Effects of a late supper on digestion and the absorption of dietary carbohydrates in the following morning

Early Dinner Improves the Glycemic Profile in Habitual Late Eaters With Uncontrolled Type 2 Diabetes Mellitus in the Short Term

Background Late dinner (LD) can worsen the glucose profile in type 2 diabetes (T2D). We assessed the short-term effect of early dinner (ED) on glycemic control in habitual late eaters with uncontrolled T2D. Methodology This interventional, single-arm, within-group trial recruited 10 habitual late eaters with uncontrolled T2D (glycosylated hemoglobin: 7-9% and either fasting plasma glucose (FPG): ≥140 mg/dl or post-prandial plasma glucose: ≥200 mg/dl). They had their usual LD (beyond 22:00 hours) on Days 0-3 and ED (before 20:00 hours) on Days 4-10. Continuous glucose monitoring system (CGMS) parameters, two-hour post-dinner, and fasting (10-hour post-dinner) investigations were analyzed. Bedtime hunger was assessed using a Labeled Magnitude Satiety Scale. Results The mean dinner time was reduced from 22:28 hours to 19:29 hours. CGMS revealed that ED lowered the 10-hour post-dinner incremental area under the curve (22,587.9 ± 5,168.3 mg/dl×mins vs. 15,886.3 ± 4,288.7 mg/dl×mins, P < 0.002), 10-hour post-dinner average blood glucose (ABG) (137.5 ± 9.3 mg/dl vs. 125 ± 7.9 mg/dl, P < 0.002), 24-hour ABG (132.2 ± 7.5 mg/dl vs. 124.8 ± 5.4 mg/dl, P = 0.037), and night mean amplitude of glucose excursion (83.7 ± 5.8 mg/dl vs. 69.3 ± 7.5 mg/dl, P = 0.027). ED also reduced FPG (119.8 ± 7.3 mg/dl vs. 105.2 ± 5.7 mg/dl, P = 0.015), fasting insulin (15.0 ± 4.3 µIU/ml vs. 9.7 ± 2.7 µIU/ml, P < 0.002), and HOMA-IR (4.36 ± 1.2 vs. 2.56 ± 0.79, P < 0.002). Post-dinner glucose, insulin, and inflammatory markers were unchanged. Bedtime hunger increased significantly on Days 4 and 5 but returned to baseline by Day 10. Conclusions A simple modification of dinner time in habitual late eaters with uncontrolled T2D improves FPG, glycemic control, and insulin resistance in the short term.

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.

The impact of dietary and sleep rhythms on blood pressure in children and adolescents: a cross-sectional study

Evidence about the relationship between meal and sleep time and CVD in children is scarce. The aims of this study were to describe the association between life rhythm patterns and blood pressure in children. This research was conducted among 5,608 children aged 6 to 15 years old in Chongqing and Sichuan provinces in 2021 and 2022. Dietary and sleep rhythms information was collected. The time of the first meal and last meal, and sleep time, were obtained. The mean age was 10.48 ± 2.24 years old, with 2958 (52.75%) male participants. The mean feeding window on weekdays was 11.69 h, 12.42 h, and 13.23 h for participants aged 6-7 years old, 8-12 years old and 13-15 years old, respectively. Weekday feeding window and last mealtime were positively correlated with blood pressure levels. And the changes in the feeding window between weekdays and weekends were significantly correlated with BP. Sleep duration and change in wake time were significantly correlated with SBP. Based on these results, this study identified the optimal combination of dietary and sleep rhythm interventions for children younger than 12 years of age and aged 12 and older, respectively. Disorder dietary and sleep rhythms disorders may correlate with elevated blood pressure levels, suggesting developing optimal dietary and sleep rhythm patterns could prevent the incidence of CVDs in children. The optimal dietary rhythm was defined by the indexes of breakfast time, dinner time and daily feeding window. As good meal patterns are defined as satisfied the following three items: for children younger than 12 years should have breakfast after 7:30 am; aged 12 years and over should have breakfast after 7 am; having dinner before 6 pm; daily feeding window less than 12.5 h. And less optimal dietary rhythm should satisfy any condition or eat dinner between 6 pm and 8 pm; and poor dietary rhythm should not satisfy any of the three criteria and eat dinner after 8 pm. Children with optimal dietary rhythm (in group A) had lower SBP (P < 0.001), DBP (P = 0.002) and MAP (P < 0.001) than those in group C.

Early time-restricted eating improves markers of cardiometabolic health but has no impact on intestinal nutrient absorption in healthy adults

Early time-restricted eating (eTRE) improves aspects of cardiometabolic health. Although the circadian system appears to regulate nutrient absorption, little is known about the effects of eTRE on intestinal absorption. In this randomized crossover trial, 16 healthy adults follow a controlled, weight maintenance diet for 9 days, consuming all calories between 0800 and 1400 (eTRE schedule) or 0800 and 2000 (control schedule). We measure the energy content of the diet, stool, and urine with bomb calorimetry and calculate intestinal energy absorption. The eTRE schedule is more effective than the control eating schedule for improving markers of cardiometabolic health, including 24-h mean glucose concentrations and glycemic variability, assessed as the mean amplitude of glycemic excursions. However, eTRE has no effect on intestinal energy and macronutrient absorption, gastrointestinal transit time, colonic hydrogen gas production, or stool microbial composition, suggesting eTRE does not impact gastrointestinal function. This trial is registered (ClinicalTrials.gov: NCT04877262).

Association between lifestyle habits and glaucoma incidence: a retrospective cohort study

BACKGROUND/OBJECTIVES

Although lifestyle habits may represent modifiable risk factors of glaucoma, the association between lifestyle factors and glaucoma is not well understood. The aim of this study was to investigate the association between lifestyle habits and the development of glaucoma.

SUBJECTS/METHODS

Participants who underwent health check-ups from 2005 to 2020 using a large-scale administrative claims database in Japan were included in the study. Cox regression analyses were performed where glaucoma development was regressed on the lifestyle (body mass index, current smoking, frequency and amount of alcohol consumption, eating habits, exercise habits and quality of sleep), age, sex, hypertension, diabetes mellitus and dyslipidaemia.

RESULTS

Among the 3,110,743 eligible individuals, 39,975 developed glaucoma during the mean follow-up of 2058 days. Factors associated with increased risk of glaucoma were overweight/obese (vs. moderate weight: hazard ratio, 1.04 [95% confidence interval, 1.02-1.07]), alcohol consumption of 2.5-4.9 units/day, 5-7.4 units/day, and ≥7.5 units/day (vs. <2.5 units/day: 1.05 [1.02-1.08], 1.05 [1.01-1.08] and 1.06 [1.01-1.12], respectively), skipping breakfast (1.14 [1.10-1.17]), late dinner (1.05 [1.03-1.08]) and daily walking of 1 h (1.14 [1.11-1.16]). Factors associated with decreased risk of glaucoma were daily alcohol consumption (vs. rarely: 0.94 [0.91-0.97]) and regular exercise (0.92 [0.90-0.95]).

CONCLUSIONS

Moderate body mass index, having breakfast, avoiding late dinner, limiting alcohol intake to <2.5 units/day, and regular exercise were associated with a reduced risk of developing glaucoma in the Japanese population. These findings may be useful for promoting glaucoma prophylaxis.

Relationship Between Carbohydrate Intake (Quantity, Quality, and Time Eaten) and Mortality (Total, Cardiovascular, and Diabetes): Assessment of 2003-2014 National Health and Nutrition Examination Survey Participants

OBJECTIVE

In this study we investigated the association of the quantity, quality, and timing of carbohydrate intake with all-cause, cardiovascular disease (CVD), and diabetes mortality.

RESEARCH DESIGN AND METHODS

This secondary data analysis included use of National Health and Nutrition Examination Survey (2003-2014) and National Death Index data from adults (n = 27,623) for examination of the association of total daily and differences in carbohydrate intake with mortality. Participants were categorized into four carbohydrate intake patterns based on the median values of daily high- and low-quality carbohydrate intake. The differences (Δ) in carbohydrate intake between dinner and breakfast were calculated (Δ = dinner - breakfast). Cox regression models were used.

RESULTS

The participants who consumed more high-quality carbohydrates throughout the day had lower all-cause mortality risk (hazard ratio [HR] 0.88; 95% CI 0.79-0.99), whereas more daily intake of low-quality carbohydrates was related to greater all-cause mortality risk (HR 1.13; 95% CI: 1.01-1.26). Among participants whose daily high- and low-quality carbohydrate intake were both below the median, the participants who consumed more high-quality carbohydrates at dinner had lower CVD (HR 0.70; 95% CI 0.52-0.93) and all-cause mortality (HR 0.82; 95% CI 0.70-0.97) risk; an isocaloric substitution of 1 serving low-quality carbohydrates intake at dinner with high-quality reduced the CVD and all-cause mortality risks by 25% and 19%. There was greater diabetes mortality among the participants who consumed more low-quality carbohydrates at dinner (HR 1.78; 95% CI 1.02-3.11), although their daily high-quality carbohydrate intake was above the median.

CONCLUSIONS

Consuming more low-quality carbohydrates at dinner was associated with greater diabetes mortality, whereas consuming more high-quality carbohydrates at dinner was associated with lower all-cause and CVD mortality irrespective of the total daily quantity and quality of carbohydrates.

Effects of Time-Restricted Feeding and Ramadan Fasting on Body Weight, Body Composition, Glucose Responses, and Insulin Resistance: A Systematic Review of Randomized Controlled Trials

Time-restricted feeding (TRF) and Ramadan fasting (RF) have been recently associated with several health outcomes. However, it is not yet clear if they are superior to existing treatments in terms of glucose metabolism, insulin action, and weight loss. This review aims to summarize the current data on the effects of these regimes on body weight, body composition, and glycemia. An electronic search was conducted in PUBMED and SCOPUS databases up to August 2022. Twenty-four records met the inclusion criteria and underwent a risk-of-bias assessment. The main outcomes were: (a) TRF may result in moderate weight loss in individuals with overweight/obesity; when TRF is combined with caloric restriction, weight loss is >5% of the initial body weight, (b) 14 h of fasting may be as effective as 16 h in terms of weight loss, and (c) TRF may lead to improved insulin sensitivity and glycemic responses/variability throughout the day in individuals with overweight/obesity. Concerning RF, only two studies were available and thus, conclusions were not drawn. TRF may be an effective nutritional approach for weight loss, and the amelioration of glycemic control and insulin sensitivity in individuals with overweight/obesity. However, more long-term, well-designed studies are needed.

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.

Extended Inter-Meal Interval Negatively Impacted the Glycemic and Insulinemic Responses after Both Lunch and Dinner in Healthy Subjects

This study aimed to investigate the glycemic and insulinemic effects of lunch timing based on a fixed feeding window, and the effects of apple preload on postprandial glucose and insulin responses after nutrient-balanced lunch and the subsequent high-fat dinner in healthy participants. Twenty-six participants completed four randomized, crossover experimental trials: (1) early standardized lunch at 12:00 (12S); (2) apple preload to 12S (12A+S); (3) late standardized lunch at 14:00 (14S); and (4) apple preload to 14S (14A+S); wherein twenty participants’ blood samples were collected for insulin analysis following the lunch trails. In each experimental trial, each participant equipped with a continuous glucose monitor (CGM) was provided with a standardized breakfast and a high-fat dinner to be consumed at 8:00 and 18:00, respectively. The late lunch (14S) resulted in significantly elevated glucose peak, delayed insulin peak time, decreased insulin sensitivity, and increased insulin resistance following the lunch; also decreased glycemic response following the subsequent dinner and larger blood glucose fluctuation over the 24-h period compared with the 12S. The 14A+S significantly reduced the glucose peak, the insulin peak time and the glycemic variability following the lunch, also the 24-h glycemic variability compared with the 14S. The insulin sensitivity was significantly improved in the 12A+S, compared with that of the 12S. In conclusion, the present study found that an extra 2-h inter-meal fasting before and after lunch resulted in elevated glycemic response in both macronutrient-balanced meal and high-fat meal in healthy subjects. The negative impact of a late lunch could be partly reversed by the apple preload, without a trade-off of insulin secretion.

The Role of Sleep and Eating Patterns in Adiposity Gain among Preschool-Aged Children

BACKGROUND

Short sleep duration is related to risk for obesity in preschool children. However, the underlying mechanism(s) are not clear.

OBJECTIVE

We evaluated the relationship between sleep characteristics with body composition, energetics and weight-regulating behaviors in preschool-aged children; and the longitudinal associations between children's sleep and eating patterns with body composition at 1-year follow-up.

METHODS

Data were drawn from a longitudinal study of 118 children aged 3-5 years. Sleep (duration, midpoint, regularity) and physical activity (PA) were measured by accelerometry over 6 consecutive days; total energy expenditure (TEE) using the doubly-labeled water method; body composition (fat mass, fat-free mass, and %body fat) by dual energy x-ray absorptiometry; and dietary intake (energy intake, timing) using two 24-h recalls. Multivariable regression was used to estimate interindividual associations of sleep parameters with body composition, PA, TEE and dietary outcomes; and to examine the relationship between sleep and dietary behaviors with body composition one year later.

RESULTS

Cross-sectionally, later sleep midpoint was associated with greater fat mass (0.33; 95% CI: 0.05, 0.60) and %body fat (0.92; 95% CI: 0.15, 1.70). Later sleep midpoint was associated with delayed morning (0.51; 95% CI: 0.28, 0.74) and evening meal times (0.41; 95% CI: 0.29, 0.53), higher nighttime (45.6; 95% CI: 19.7, 71.4), and lower morning (-44.8; 95% CI: -72.0, -17.6) energy intake. Longitudinally, shorter sleep duration (-0.02; 95% CI: -0.03, -0.00) and later meal timing (0.83; 95% CI: 0.24, 1.42) were associated with higher %body fat 1 year later.

CONCLUSIONS

Shorter sleep duration and later meal timing are associated with adiposity gain in preschoolers.

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

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

A scoping review of chronotype and temporal patterns of eating of adults: tools used, findings, and future directions

Circadian rhythms, metabolic processes and dietary intake are inextricably linked. Timing of food intake is a modifiable temporal cue for the circadian system and may be influenced by numerous factors, including individual chronotype - an indicator of an individual's circadian rhythm in relation to the light-dark cycle. This scoping review examines temporal patterns of eating across chronotypes and assesses tools that have been used to collect data on temporal patterns of eating and chronotype. A systematic search identified thirty-six studies in which aspects of temporal patterns of eating, including meal timings; meal skipping; energy distribution across the day; meal frequency; time interval between meals, or meals and wake/sleep times; midpoint of food/energy intake; meal regularity; and duration of eating window, were presented in relation to chronotype. Findings indicate that, compared with morning chronotypes, evening chronotypes tend to skip meals more frequently, have later mealtimes, and distribute greater energy intake towards later times of the day. More studies should explore the difference in meal regularity and duration of eating window amongst chronotypes. Currently, tools used in collecting data on chronotype and temporal patterns of eating are varied, limiting the direct comparison of findings between studies. Development of a standardised assessment tool will allow future studies to confidently compare findings to inform the development and assessment of guidelines that provide recommendations on temporal patterns of eating for optimal health.

A mathematical model of food intake

The metabolic, hormonal and psychological determinants of the feeding behavior in humans are numerous and complex. A plausible model of the initiation, continuation and cessation of meals taking into account the most relevant such determinants would be very useful in simulating food intake over hours to days, thus providing input into existing models of nutrient absorption and metabolism. In the present work, a meal model is proposed, incorporating stomach distension, glycemic variations, ghrelin dynamics, cultural habits and influences on the initiation and continuation of meals, reflecting a combination of hedonic and appetite components. Given a set of parameter values (portraying a single subject), the timing and size of meals are stochastic. The model parameters are calibrated so as to reflect established medical knowledge on data of food intake from the National Health and Nutrition Examination Survey (NHANES) database during years 2015 and 2016.

Recent Evidence on the Impact of Ramadan Diurnal Intermittent Fasting, Mealtime, and Circadian Rhythm on Cardiometabolic Risk: A Review

In this article, we reviewed recent data that examined the relationship of circadian rhythm, mealtime, and intermittent fasting with the risk of cardiometabolic dysfunction. We also examined the effect of their interactions on cardiometabolic risks. Furthermore, since major differences exists between Ramadan diurnal intermittent fasting compared to other forms of experimental intermittent fasting, in this article, we further restricted the discussion to Ramadan diurnal intermittent fasting. PubMed and Google Scholar databases were searched using “intermittent fasting,” “time-restricted feeding,” “fasting,” “mealtime,” “circadian rhythm,” and “cardiometabolic risk,” focusing on human studies published after 2013. Recent evidence indicates that meal timing may influence circadian rhythm, as a result, it may also directly or indirectly impact cardiometabolic risk. In humans, several studies suggested that late mealtime is related to an increased risk of poor cardiometabolic health. Nevertheless, large clinical interventional studies are required to assess causality between late mealtime and cardiometabolic morbidity. Currently, evidence indicates that Ramadan diurnal intermittent fasting has several beneficial effects that may reduce the risk of cardiometabolic disorders, such as weight reduction, improvement in lipid profile and glycemic control, reduction in proinflammatory markers, and oxidative stress. Nevertheless, several changes in daily lifestyle routine, happening during the Ramadan month, may affect the all measured markers of cardiometabolic diseases. Summarily, no definitive conclusion about the impact of Ramadan intermittent fasting on oxidative stress can be formulated. Therefore, large, well-designed studies, which control for various confounding factors are required to assess the influence of Ramadan diurnal intermittent fasting on markers of cardiometabolic risk and disorders.

Chrononutrition in the management of diabetes

Circadian rhythms are 24-h cycles regulated by endogeneous molecular oscillators called the circadian clock. The effects of diet on circadian rhythmicity clearly involves a relationship between factors such as meal timings and nutrients, known as chrononutrition. Chrononutrition is influenced by an individual's "chronotype", whereby "evening chronotypes" or also termed "later chronotype" who are biologically driven to consume foods later in the day. Research in this area has suggested that time of day is indicative of having an influence on the postprandial glucose response to a meal, therefore having a major effect on type 2 diabetes. Cross-sectional and experimental studies have shown the benefits of consuming meals early in the day than in the evening on postprandial glycaemia. Modifying the macronutrient composition of night meals, by increasing protein and fat content, has shown to be a simple strategy to improve postprandial glycaemia. Low glycaemic index (GI) foods eaten in the morning improves glycaemic response to a greater effect than when consumed at night. Timing of fat and protein (including amino acids) co-ingested with carbohydrate foods, such as bread and rice, can reduce glycaemic response. The order of food presentation also has considerable potential in reducing postprandial blood glucose (consuming vegetables first, followed by meat and then lastly rice). These practical recommendations could be considered as strategies to improve glycaemic control, rather than focusing on the nutritional value of a meal alone, to optimize dietary patterns of diabetics. It is necessary to further elucidate this fascinating area of research to understand the circadian system and its implications on nutrition that may ultimately reduce the burden of type 2 diabetes.

A Delayed Morning and Earlier Evening Time-Restricted Feeding Protocol for Improving Glycemic Control and Dietary Adherence in Men with Overweight/Obesity: A Randomized Controlled Trial

We determined the effects of time-restricted feeding (TRF; 8 h/d) versus extended feeding (EXF; 15 h/d) on 24-h and postprandial metabolism and subjective opinions of TRF in men with overweight/obesity. In a randomized crossover design, 11 sedentary males (age 38 ± 5 y; BMI: 32.2 ± 2.0 kg/m²) completed two isoenergetic diet protocols for 5 days, consuming meals at 1000, 1300 and 1700 h (TRF) or 0700, 1400 and 2100 h (EXF). On Day 5, participants remained in the laboratory for 24 h, and blood samples were collected at hourly (0700–2300 h) then 2-hourly (2300–0700 h) intervals for concentrations of glucose, insulin and appetite/incretin hormones. Structured qualitative interviews were conducted following completion of both dietary conditions and investigated thematically. Total 24-h area under the curve (AUC_total) [glucose] tended to be lower for TRF versus EXF (−5.5 ± 9.0 mmol/L/h, p = 0.09). Nocturnal glucose AUC was lower in TRF (−4.2 ± 5.8 mmol/L/h, p = 0.04), with no difference in waking glucose AUC or AUC_total for [insulin]. Attitudes towards TRF were positive with improved feelings of well-being. Barriers to TRF were work schedules, family commitments and social events. Compared to extended feeding, short-term TRF improved nocturnal glycemic control and was positively perceived in men with overweight/obesity.

Breakfast skipping is associated with persistently increased arterial stiffness in patients with type 2 diabetes

OBJECTIVE

While certain lifestyle habits may be associated with arterial stiffness, there is limited literature investigating the relationship between lifestyle habits and longitudinal changes in arterial stiffness in patients with type 2 diabetes mellitus (T2DM). This is an exploratory study to determine whether lifestyle habits, in addition to conventional atherosclerotic risk factors, are associated with increased arterial stiffness.

RESEARCH DESIGN AND METHODS

The study participants comprised 734 Japanese outpatients with T2DM and no history of apparent cardiovascular diseases. Lifestyle habits were analyzed using self-reported questionnaires, and brachial-ankle pulse wave velocity (baPWV) was measured at baseline, and at years 2 and 5. A multivariable linear mixed-effects model was used to determine the predictive value of lifestyle habits and possible atherosclerotic risk factors for longitudinal change in baPWV.

RESULTS

Over 5 years of follow-up, baPWV values significantly increased. In a multivariable linear mixed-effects model that adjusted for age and gender, a low frequency of breakfast intake was significantly associated with persistently high baPWV, independently of other lifestyle habits. Furthermore, in a multivariable linear mixed-effects model that included both lifestyle habits and possible atherosclerotic risk factors, a low frequency of breakfast intake remained the only independent predictive factor for persistently high baPWV. Subjects who ate breakfast less frequently tended to have additional unhealthy lifestyle habits and atherosclerotic risk factors.

CONCLUSIONS

Our analyses suggest that breakfast skipping is an independent lifestyle habit that is associated with persistently increased arterial stiffness in patients with T2DM.

TRIAL REGISTRATION NUMBER

UMIN000010932.

Day-Time Patterns of Carbohydrate Intake in Adults by Non-Parametric Multi-Level Latent Class Analysis-Results from the UK National Diet and Nutrition Survey (2008/09-2015/16)

This study aims at combining time and quantity of carbohydrate (CH) intake in the definition of eating patterns in UK adults and investigating the association of the derived patterns with type 2 diabetes (T2D). The National Diet and Nutrition Survey (NDNS) Rolling Program included 6155 adults in the UK. Time of the day was categorized into 7 pre-defined time slots: 6–9 am, 9–12 noon, 12–2 pm, 2–5 pm, 5–8 pm, 8–10 pm, and 10 pm–6 am. Responses for CH intake were categorized into: no energy intake, CH <50% or ≥50% of total energy. Non-parametric multilevel latent class analysis (MLCA) was applied to identify eating patterns of CH consumption across day-time, as a novel method accounting for the repeated measurements of intake over 3–4 days nested within individuals. Survey-designed multivariable regression was used to assess the associations of CH eating patterns with T2D. Three CH eating day patterns (low, high CH percentage and regular meal CH intake day) emerged from 24,483 observation days; based on which three classes of CH eaters were identified and characterized as: low (28.1%), moderate (28.8%) and high (43.1%) CH eaters. On average, low-CH eaters consumed the highest amount of total energy intake (7985.8 kJ) and had higher percentages of energy contributed by fat and alcohol, especially after 8 pm. Moderate-CH eaters consumed the lowest amount of total energy (7341.8 kJ) while they tended to have their meals later in the day. High-CH eaters consumed most of their carbohydrates and energy earlier in the day and within the time slots of 6–9 am, 12–2 p.m. and 5–8 pm, which correspond to traditional mealtimes. The high-CH eaters profile had the highest daily intake of CH and fiber and the lowest intake of protein and fat. Low-CH eaters had greater odds than high-CH eaters of having T2D in self-reported but not in previously undiagnosed diabetics. Further research using prospective longitudinal studies is warranted to ascertain the direction of causality in the association of CH patterns with type 2 diabetes.

Heritability of the timing of food intake

BACKGROUND & AIMS

While environmental factors are presumed to be primary drivers of food timing, preliminary evidence suggests that genetics may be an additional determinant. The aim was to explore the relative contribution of genetics and environmental factors to variation in the timing of food intake in a Spanish twin population. Because chronotype, bedtime and wake time are related to food timing, covariance with food timing was further assessed.

METHODS

In this observational study, 53 pairs of adult (mean (SD) = 52 (6.03) years) female twins (28 monozygotic; 25 dizygotic) were recruited from the Murcia Twin Register. Zygosity was determined by DNA-testing. Timing of the three main meals of the day was assessed via 7-day dietary records, and the midpoint of food intake was computed by calculating the midpoint between breakfast and dinner times. Chronotype, bedtime and wake time were self-reported. Heritability of food timing and related traits were estimated by comparing monozygotic and dizygotic twin correlations and fitting genetic structural equation models to measured variables.

RESULTS

We observed genetic influences for food timing, with highest heritability for the midpoint of food intake (64%) in an overweight/obese population (BMI = 26.01 ± 3.77). Genetic factors contributed to a higher degree to the timing of breakfast (56%) than the timing of lunch (38%) or dinner (n.s.). Similarly, heritability estimates were larger in related behavioral traits earlier on in the day (i.e. wake time, (55%)), than those later on in the day (i.e. bedtime, (38%)). Bivariate analyses revealed a significant genetic overlap between food timing and bedtime and chronotype (rG between 0.78 and 0.91).

CONCLUSIONS

Genetic influences appear to account for a significant proportion of the variability in food timing, particularly breakfast. Thus, interventions related to food timing may be more effective when targeting afternoon/evening traits, such as lunch or dinner times. Furthermore, our data suggest shared genetic architecture underlying food timing and phenotypically related traits.

CLINICAL TRIAL

NCT03059576. https://clinicaltrials.gov/ct2/show/NCT03059576.

Potential circadian and circannual rhythm contributions to the obesity epidemic in elementary school age children

Children gain weight at an accelerated rate during summer, contributing to increases in the prevalence of overweight and obesity in elementary-school children (i.e., approximately 5 to 11 years old in the US). Int J Behav Nutr Phys Act 14:100, 2017 explained these changes with the "Structured Days Hypothesis" suggesting that environmental changes in structure between the school year and the summer months result in behavioral changes that ultimately lead to accelerated weight gain. The present article explores an alternative explanation, the circadian clock, including the effects of circannual changes and social demands (i.e., social timing resulting from societal demands such as school or work schedules), and implications for seasonal patterns of weight gain. We provide a model for understanding the role circadian and circannual rhythms may play in the development of child obesity, a framework for examining the intersection of behavioral and biological causes of obesity, and encouragement for future research into bio-behavioral causes of obesity in children.

Multi-etiological Perspective on Child Obesity Prevention

PURPOSE OF REVIEW

The simple energy balance model of obesity is inconsistent with the available findings on obesity etiology, prevention, and treatment. Yet, the most commonly stated causes of pediatric obesity are predicated on this model. A more comprehensive biological model is needed upon which to base behavioral interventions aimed at obesity prevention. In this light, alternative etiologies are little investigated and thereby poorly understood.

RECENT FINDINGS

Three candidate alternate etiologies are briefly presented: infectobesity, the gut microbiome, and circadian rhythms. Behavioral child obesity preventive investigators need to collaborate with biological colleagues to more intensively analyze the behavioral aspects of these etiologies and to generate innovative procedures for preventing a multi-etiological problem, e.g., group risk analysis, triaging for likely causes of obesity.

Relationships between lifestyle patterns and cardio-renal-metabolic parameters in patients with type 2 diabetes mellitus: A cross-sectional study

INTRODUCTION

While individuals tend to show accumulation of certain lifestyle patterns, the effect of such patterns in real daily life on cardio-renal-metabolic parameters remains largely unknown. This study aimed to assess clustering of lifestyle patterns and investigate the relationships between such patterns and cardio-renal-metabolic parameters.

PARTICIPANTS AND METHODS

The study participants were 726 Japanese type 2 diabetes mellitus (T2DM) outpatients free of history of cardiovascular diseases. The relationship between lifestyle patterns and cardio-renal-metabolic parameters was investigated by linear and logistic regression analyses.

RESULTS

Factor analysis identified three lifestyle patterns. Subjects characterized by evening type, poor sleep quality and depressive status (type 1 pattern) had high levels of HbA1c, alanine aminotransferase and albuminuria. Subjects characterized by high consumption of food, alcohol and cigarettes (type 2 pattern) had high levels of γ-glutamyl transpeptidase, triglycerides, HDL-cholesterol, blood pressure, and brachial-ankle pulse wave velocity. Subjects characterized by high physical activity (type 3 pattern) had low uric acid and mild elevation of alanine aminotransferase and aspartate aminotransferase. In multivariate regression analysis adjusted by age, gender and BMI, type 1 pattern was associated with higher HbA1c levels, systolic BP and brachial-ankle pulse wave velocity. Type 2 pattern was associated with higher HDL-cholesterol levels, triglycerides, aspartate aminotransferase, ɤ- glutamyl transpeptidase levels, and diastolic BP.

CONCLUSIONS

The study identified three lifestyle patterns that were associated with distinct cardio-metabolic-renal parameters in T2DM patients.

TRIAL REGISTRATION

UMIN000010932.

Meal Timing and Frequency: Implications for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association

Eating patterns are increasingly varied. Typical breakfast, lunch, and dinner meals are difficult to distinguish because skipping meals and snacking have become more prevalent. Such eating styles can have various effects on cardiometabolic health markers, namely obesity, lipid profile, insulin resistance, and blood pressure. In this statement, we review the cardiometabolic health effects of specific eating patterns: skipping breakfast, intermittent fasting, meal frequency (number of daily eating occasions), and timing of eating occasions. Furthermore, we propose definitions for meals, snacks, and eating occasions for use in research. Finally, data suggest that irregular eating patterns appear less favorable for achieving a healthy cardiometabolic profile. Intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiometabolic risk factor management.

Combined eating behaviors and overweight: Eating quickly, late evening meals, and skipping breakfast

OBJECTIVE

Various eating behaviors have been linked with body weight management. However, combined effects of major eating behaviors are not fully understood. This study aimed to clarify the association of the combination of eating quickly (EQ), late evening meals (LEM), and skipping breakfast (SB) with being overweight.

METHOD

A cross-sectional study with standardized questions for EQ, LEM, and SB was conducted. Stratified random sampling of 5% of residents aged 20 to 80years was surveyed in a city in northeast Japan in 2011, and 4249 (84.9%) residents were analyzed. Association of combinations of eating behaviors on being overweight (BMI (kg/m(2)≥25.0)) was estimated by using logistic analysis, and odds ratio (OR) and 95% confidential interval were calculated after adjustment for potential covariates.

RESULTS

LEM, SB, or a combination of LEM and SB was not significantly associated with being overweight. However, the combination of EQ or only EQ was significantly associated with being overweight. As the number of eating behavior practices increased, there was a linear increase in OR for being overweight. The OR of all three combined eating behaviors was higher than that of any combined two behaviors or of each behavior.

DISCUSSION

This study result supports the evidence that EQ increases the risk of being overweight whether by itself or in combinations with LEM and/or SB. However, only LEM or only SB did not increase the risk of being overweight.

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

BACKGROUND/OBJECTIVES

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

SUBJECTS/METHODS

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

DESIGN

Prospective cohort study.

RESULTS

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

CONCLUSIONS

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

Influence of night-time protein and carbohydrate intake on appetite and cardiometabolic risk in sedentary overweight and obese women

The present study investigated whether whey (WH) protein, casein (CAS) protein or a carbohydrate placebo (PLA) consumed 30 min before sleep could acutely alter appetite or cardiometabolic risk the following morning. A total of forty-four sedentary overweight and obese women (BMI: 25·7-54·6 kg/m2) completed this stratified, randomised, double-blind, placebo-controlled study (WH: n 16, age 27·4 (sd 5·0) years; CAS: n 15, age 30·3 (sd 8·1) years; PLA: n 13, age 28·5 (sd 7·2) years). The participants came to the laboratory at baseline (visit 1) and again in the morning after night-time ingestion of either protein or PLA (visit 2). Visit 2 was conducted at least 48 h after visit 1. During visits 1 and 2, the following parameters were measured: appetite (hunger, satiety and desire to eat); resting metabolism; blood lipid and glucose levels; the levels of insulin, leptin, C-reactive protein, insulin-like growth factor-1, cortisol and adiponectin. Data were analysed using repeated-measures ANOVA. No group × time interactions were observed for the measured variables; however, a main effect of time was observed for increased satiety (P= 0·03), reduced desire to eat (P= 0·006), and increased insulin levels (P= 0·004) and homeostatic model assessment of insulin resistance values (P= 0·01) after the consumption of either protein or PLA. The results of the present study reveal that night-time consumption of protein or carbohydrate by sedentary overweight and obese women improves their appetite measures but negatively affects insulin levels. Long-term studies are needed to evaluate the effects of chronic consumption of low-energy snacks at night on body composition and cardiometabolic risk.