Selected eating behaviours and excess body weight: a systematic review

Meal timing and its role in obesity and associated diseases

Meal timing emerges as a crucial factor influencing metabolic health that can be explained by the tight interaction between the endogenous circadian clock and metabolic homeostasis. Mistimed food intake, such as delayed or nighttime consumption, leads to desynchronization of the internal circadian clock and is associated with an increased risk for obesity and associated metabolic disturbances such as type 2 diabetes and cardiovascular diseases. Conversely, meal timing aligned with cellular rhythms can optimize the performance of tissues and organs. In this review, we provide an overview of the metabolic effects of meal timing and discuss the underlying mechanisms. Additionally, we explore factors influencing meal timing, including internal determinants such as chronotype and genetics, as well as external influences like social factors, cultural aspects, and work schedules. This review could contribute to defining meal-timing-based recommendations for public health initiatives and developing guidelines for effective lifestyle modifications targeting the prevention and treatment of obesity and associated metabolic diseases. Furthermore, it sheds light on crucial factors that must be considered in the design of future food timing intervention trials.

Meal patterns, including intermittent fasting - a scoping review for Nordic Nutrition Recommendations 2023

Introduction

'Meal patterns' refers to eating frequency, snacking, regularity, and timing. Here also including intermittent fasting. The effect of meal patterns on health is inconsistent and when updating the Nordic Nutrition Recommendations 2023 (NNR2023), summarizing the evidence is important.

Aims

To describe the evidence for the role of meal patterns on bodyweight, body composition, and cardiovascular risk factors (i.e. blood pressure and lipid- and glukose metabolism) in healthy people living with normal weight, overweight, or obesity in all age groups.

Methods

An initial search in PubMed found 481 reviews, of which 104 were identified based on titles. Of these, 47 were excluded based on title and abstracts. Of the remaining 57 reviews, 16 were included reporting search terms and inclusion/exclusion criteria. In addition, 8 reviews from reference list or known by authors were included. In total, 24 reviews were relevant. Cochrane Library was searched with no results.

Results

All reviews were rated low or critically low (AMSTAR 2). No consistent findings on eating frequency and body weight or composition were found in children/adolescents or adults. In snacking, mixed results were found, although among adults, some consistent results showed positive associations between snacking and body weight. In regularity, breakfast skipping showed mixed results in children/adolescents on body weight and composition. Among adults, randomized controlled trials on breakfast skipping showed a minor impact on improved weight loss. In prospective studies on timing, lower energy intake during late afternoon/evening was related to less body weight. Intermittent fasting reduced body weight but was not superior to continuous energy restrictions. Cardiovascular risk factors were assessed in a minority of the reviews, and despite some beneficial effects, the evidence was limited.

Conclusion

Given the overall low to critically low quality of the reviews, the evidence is limited and inconclusive. No consistent results providing evidence for setting recommendations for meal patterns were shown. In this regard, meal patterns may vary within the context of an energy balanced and nutritionally adequate diet.

The Connection between Knowledge and the Nutritional Behaviour of Parents and the Occurrence of Overweight and Obesity among Preschool Children-A Pilot Study

The phenomenon of overweight and obesity constitutes a threat for health and children's lives at preschool age. Eating habits formed during this period seriously affect not only future dietary preferences but also the development of diet-related diseases. The purpose of the present study was the assessment of the relationship between the state of knowledge of children's nutrition and parents' eating behaviour and the prevalence of overweight and obesity in children aged 4-6 years. The study was conducted using 200 parent-child pairs. The behaviour and nutritional knowledge of parents was assessed using a questionnaire method. In contrast, anthropometric measurements were taken among the children. Nutritional disorders were noted in 46.5% of children of whom 39.0% struggled with overweight and 7.5% with obesity. The study showed that the children of parents with higher levels of nutritional knowledge were more likely to develop overweight and obesity. It also proved that irregularity of parental food intake predisposed the development of excessive body weight in children (p = 0.0049). Therefore, it is reasonable to undertake further investigation into factors implying the development of nutritional disorders among those youngest. Early recognition of dietary mistakes can contribute to their elimination at an early age.

Evaluation of an experiment to increase availability of healthier snack foods in vending machines situated within English sports facilities

OBJECTIVE

To evaluate the impact of increased availability of healthier options on purchasing of different types of vending snack products sold in English leisure (sports) centres.

DESIGN

An evaluation of an intervention using pre-post methods and interrupted time series analysis. Products within the vending machines were altered over three phases to increase the availability of healthier options, using agreed nutrition criteria - Government Buying Standards for Food and Catering Services (GBSF) for England - as a guide, as well as product availability. The primary outcome was the change in mean weekly purchased energy between the first and third phase. Secondary outcomes included changes by phase and by week in weekly number of purchases, fats, sugars and salt for all products combined and by individual product categories.

SETTING

Fifteen sports centres in the city of Leeds, West Yorkshire, UK.

PARTICIPANTS

Snack products sold in eighteen vending machines.

RESULTS

Energy purchased reduced from baseline to phase 2, for all product categories combined, by 47·25 MJ (95 % CI (-61·22, -33·27)) per machine and by 279 kJ, (95 % CI (-325, -266)) per product unit. There were reductions in most nutrients purchased in all individual product categories except chocolate confectionery. Nutrients per product unit decreased for all product categories except saturated fat in chocolate confectionery. Minimal underlying trends in the baseline phase were identified, indicating changes in outcomes were likely to be due to the intervention.

CONCLUSIONS

Introducing standards to increase availability of healthier snack products in vending machines is feasible without substantially affecting sales.

The effects of eating frequency on changes in body composition and cardiometabolic health in adults: a systematic review with meta-analysis of randomized trials

BACKGROUND

Eating frequency may affect body weight and cardiometabolic health. Intervention trials and observational studies have both indicated that high- and low-frequency eating can be associated with better health outcomes. There are currently no guidelines to inform how to advise healthy adults about how frequently to consume food or beverages.

AIM

To establish whether restricted- (≤ three meals per day) frequency had a superior effect on markers of cardiometabolic health (primary outcome: weight change) compared to unrestricted-eating (≥ four meals per day) frequency in adults.

METHODS

We searched Medline (Ovid), Embase, CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), CAB Direct and Web of Science Core Collection electronic databases from inception to 7 June 2022 for clinical trials (randomised parallel or cross-over trials) reporting on the effect of high or low-frequency eating on cardiometabolic health (primary outcome: weight change). Trial interventions had to last for at least two weeks, and had to have been conducted in human adults. Bias was assessed using the Cochrane Risk of Bias tool 2.0. Standardized mean differences (SMD) and 95% confidence intervals were calculated for all outcomes. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Seventeen reports covering 16 trials were included in the systematic review. Data from five trials were excluded from meta-analysis due to insufficient reporting. 15 of 16 trials were at high risk of bias. There was very low certainty evidence of no difference between high- and low-frequency eating for weight-change (MD: -0.62 kg, CI95: -2.76 to 1.52 kg, p = 0.57).

CONCLUSIONS

There was no discernible advantage to eating in a high- or low-frequency dietary pattern for cardiometabolic health. We cannot advocate for either restricted- or unrestricted eating frequency to change markers of cardiometabolic health in healthy young to middle-aged adults.

PROTOCOL REGISTRATION

CRD42019137938.

Snacking Consumption among Adults in the United States: A Scoping Review

Snacks are a staple of the American diet, contributing to approximately 20% of energy intake. Most U.S. adults consume one to three snacks/day, yet few reviews have focused on snacking among this population. This scoping review was conducted to characterize snacks and snacking occasions among U.S. adults to further inform healthy eating practices. The protocol was prepared following the PRISMA-Extension for Scoping Reviews. Three web databases were used to identify articles using snacking or eating occasions as primary or secondary outcomes among U.S. adults. A search strategy was developed using subject headings, truncation, and phrase searching in the title and abstract of articles published between 2010 and 2022. A two-stage, multi-step screening process identified 31 of 4795 publications as meeting the inclusion criteria. Findings included identification of snacking themes, e.g., cues and motivations; diet composition; and weight management. Food quality, time of consumption, and convenience emerged as characteristics of snacking; time of day was found to influence food choice. Snacks contribute to or detract from a healthy diet. Strategic selection of healthy snack options can improve diet quality. Applied to nutrition education, this information can help strengthen programs or policies, ultimately contributing to health and wellbeing.

The association between meal-based diet quality index-international (DQI-I) with obesity in adults

BACKGROUND AND OBJECTIVE

Due to the growing global trend of obesity, it is necessary to study the diet quality as a modifiable factor to reduce the dangerous consequences of obesity. Therefore, the aim of this study was to evaluate the association between meal-based diet quality index-international (DQI-I) with obesity in adults.

METHODS

This cross-sectional study was performed on 850 men and women in Tehran (aged 20-59 y). Dietary intakes were assessed using three 24-h dietary recalls. Meal-based Diet quality was assessed based on the construction of DQI-I. The total DQI-I score ranged from 0 to 100, with higher scores denoting better diet quality. Multiple linear regression analysis was used to examine the association of DQI-I and BMI in each meal and Logistic regression analysis was used to examine the association of DQI-I and obesity in each meal.

RESULTS

The mean (± SD) of age, body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR) were 42.35(± 10.90) years, 27.32(± 5.61) kg/m2, 89.09 (± 12.04) cm and 0.86 (± 0.11), respectively. In none of the meals, after adjusting for confounders, no significant difference in BMI was observed in the both women and men groups. After controlling of confounders, there was not any relationship between meal-based DQI-I and BMI resulted from multiple linear regression analysis also there was not any significant association between meal-based DQI-I and obesity resulted from Logistic regression analysis.

CONCLUSION

In this study, we did not find any significant association between meal-specified DQI with obesity. To reach the better evaluation, more prospective studies with large sample size are needed.

Integration of Time-Based Recommendations with Current Pediatric Health Behavior Guidelines: Implications for Obesity Prevention and Treatment in Youth

PURPOSE OF REVIEW

Youth-onset obesity is associated with negative health outcomes across the lifespan including cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, dyslipidemias, asthma, and several cancers. Pediatric health guidelines have traditionally focused on the quality and quantity of dietary intake, physical activity, and sleep.

RECENT FINDINGS

Emerging evidence suggests that the timing (time of day when behavior occurs) and composition (proportion of time spent allocated to behavior) of food intake, movement (i.e., physical activity, sedentary time), and sleep may independently predict health trajectories and disease risks. Several theoretically driven interventions and conceptual frameworks feature behavior timing and composition (e.g., 24 h movement continuum, circadian science and chronobiology, intermittent fasting regimens, structured day hypothesis). These literatures are, however, disparate, with little crosstalk across disciplines. In this review, we examine dietary, sleep, and movement guidelines and recommendations for youths ages 0-18 in the context of theoretical models and empirical findings in support of time-based approaches. The review aims to inform a unifying framework of health behaviors and guide future research on the integration of time-based recommendations into current quantity and quality-based health guidelines for children and adolescents.

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.

Petrol prices and obesity

Using 13 waves of longitudinal data from Australia, we examine the relationship between petrol prices and obesity. Applying panel data models that control for individual fixed effects and the endogeneity of petrol prices, our results suggest that petrol prices have a negative effect on obesity. Specifically, our preferred instrumental variable estimates, which instrument for petrol prices using the Arca Oil Stock price and control for individual and time fixed effects, suggest that a standard deviation increase in petrol prices generates a 0.006 standard deviation decline in body mass index, while a unit increase in petrol prices results in a 2 percentage point decrease in the probability that a survey participant is obese. These results are robust to several sensitivity checks. Back of the envelope calculations suggest that our results imply that a permanent $1 per liter increase in petrol prices would reduce the number of people who were obese by 672,000 and save $1.4 billion dollars in medical expenditure related to obesity every year. We also find that frequency of participation in physical activity and expenditure on meals eaten out are channels through which petrol prices affect obesity.

Observational Study on Unhealthy Eating Behavior and the Effect of Sodium-Glucose Cotransporter 2 Inhibitors: The Luseogliflozin Ehime Diabetes Study

INTRODUCTION

Luseogliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor. Unhealthy eating behavior is associated with diabetes, hypertension, and obesity. However, evidence regarding the effect of medications, including SGLT2 inhibitors, on unhealthy eating behavior is limited. This study investigated the association between unhealthy eating behavior and the laboratory and physical findings of Japanese patients with type 2 diabetes given luseogliflozin once daily for 24 weeks.

METHODS

Twenty-nine patients with type 2 diabetes mellitus were enrolled in a 24-week prospective, open-label, single-arm pilot study. The information regarding unhealthy eating behaviors (eating fast, late dinner, nighttime snack, skipping breakfast, and eating until full) was obtained using self-reported questionnaires.

RESULTS

The baseline rate of eating fast, late dinner, nighttime snack, skipping breakfast, and eating until full was 51.7%, 24.1%, 24.1%, 10.3% and 55.2%, respectively. After administration of luseogliflozin, fasting plasma glucose, HbA1c, aspartate aminotransferase (ALT), weight, body mass index, and waist measurement all decreased significantly. High-density lipoprotein cholesterol and hematocrit increased significantly. In the healthy eating behavior group, the improvements of fasting plasma glucose and ALT, but not other variables, were attenuated. HbA1c level was significantly improved in patients with eating fast, while other unhealthy eating behaviors attenuated the effect of luseogliflozin for HbA1c. The effect of leseogliflozin on the relationship between eating behavior and weight reduction was inconsistent after administration luseogliflozin.

CONCLUSION

Luseogliflozin might be more effective for controlling plasma glucose in patients with type 2 diabetes who have a tendency to eat fast, but it might have less effect on those with other unhealthy eating habits.

Effect of the multicomponent healthy high school intervention on meal frequency and eating habits among high school students in Denmark: a cluster randomized controlled trial

Background

Previous studies have shown that multicomponent interventions may improve meal frequency and eating habits in children, but evidence among young people is limited. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at 9-month follow-up.

Methods

The study included first-year students (≈16 years) attending high school in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (operating as usual) (N = 15). The intervention was designed to promote well-being (primary outcome) by focusing on healthy habits including meals, stress prevention, and strong peer relations. It included a curriculum, structural and organisational initiatives, a workshop, and a smartphone application. Students completed self-administered online questionnaires at the beginning of the school year and nine months later. To account for clustering of data, we used multilevel logistic regression analyses to estimate odds ratios (OR). We applied an intention-to-treat approach with multiple imputations of missing data.

Results

At baseline 4577 of 5201 students answered the questionnaire and 4512 at follow-up. In both groups the proportion of students eating breakfast decreased from approximately 50% to 40% from baseline to follow-up, and lunch frequency decreased from approximately 50% to 47%. Daily water intake, intake of fresh fruit and intake of vegetables remained unchanged from baseline to follow-up. There were no significant between group differences on any of the outcomes at first follow-up: breakfast: OR = 0.85 (95% CI: 0.65;1.10), lunch: OR = 0.96 (95% CI: 0.75;1.22), water intake: OR = 1.14 (95% CI: 0.92;1.40), intake of fresh fruit: (OR = 1.07, 95% CI: 0.84;1.37), vegetables: (OR = 1.01, 95% CI: 0.77;1.33).

Conclusion

No evidence of an effect of the HHS intervention was found for any of the outcomes. Future studies are warranted to explore how health promoting interventions can be integrated in further education to support educational goals. Moreover, how to fit interventions to the lives and wishes of young people, by also including systems outside of the school setting.

Trial registration

ISRCTN, ISRCTN43284296. Registered 28 April 2017 - retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01228-2.

Characterizing children's eating patterns: does the choice of eating occasion definition matter?

BACKGROUND

Recommendations to define eating occasions (EO) currently exist for research in adults, but not for children or adolescents. We examined how varying EO definitions affect the characterization of eating patterns in children and adolescents.

METHODS

Cross-sectional dietary data collected using a 24-h recall data during the 2011-12 Australian National Nutrition and Physical Activity Survey (1364 boys and 1337 girls aged 2-18 years) were analyzed. Eight definitions were applied: participant-identified, time-of-day, and 6 neutral definitions (EO separated by 15- or 60-min and/or an additional energy criterion of 21 or 210 kJ). Frequency of and total energy intake from meals, snacks, and all EO were estimated. F tests stratified by gender and age-group, were used to assess differences between definitions. Agreement between definitions of meal and snack frequencies was assessed using intraclass correlation coefficients (ICC). Linear regression was used to estimate the proportion of variance in total energy intake (kJ) and BMI z-score predicted by each definition.

RESULTS

Mean frequencies of meals and snacks differed between the participant-identified and time-of-day definitions, in boys and girls and for all age groups (P < 0.01). Across the six neutral definitions, there were differences between mean frequencies of EO with the largest mean difference observed for children aged 2-3 y (boys: 2.3, girls: 2.5; P < 0.003). Between the participant-identified and time-of-day definitions, there was good agreement for frequencies of snacks (ICC for both genders: 0.93) but not meals (boys: 0.36; girls: 0.38). The 15-min time interval plus 210 kJ definition of an EO consistently predicted the most variance in total energy intake (R2 range = 8.1-34.8). Definitions that delineated meals and snacks better predicted variance in BMI z-score, when compared to the neutral definitions.

CONCLUSIONS

How eating patterns are characterized vary depending on the EO definitions employed, particularly in young children. Variance in total energy intake was best predicted by a variation of the neutral definition whereas definitions that delineated meals and snacks performed better in relation to predicting BMI variance. Further international research that compares EO definitions in children will help inform a standard approach.

The feasibility, acceptability, and benefit of interventions that target eating speed in the clinical treatment of children and adolescents with overweight or obesity: A systematic review and meta-analysis

Eating at a faster speed is positively correlated with having a higher BMI. Modifying eating speed may offer a treatment opportunity for those with overweight and obesity. This review sought to understand the feasibility, acceptability, and benefit to using eating speed interventions in paediatric clinical weight-management settings. The PICO Framework was used. Clinical studies of eating speed interventions as a treatment for paediatric patients with overweight or obesity were included. No limits to search date were implemented. A systematic search of MEDLINE, PsychINFO and EMBASE via OVID, Web of Science and JBI, Database of systematic reviews and Implementation reports, along with trial registers NICE, ClinicalTrials.gov and Cochrane Central Register of Controlled Trials was conducted. Two authors were responsible for screening, extraction, and evaluation of the risk of bias. Fifteen papers reporting twelve interventions addressing eating-speed were identified, involving a total of 486 active participants (range 7-297). Study design was weak with only one full RCT and there were some concerns over quality and risk of bias (Cochrane RoB 2.0). Limited sample sizes and different measured outcomes did not allow powered evaluations of effect for all outcomes. There is some indication, overall, that addressing eating speed has the potential to be a beneficial adjunct to clinical obesity treatment, although the pooled effect estimate did not demonstrate a difference in BMISDS status following eating speed interventions compared to control [pooled mean difference (0.04, 95% CI -0.39 to 0.46, N = 3)]. Developments to improve the engagement to, and acceptability of, interventions are required, alongside rigorous high-quality trials to evaluate effectiveness.

Changes in Adolescents' Dietary Intake Following the Initiation of an 8-Week Exercise Program

Purpose: To assess changes in dietary intake of adolescents following an 8-week aerobic exercise program.Methods: Twenty-six adolescents (14-18 years) participated in an 8-week aerobic exercise program on cycle ergometer at their high school in Quebec, Canada. Twenty-four hour recalls were collected pre- and post-intervention. A two-way repeated measures ANOVA and paired sample t-tests were used to assess differences in energy and dietary intake parameters (food quantity, diet quality, eating patterns) between pre- and postintervention.Results: A decrease in total daily energy intake (-287.8 kcal, P = 0.007), in meal size at lunch (-110.1 g, P = 0.02) and dinner (-143.7 g, P = 0.03), in food density at breakfast (-1.8 kcal/g, P = 0.04), in daily carbohydrate intake (-56.1 g, P = 0.005), and in percentage of energy intake consumed at school (-5.1%, P = 0.04) were observed following initiation of an aerobic exercise program. No change in healthy eating index scores or percentage of energy from processed foods was observed.Conclusions: Changes in energy intake, food quantity, and eating pattern but not diet quality (Healthy Eating Index or food processing scores) were observed following the initiation of an aerobic exercise program. Nutrition interventions may be needed, in addition to an exercise program, to target diet quality and promote healthy eating habits in adolescents.

The association between lunch composition and obesity in Iranian adults

We aimed to assess the dietary composition of lunch meal using a posteriori-derived dietary patterns and to determine the association of lunch composition with obesity in a sample of Iranian adults. This cross-sectional study was conducted on 850 men and women in Tehran (aged 20-59 years). Dietary intakes were assessed using three 24-h dietary recalls, and dietary patterns were identified via principal component factor analysis. For each identified pattern, scores were calculated for each participant and then classified into tertiles. Central obesity was defined WHO criteria. General obesity was defined as a BMI of more than 30 kg/m2. Three major dietary patterns were identified at lunch meal using twelve food groups: 'Bread, grains and fat', 'Western' and 'Potato and eggs'. After adjustment for potential confounders, participants at the top tertile of the 'Bread, grains and fat' dietary pattern had greater odds for a higher waist-to-hip ratio (WHR), compared with those in the lowest tertile (OR: 1·44, 95 % CI 1·01, 2·07). However, we found no association between 'Western' or 'potato and eggs' patterns and WHR (OR: 0·89, 95 % CI 0·62, 1·28 and OR: 1·16, 95 % CI 0·69, 1·42, respectively). None of the identified dietary patterns was associated when defining obesity with waist circumference or BMI. In conclusion, participants had a greater chance of central obesity defined based on WHR following a lunchtime pattern with a higher and positive loading factor for 'Bread, grains and fat'.

Serum Trace Element Levels and Their Correlation with Picky Eating Behavior, Development, and Physical Activity in Early Childhood

Trace elements are vital components for healthy growth, development, and physical activity. The aim of this study was to investigate the relationship between trace element (iron, zinc, copper) deficiencies and picky eating behavior, development level, and physical activity level. This cross-sectional study involved 203 children aged 4-7 years; picky eating behavior, development level, and physical activity level were assessed through questionnaires. Zinc deficiency has the highest prevalence (37.4%); 67.5% of the children were assessed as picky eaters. Children with picky eating behaviors, poor development level, or poor physical activity level have significantly lower zinc levels, and higher prevalence of zinc deficiency. Pearson's correlation coefficient indicated a positive correlation between serum zinc level and development scores (r = 0.221, p = 0.002) and physical activity scores (r = 0.469, p < 0.001). In multivariate analysis, zinc deficiency independently related to picky eating (OR = 2.124, p = 0.037, CI = 1.042-4.312), developmental level (OR = 0.893, p = 0.022, CI = 0.810-0.984), and physical activity level (OR = 0.785, p < 0.001, CI = 0.700-0.879). In conclusion, the prevalence of zinc deficiency in children aged 4-7 was high, especially in picky eaters. Zinc deficiency was significantly associated with low development and poor physical activity in early childhood.

Breakfast patterns and weight status among adolescents: a study on the Brazilian National Dietary Survey 2008-2009

Examining the composition of breakfast concerning weight status is essential for evaluating adolescent health and understanding this gap. This study aimed to identify breakfast patterns and investigate the relationship with weight status among Brazilian adolescents. We used a subsample of 7425 adolescents aged 10-19 years from the 2008-2009 Brazilian Household Budget Survey. Breakfast eaters were those with intake of at least 50 kcal (209·2 kJ) between 05.00 and 10.00 hours. Breakfast dietary patterns were derived by principal component factor analysis with varimax rotation. We performed logistic regression analyses between breakfast patterns and weight status, considering the complexity of the survey sample design. Three breakfast patterns were identified explaining 44·8 % of data variability: (1) the Cereal, protein, fruit beverages and Northern/Northeastern pattern, characterised by high consumption of cookies, meats, dairy products, preparations with maize, eggs, fruit juices/fruit drinks/soya-based drinks, tubers/roots/potatoes and cereals, and negative adherence to cold cut meat and savoury snacks/crackers; (2) the Protein-based pattern, characterised by positive loadings for cold cut meat, milk and cheese, and negative for cookies, fruit juices/fruit drinks/soya-based drinks, tubers/roots/potatoes and cereals; and (3) the Mixed pattern, with positive loadings for cakes, coffee/tea, bread, fruit juices/fruit drinks/soya-based drinks, chocolate/desserts and savoury snacks/crackers. No association was found between skipping and weight status. Overweight adolescents had lower adherence to the Cereal, protein, fruit beverages and Northern/Northeastern pattern (OR = 0·67; 95 % CI 0·47, 0·96). This is the first study to address dietary patterns at the meal level with adolescent population-based data, which requires further investigation.

Weight-related behaviors and weight loss maintenance: a cross-sectional study in Cyprus

Background

This study examined the differences between maintainers and regainers regarding obesity related eating behaviors. A secondary objective was to develop an eating behavior index predicting the likelihood of successful weight loss maintenance.

Methods

The current cross-sectional evaluation conducted in Cyprus was part of the MedWeight (Greek) study. Eligible for participation were Cypriot (maintainers = 145; regainers = 87) adult men and women who reported being at least overweight (BMI ≥25 kg/m²) and experienced an intentional weight loss of ≥10% of their maximum lifetime weight, at least 1 year before participation. Among other assessments, weight-related behaviors were evaluated through Weight-Related Behaviors Index (WRBI).

Results

Statistically significant differences between the two groups were observed regarding meals per day (P = 0.008), frequency of eating home cooked meals (P = 0.004) and WRBI total score (P = 0.022). Results from logistic regression models indicated that the odds of maintaining weight loss increase at 30% (Model 1: P < 0.05, Odds ratio 1.306, 1.095–1.556 95% C.I., Model 2: P < 0.05, OR 1.308, 1.097–1.560 95% C.I.) and at 38% after adjusting for physical activity (Model 3: P < 0.05, OR 1.377, 1.114–1.701 95% C.I..) for each point scored in WRBI total score.

Conclusions

Eating more frequently home cooked meals and less eating away from home meals may be beneficially associated with weight loss maintenance. WRBI seems to be a useful tool when dealing with patients who have previously lost significant weight.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11153-5.

The inverse association between unhealthy eating habit and mucosal healing among patients with ulcerative colitis

Background

Although the association between eating habits which can be modified and digestive diseases has been reported, to date, no research has evaluated the association between eating habits and ulcerative colitis (UC). Thus, we investigate the association between eating behavior and clinical outcome in Japanese patients with UC.

Methods

Eating quickly, eating until full, and skipping breakfast data was obtained from a self-administered questionnaire. Information on clinical outcome was collected from medical records. Mucosal healing (MH) and partial MH was defined as a Mayo endoscopic subscore of 0 or 0–1, respectively. Age, sex, BMI, current smoking, current drinking, prednisolone use, and anti-TNFα monoclonal antibody use were selected a priori as potential confounding factors.

Results

Study subjects consisted of 294 Japanese patients with UC. Eating at speed moderate and eating quickly were independently inversely associated with MH: the adjusted odds ratios (ORs) were 0.38 (95% confidence interval [CI] 0.16–0.85) and 0.38 (95% CI 0.17–0.81) (p for trend = 0.033). Eating until full was independently inversely associated with MH: the adjusted OR was 0.38 (95% CI 0.27–0.86). MH in patients who skipped breakfast was marginally lower than that in patients who did not skip breakfast. No association between eating habits and clinical remission or partial MH was found.

Conclusion

Among patients with UC, eating rate and eating until full may be independently inversely associated with MH but not clinical remission.

The feeding microstructure of male and female mice

The feeding pattern and control of energy intake in mice housed in groups are poorly understood. Here, we determined and quantified the normal feeding microstructure of social male and female mice of the C57BL/6J genetic background fed a chow diet. Mice at 10w, 20w and 30w of age showed the expected increase in lean and fat mass, being the latter more pronounced and variable in males than in females. Under ad libitum conditions, 20w and 30w old females housed in groups showed significantly increased daily energy intake when adjusted to body weight relative to age-matched males. This was the combined result of small increases in energy intake during the nocturnal and diurnal photoperiods of the day without major changes in the circadian pattern of energy intake or spontaneous ambulatory activity. The analysis of the feeding microstructure suggests sex- and age-related contributions of meal size, meal frequency and intermeal interval to the control of energy intake under stable energy balance, but not under negative energy balance imposed by prolonged fasting. During the night, 10-20w old females ate less frequently bigger meals and spent more time eating them resulting in reduced net energy intake relative to age-matched males. In addition, male and female mice at all ages tested significantly shortened the intermeal interval during the first hours of re-feeding in response to fasting without affecting meal size. Further, 20-30w old males lengthened their intermeal interval as re-feeding time increased to reach fed-levels faster than age-matched females. Collectively, our results suggest that the physiological mechanisms controlling meal size (satiation) and the non-eating time spent between meals (satiety) during stable or negative energy balance are regulated in a sex- and age-dependent manner in social mice.

Association between Household Exposure to Secondhand Smoke and Dental Caries among Japanese Young Adults: A Cross-Sectional Study

The long-term effects of secondhand smoke (SHS) on dental caries among Japanese young adults remain unclear. The purpose of this cross-sectional study was to evaluate whether household exposure to SHS is associated with dental caries in permanent dentition among Japanese young adults. The study sample included 1905 first-year university students (age range: 18–19 years) who answered a questionnaire and participated in oral examinations. The degree of household exposure to SHS was categorized into four levels according to the SHS duration: no experience (−), past, current SHS < 10 years, and current SHS ≥ 10 years. Dental caries are expressed as the total number of decayed, missing, and filled teeth (DMFT) score. The relationships between SHS and dental caries were determined by logistic regression analysis. DMFT scores (median (25th percentile, 75th percentile)) were significantly higher in the current SHS ≥ 10 years (median: 1.0 (0.0, 3.0)) than in the SHS—(median: 0.0 (0.0, 2.0)); p = 0.001). DMFT ≥ 1 was significantly associated with SHS ≥ 10 years (adjusted odds ratio: 1.50, 95% confidence interval: 1.20–1.87, p < 0.001). Long-term exposure to SHS (≥10 years) was associated with dental caries in permanent dentition among Japanese young adults.

Influence of the Accumulation of Unhealthy Eating Habits on Obesity in a General Japanese Population: The Hisayama Study

Few studies have examined the association between the accumulation of unhealthy eating habits and the likelihood of obesity or central obesity in a general Japanese population. We examined this association in a sample of 1906 community-dwelling Japanese subjects (age: 40-74 years) who participated in a health check-up in 2014. A face-to-face questionnaire interview was conducted to collect information about three unhealthy eating habits, i.e., snacking, eating quickly, and eating late-evening meals. Obesity was defined as body mass index ≥25 kg/m2 and central obesity was defined as waist circumference ≥90 cm in men and ≥80 cm in women. The odds ratios (OR) were estimated by using a logistic regression analysis. Subjects with any one of the three eating habits had a significantly higher likelihood of obesity than those without that habit after adjusting for confounding factors. The multivariable-adjusted OR for obesity increased linearly with an increase in the number of accumulated unhealthy eating habits (p for trend < 0.001). Similar associations were observed for central obesity. Our findings suggest that modifying each unhealthy eating habit and avoiding an accumulation of multiple unhealthy eating habits might be important to reduce the likelihood of obesity.

Breakfast Skipping, Body Composition, and Cardiometabolic Risk: A Systematic Review and Meta-Analysis of Randomized Trials

OBJECTIVE

The objective of this study was to evaluate the effect of skipping breakfast on body composition and cardiometabolic risk factors.

METHODS

This study conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating breakfast skipping compared with breakfast consumption. Inclusion criteria included age ≥ 18, intervention duration ≥ 4 weeks, ≥ 7 participants per group, and ≥ 1 body composition measure. Random-effects meta-analyses of the effect of breakfast skipping on body composition and cardiometabolic risk factors were performed.

RESULTS

Seven RCTs (n = 425 participants) with an average duration of 8.6 weeks were included. Compared with breakfast consumption, breakfast skipping significantly reduced body weight (weighted mean difference [WMD] = -0.54 kg [95% CI: -1.05 to -0.03], P = 0.04, I²  = 21.4%). Percent body fat was reported in 5 studies and was not significantly different between breakfast skippers and consumers. Three studies reported on low-density lipoprotein cholesterol (LDL), which was increased in breakfast skippers as compared with breakfast consumers (WMD = 9.24 mg/dL [95% CI: 2.18 to 16.30], P = 0.01). Breakfast skipping did not lead to significant differences in blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, C-reactive protein, insulin, fasting glucose, leptin, homeostatic model assessment of insulin resistance, or ghrelin.

CONCLUSIONS

Breakfast skipping may have a modest impact on weight loss and may increase LDL in the short term. Further studies are needed to provide additional insight into the effects of breakfast skipping.

Association Between Serum Lipid Levels in Greek Children with Dyslipidemia and Mediterranean Diet Adherence, Dietary Habits, Lifestyle and Family Socioeconomic Factors

Background: Childhood dyslipidemia is an important risk factor for developing cardiovascular disease in adulthood. Our study aimed to investigate a possible correlation between nutritional, lifestyle, behavioral and socioeconomic factors and serum lipid levels in children with dyslipidemia. Methods: In this retrospective, observational study, in 31 children with dyslipidemia, aged 3–14 years, dietary habits, physical activity, hours watching television or playing video games, family’s socioeconomic status, weight of children and parents, and duration of breastfeeding were recorded. The children’s adherence to the Mediterranean diet was also evaluated by KidMed index. Statistical analysis was performed using SPSS.22. Results: Children with increased physical activity had lower triglyceride levels, compared to those with lower physical activity (p = 0.001). Children who consumed only one meal per day, had increased levels of total cholesterol (p = 0.01), LDL-cholesterol (p = 0.01), ApoB (p = 0.001) and lipoprotein (a) (p = 0.018), compared to those who consumed more than 3 meals per day (p < 0.05). Children who were breastfed less than 6 months had significantly increased LDL-C levels (p = 0.022), compared to children who were breastfed more than 6 months. All other parameters investigated did not differ significantly. Conclusions: This study showed association between lipid profile of children with dyslipidemia and specific nutritional and socioeconomic factors, such as increased physical activity, increased meals consumption during the day, and exclusive breastfeeding for more than 6 months. Nevertheless, further research is needed, in order to confirm these findings.

Change in Growth and Diet Quality Among Preschool Children in Tokyo, Japan

Dietary intake of adequate quality and quantity in early life is essential for healthy growth and development. This study aimed to examine the association between one-year change in growth and diet quality in preschool children in Adachi City, Tokyo, Japan. A total of 110 participants (49% boys, four to five years old at baseline) were included in this analysis. Body mass index for age z-score (BAZ) and height for age z-score (HAZ) were calculated in accordance with WHO reference. Dietary intakes were assessed using the brief-type self-administered diet history questionnaire for children (BDHQ3y), and daily quality score was calculated based on the Japanese Food Guide Spinning Top (JFGST score). Regression analyses found no significant association between one-year change in growth and diet quality (compared to a low JFGST score, BAZ: β = 0.16, 95% CI: −0.29 to 0.60 for a middle JFGST score, β = −0.14, 95% CI: −0.61 to 0.33 for a high JFGST score, HAZ: β = −0.15, 95% CI: −0.50 to 0.21 for a middle JFGST score, β = −0.06, 95% CI: −0.43 to 0.30 for a high JFGST score). Further studies are needed to develop an appropriate diet quality index for healthy growth in Japanese preschool children.

Breakfast skipping, nutritional status, and physical activity in a middle-aged Latin American population: a population-based study from Ecuador

Introduction

Introduction: the failure to eat breakfast has been associated with weight gain, a lower level of physical activity, and poor diet quality. Objective: to examine the frequency of skipping breakfast in an Ecuadorian population and its association with nutritional status and level of physical activity. Methods: a cross-sectional study of individuals who reported breakfast omission in a national survey. Nutritional status and physical activity were evaluated through anthropometric measures and the International Physical Activity Questionnaire, respectively. Results: the mean age of the study sample was 34.2 ± 14 years, 40% were aged 20 to 34 years, one half were women, 55% were living in the coastal region, and one half were classified as low socioeconomic status. Overall, 6.6% of participants did not mention breakfast in both recalls. Individuals who skipped breakfast were more likely to be aged 20 to 34 years (42.6% vs. 37.4%) and from the coastal region (61.1% vs. 51.8%) than those who ate breakfast. We did not find an association between skipping breakfast and being overweight or obese (35.2% vs. 36.1%), nor achieving a low level of physical activity (28.6% vs. 29.8%). In addition, breakfast consumers (vs. non-consumers) had higher intake of total energy, macronutrients (protein, carbohydrate, fat, and sugar), and micronutrients (fiber and calcium). Conclusions: in Ecuador, ~ 7% of the population skips breakfast. The nutritional status and level of physical activity did not differ between those who ate breakfast and those who did not. However, the long-term health consequences should be avoided by changing this eating habit.

A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study

Background

Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology.

Objective

This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds.

Methods

A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight–promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants’ user experience feedback and development ideas were collected through focus groups and completion of questionnaires.

Results

For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology.

Conclusions

Incorporating adolescents’ preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial.

Comparison of Self-Reported Speed of Eating with an Objective Measure of Eating Rate

Slow eating may be beneficial in reducing energy intake although there is limited research quantifying eating rate. Perceived speed of eating was self-reported by 78 adults using a standard question “On a scale of 1–5 (very slow–very fast), how fast do you believe you eat?” Timing the completion of meals on three occasions was used to assess objective eating rate. The mean (SD) speeds of eating by self-reported categories were 49 (13.7), 42 (12.2), and 35 (10.5) g/min for fast, medium, and slow eaters, respectively. Within each self-reported category, the range of timed speed of eating resulted in considerable overlap between self-identified ‘fast’, ‘medium’ and ‘slow’ eaters. There was 47.4% agreement (fair) between self-reported speed of eating and the objective measure of eating rate (κ = 0.219). Self-reported speed of eating was sufficient at a group level to detect a significant difference (10.9 g/min (95% CI: 2.7, 19.2 g/min, p = 0.009)) between fast and slow; and fast and medium eaters (6.0 g/min (0.5, 11.6 g/min p = 0.033)). The mean difference (95% CI) between slow and medium eaters was 4.9 (−3.4, 12.2) g/min (p = 0.250). At an individual level, self-report had poor sensitivity. Compared to objectively measured speed of eating, self-reported speed of eating was found to be an unreliable means of assessing an individual’s eating rate. There are no standard protocols for assessing speed of eating or eating rate. Establishing such protocols would enable the development of population reference ranges across various demographic groups that may be applicable for public health messages and in clinical management.

Social-ecological influences on unhealthy dietary behaviours among Moroccan adolescents: a mixed-methods study

OBJECTIVE

To identify the prevalence of unhealthy dietary behaviours and their social-ecological influences in adolescents.

DESIGN

The study used a sequential explanatory mixed-methods design, which begins with the collection of quantitative data, followed by the collection of qualitative data to explain and enrich the quantitative findings. Quantitative data were collected via a global school-based student health survey and were analysed using quantitative approaches. Qualitative data were obtained via focus group discussions and were analysed thematically.

SETTING

Middle and high secondary schools in Taza city, Morocco.

PARTICIPANTS

Our quantitative analyses included 764 students (14-19 years). For the qualitative part, seventeen focus group discussions were conducted with 100 participants (fifty-six adolescents, twenty-six parents and eighteen teachers).

RESULTS

Of total student participants, 46·1 % skipped breakfast, 60·6 % had inadequate intake of fruits and vegetables (F&V), 39·4 % consumed soft drinks and 28·0 % consumed fast foods. All of these dietary behaviours could coexist in the same person except for inadequate intake of F&V. Gender, academic performance, age, perceived family income and education level of mother were associated with unhealthy dietary behaviours. Qualitative findings identified seven themes regarding social-ecological influences on adolescents' dietary behaviours: cognitive, affective/biological, lifestyle, outcome expectation, social network, accessibility/availability and macro-level influences.

CONCLUSIONS

The prevalence of unhealthy dietary behaviours in our study group is a concern. Dietary behaviours are the result of inseparable interactions among social-ecological influences. Modifiable factors identified may be useful when designing a future intervention aimed at improving breakfast and F&V consumption and reducing fast/snack-food consumption among adolescents.

Association of frequent intake of fast foods, energy drinks, or convenience food with atopic dermatitis in adolescents

PURPOSE

Specific food consumption, besides food allergy, may aggravate atopic dermatitis (AD). However, previous reports on the association between AD and food intake in adolescents are scarce. The aim of this study was to determine the relationship between AD and specific food consumption frequency in adolescents.

METHODS

A cross-sectional analysis using data from the Korea Youth Risk Behavior Web-based Survey 2017 was performed. The frequency of food consumption in the recent-diagnosed AD group (AD diagnosed within 12 months) compared to those in the previous-diagnosed AD (AD diagnosed more than 12 months ago) or control group were investigated.

RESULTS

A total of 53,373 participants were eligible for this study. The weighted prevalence of the recent-diagnosed AD and the previous-diagnosed AD was 7.39% and 18.00%, respectively. When compared with subjects with the previous-diagnosed AD, those with the recent-diagnosed AD were significantly more likely to frequently consume fast foods (odds ratio OR 1.405; 95% CI 1.150-1.717), energy drinks (OR 1.457; 95% CI 1.175-1.807), or convenience food (OR 1.304; 95% CI 1.138-1.495). Patients of the recent-diagnosed AD were significantly more likely to frequently consume fast foods (OR 1.374; 95% CI 1.155-1.634) than the control group. The differences in the frequency of specific food consumption among groups were more pronounced in high school students than in middle school students.

CONCLUSIONS

Frequent intake of fast foods, energy drinks, and convenience food was related to the recent-diagnosed AD in adolescents. Prospective cohort and interventional studies are needed to identify causal relationships.

Eating Style and the Frequency, Size and Timing of Eating Occasions: A cross-sectional analysis using 7-day weighed dietary records

The tendencies to overeat in response to negative emotions (emotional eating) and environmental cues (external eating) have both been associated with BMI. However, it is unclear how they are expressed at the eating architecture level, for example, respecting frequency, timing and size of eating occasions, which could comprise 'downstream' specific behavioural intervention targets. In our analyses of the UK National Diet and Nutrition Survey 2000-2001, a 1-unit higher emotional eating score was associated with meals containing approximately 15 (3, 26) fewer kcals per occasion, consuming 1.4 (0.5, 2.3) more snacks per week and snacking over a 35- (16, 53) minute longer period a day. A 1-unit higher external eating score was associated with snacking over a 24- (1, 46) minute shorter period a day. Associations were independent of BMI and other potential confounders. The distinct pattern of eating architecture associated with emotional eating, suggests specific approaches to intervention, such as the number, timing and caloric content of snacks, could be considered further in experimental studies for their potential to prevent weight gain in people with a higher emotional eating tendency. Longitudinal studies and better measurement are also needed to strengthen causal inference in terms of the downstream effects of eating styles.

Eating Occasions, Obesity and Related Behaviors in Working Adults: Does it Matter When You Snack?

Reported relationships between frequency, type, and timing of eating occasions and obesity-risk among adults are mixed while associations with obesogenic eating behaviors remain unexplored. The Physical Activity and Changes in Eating (PACE) study was a group-randomized controlled trial to prevent weight gain among 34 small worksites in Seattle from 2005-2009. Baseline surveys assessed body mass index (BMI), obesogenic eating behaviors (e.g., fast food and distracted-eating), and eating occasions (i.e., snacks and meals) among 2265 employees. BMI and waist circumference were measured on a subset (n = 567). Time-periods for analyses included: morning (12:00 a.m. to 10:59 a.m.), mid-day (11:00 a.m. to 4:29 p.m.), and evening (4:30 p.m. to 11:59 p.m.). Multilevel linear models estimated associations between snack timing, obesity, and related behaviors while adjusting for meal timing, gender, and worksite random effects. Greater morning snacking was associated with increased fruit and vegetable consumption, while greater evening snacking was associated with higher BMI, higher obesogenic dietary index (intake of fast food, French fries, and soft drinks), and higher percent time eating while distracted. Associations with mid-day snacking were mixed. Patterns of association were consistent across repeated and objective measures. Findings suggest that evening snacking is more detrimental to healthy weight compared to snacking at other times of day. Reducing evening snacks may be an important and simple message for population-level obesity prevention efforts.

Food choices: concordance in Australian children aged 11-12 years and their parents

OBJECTIVES

Snack foods-typically high in salt, sugar, fat and/or energy-are likely important to the obesity epidemic. In the context of a population-based health assessment involving parent-child dyads at child age 11-12 years, we report cross-generational concordance in intake at a controlled snack food observation.

DESIGN

Cross-sectional study (Child Health CheckPoint), nested within the Longitudinal Study of Australian Children.

SETTING

Assessment centres in seven Australian cities, February 2015-March 2016.

PARTICIPANTS

Of all participating CheckPoint families (n=1874), 1299 children (50.3% girls) and 1274 parents (85.9% mothers) with snack data were included. Survey weights and methods were applied to account for the clustered multistage sample design.

OUTCOME MEASURES

Partway through the 3.5-hour assessment, parents and children attended Food Stop separately for a timed 15 min 'snack break'. One of four standardised box size/content combinations was randomly provided to all participants on any given day. Total food mass, energy, nutrients and sodium consumed was measured to the nearest 1 g. Pearson's correlation coefficients and adjusted multivariable linear regression models assessed parent-child concordance in each variable.

RESULTS

Children consumed less grams (151 g [SD 80] vs 165 g [SD 79]) but more energy (1393 kJ [SD 537] vs 1290 kJ [SD 658]) than parents. Parent-child concordance coefficients were small, ranging from 0.07 for sodium intake to 0.17 for carbohydrate intake. Compared with children with parents' energy intake on the 10th centile, children whose parents were on the 90th centile ate on average 227 kJ more. If extrapolated to one similar unsupervised snack on a daily basis, this equates to an additional 83 050 kJ per year, which could have a cumulative impact on additional body fat.

CONCLUSIONS

Although modest at an individual level, this measured parent-child concordance in unsupervised daily snack situations could account for substantial annual population differences in energy, fat and sodium intake for children aged 11-12 years.

TRIAL REGISTRATION NUMBER

ISRCTN12538380.

Eating frequency and weight status in Portuguese children aged 3-9 years: results from the cross-sectional National Food, Nutrition and Physical Activity Survey 2015-2016

OBJECTIVE

To evaluate daily eating frequency (main meals and snacks) in relation to weight status in children aged 3-9 years, representative of the Portuguese population.

DESIGN

Cross-sectional study. Dietary intake was estimated as the mean of two non-consecutive days of food diaries, followed by face-to-face interviews. Weight and height were measured by trained observers. Eating occasions (EO) were defined by the children's caregiver; an EO was considered separate if the time of consumption was different from other EO and it provided at least 209 kJ (50 kcal). Main meals defined as 'breakfast', 'lunch' and 'dinner' could be selected only once per day. The remaining EO were considered snacks. The association between eating frequency and overweight/obesity was evaluated through logistic regressions weighted for the population distribution.

SETTING

National Food, Nutrition and Physical Activity Survey of the Portuguese population, 2015-2016.

PARTICIPANTS

Portuguese children aged 3-9 years with complete dietary data and anthropometric measurements (n 517).

RESULTS

Overall, the number of daily EO ranged from 3·5 to 11, and on average children had 5·7 daily EO. After adjustment for child's sex, age and total energy intake, and considering only plausible energy intake reporters, having < 3 snacks/d was positively associated with being overweight/obese (OR = 1·98; 95 % CI 1·00, 3·90), compared with having ≥ 3 snacks/d.

CONCLUSIONS

Lower daily frequency of EO was associated with increased odds of being overweight or obese in children. A higher eating frequency, maintaining the same energy intake, seems to contribute to a healthy body weight in children.

Impacts of skipping breakfast and late dinner on the incidence of being overweight: a 3-year retrospective cohort study of men aged 20-49 years

BACKGROUND

Most studies on the dietary habits and overweight status of men aged 20-49 years have been cross-sectional, with longitudinal studies being scarce. One-quarter of Japanese men aged 20-49 years skip breakfast or have dinner within 2 h of bedtime (late dinner); therefore, the effects of these eating habits on men's increasing body weight need to be determined.

METHODS

We conducted a retrospective cohort study using health check-up data provided from several health insurance societies in Japan. Participants comprised 45 524 men employees aged 20-49 years who were followed up for 3 years. The primary outcome investigated was body mass index (BMI) ≥25 kg m^-2 . We conducted a multivariable logistic regression analysis and calculated the odds ratios for skipping breakfast and late dinner, as well as baseline age, body mass index, smoking status, eating speed, snack-eating status, alcohol drinking frequency, physical activity, sleep habits, and the interaction between skipping breakfast and late dinner.

RESULTS

Of the participants, 17 706 (38.8%) skipped breakfast and 25 987 (57.1%) had a late dinner. At the 3-year follow-up, 5093 (11.2%) had a BMI ≥25 kg m^-2 . The odds ratios of men skipping breakfast and having a late dinner were 1.18 (95% confidence interval = 1.04-1.33) and 0.92 (95% confidence interval = 0.84-1.01), respectively. The interaction between these factors was nonsignificant.

CONCLUSIONS

We suggest that skipping breakfast among men aged 20-49 years was one predictor of being overweight; however, having dinner within 2 h of bedtime was not a predictor.

Dietary and physical activity patterns related to cardio-metabolic health among Malaysian adolescents: a systematic review

BACKGROUND

A sedentary lifestyle and an unhealthy diet are major factors in the increasing prevalence of obesity among Malaysian adolescents. The purpose of this systematic review is to compile the evidence from observational and intervention studies among Malaysian adolescents to evaluate the associations between diet and physical activity (PA) as determinants of cardio-metabolic risk factors.

METHODS

A systematic search of Medline via the PubMed, Science Direct, Cochrane Review and Web of Science databases was conducted for studies on the associations between diet and PA factors and cardio-metabolic risk factors among Malaysian adolescents aged 13-18 years that were published until 31 August 2017. The search results were independently screened and extracted by two reviewers.

RESULTS

From over 2,410 references retrieved, 20 full texts articles were screened as potentially relevant. Seventeen (16 cross-sectional and one intervention) met the inclusion criteria for data extraction and analysis. All 17 studies were rated as poor quality and the majority had made insufficient adjustment for confounders. As regards the effect of diet and PA on cardio-metabolic health, the intakes of energy (n = 4) and macronutrients (n = 3) and meal frequency (n = 5) were the most commonly studied dietary factors, while the PA score and level were the most commonly studied PA factors. In addition, BMI and body weight were the most common cardio-metabolic health outcomes. The studies showed that obese and overweight adolescents consume significantly more energy and macronutrients. They are also more likely to skip their daily meals compared to their normal weight peers. In most studies, the direction of the PA effect on body weight was unclear. Some studies found that higher PA is associated with a lower risk of overweight and obesity. However, the associations are often small or inconsistent, with few studies controlling for confounding factors.

CONCLUSIONS

This review identified a lack of evidence and well-conducted prospective studies on the effect of diet and PA on cardio-metabolic health of Malaysian adolescents.

Feeding behaviour, risk-sensitivity and response control: effects of 5-HT2C receptor manipulations

People, like animals, tend to choose the variable option when given the choice between a fixed and variable delay to reward where, in the variable delay condition, some rewards are available immediately (Laura-Jean et al. 2019 Phil. Trans. R. Soc. B 374, 20180141. ( doi:10.1098/rstb.2018.0141 )). This bias has been suggested to reflect evolutionary pressures resulting from food scarcity in the past placing a premium on obtaining food quickly that can win out against the risks of sometimes sustaining longer delays to food. The psychologies mediating this effect may become maladaptive in the developed world where food is readily available contributing, potentially, to overeating and obesity. Here, we report our development of a novel touchscreen task in mice allowing comparisons of the impact of food delay and food magnitude across species. We show that mice exhibit the typical preference, as shown by humans, for variable over fixed delays to rewards but no preference when it comes to fixed versus variable reward amounts and further show that this bias is sensitive to manipulations of the 5-HT2C receptor, a key mediator of feeding and impulse control. We discuss the data in terms of the utility of the task to model the psychologies and underlying brain mechanisms impacting on feeding behaviours. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.

Exploring preferences for variable delays over fixed delays to high-value food rewards as a model of food-seeking behaviours in humans

Foraging and operant models suggest that animals will tolerate uncertainty or risk to obtain food quickly. In modern food environments, sustained access to quick energy-dense foods can promote weight gain. Here, we used a discrete-choice procedure to examine peoples' decisions about when next to eat high-value, palatable food rewards, probabilistically delivered immediately or following longer delays. In Experiment 1, moderately hungry young females showed consistent preferences for a variable delay option that delivered food rewards immediately or following long delays over a fixed delay option that delivered the same rewards following intermediate delays. These preferences were stronger in females with higher BMIs compared with lower BMIs, suggesting that quick food can enhance the value of uncertain or 'risky' food-seeking strategies in individuals vulnerable to future weight gain. In Experiment 2, prior exposure to a subtle and not easily identifiable food aroma increased selections of the variable delay option following delayed food rewards in a mixed sample of male and female adults, providing preliminary evidence that food cues can sustain uncertain food-seeking strategies. These data highlight a working hypothesis that the rapid delivery and consumption of food rewards, and food cues, can increase risk-tolerance in the food-seeking behaviours of individuals who are vulnerable to weight gain. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.

Breakfast Consumption, Family Breakfast, and Adiposity Trajectory in Adolescence-The Adolescent Nutritional Assessment Longitudinal Cohort Study

BACKGROUND

The relationship between breakfast and family breakfast and adiposity gain during adolescence remains inconclusive.

OBJECTIVE

This study aimed to investigate the relationship between breakfast and family breakfast frequency and adiposity trajectory in adolescence.

DESIGN

Prospective cohort study with middle school students aged 10 to 16 years enrolled in 2010 (baseline) and followed for 3 years.

PARTICIPANTS/SETTING

A total of 945 students from two public and four private schools in the metropolitan area of Rio de Janeiro were included. Among 945 students, 809 participated in the study at baseline. Pregnant or lactating students and those with physical or mental disabilities were excluded.

MAIN OUTCOME MEASURES

Body mass index (BMI) was assessed by measuring the participants' weight and height, and percent body fat (%BF) was assessed by performing bioelectrical impedance analysis.

STATISTICAL ANALYSES PERFORMED

Linear mixed-effect models were used to examine the relationship between baseline and persistence of breakfast consumption and family breakfast over a 3-year period and change in BMI and %BF. Breakfast and family breakfast were assessed by questions on frequency of consumption. Both variables were classified as regular, intermediate, and no consumption at baseline. Persistence was divided into persistently regular, persistently irregular, changing from regular to irregular, and contrariwise.

RESULTS

Overall, frequent breakfast consumption and family breakfast did not have protective effects against adiposity. At baseline, these behaviors were associated with low BMI and %BF among girls. During follow-up, these behaviors and persistence of regular breakfast consumption were associated with an increase in %BF (P<0.05). In boys, those who increased or decreased family breakfast frequency had greater decrease in %BF compared with those persistently regular at both time points.

CONCLUSION

Breakfast had no consistent relationship with adolescence adiposity trajectory, which is in line with the results of experimental studies and in contrast with those of many cross-sectional studies.

Association between breakfast composition and abdominal obesity in the Swiss adult population eating breakfast regularly

BACKGROUND

Evidence from experimental and observational studies is limited regarding the most favorable breakfast composition to prevent abdominal fat accumulation. We explored the association between breakfast composition (a posteriori derived dietary patterns) and abdominal obesity among regular breakfast eaters from a Swiss population-based sample.

METHODS

The cross-sectional survey assessed diet using two 24-h dietary recalls in a nationally representative sample of adults aged 18 to 75 years. We derived dietary patterns using principal component analysis based on the intake of 22 breakfast-specific food groups. All regular breakfast eaters were predicted an individual score for each identified pattern, and then classified into tertiles (T1, T2, T3). We defined abdominal obesity as waist-to-hip ratio (WHR) ≥ 0.9 in men and ≥ 0.85 in women. Logistic models were adjusted for sociodemographic characteristics, relevant nutrition- and health-related behaviors, and diet quality during the rest of the day.

RESULTS

Of the 2019 included survey participants, 1351 (67%) were regular breakfast eaters. Among them, we identified three breakfast types: 1) 'traditional' - white bread, butter, sweet spread, 2) 'prudent' - fruit, unprocessed and unsweetened cereal flakes, nuts/seeds, yogurt, and 3) 'western' - processed breakfast cereals, and milk. The 'prudent' breakfast was negatively associated with abdominal obesity. After full adjustment, including diet quality during the rest of the day, the association was weaker (T3 vs. T1: OR 0.72, 95% CI: 0.47 to 1.08). People taking a 'prudent' breakfast (in T3) had 1.2% lower WHR compared to people taking a breakfast distant from 'prudent' (in T1) (P = 0.02, fully adjusted model with continuous log-WHR). We found no association between 'traditional' or 'western' breakfasts and WHR (OR 1.00, 95% CI: 0.67 to 1.50 and OR 1.16, 95% CI: 0.79 to 1.71, respectively). Findings were in the same directions for the three breakfast types when defining obesity with waist circumference, waist-to-height ratio, or body mass index (≥ 30 kg/m2, for 'prudent' breakfast: OR 0.51, 95% CI: 0.31 to 0.85).

CONCLUSIONS

Regular breakfast consumers had less abdominal obesity if their breakfast was composed of fruit, natural cereal flakes, nuts/seeds and yogurt. This association was partly explained by their healthier diet during the rest of the day.

TRIAL REGISTRATION

ISRCTN16778734 .

Changes in the nutritional quality of products sold in university vending machines since implementation of the health star rating in 2014; an environmental audit

Background

Snacking is a prevalent dietary behaviour among young adults, which could independently contribute to weight gain. Vending machines provide easy access to unhealthy snacks and beverages for young adults in universities. A voluntary front-of-pack labelling, named the Health Star Rating (HSR) system, has been implemented nationally by the Australian government as one strategy to address obesity since 2014. The primary aim of this study was to detect changes in the availability, pricing and advertising of healthy and unhealthy snacks and beverages in university vending machines after introduction of the HSR.

Methods

The study design was two cross-sectional audits of university vending machines one before (in 2014) and another after (in 2017) the implementation of the HSR. Data collections were conducted in a large urban university (> 60,000 students). Every machine was assessed; the product’s name, price, portion sizes and advertisements were recorded. Products were assigned an HSR to classify as healthy (≥3.5 stars) or unhealthy (< 3.5 stars). To compare the differences of product availability between 2014 and 2017, the Chi-square test was used.

Results

A total of 1836 and 2458 slots were audited in 2014 and 2017, respectively. The proportion of healthy snacks and beverages increased from 7 to 14% (p < 0.001) and 38 to 44% (p < 0.05) since 2014, respectively. The mean costs of unhealthy snacks and healthy beverages increased after three years. Healthy food and drink options were more expensive than unhealthy choices in 2017. Advertisements on vending machines for unhealthy foods and drinks remained prevalent.

Conclusion

Only small changes have been observed in the availability of healthy snacks and beverages in vending machines since implementation of the HSR system. Policy directives are indicated to encourage further improvements.

Breakfast Consumption in French Children, Adolescents, and Adults: A Nationally Representative Cross-Sectional Survey Examined in the Context of the International Breakfast Research Initiative

This study examines the consumption of breakfast on the basis of a 7-day dietary record (Comportements et Consommations Alimentaires en France 2012–2013) in a representative sample of French children (n = 426), adolescents (n = 250), and adults (n = 1045). A large majority of the participants were regular consumers of breakfast (5–7 times per week). Breakfast accounted for 17.6% of total daily energy (339.4 kcal). Breakfast was rich in carbohydrates (24% of total daily intake) and simple sugars (31% of total daily intake). Relative to its contribution in daily energy intake, breakfast contributed higher proportions in the daily intake of many vitamins (B, C), and minerals (calcium, iron, iodine, manganese, phosphorus, potassium, magnesium). The main foods/beverages contributing to breakfast changed with age, with increasing contributions of non-wholegrain “bread and toasts” and “fruits”, and a decreasing contribution of milk. Better quality of the diet, as measured by tertiles of the Nutrient Rich Food Index 9.3, was associated with higher intakes of cereal products (bread and breakfast cereals, particularly wholegrain), dairy (milk, fresh dairy), and fruit at breakfast. In conclusion, breakfast is regularly consumed in France and contributes significantly to diet quality but could be improved in terms of content in fiber and protein.

Ecological momentary assessment of food perceptions and eating behavior using a novel phone application in adults with or without obesity

We developed a smart phone application to measure participants' food-reward perceptions and eating behavior in their naturalistic environment. Intensity ratings (0 - not at all to 10 - very strongly) of perceived anticipation of food (wanting) and food enjoyment at endpoint of intake (liking) were recorded as they occurred over a period of 14 days. Moreover, food craving trait, implicit and explicit attitude towards healthy food, and body composition were assessed. 53 participants provided complete data. Participants were classified by percentage of body fat; 33 participants with lower body fat (L-group) and 20 with higher body fat (H-group; ≥25% body fat for males and ≥32% for females). L-group participants reported 6.34 (2.00) food wanting events per day, whereas H-group participants recorded significantly fewer food wanting events (5.07 (1.42)); both groups resisted about the same percentage of wanting events (L-group: 29.2 (15.5)%; H-group 27.3 (12.8)%). Perceived intensity ratings were significantly different within the L-group in the order liking (7.65 (0.81)) > un-resisted wanting (leading to eating) (7.00 (1.01)) > resisted wanting (not leading to eating) (6.02 (1.72)) but not in the H-group. Liking scores (L-group: 7.65 (0.81); H-group: 7.14 (1.04)) were significantly higher in L-group than in H-group after controlling for age. Our results show that individuals with higher percentage of body fat show less food enjoyment after intake and reveal no differentiation in intensity ratings of perceived anticipatory and consummatory food reward. These results are consistent with a hypothesized reward deficiency among individuals with higher percentage of body fat.

Intelligence in youth and health behaviours in middle age

OBJECTIVE

We investigated the association between intelligence in youth and a range of health-related behaviours in middle age.

METHOD

Participants were the 5347 men and women who responded to the National Longitudinal Survey of Youth 1979 (NLSY-79) 2012 survey. IQ was recorded with the Armed Forces Qualification Test (AFQT) when participants were aged 15 to 23 years of age. Self-reports on exercise (moderate activity, vigorous activity, and strength training), dietary, smoking, drinking, and oral health behaviours were recorded when participants were in middle age (mean age = 51.7 years). A series of regression analyses tested for an association between IQ in youth and the different health related behaviours in middle age, while adjusting for childhood socio-economic status (SES) and adult SES.

RESULTS

Higher IQ in youth was significantly associated with the following behaviours that are beneficial to health: being more likely to be able to do moderate cardiovascular activity (Odds Ratio, 95% CI) (1.72, 1.35 to 2.20, p < .001) and strength training (1.61, 1.37 to 1.90, p < .001); being less likely to have had a sugary drink in the previous week (0.75, 0.71 to 0.80, p < .001); a lower likelihood of drinking alcohol heavily (0.67, 0.61 to 0.74, p < .001); being less likely to smoke (0.60, 0.56 to 0.65, p < .001); being more likely to floss (1.47, 1.35 to 1.59, p < .001); and being more likely to say they "often" read the nutritional information (1.20, 1.09 to 1.31, p < .001) and ingredients (1.24, 1.12 to 1.36, p < .001) on food packaging compared to always reading them. Higher IQ was also linked with dietary behaviours that may or may not be linked with poorer health outcomes (i.e. being more likely to have skipped a meal (1.10, 1.03 to 1.17, p = .005) and snacked between meals (1.37, 1.26 to 1.50, p < .001) in the previous week). An inverted u-shaped association was also found between IQ and the number of meals skipped per week. Higher IQ was also linked with behaviours that are known to be linked with poorer health (i.e. a higher likelihood of drinking alcohol compared to being abstinent from drinking alcohol (1.58, 1.47 to 1.69, p < .001)). A u-shaped association was found between IQ and the amount of alcohol consumed per week and an inverted u-shaped association was found between IQ and the number of cigarettes smoked a day. Across all outcomes, adjusting for childhood SES tended to attenuate the estimated effect size only slightly. Adjusting for adult SES led to more marked attenuation but statistical significance was maintained in most cases.

CONCLUSION

In the present study, a higher IQ in adolescence was associated with a number of healthier behaviours in middle age. In contrast to these results, a few associations were also identified between higher intelligence and behaviours that may or may not be linked with poor health (i.e. skipping meals and snacking between meals) and with behaviours that are known to be linked with poor health (i.e. drinking alcohol and the number of cigarettes smoked). To explore mechanisms of association, future studies could test for a range of health behaviours as potential mediators between IQ and morbidity or mortality in later life.

Understanding the risk and protective factors associated with obesity amongst Libyan adults - a qualitative study

Background

There are a range of multifaceted behavioural and societal factors that combine to contribute to the causes of obesity. However, it is not yet known how particularly countries’ cultural norms are contributing to the global obesity epidemic. Despite obesity reaching epidemic proportions in Libya, since the discovery of oil in 1959, there is a lack of information about obesity in Libyan adults. This study sought to explore the views of key informants about the risk and protective factors associated with obesity among Libyan men and women.

Methods

A series of qualitative semi-structured interviews were conducted with Libyan healthcare professionals and community leaders.

Results

Eleven main themes (risk and protective factors) were identified, specifically: socio-demographic and biological factors, socioeconomic status, unhealthy eating behaviours, knowledge about obesity, social-cultural influences, Libya’s healthcare facilities, physical activity and the effect of the neighbourhood environment, sedentary behaviour, Libyan food-subsidy policy, and suggestions for preventing and controlling obesity.

Conclusions

Key recommendations are that an electronic health information system needs to be implemented and awareness about obesity and its causes and consequences needs to be raised among the public in order to dispel the many myths and misconceptions held by Libyans about obesity. The current political instability within Libya is contributing to a less-active lifestyle for the population due to security concerns and the impact of curfews. Our findings have implications for Libyan health policy and highlight the urgent need for action towards mitigating against the obesity epidemic in Libya.

Screening for Binge Eating Disorder in people with obesity

The Risk factors for Binge Eating Disorder in Overweight (REO) questionnaire is a screening tool for nutritionists to discriminate between individuals with obesity with and without Binge Eating Disorder (BED). The first study tested the discriminative ability of the REO and identified an optimal cut-off value. In the second study this cut-off value was used to identify individuals with and without BED from a sample of individuals with obesity visiting a nutritionist and compared clinical and personality characteristics with a group of individuals officially diagnosed with BED. Results showed that the REO has a sensitivity of 95.1%, specificity of 81.5%, a good internal consistency of α=.96, and an exploratory factor analysis showed four underlying factors of the REO that explained a total variance of 63.7%. Characteristics of individuals with BED symptoms identified by the REO and those officially diagnosed with BED were comparable and differed from individuals with obesity without BED symptoms. By screening individuals with obesity with the REO those presenting with BED symptoms are more easily identified, and can be referred to psychological treatment facilities for further assessment and appropriate treatment.