliance with healthy dietary habits among students was less than optimal. Special consideration should be paid to gender and obesity that have been associated with insufficient water intake, irregular meal times, skipping meals, night-eating habits, and fast food consumption.

The Association of Breakfast Frequency and Cardiovascular Disease (CVD) Risk Factors among Adolescents in Malaysia

Breakfast frequency is associated with cardiovascular disease (CVD) risk in Western populations, possibly via the types of food eaten or the timing of food consumption, but associations in Malaysian adolescents are unknown. While the timing of breakfast is similar, the type of food consumed at breakfast in Malaysia differs from Western diets, which allows novel insight into the mechanisms underlying breakfast-CVD risk associations. We investigated foods eaten for breakfast and associations between breakfast frequency and CVD risk factors in the Malaysian Health and Adolescents Longitudinal Research Team study (MyHeARTs). Breakfast (frequency of any food/drink reported as breakfast in 7-day diet history interviews) and CVD risk factors (body mass index (BMI), waist circumference, fasting blood glucose, triacylglycerol, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and systolic and diastolic blood pressure) were cross-sectionally associated using linear regression adjusting for potential confounders (n = 795, age 13 years). Twelve percent of adolescents never ate breakfast and 50% ate breakfast daily, containing mean (SD) 400 (±127) kilocalories. Commonly consumed breakfast foods were cereal-based dishes (primarily rice), confectionery (primarily sugar), hot/powdered drinks (primarily Milo), and high-fat milk (primarily sweetened condensed milk). After adjustment, each extra day of breakfast consumption per week was associated with a lower BMI (-0.34 kg/m², 95% confidence interval (CI) -0.02, -0.66), and serum total (-0.07 mmol/L 95% CI -0.02, -0.13) and LDL (-0.07 mmol/L 95% CI -0.02, -0.12) cholesterol concentrations. Eating daily breakfast in Malaysia was associated with slightly lower BMI and total and LDL cholesterol concentrations among adolescents. Longitudinal studies and randomized trials could further establish causality.

Food-Insecure Women Eat a Less Diverse Diet in a More Temporally Variable Way: Evidence from the US National Health and Nutrition Examination Survey, 2013-4

Food insecurity is associated with high body weight amongst women, but not men, in high-income countries. Previous research using food recalls suggests that the total energy intake of food-insecure women is not elevated, though macronutrient composition may differ from that of food-secure women. There is limited evidence on temporal patterns of food consumption. Here, we used food recalls from women in the 2013-4 cycle of the National Health and Nutrition Examination Survey (NHANES, n = 2798) to characterise temporal patterns of food consumption in relation to food insecurity. Compared to the food-secure, food-insecure women had more variable time gaps between eating; ate a smaller and less variable number of distinct foods at a time; were more variable from day to day in their time of first consumption; were more variable from day to day in the number of times they ate; and consumed relatively more carbohydrate, less protein, and less fibre. However, their overall energy intake was no higher. Food-insecure women had higher BMIs (2.25 kg/m²), and around 15% of the BMI difference between food-insecure and food-secure women was accounted for by their more variable time gaps between eating, their lower diversity of foods, and their lower fibre consumption. Food insecurity is associated with measureable differences in the temporal pattern of food consumption, and some of these differences shed light on how food-insecure women come to have higher body weights.

Impact of food security on glycemic control among low-income primarily Hispanic/Latino children in Los Angeles, California: A cross-sectional study

Studies examining the impact of food insecurity on metabolic markers are limited, specifically in Hispanic youth. This study was a cross-sectional analysis of 218 3^rd-5^th grade students (83% Hispanic and 49% male). Anthropometrics, blood glucose, insulin, and lipids via fasting blood draw, dietary intake via Block screener, and a 5-item food security scale were collected. HOMA-Insulin Resistance was calculated. Multivariate analyses of covariance were used to examine differences in glucose and insulin indices, adiposity, metabolic and dietary intake variables between categories of food security. Food secure children had greater glycemic control and decreased insulin resistance compared to food insecure children.

Adherence to the French Eating Model is inversely associated with overweight and obesity: results from a large sample of French adults

The ‘French Eating Model’ characterised by structured meals and conviviality has received little attention, although it has been suggested as a potential explanation of the French paradox. This study aims at assessing the adherence to this model in French adults and whether it is associated with weight status. Eating behaviour and, in particular, number of meals per day, snacking frequency, meal time, meal duration, number of courses, position (standing, sitting), presence of others and pleasure experienced was assessed in 2014, in 47 219 participants of the NutriNet-Santé study. A global score of adherence to the French Eating Model was computed on the basis of eating behaviour components. Prevalence of the model was assessed on a sample weighted according to Census data. Associations between adherence to the model (and its components) and overweight and obesity were assessed using logistic regression analyses adjusted for individual characteristics. Most individuals followed the French Eating Model: three meals a day, at set times, sitting at a table with other people and considering meals as a moment of pleasure. Individuals who exhibited higher adherence to the model were less likely to be overweight (OR=0·89; 95 % CI 0·87, 0·92 or obese (0·76; 95 % CI 0·74, 0·79). Similar trends were found for the following components: number of meals per day, snacking frequency, meal time, meal duration and pleasure experience, whereas an opposite trend was observed for the eating with others component. Although prospective studies are needed to conclude on a causal relationship, these results suggested the potential role of the French Eating Model, which is still prevailing in France, in obesity prevention.

Longitudinal association between eating frequency and hemoglobin A1c and serum lipids in diabetes in the SEARCH for Diabetes in Youth study

BACKGROUND

Few studies have evaluated the prospective association of eating frequency with HbA1c levels and cardiovascular disease risk markers among youth with diabetes.

OBJECTIVE

To examine the 5-year longitudinal association of eating frequency with HbA1c and serum lipid levels among youth with type 1 diabetes (T1D) or type 2 diabetes (T2D).

METHODS

One-thousand and forty-nine youth (≥10-year old) with incident T1D (n = 821) or T2D (n = 228) who participated in the SEARCH for Diabetes in Youth study were included. Eating frequency (≤3, 4-5, or 6-10 times/d) measured at baseline and follow-up visits was related to HbA1c and serum lipid levels measured repeatedly over 5 years.

RESULTS

Increased eating frequency was associated with larger increases in HbA1c among youth T1D. For example, for youth with T1D who ate ≤3 times/d at the outset and ate 6-10 times/d 5 years later, the longitudinal model predicted greater absolute increases in HbA1c (2.77%); whereas for youth with T1D who ate 6-10 times/d at the outset and ate ≤3 times/d 5 years later, the model predicted lesser absolute increases in HbA1c (1.33%). Eating frequency was not associated with changes in serum lipid levels among youth with T1D or T2D.

CONCLUSIONS

Youth with T1D who increased their eating frequency vs those who decreased it had larger increases in HbA1c over 5 years.

Effects of 6 vs 3 eucaloric meal patterns on glycaemic control and satiety in people with impaired glucose tolerance or overt type 2 diabetes: A randomized trial

BACKGROUND/OBJECTIVES

The study aimed to compare the effects of two eucaloric meal patterns (3 vs 6 meals/day) on glycaemic control and satiety in subjects with impaired glucose tolerance and plasma glucose (PG) levels 140-199mg/dL at 120min (IGT-A) or PG levels 140-199mg/dL at 120min and >200mg/dL at 30/60/90min post-oral glucose load on 75-g OGTT (IGT-B), or overt treatment-naïve type 2 diabetes (T2D).

SUBJECTS/METHODS

In this randomized crossover study, subjects with IGT-A (n=15, BMI: 32.4±5.2kg/m²), IGT-B (n=20, BMI: 32.5±5kg/m²) or T2D (n=12, BMI: 32.2±5.2kg/m²) followed a weight-maintenance diet (45% carbohydrates, 20% proteins, 35% fats) in 3 or 6 meals/day (each intervention lasting 12 weeks). Anthropometrics, diet compliance and subjective appetite were assessed every 2 weeks. OGTT and measurements of HbA1c and plasma lipids were performed at the beginning and end of each intervention period.

RESULTS

Body weight and physical activity levels remained stable throughout the study. In T2D, HbA1c and PG at 120min post-OGTT decreased with 6 vs 3 meals (P<0.001 vs P=0.02, respectively). The 6-meal intervention also improved post-OGTT hyperinsulinaemia in IGT-A subjects and hyperglycaemia in IGT-B subjects. In all three groups, subjective hunger and desire to eat were reduced with 6 vs 3 meals/day (P<0.05). There were no differences in HOMA-IR or plasma lipids between interventions.

CONCLUSION

Although weight loss remains the key strategy in hyperglycaemia management, dietary measures such as more frequent and smaller meals may be helpful for those not sufficiently motivated to adhere to calorie-restricted diets. Our study shows that 6 vs 3 meals a day can increase glycaemic control in obese patients with early-stage T2D, and may perhaps improve and/or stabilize postprandial glucose regulation in prediabetes subjects.

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.

Postprandial Metabolism and Appetite Do Not Differ between Lean Adults that Eat Breakfast or Morning Fast for 6 Weeks

Background

It remains unknown whether sustained daily feeding-fasting patterns modify the acute response to specific feedings on a given day.

Objective

We conducted a randomized controlled trial to establish if daily breakfast consumption or fasting until noon modifies the acute metabolic and appetitive responses to a fixed breakfast and ad libitum lunch.

Methods

With the use of a parallel group design, we randomly assigned 31 healthy, lean men and women (22-56 y) to 6 wk of either consuming ≥700 kcal of self-selected items before 1100 or fasting (0 kcal) until 1200 daily. Following 48 h of diet and physical activity standardization, we examined metabolic and appetite responses to a standardized breakfast and ad libitum lunch before and after the intervention. Data were analyzed using 3- and 2-way ANCOVA.

Results

Systemic concentrations of energy balance regulatory hormones total and acylated ghrelin, leptin, and peptide tyrosine-tyrosine) responded similarly to breakfast and lunch before and after 6 wk of either morning fasting or regular breakfast, with the exception of a tendency for increased glucagon-like peptide-1 concentrations from baseline to follow-up in the Breakfast Group compared with a decrease over that period in the Fasting Group [P = 0.06, partial eta squared value (ƞ2) = 0.16]. Subjective appetite sensations also did not differ over the course of the day, and ad libitum energy intake at lunch was not systematically affected by either intervention, decreasing by 27 kcal (95% CI: -203, 149 kcal) with fasting and by 77 kcal (95% CI: -210, 56 kcal) with breakfast. Similarly, glycemic, insulinemic, lipemic, and thermogenic responses to breakfast and lunch were very stable at baseline and follow-up and, thus, did not differ between treatment groups.

Conclusions

Our results indicate that a sustained period of either extended morning fasting or eating a daily breakfast has minimal effect upon acute metabolic and appetite responses in lean adults. This trial was registered at www.isrctn.org as ISRCTN31521726.

Sleep duration, nightshift work, and the timing of meals and urinary levels of 8-isoprostane and 6-sulfatoxymelatonin in Japanese women

It has been hypothesized that disruption of circadian rhythms affects human health. Shift work and sleep deprivation are thought to disrupt the normal light-dark cycle, although the disruption due to shiftwork may be dependent on sleep deprivation. Both conditions have been suggested to be associated with an increased risk of cardiometabolic disorders. Non-photic environmental factors, such as the timing of eating, are also thought to regulate circadian rhythm and thus, may have effects on health, but the evidence from human studies is scarce. Oxidative stress is a risk factor of cardiometabolic disorders. Some laboratory studies suggest an involvement of circadian clock genes in the regulation of the redox system. The present study aimed to examine the association of sleeping habits, nightshift work, and the timing of meals with urinary levels of 8-isoprostane, a marker of oxidative stress, and 6-sulfatoxymelatonin, the principal metabolite of melatonin. Study subjects were 542 women who had previously attended a breast cancer mass screening in a community in Japan. Information on bedtimes and wake-up times, history of nightshift work, and the timing of meals was obtained by a self-administered questionnaire. The 8-isoprostane and 6-sulfatoxymelatonin were measured using the first morning void of urine and expressed per mg of creatinine. The geometric mean of 8-isoprostane levels was 12.1% higher in women with ≤6 hours of sleep than that in those with >8 hours of sleep on weekdays, and longer sleep duration on weekdays was significantly associated with lower urinary levels of 8-isoprostane after controlling for covariates (p for trend = 0.04). Women who were currently working the nightshift had a 33.3% higher geometric mean of 8-isoprostane levels than those who were not working nightshift (p = 0.03). Urinary 6-sulfatoxymelatonin levels were unrelated to sleep habits or nightshift work. Women who ate breakfast at irregular times had a 19.8% higher geometric mean of 8-isoprostane levels than those who ate breakfast at a regular time or who did not eat (p = 0.02). Women who ate nighttime snacks at irregular times had a 16.2% higher geometric mean of 8-isoprostane levels than those who did not eat nighttime snacks or who ate nighttime snacks at a regular time (p = 0.003). Among women who ate dinner at a regular time, earlier times for dinner were associated with higher 8-isoprostane and 6-sulfatoxymelatonin levels (p values for trends were 0.01 and 0.02, respectively). However, the times of dinner and nighttime snack are overlapping, and the time of last meal of the day was not associated with 8-isoprostane and 6-sulfatoxymelatonin levels. The time of breakfast or lunch was not associated with these biomarkers among women who ate the meal at regular times. Disturbing the rhythmicity of daily life may be associated with oxidative stress.

Role of addiction and stress neurobiology on food intake and obesity

The US remains at the forefront of a global obesity epidemic with a significant negative impact on public health. While it is well known that a balance between energy intake and expenditure is homeostatically regulated to control weight, growing evidence points to multifactorial social, neurobehavioral and metabolic determinants of food intake that influence obesity risk. This review presents factors such as the ubiquitous presence of rewarding foods in the environment and increased salience of such foods that stimulate brain reward motivation and stress circuits to influence eating behaviors. These rewarding foods via conditioned and reinforcing effects stimulate not only metabolic, but also stress hormones, that, in turn, hijack the brain emotional (limbic) and motivational (striatal) pathways, to promote food craving and excessive food intake. Furthermore, the impact of high levels of stress and trauma and altered metabolic environment (e.g. higher weight, altered insulin sensitivity) on prefrontal cortical self-control processes that regulate emotional, motivational and visceral homeostatic mechanisms of food intake and obesity risk are also discussed. A heuristic framework is presented in which the interactive dynamic effects of neurobehavioral adaptations in metabolic, motivation and stress neurobiology may further support food craving, excessive food intake and weight gain in a complex feed-forward manner. Implications of such adaptations in brain addictive-motivational and stress pathways and their effects on excessive food intake and weight gain are discussed to highlight key questions that requires future research attention in order to better understand and address the growing obesity epidemic.

Matching Meals to Body Clocks-Impact on Weight and Glucose Metabolism

The prevalence of type 2 diabetes continues to rise worldwide and is reaching pandemic proportions. The notion that this is due to obesity, resulting from excessive energy consumption and reduced physical activity, is overly simplistic. Circadian de-synchrony, which occurs when physiological processes are at odds with timing imposed by internal clocks, also promotes obesity and impairs glucose tolerance in mouse models, and is a feature of modern human lifestyles. The purpose of this review is to highlight what is known about glucose metabolism in animal and human models of circadian de-synchrony and examine the evidence as to whether shifts in meal timing contribute to impairments in glucose metabolism, gut hormone secretion and the risk of type 2 diabetes. Lastly, we examine whether restricting food intake to discrete time periods, will prevent or reverse abnormalities in glucose metabolism with the view to improving metabolic health in shift workers and in those more generally at risk of chronic diseases such as type 2 diabetes and cardiovascular disease.

Meal frequency patterns and glycemic properties of maternal diet in relation to preterm delivery: Results from a large prospective cohort study

Background

Dietary habits are linked to high maternal glucose levels, associated with preterm delivery. The aim of this study was to examine the associations between meal frequency and glycemic properties of maternal diet in relation to preterm delivery.

Methods

This prospective cohort study included 66,000 women from the Norwegian Mother and Child Cohort Study (MoBa). Meal frequency and food intake data were obtained from a validated food frequency questionnaire during mid-pregnancy. Principal component factor analysis was used with a data-driven approach, and three meal frequency patterns were identified: “snack meal”, “main meal”, and “evening meal”. Pattern scores were ranked in quartiles. Glycemic index and glycemic load were estimated from table values. Intakes of carbohydrates, added sugar, and fiber were reported in grams per day and divided into quartiles. Gestational age was obtained from the Medical Birth Registry of Norway. Preterm delivery was defined as birth at <37 gestational weeks. A Cox regression model was used to assess associations with preterm delivery.

Results

After adjustments, the “main meal” pattern was associated with a reduced risk of preterm delivery, with hazard ratios (HRs) of 0.89 (95% confidence interval (CI): 0.80, 0.98) and 0.90 (95% CI: 0.81, 0.99) for the third and fourth quartiles, respectively, and p for trend of 0.028. This was mainly attributed to the group of women with BMI ≥25 kg/m², with HRs of 0.87 (95% CI: 0.79, 0.96) and 0.89 (95% CI: 0.80, 0.98) for the third and fourth quartiles, respectively, and p for trend of 0.010. There was no association between glycemic index, glycemic load, carbohydrates, added sugar, fiber, or the remaining meal frequency patterns and preterm delivery.

Conclusion

Regular consumption of main meals (breakfast, lunch, dinner) was associated with a lower risk of preterm delivery. Diet should be further studied as potential contributing factors for preterm delivery.