Meal distribution across the day and its relationship with body composition

Associations between Variability in Between- and Within-day Dietary Intake with Adiposity and Glucose Homeostasis in Adults: A Systematic Review

This systematic review aims to comprehensively evaluate the literature regarding the impact of variations in dietary intake, both between- and within-days, on adiposity and glucose metabolism. We included observational and experimental articles obtained from PubMed, Scopus, Cochrane Library, and gray literature until October 9, 2023, evaluating the impact of between- or within-day variations in meal, energy, or macronutrient intake on these outcomes. Our focus was on adults aged ≥18y, spanning both healthy individuals and those with type 2 diabetes mellitus (T2DM). Given the diverse range of exposures, treatments, and outcomes among the selected articles, we chose a qualitative synthesis approach to effectively analyze the data. Eighty articles from 43 observational and 37 experimental studies were included, involving 89,178 participants. Patterns of dietary intake variation were identified and systematically organized into distinct categories based on similarities. Between-day variations in dietary intake consisted of between-day variations in both the quantity consumed and meal timing. Meanwhile, within-day variations encompassed factors such as eating window, meal omission, within-day meal timing, within-day variation in dietary intake quantity, and temporal distribution. Despite mixed results, time-restricted eating was generally associated with lower adiposity. However, limited control for total daily energy intake (TDEI) suggests that the contribution of lower energy intake cannot be conclusively excluded. Conversely, the adverse effect of meal omission on glucose parameters was consistently supported by randomized trials. Interestingly, the results showed that consuming a substantial portion of TDEI in the morning may increase the likelihood of observing improvements in adiposity. Furthermore, inconsistencies in outcomes across articles examining the effects in healthy versus T2DM populations, or in energy-sufficient vs deficient individuals, indicate potential condition-specific effects. These findings support the need for further investigation into the effects of between- and within-day variations in dietary intake to better understand their impact on adiposity and glucose homeostasis.

Associations of timing of food intake with energy intake, eating behaviour traits and psychosocial factors in adults with overweight and obesity

Introduction

Whether a late distribution of food intake impacts obesity through increased energy intake remains uncertain and the behavioural characterization of late eating needs to be further investigated. The first objective of this study was to assess the associations between late eating and body mass index (BMI) and total energy intake (TEI), and whether TEI mediates the association between late eating and BMI. The second objective was to assess the associations between late eating and eating behaviour traits or psychosocial factors and whether eating behaviour traits mediate the association between late eating and TEI.

Methods

Baseline data from 301 individuals (56% women, age = 38.7 ± 8.5 years; BMI = 33.2 ± 3.4 kg/m²), who participated in four weight loss studies were used in this cross-sectional study. Total energy intake was assessed using a three-day food record from which the percentage of TEI after 17:00 and after 20:00 was calculated. Eating behaviour traits and psychosocial factors were assessed with questionnaires. Pearson correlations and mediation analyses adjusted for age, sex, underreporting of energy intake, sleep duration and bedtime were performed.

Results

Percent TEI after 17:00 and after 20:00 were associated with TEI (r = 0.13, p = 0.03 for both), and TEI mediated the association between percent TEI after 17:00 and BMI (β = 0.01 ± 0.01, 95% CI: 0.001, 0.02). Percent TEI after 17:00 was associated with disinhibition (r = 0.13, p = 0.03) and percent TEI after 20:00 was associated with susceptibility to hunger (r = 0.13, p = 0.03), stress (r = 0.24, p = 0.002) and anxiety (r = 0.28, p = 0.0004). In women, disinhibition mediated the association between percent TEI after 17:00 and TEI (β = 3.41 ± 1.43, 95% CI: 0.92, 6.47). Susceptibility to hunger mediated the association between percent TEI after 20:00 and TEI (β = 0.96 ± 0.59, 95% CI: 0.02, 2.34) in men and women.

Conclusion

Late eating is associated with TEI and suboptimal eating behaviours which could contribute to explaining the association between timing of food intake and obesity.

Late Evening Eating Patterns among US Adults Vary in Their Associations With, and Impact on, Energy Intake and Diet Quality: Evidence from What We Eat in America, National Health and Nutrition Examination Survey 2013-2016

BACKGROUND

Evening eating has been associated with higher energy intake and lower nutrient density. However, these qualities may not characterize all late evening (LE) eating patterns.

OBJECTIVE

We sought to characterize US adults' LE eating patterns on a given day and identify differences, if any, in pattern-specific associations with, and impact on, daily energy intake and total diet quality.

DESIGN

LE eating patterns, energy intakes, and Healthy Eating Index (HEI) scores were identified using Day-1 dietary recall data from the cross-sectional National Health and Nutrition Examination Survey 2013-2016.

PARTICIPANTS/SETTING

The sample included adults aged ≥ 20 years (n = 9,861). LE reporters were respondents who consumed foods/beverages between 20:00 and 23:59 on the intake day.

MAIN OUTCOME MEASURES

Energy intake and HEI-2015 scores by LE status/pattern and the impact of LE consumption on these measures.

STATISTICAL ANALYSES

Cluster analysis assigned individuals to LE eating patterns based on the LE energy contribution of food/beverage groups. Regression models estimated energy intake and HEI-2015 scores; estimates were compared between LE reporters and nonreporters. Similarly, LE's contribution to total energy and the difference in total HEI inclusive vs exclusive of LE consumption were estimated and compared among patterns.

RESULTS

Among US adults, 64.4% were LE reporters. Eleven LE patterns were identified; the six most prevalent patterns (representing 89% of LE reporters) were further analyzed. Daily energy intake in all prevalent patterns except the fruit pattern exceeded that of nonreporters by ≥ 268 kcal (unadjusted; P < 0.001), varying by pattern. Conversely, total HEI score did not differ from that of nonreporters (51.0) in any pattern except the fruit pattern, where it was higher (57.4, unadjusted; P < 0.001). Generally, LE consumption's impact on energy was high and its impact on HEI scores was low.

CONCLUSIONS

Late evening food/beverage consumption is common among US adults, and LE patterns are not monolithic in their associations with, and impact on, total energy intake and dietary quality.

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

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

Meal patterns associated with energy intake in people with obesity

It is widely assumed that people with obesity have several common eating patterns, including breakfast skipping, eating during the night and high fast-food consumption. However, differences in individual meal and dietary patterns may be crucial to optimising obesity treatment. Therefore, we investigated the inter-individual variation in eating patterns, hypothesising that individuals with obesity show different dietary and meal patterns, and that these associate with self-reported energy intake (rEI) and/or anthropometric measures. Cross-sectional data from 192 participants (aged 20-55 years) with obesity, including 6 d of weighed food records, were analysed. Meal patterns and dietary patterns were derived using exploratory hierarchical cluster analysis and k-means cluster analysis, respectively. Five clear meal patterns were found based on the time-of-day with the highest mean rEI. The daily rEI was highest among 'midnight-eaters' (10 669 (sd 2301) kJ), and significantly (P < 0·05) higher than 'dinner-eaters' (8619 (sd 2301) kJ), 'lunch-eaters' (8703 (sd 2176) kJ) and 'supper-eaters' (8786 (sd 1925) kJ), but not 'regular-eaters' (9749 (sd 2720) kJ). Despite differences of up to 2050 kJ between meal patterns, there were no significant differences in anthropometric measures or physical activity level (PAL). Four dietary patterns were also found with significant differences in intake of specific food groups, but without significant differences in anthropometry, PAL or rEI. Our data highlight meal timing as a determinant of individual energy intake in people with obesity. The study supports the importance of considering a person's specific meal pattern, with possible implications for more person-focused guidelines and targeted advice.

Chrono-nutrition: From molecular and neuronal mechanisms to human epidemiology and timed feeding patterns

The circadian timing system governs daily biological rhythms, synchronising physiology and behaviour to the temporal world. External time cues, including the light-dark cycle and timing of food intake, provide daily signals for entrainment of the central, master circadian clock in the hypothalamic suprachiasmatic nuclei (SCN), and of metabolic rhythms in peripheral tissues, respectively. Chrono-nutrition is an emerging field building on the relationship between temporal eating patterns, circadian rhythms, and metabolic health. Evidence from both animal and human research demonstrates adverse metabolic consequences of circadian disruption. Conversely, a growing body of evidence indicates that aligning food intake to periods of the day when circadian rhythms in metabolic processes are optimised for nutrition may be effective for improving metabolic health. Circadian rhythms in glucose and lipid homeostasis, insulin responsiveness and sensitivity, energy expenditure, and postprandial metabolism, may favour eating patterns characterised by earlier temporal distribution of energy. This review details the molecular basis for metabolic clocks, the regulation of feeding behaviour, and the evidence for meal timing as an entraining signal for the circadian system in animal models. The epidemiology of temporal eating patterns in humans is examined, together with evidence from human intervention studies investigating the metabolic effects of morning compared to evening energy intake, and emerging chrono-nutrition interventions such as time-restricted feeding. Chrono-nutrition may have therapeutic application for individuals with and at-risk of metabolic disease and convey health benefits within the general population.

Is the timing of food intake a potential indicator of low weight loss responders? A secondary analysis of three weight loss studies

Individual variability in weight loss in response to a weight loss intervention is commonly observed. Recently, the timing of food intake has been identified as one possible factor implicated in obesity and weight loss. The objective of this study was to further characterize low weight loss responders by assessing the pre-diet distribution of daily energy and macronutrient intakes. A pooled cohort of men and women (n = 122; aged 39.1 ± 8.2 years; body mass index [BMI] 33.1 ± 3.8 kg/m² ) who participated in a 12 to 15 week energy-restricted intervention (-500 to -700 kcal/d) were included in this study. Participants were categorized into two weight loss groups (ie, low [-1.3 ± 2.3 kg] and high [-6.1 ± 2.1 kg] weight loss). Food intake and distribution of energy and macronutrient intakes were assessed using a 3-day food record at baseline. The daily distribution of energy intake (% of total energy intake) was similar in the two weight loss groups with the exception of the low weight loss group who consumed a slightly lower proportion of their total energy intake before 9:00 am compared with the high weight loss group (12.5% ± 5.8% vs 15.0% ± 6.6%, respectively, P = .03). In the low weight loss group, the percentage of energy intake consumed after 8:00 pm was positively associated with total energy intake (r = 0.27, P = .04). The results of this study suggest that the timing of food intake measured prior to a weight loss intervention does not permit the characterization of low weight loss responders.

Development, validation and reliability of the Chrononutrition Profile - Questionnaire

Chrononutrition, or the circadian timing of food intake, has garnered attention as a topic of study due to its associations with health (e.g. weight gain); however, a valid and reliable assessment of chrononutrition in daily life has not yet been developed. This paper details the development and initial reliability and validity testing of the Chrononutrition Profile - Questionnaire (CP-Q). The CP-Q assesses six components of chrononutrition that are likely to influence health (breakfast skipping, largest meal, evening eating, evening latency, night eating, and eating window). This questionnaire is designed to assess general chrononutrition behaviors and preferred timing of food intake. The CP-Q can be used as a sole evaluation of chrononutrition, and can also be utilized in conjunction with existing dietary measures to provide a comprehensive assessment of one's eating behaviors. This measure offers health-care professionals, researchers, and stakeholders a cost-effective and comprehensive method of evaluating chrononutrition and identifying targets for health improvement.

Temporal eating patterns: associations with nutrient intakes, diet quality, and measures of adiposity

Background: Some evidence suggests that higher energy intake (EI) later in the day is associated with poor diet quality and obesity. However, EI at one eating occasion (EO) is also dependent on EI at surrounding EOs. Studies that examine the distribution of EOs across the day are rare.Objective: The aim of this study was to examine associations between temporal eating patterns, nutrient intakes, diet quality, and measures of adiposity in a representative sample of Australian adults.Design: Dietary data from two 24-h recalls collected during the cross-sectional 2011-2012 Australian National Nutrition and Physical Activity Survey were analyzed (n = 4544 adults, aged ≥19 y). Temporal eating patterns, based on the distribution of EOs across the day, were determined by using latent class analysis. Diet quality estimated adherence to healthy eating recommendations and was assessed by using the 2013 Dietary Guidelines Index (DGI). Multivariate regression models assessed associations between temporal eating patterns, nutrient intakes, diet quality, and adiposity (body mass index, waist circumference, weight status, and central weight status). Models were adjusted for potential confounders and energy misreporting.Results: Three patterns, labeled "conventional," "later lunch," and "grazing," were identified. Compared with a "conventional" or "later lunch" pattern, men and women with a "grazing" pattern had lower DGI scores and higher intakes of discretionary (noncore) foods (P < 0.05). Among women, the "grazing" pattern was associated with overweight or obesity (OR: 1.57; 95% CI: 1.15, 2.13) and central overweight or obesity (OR: 1.73; 95% CI: 1.19, 2.50). These associations were attenuated after the exclusion of energy misreporters and adjustment for total EI.Conclusions: This study found that a "grazing" temporal eating pattern was modestly but significantly associated with poorer diet quality and adiposity among women, after adjustment for covariates and energy misreporting. Future research should consider the impact of energy misreporting on the relation between temporal eating patterns and adiposity. This secondary analysis was registered at anzctr.org.au as ACTRN12617001029381.

Nutritional aspects of night eating and its association with weight status among Korean adolescents

BACKGROUND/OBJECTIVES

A growing body of research has indicated that night eating could be associated with poor diet quality and negative health outcomes. This study examined the nutritional aspects of night eating, its related factors, and the association between night eating and body weight among Korean adolescents.

SUBJECTS/METHODS

This study analysed the data from a one day 24-hour dietary recall as well as a demographic survey of 1,738 Korean adolescents aged 12 to 18-years-old obtained from the 2010-2012 Korea National Health and Nutrition Examination Survey. 'Night eating' was defined as consuming 25% or more of one's daily energy intake between 21:00 and 06:00. Subjects complying with the preceding condition were classified as 'night eaters', whereas the rest were considered 'non-night eaters'. Logistic regression analysis examined factors related to night eating. Multiple linear regression analyses were used to examine the relationship between night eating and BMI z-scores, whereas multinomial logistic regression analysis was used to examine the relationship between night eating and weight status.

RESULTS

About 21% of Korean adolescents appeared to be night eaters. Night eaters showed increased breakfast skipping (P = 0.001), higher energy intake from snacks (P < 0.001), greater proportion of energy intake from fat (P = 0.029), and lower Dietary Diversity Scores (P = 0.008) than non-night eaters. Male adolescents presented 1.9 times higher odds of being night eaters than females. Adolescents whose both parents were night eaters were 4.4 times as likely to be night eaters as those whose neither parents were. Female adolescents showed a significant relationship between night eating and BMI z-scores (β = 0.28, P = 0.004). However, night eating did not increase odds of being overweight or obese in adolescents.

CONCLUSIONS

Night eating in Korean adolescents was related to undesirable dietary behaviours and low diet quality in general as well as higher BMI z-scores in females. Male gender and parental night eating appeared to be the factors that significantly increased odds of night eating. These results suggest that night eating should be considered when designing nutrition education or intervention programs targeting adolescents.

Understanding meal patterns: definitions, methodology and impact on nutrient intake and diet quality

Traditionally, nutrition research has focused on individual nutrients, and more recently dietary patterns. However, there has been relatively little focus on dietary intake at the level of a ‘meal’. The purpose of the present paper was to review the literature on adults' meal patterns, including how meal patterns have previously been defined and their associations with nutrient intakes and diet quality. For this narrative literature review, a comprehensive search of electronic databases was undertaken to identify studies in adults aged ≥  19 years that have investigated meal patterns and their association with nutrient intakes and/or diet quality. To date, different approaches have been used to define meals with little investigation of how these definitions influence the characterisation of meal patterns. This review identified thirty-four and fourteen studies that have examined associations between adults' meals patterns, nutrient intakes and diet quality, respectively. Most studies defined meals using a participant-identified approach, but varied in the additional criteria used to determine individual meals, snacks and/or eating occasions. Studies also varied in the types of meal patterns, nutrients and diet quality indicators examined. The most consistent finding was an inverse association between skipping breakfast and diet quality. No consistent association was found for other meal patterns, and little research has examined how meal timing is associated with diet quality. In conclusion, an understanding of the influence of different meal definitions on the characterisation of meal patterns will facilitate the interpretation of the existing literature, and may provide guidance on the most appropriate definitions to use.