The Relationship Between Breakfast Skipping, Chronotype, and Glycemic Control in Type 2 Diabetes

Irregular breakfast eating in type 2 diabetes mellitus is associated with greater social jetlag and poorer metabolic health

Circadian disruption, arising from conflict between internal circadian time and behavioural sleep-wake and fasting-feeding rhythms, may contribute to the prevalence of type 2 diabetes mellitus and disease severity. Previous studies have demonstrated a link between irregular breakfast eating and poorer metabolic health. We aimed to further explore the relationships between breakfast habits, circadian misalignment (social jetlag), and metabolic parameters in a cohort of adult participants with type 2 diabetes mellitus. A total of 330 adult participants with type 2 diabetes mellitus attending for routine clinical review completed structured questionnaires to assess habitual sleep timing, chronotype, and social jetlag. Statistical analysis was via inferential groupwise approaches and path analysis to establish interdependencies of effects of social jetlag, chronotype, and breakfast eating regularity on HbA1c. 22.7% of the participants reported eating breakfast five times or fewer a week, and were categorised as irregular breakfast eaters. Compared with those who ate breakfast six or seven times a week, irregular breakfast eaters had significantly higher HbA1c and diastolic blood pressure, were younger and had greater social jetlag. In the path analysis, irregular breakfast eating exerted a direct effect on HbA1c, whilst social jetlag exerted only an indirect effect on HbA1c through breakfast eating regularity. Chronotype did not exert any effect on HbA1c, but did exert an indirect effect on breakfast eating regularity via social jetlag. Our results showed that adult participants with type 2 diabetes mellitus, who ate breakfast irregularly had poorer metabolic health and greater social jetlag. The relationship between social jetlag and glycaemic control appears to be mediated through breakfast eating habits.

Sex-specific chrono-nutritional patterns and association with body weight in a general population in Spain (GCAT study)

BACKGROUND

Altered meal timing patterns can disrupt the circadian system and affect metabolism. Our aim was to describe sex-specific chrono-nutritional patterns, assess their association with body mass index (BMI) and investigate the role of sleep in this relationship.

METHODS

We used the 2018 questionnaire data from the population-based Genomes for Life (GCAT) (n = 7074) cohort of adults aged 40-65 in Catalonia, Spain, for cross-sectional analysis and its follow-up questionnaire data in 2023 (n = 3128) for longitudinal analysis. We conducted multivariate linear regressions to explore the association between mutually adjusted meal-timing variables (time of first meal, number of eating occasions, nighttime fasting duration) and BMI, accounting for sleep duration and quality, and additional relevant confounders including adherence to a Mediterranean diet. Finally, cluster analysis was performed to identify chrono-nutritional patterns, separately for men and women, and sociodemographic and lifestyle characteristics were compared across clusters and analyzed for associations with BMI.

RESULTS

In the cross-sectional analysis, a later time of first meal (β 1 h increase = 0.32, 95% CI 0.18, 0.47) and more eating occasions (only in women, β 1 more eating occasion = 0.25, 95% CI 0.00, 0.51) were associated with a higher BMI, while longer nighttime fasting duration with a lower BMI (β 1 h increase=-0.27, 95% CI -0.41, -0.13). These associations were particularly evident in premenopausal women. Longitudinal analyses corroborated the associations with time of first meal and nighttime fasting duration, particularly in men. Finally, we obtained 3 sex-specific clusters, that mostly differed in number of eating occasions and time of first meal. Clusters defined by a late first meal displayed lower education and higher unemployment in men, as well as higher BMI for both sexes. A clear "breakfast skipping" pattern was identified only in the smallest cluster in men.

CONCLUSIONS

In a population-based cohort of adults in Catalonia, we found that a later time of first meal was associated with higher BMI, while longer nighttime fasting duration associated with a lower BMI, both in cross-sectional and longitudinal analyses.

Exploring the associations between chronotype, meal frequency, and physical activity: A population-based study in adults

Chronotype is an established concept designed to capture the internal clock's phase in real-life conditions. It is vital in many aspects of daily life and can interfere considerably with numerous factors in a given population. Recognizing nonmodifiable and modifiable factors is crucial for identifying covariates of interest when studying the link between chronotype and health status. To date, chronotype and its related factors have not been extensively investigated. The present study aimed to explore the association of chronotypes with meal frequency, physical activity, and demographic factors among the Saudi population. This cross-sectional web-based questionnaire involved 1369 adults (aged 18 years and above) from the general public in Saudi Arabia and was conducted between March and May 2019. Chronotype was assessed using the reduced version of the original Horne and Ostberg morningness-eveningness questionnaire (MEQ). Meal frequencies and demographics data (age, gender, marital status, place of residence, educational level, employment status, income) were obtained. Physical activity level was also obtained using the international physical activity questionnaire. The MEQ scores group individuals into three categories: morning-type, neither-type, and evening-type. The neither-type individuals represented 41.6% (95% confidence interval [CI], 37.5% - 45.6%) of the study population, followed by the morning-type (34.1%; 95% [CI], 29.8% - 38.4%), then the evening-type (24.3%, 95% [CI], 19.6% - 28.9%). Chronotype was significantly associated with age, marital status, employment status and monthly income (All p < 0.05). Significant associations between chronotype with meal frequencies (number of meals per day, breakfast frequency, lunch frequency, and dinner frequency) and physical activity were also observed (All p < 0.05). This study highlights that meal frequencies and physical activity levels are associated with chronotype distribution. Furthermore, demographics, including age, marital status, employment status, and income, were associated with chronotype distribution.

Association between Mediterranean Diet and Advanced Glycation End Products in University Students: A Cross-Sectional Study

The aim of this study was to evaluate the association between the Mediterranean diet (MD) and the accumulation of advanced glycation end products (AGEs) measured by skin autofluorescence. This cross-sectional study included 1016 healthy students from the University of Split, Croatia. Participants completed a self-administered questionnaire. Adherence to the MD was assessed using the Mediterranean Diet Serving Score (MDSS), and tissue AGEs accumulation was measured using the AGE Reader mu (DiagnOptics). Multivariate linear regression was used in the analysis. Students' age and female gender were associated with higher levels of AGEs, which was likewise found for greater coffee intake, adequate olive oil consumption, smoking, and lower levels of physical activity. Higher consummation of vegetables and eating breakfast regularly were associated with lower AGEs levels. The overall MD adherence was not associated with AGEs, possibly due to very low overall compliance to the MD principles among students (8.3% in women and 3.8% in men). Health perception was positively associated with the MD and nonsmoking and negatively with the perceived stress level, while AGEs did not show significant association with self-rated students' health. These results indicate that various lifestyle habits are associated with AGEs accumulation even in young and generally healthy people. Hence, health promotion and preventive measures are necessary from an early age.

Age-specific association between meal-skipping patterns and the risk of hyperglycemia in Korean adults: a national cross-sectional study using the KNHANES data

BACKGROUND

Glucose metabolism regulation is influenced by age and meal skipping, although research on their interplay with hyperglycemia remains limited. This study aims to explore the intricate relationship between meal-skipping patterns and hyperglycemia risk across distinct age groups in South Korean adults.

METHODS

Utilizing data from the Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2013 to 2020, comprising 28,530 individuals aged 19 years and older, this study employed multivariable logistic regression models to examine the associations between meal-skipping patterns and the risk of hyperglycemia.

RESULTS

Meal-skipping patterns were categorized into three groups: no skipping (NS), skipping breakfast (SB), and skipping dinner (SD). Age groups were defined as "young" (aged 19-44), "middle-aged" (aged 45-64), and "elderly" adults (over 65 years old). Among "young" adults, SB was associated with a 1.33-fold higher risk of hyperglycemia (OR = 1.33, 95% CI = 1.14-1.54) compared to NS. Conversely, in "elderly" adults, SD was linked to a 0.49-fold reduced risk (95% CI = 0.29-0.82) when compared to NS. Additionally, we observed that the Korean Health Eating Index (KHEI) scores, representing the quality of diet on a scale of 0 to 100, were consistently lower in SB compared to NS across all age groups. Intriguingly, specifically among the "elderly" group, this score was higher in SD compared to NS (p < 0.001).

CONCLUSIONS

This study demonstrates age-specific variations in the association between meal-skipping patterns and the risk of hyperglycemia.

Scoping review: Exploring the relationship between chrononutrition and glycemic responses in the adult population

Chrononutrition, an emerging body of evidence on the relationship between biological rhythms and metabolism, has been established to be associated with glycemic responses. However, the available evidence is inconsistent, due to protocol variations. Therefore, this review aims to summarize the findings on chrononutrition characteristics and their association with glycemic responses among adults. Systematic searches were conducted across six databases (PubMed, EBSCO Host, ProQuest Central, MEDLINE & Ovid, Scopus and Web of Science) to identify all relevant studies published from January 2012. Two reviewers independently screened the abstracts and full-text articles based on the inclusion and exclusion criteria. Details about population characteristics, study methods and key findings were extracted following the PRISMA-ScR guideline. The quality of selected studies was evaluated using the mixed methods appraisal tool. The searchers identified 49 studies eligible for analysis. The results showed that meal timing, particularly night-time eating and snacking were associated with glycemic responses. Regarding meal regularity, skipping breakfast may affect glycemic responses, but no clear conclusion was drawn about its effect on insulin. The association between meal frequency and glycemic responses was inconclusive. Night fasting duration and restricted eating window are potentially associated with glycemic responses. The current review extensively investigates the association between chrononutrition factors and glycemic responses in adults. However, more prospective cohort and interventional studies are needed to better understand this causal-effect relationship.

Eating Patterns, Chronotypes, and Their Relationship with Metabolic Health in the Early Postpartum Period in Women after Gestational Diabetes Mellitus

Observational studies have shown a relationship between eating patterns and chronotypes with metabolic health in the general population and in healthy pregnancies. Data are lacking in the postpartum period, which is characterized by an externally driven misalignment of sleep and food intake. We investigated the associations between eating patterns, chronotypes, and metabolic health in the early postpartum period in women who had gestational diabetes mellitus (GDM). We prospectively included 313 women who completed their 6-8 weeks postpartum visit between January 2021 and March 2023 at the Lausanne University Hospital. Women filled questionnaires on the timing of food intake, sleep (a shortened Pittsburgh Sleep Quality Questionnaire), and the chronotype (the Morningness-Eveningness Questionnaire) and underwent HbA1c and fasting plasma glucose measurements. After adjustments for weight, sleep quality, or breastfeeding, the later timing of the first and last food intake were associated with higher fasting plasma glucose and HbA1c levels 6-8 weeks postpartum (all p ≤ 0.046). A higher number of breakfasts per week and longer eating durations were associated with lower fasting plasma glucose levels (all p ≤ 0.028). The chronotype was not associated with metabolic health outcomes. Eating patterns, but not the chronotype, were associated with worsened metabolic health in the early postpartum period in women with previous GDM.

Association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy

To analyse the association between sleep duration and quality with food intake, chrononutrition patterns, and weight gain during pregnancy. A prospective cohort study was conducted with 100 pregnant women. Data collection occurred once during each gestational trimester. The assessment of sleep quality and duration was performed using the Pittsburgh Sleep Quality Index. Food intake was assessed using three 24-h recalls in each trimester. Body weight was measured during the three trimesters, and height was measured only once to calculate the BMI. Linear regression analyses were performed to associate sleep duration and quality with food consumption and weight gain variables. Longer sleep duration was associated with a later dinner in the first trimester (β = 0·228, P = 0·025) and earlier in the third trimester (β = -0·223, P = 0·026), in addition to a later morning snack in the second trimester (β = 0·315, P = 0·026). Worse sleep quality was associated with higher total energy intake (β = 0·243, P = 0·044), total fat (β = 0·291, P = 0·015) and the chrononutrition variables such as a higher number of meals (β = 0·252, P = 0·037), higher energetic midpoint (β = 0·243, P = 0·044) and shorter fasting time (β = -0·255, P = 0·034) in the third trimester. Sleep quality was also associated with a higher BMI in the first trimester of pregnancy (β = 0·420, P = < 0·001). Most of the associations found in the present study show that poor sleep is associated with higher energy and fat intake and higher BMI. Longer sleep duration was associated with a later dinner in early pregnancy and an earlier dinner in late pregnancy, as well as with a later morning snack in the second trimester of pregnancy.

Circadian Disruption as a Risk Factor for Development of Cardiovascular and Metabolic Disorders - From Animal Models to Human Population

The lifestyle of human society is drifting apart from the natural environmental cycles that have influenced it since its inception. These cycles were fundamental in structuring the daily lives of people in the pre-industrial era, whether they were seasonal or daily. Factors that disrupt the regularity of human behaviour and its alignment with solar cycles, such as late night activities accompanied with food intake, greatly disturb the internal temporal organization in the body. This is believed to contribute to the rise of the so-called diseases of civilization. In this review, we discuss the connection between misalignment in daily (circadian) regulation and its impact on health, with a focus on cardiovascular and metabolic disorders. Our aim is to review selected relevant research findings from laboratory and human studies to assess the extent of evidence for causality between circadian clock disruption and pathology. Keywords: Circadian clock, Chronodisruption, Metabolism, Cardiovascular disorders, Spontaneously hypertensive rat, Human, Social jetlag, Chronotype.

Eating time variation from weekdays to weekends and its association with dietary intake and BMI in different chronotypes: findings from National Health and Nutrition Examination Survey (NHANES) 2017-2018

Evidence suggests that differences in meal timing between weekends and weekdays can disrupt the body's circadian rhythm, leading to a higher BMI. We aimed to investigate the associations between mealtime variation from weekdays to weekends (eating midpoint jetlag), dietary intake and anthropometric parameters, based on individuals' chronotype. The study utilised data from National Health and Nutrition Examination Survey 2017-2018. Food consumption was estimated by weighted average of participants' food intake on weekdays and weekends. Eating midpoint jetlag, defined as the difference between the midpoint of the first and last mealtimes on weekends and weekdays, was calculated. Chronotype was assessed by participants' mid-sleep time on weekends, adjusted for sleep debt. Linear regression analysis was conducted to investigate the associations between variables. The sample was categorised into chronotype tertiles. Among individuals in the third chronotype tertile, there was a positive association between eating midpoint jetlag and BMI (β = 1·2; 95 % CI (1·13, 1·27)). Individuals in the first tertile showed a positive association between eating midpoint jetlag and energy (β = 96·9; 95 % CI (92·9, 101·7)), carbohydrate (β = 11·96; 95 % CI (11·2, 12·6)), fat (β = 3·69; 95 % CI (3·4, 3·8)), cholesterol (β = 32·75; 95 % CI (30·9, 34·6)) and sugar (β = 8·84; 95 % CI (8·3, 9·3)) intake on weekends. Among individuals with an evening tendency, delaying meals on weekends appears to be linked to a higher BMI. Conversely, among individuals with a morning tendency, eating meals later on weekends is associated with higher energetic intake on weekends.

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.

Is time of eating associated with BMI and obesity? A population-based study

PURPOSE

Time-related eating patterns have been associated with metabolic and nutritional diseases such as obesity. However, there is a lack of representative studies on this subject. This study's aim was to assess the association between the timing of eating and obesity in a large and representative sample of the Brazilian adult population (POF 2008-2009 survey).

METHODS

Two days of adults' food diary (n = 21,020) were used to estimate tertiles of first and last meal intake times, eating midpoint, caloric midpoint time, and calories consumed from 18:00 h onwards. BMI was estimated and its values, as well as excess weight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) were used as outcomes. Multiple linear and logistic regressions were performed.

RESULTS

The first (β = 0.65, 95% CI 0.37-0.93) and last food intake time (β = 0.40, 95% CI 0.14-0.66), eating midpoint (β = 0.61, 95% CI 0.34-0.88) and calories consumed after 21:00 h (β = 0.74, 95% CI 0.32-1.16) and 22:00 h (β = 0.75, 95% CI 0.18-1.32) were positively associated with BMI. The likelihood of having excess weight or obesity was significantly higher in the third tertile of the first food intake time (OR = 1.28, 95% CI 1.13-1.45 and OR = 1.34, 95% CI 1.13-1.58, respectively), last food intake time (OR = 1.16, 95% CI 1.03-1.32; and OR = 1.18, 95% CI 1.00-1.41, respectively), eating midpoint (OR = 1.28, 95% CI 1.13-1.45; and OR = 1.35, 95% CI 1.14-1.59, respectively) and energy consumption after 21:00 h (OR = 1.33, 95% CI 1.10-1.59).

CONCLUSION

Chrononutrition meal patterns indicative of late meal intake were significantly associated with high BMI, excess weight and obesity in the Brazilian population.

Chronodisruption and Gut Microbiota: Triggering Glycemic Imbalance in People with Type 2 Diabetes

The desynchronization of physiological and behavioral mechanisms influences the gut microbiota and eating behavior in mammals, as shown in both rodents and humans, leading to the development of pathologies such as Type 2 diabetes (T2D), obesity, and metabolic syndrome. Recent studies propose resynchronization as a key input controlling metabolic cycles and contributing to reducing the risk of suffering some chronic diseases such as diabetes, obesity, or metabolic syndrome. In this analytical review, we present an overview of how desynchronization and its implications for the gut microbiome make people vulnerable to intestinal dysbiosis and consequent chronic diseases. In particular, we explore the eubiosis-dysbiosis phenomenon and, finally, propose some topics aimed at addressing chronotherapy as a key strategy in the prevention of chronic diseases.

Dietary Practices Among Type 2 Diabetes Patients Visiting a Non-communicable Disease (NCD) Clinic in a District of Western India: A Cross-Sectional Study

BACKGROUND AND AIMS

Diabetes is becoming a major public health problem in the country. One of the most important lifestyle modifications necessary for diabetic patients is maintaining healthy dietary choices. These modifications in dietary practices are supposed to be followed lifelong, along with medication, for better glycemic control. Despite understanding the importance of dietary control and physical activity in the management of diabetes, adherence to these practices is poor. This study aimed to assess the dietary practices of type 2 diabetes mellitus (T2DM) patients and various factors that determine adherence to these healthy dietary practices. The secondary objective was to find the perceptions of participants about the role of diet in controlling diabetes and to find the perception-practice gap among study participants.

METHODOLOGY

It was a hospital-based cross-sectional study conducted among 450 T2DM patients visiting the non-communicable disease (NCD) clinics of tertiary care hospitals and community health centres (CHCs) of the study district. Dietary practice was assessed using a modified UK Diabetes and Diet Questionnaire (UKDDQ), considering the food patterns in the study area. Statistical tests like chi-square and ordinal logistic regression were applied using Jamovi software for univariate and multivariate analyses.

RESULTS

The healthiest food choices were abstinence from alcohol consumption (100%), avoiding processed meat (92.21%), high-fibre breakfast (70.4%), and daily consumption of vegetables (68.2%). Improper dietary practices were regular sugary drinks (38%) and high-glycemic-index food items (22.4%). The mean (SD) of the composite score was 68.02 (8.7) and the median score (interquartile range (IQR)) was 69 (60-76). Tertile analysis of the composite score revealed that with the increase in age, patients were less likely to be in the intermediate or upper tertile score (β = -0.0219, p = 0.016). Being female (odds ratio (OR) =0.603, CI: 0.395-0.917, p = 0.019) and living in a three-generation family made the patients less likely to be in the upper tertile score.

CONCLUSION

Nearly half of the participants had an overall healthy score. Dietary practices were healthy among the participants of lower ages, males, and those living in nuclear and joint families. The highest perception-practice gap was seen for fruit and rice consumption.

Causal relationship between breakfast skipping and bone mineral density: a two-sample Mendelian randomized study

Objective

To explore the causal association between breakfast skipping and bone mineral density (BMD) through two-sample Mendelian randomisation (MR) analysis.

Methods

A two-sample MR approach was adopted to explore the causal relationship of breakfast skipping with BMDs (across three skeletal sites and five age groups). Publicly available genome-wide association study summary data were used for MR analysis. We used five methods to estimate the causal associations between breakfast skipping and BMDs: inverse-variance weighting (IVW), MR-Egger, weighted median, simple mode, and weighted mode. IVW was used for the main analysis and the remaining four methods were used as supplementary analyses. The heterogeneity of the MR results was determined using IVW and MR-Egger methods. The pleiotropy of the MR results was determined using MR-Egger intercept. Furthermore, a leave-one-out test was performed to determine whether the MR results were affected by a single nucleotide polymorphism.

Results

With the IVW method, we did not find any causal relationship between breakfast skipping and forearm, femoral neck, and lumbar spine BMD. Subsequently, when we included BMD data stratified by five different age groups in the analysis, the results showed that there was no apparent causal effect between breakfast skipping and age-stratified BMD. This finding was supported by all four supplementary methods (P > 0.05 for all methods). No heterogeneity or horizontal pleiotropy was detected in any of the analyses (P > 0.05). The leave-one-out tests conducted in the analyses did not identify any single nucleotide polymorphism that could have influenced the MR results, indicating the reliability of our findings.

Conclusion

No causal effect was found between breakfast skipping and BMD (across three skeletal sites and five age groups).

Rise and shine for eating right: the link between healthy nutrition and chronotype among young adults

Aim

Many studies have examined the relationship between chronotype and general health. Because healthy eating is the basis of health aim of this study is to evaluate the relationship between healthy nutrition attitudes and chronotype in young adults. Methods: This cross-sectional study was conducted with 1,400 young adults (936 females and 464 males). Chronotype was assessed by the Turkish version of the Morningness-Eveningness Questionnaire (MEQ) and the Attitude Scale for Healthy Nutrition (ASHN) was applied by face-to-face interview. Furthermore, 24-h dietary recall was collected. The scores of nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) were calculated. The anthropometric measurements including body weight and height were taken.

Results

The chronotype distribution of participants according to the MEQ score and MAR score were not significantly different between females and males (p > 0.05). The percentage of participants with high healthy eating attitude was lowest in the evening chronotype and highest in the morning chronotype (49.7, 37.7 and 25.4% in morning-, intermediate-, evening-types, respectively; p = 0.000 for all groups according to the reciprocal comparisons). There was a positive correlation of the MEQ scores with the scores of ASHN (r = 0.282, p < 0.01). ASHN score was shown to be a predictor for MEQ score (β = 0.280, p = 0.000). Moreover, the score of "poor eating habits" was shown to be highest in the evening chronotype and lowest in the morning chronotype (14.9 ± 3.0 and 13.1 ± 3.0, respectively; p < 0.01).

Conclusion

The results of this study indicate that individuals with the evening chronotype are more deficient in terms of healthy nutrition attitudes. Further studies with larger populations will potentially guide the development of health promotion strategies to prevent and treat chronic diseases based on an individual's chronotype.

Differences in Dietary Intake, Eating Occasion Timings and Eating Windows between Chronotypes in Adults Living with Type 2 Diabetes Mellitus

Chronotype studies investigating dietary intake, eating occasions (EO) and eating windows (EW) are sparse in people with type 2 Diabetes mellitus (T2DM). This analysis reports data from the CODEC study. The Morningness-Eveningness questionnaire (MEQ) assessed chronotype preference. Diet diaries assessed dietary intake and temporal distribution. Regression analysis assessed whether dietary intake, EW, or EO differed by chronotype. 411 participants were included in this analysis. There were no differences in energy, macronutrient intake or EW between chronotypes. Compared to evening chronotypes, morning and intermediate chronotypes consumed 36.8 (95% CI: 11.1, 62.5) and 20.9 (95% CI: -2.1, 44.1) fewer milligrams of caffeine per day, respectively. Evening chronotypes woke up over an hour and a half later than morning (01:36 95% CI: 01:09, 02:03) and over half an hour later than intermediate chronotypes (00:45 95% CI: 00:21; 01:09. Evening chronotypes went to sleep over an hour and a half later than morning (01:48 95% CI: 01:23; 02:13) and an hour later than intermediate chronotypes (01:07 95% CI: 00:45; 01:30). Evening chronotypes' EOs and last caffeine intake occurred later but relative to their sleep timings. Future research should investigate the impact of chronotype and dietary temporal distribution on glucose control to optimise T2DM interventions.

Chronotype and Cardiometabolic Parameters in Patients with Bipolar Disorder: Preliminary Findings

Cardiometabolic alterations are very common in bipolar disorder (BD). The aim of this study was to investigate the relationship between chronotype and cardiometabolic parameters in patients with a primary diagnosis of BD. This study is an observational clinical investigation including 170 subjects consecutively admitted to the Psychiatric Inpatient Unit of the IRCCS Ospedale Policlinico San Martino (Genoa, Italy), recruited over a period of 48 months. A psychometric tool assessing chronotype was administered and blood tests were performed. Furthermore, the atherogenic coefficient ((total cholesterol-HDL cholesterol)/HDL cholesterol), and Castelli risk index-I (total cholesterol/HDL cholesterol) and -II (LDL cholesterol/HDL cholesterol) were calculated. Patients with BD and an eveningness chronotype showed a higher body mass index, total and low-density lipotrotein cholesterol compared to patients with BD and an intermediate or morning chronotype. Furthermore, the Atherogenic Coefficient and Castelli Risk-Index I-II were found to be higher in bipolar patients with an evening chronotype. The role of chronotype in the development of obesity and cardiovascular risk is, therefore, a relationship worth being investigated, especially in the context of BD, to ameliorate the clinical and therapeutic approach, aiming at increasing the quality of life and reducing the mortality.

Association of breakfast skipping with habitual dietary intake and BMI in female rotating shift workers

OBJECTIVE

Higher BMI, lower quality of diet and a higher percentage of breakfast-skippers have been reported among rotating shift (RS) workers compared with day shift (DS) workers. As such, this study examined the association between breakfast skipping, habitual food consumption and BMI in RS workers.

DESIGN

Japanese nurses were studied using a self-administered questionnaire that assessed the height, weight, breakfast consumption habits, dietary consumption, physical activity, sleep habits, chronotype and demographic characteristics of the participants.

SETTING

A cross-sectional study was conducted in a population of nurses in Japan. Dietary and health-related questionnaires were mailed to 5536 nurses aged 20-59 years, working at 346 institutions.

PARTICIPANTS

A total of 3646 nurses at 274 institutions responded to the questionnaire. After removing those who met the exclusion criteria, 2450 participants were included in the statistical analysis.

RESULTS

The RS breakfast-skippers had lower total energy intake, diet quality and higher BMI than DS workers, whereas the RS breakfast-consumers had a higher total energy intake and BMI than the DS workers. In the RS workers, breakfast skipping on the days of DS and the end days of evening/night shift was associated with a poorer diet quality. Additionally, breakfast skipping on the days of DS was positively associated with BMI, independent of the total energy intake and diet quality.

CONCLUSIONS

Breakfast skipping on workdays may contribute to a difference in dietary intake and BMI between RS workers and DS workers and may increase BMI in RS workers, independent of dietary intake.

The association of dietary approaches to stop hypertension (DASH) and Mediterranean diet with mental health, sleep quality and chronotype in women with overweight and obesity: a cross-sectional study

PURPOSE

Mental and sleep disorders are global public health problems, especially in Middle Eastern countries, and are significantly associated with circadian rhythm. This study sought to investigate the association between the dietary approaches to stop hypertension (DASH) and Mediterranean diet scores and mental health, sleep quality, and circadian rhythm.

METHODS

We enrolled 266 overweight and obese women, and depression, anxiety, and stress scale (DASS) score, Pittsburgh Sleep Quality Index (PSQI), and Morning-Evening Questionnaire (MEQ), were assessed. The Mediterranean and DASH diet score was measured using a validated semi-quantitative Food Frequency Questionnaire (FFQ). The physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ). Analysis of variance and analysis of covariance, chi-square, and multinomial logistic regression tests were used as appropriate.

RESULTS

Our results showed that there was a significant inverse association between adherence to the Mediterranean diet and mild and moderate anxiety scores (p < 0.05). In addition, there was an inverse association between adherence to the DASH diet and the risk of severe depression and extremely severe stress scores (p < 0.05). Moreover, higher adherence to both dietary scores was associated with good sleep quality (p < 0.05). There was a significant relationship between circadian rhythm and the DASH diet (p < 0.05).

CONCLUSION

A significant association exists between a DASH and Mediterranean diet with sleep status, mental health, and chronotype in women of childbearing age with obesity and overweight.

LEVEL OF EVIDENCE

Level V, Cross-sectional observational study.

Association of breakfast styles such as Japanese, Western, and cereals with sleeping habits, eating habits, and lifestyle in preschool and elementary school children

Introduction

In Japan, breakfast styles are categorized into five groups; Japanese breakfast (JB; rice and miso soup), Western breakfast (WB; bread and milk), Japanese-Western breakfast (J-WB; alternative daily serving), cereal breakfast (CB), and breakfast skipping. In our recent studies, breakfast style was highly associated with the daily sleep-wake phase (chronotype), and healthy eating habits. In contrast with other breakfast style consumers, JB-consumers were positively associated with the morning chronotype and healthy eating habits such as a high consumption of a variety of protein sources, vegetables, and dietary fibers, and low consumption of sweetened juices. These previous studies included only adult participants; hence, in the current study, we investigated whether similar observations can be made in children.

Methods

Preschool (aged 3-5 years) and elementary school children (6-8 years) (N = 6,104, 49.87% boys, 50.13% girls, mean body mass index 15.39 ± 0.03 kg/m² for preschoolers and percentage of overweight -2.73 ± 0.22 for elementary school children) participated in this cross-sectional online survey on lifestyle, including eating and sleep habits, through their mother's responses.

Results

The results showed that the morning-evening type index values (chronotype indicator, smaller indicates morning type) were negatively correlated with JB intake (-0.05, p < 0.01) and positively correlated with WB (0.03, p < 0.05) and CB intake (0.06, p < 0.01), suggesting that the JB group exhibited the morning chronotype and the WB and CB groups exhibited the evening chronotype. The JB group consumed a variety of protein sources (mean ± SE; days/week) with more frequency (fish 2.95 ± 0.038 p < 0.001, soy 3.55 ± 0.043 p < 0.001, egg 3.82 ± 0.044 p < 0.001) compared with the WB group (fish 2.58 ± 0.033, soy 3.00 ± 0.038, egg 3.49 ± 0.039). On the other hand, the JB group consumed snacks (5.48 ± 0.042 p < 0.001) and sweetened juice (2.50 ± 0.050 p < 0.001) less frequently than the WB group (snacks; 5.80 ± 0.037 and sweetened juice; 2.74 ± 0.049).

Discussion

JB-eating children with a morning chronotype exhibited better sleep and eating habits than WB-eating children with an evening type pattern. The results suggest that JB eating habits may be associated with good eating and sleeping lifestyles, even among preschool and elementary school children.

Breakfast Frequency and Sleep Quality in College Students: The Multiple Mediating Effects of Sleep Chronotypes and Depressive Symptoms

Sleep disorders, which are prominent problems among college students, may be associated with skipping breakfast. Therefore, we aimed to explore the role of sleep chronotypes and depressive symptoms as mediators in the relationship between breakfast frequency and sleep quality. A cross-sectional survey enrolling random samples of 712 college students was conducted by the Questionnaire Star online platform. Statistical description and correlation analysis were performed by SPSS 25.0, and a chain mediation test was performed by model 6 in PROCESS 3.5. The result of the article demonstrated that breakfast frequency can affect sleep quality through two mediating pathways: ① sleep chronotypes, with a mediating effect of 32%; and ② depressive symptoms, with a mediating effect of 52.4%. However, the chain mediating effects of sleep chronotypes and depressive symptoms was not significant, and neither was the direct effect of breakfast frequency on sleep quality. Breakfast frequency can indirectly affect sleep quality by adjusting sleep chronotypes and depressive symptoms. Regular breakfast can increase morning and intermediate sleep chronotypes, reduce depressive symptoms, and thus improve sleep quality.

Influence of Fasting until Noon (Extended Postabsorptive State) on Clock Gene mRNA Expression and Regulation of Body Weight and Glucose Metabolism

The trend of fasting until noon (omission or delayed breakfast) is increasingly prevalent in modern society. This eating pattern triggers discordance between endogenous circadian clock rhythms and the feeding/fasting cycle and is associated with an increased incidence of obesity and T2D. Although the underlying mechanism of this association is not well understood, growing evidence suggests that fasting until noon, also known as an "extended postabsorptive state", has the potential to cause a deleterious effect on clock gene expression and to disrupt regulation of body weight, postprandial and overall glycemia, skeletal muscle protein synthesis, and appetite, and may also lead to lower energy expenditure. This manuscript overviews the clock gene-controlled glucose metabolism during the active and resting phases and the consequences of postponing until noon the transition from postabsorptive to fed state on glucose metabolism, weight control, and energy expenditure. Finally, we will discuss the metabolic advantages of shifting more energy, carbohydrates (CH), and proteins to the early hours of the day.

Bidirectional mediation of evening energy proportion and chronotype on their associations with blood lipid levels in a Chinese population

The bidirectional relationship between chronotype and meal energy distribution, and the effect of their relationship on blood lipid level has not been investigated. This study aims to test and compare the bidirectional mediating effects of chronotype and meal energy distribution on blood lipid levels. Data of 9376 adult participants from 2018 wave of the China Health and Nutrition Survey (CHNS) were analysed. Two mediation models were tested and compared: one with Evening energy proportion (Evening EI%) as mediator of the association between adjusted mid-sleep time on free days (MSF_a) and blood lipid levels and the other with MSF_a as mediator of the association of Evening EI% with blood lipid levels. The mediating effect of Evening EI% on the association between MSF_a and TC, LDL-C and non-HDL-C were significant (p < .001, p = .001, and p = .002, respectively). The mediating effect of MSF_a on the association between Evening EI% and TC, LDL-C and non-HDL-C were significant (p = .006, p = .035, and p < .001 respectively). Evening EI% had a larger standardized mediation effect compared to MSF_a. The bidirectional mediation effect suggests a reinforcement mechanism, in which later chronotype and higher Evening EI% reciprocally influence their negative impact on elevated blood lipid levels, leading to higher risk of cardiovascular diseases in the general population.

Identifying the Associations of Nightly Fasting Duration and Meal Timing with Type 2 Diabetes Mellitus Using Data from the 2016–2020 Korea National Health and Nutrition Survey

Nightly fasting duration and meal timing are associated with metabolic disorders. This study aimed to investigate the relationships of nightly fasting duration and meal timing with type 2 diabetes mellitus (T2DM) using data from the 2016–2020 Korea National Health and Nutrition Survey. A total of 22,685 adults ≥ 19 years were included in this study. Nightly fasting duration was calculated by subtracting the interval between the day’s first and last meal eating times from 24 h. The meal timing were analyzed using various parameters, including the times of the first and last eating episodes and the percentage of energy intake during the morning (05:00 to 9:00 a.m.), evening (06:00 to 09:00 p.m.), and night (after 09:00 p.m.). Men who fasted nightly for ≥ 12 h had lower odds of T2DM (odds ratio (OR): 0.86; 95% confidence interval (CI): 0.75–0.99) than those who fasted for < 12 h. Individuals who had their last meal after 09:00 p.m. had higher odds of T2DM (OR: 1.19, 95% CI: 1.03–1.38, men; OR: 1.19, 95% CI: 1.01–1.40, women). Additionally, the percentage of energy intake during the evening was associated with increased odds of T2DM (OR: 1.41, 95% CI: 1.08–1.84, men; OR: 1.32, 95% CI: 1.02–1.70, women). These findings emphasize the importance of nightly fasting duration and meal timing in modulating the risk of T2DM among Korean adults.

Associations between circadian disruption and cardiometabolic disease risk: A review

The human circadian system plays a vital role in many physiological processes, and circadian rhythms are found in virtually all tissues and organs. The disruption of circadian rhythms may lead to adverse health outcomes. Evidence from recent population-based studies was reviewed because they represent real-world behavior and can be useful in developing future studies to reduce the risk of adverse health conditions, including cardiovascular diseases, obesity, and diabetes mellitus, which may occur because of circadian disruption. An electronic search in PubMed and Web of Science (2012-2022) was performed. Selected articles were based on specific inclusion and exclusion criteria. Five factors that may disrupt circadian rhythm alignment are discussed: shift work, late chronotype, late sleep timing, sleep irregularity, and late meal timing. Evidence from observational studies of these circadian disruptors suggests potential detrimental effects on cardiometabolic health, including higher BMI/obesity, higher blood pressure, greater dyslipidemia, greater inflammation, and diabetes. Future research should identify the specific underlying pathways in order to mitigate the health consequences of shift work. Furthermore, optimal sleep and mealtimes for metabolic health can be explored in intervention studies. Lastly, it is important that the timing of external environmental cues (such as light) and behaviors that influence circadian rhythms are managed.

Beyond sleep: A multidimensional model of chronotype

Chronotype can be defined as an expression or proxy for circadian rhythms of varied mechanisms, for example in body temperature, cortisol secretion, cognitive functions, eating and sleeping patterns. It is influenced by a range of internal (e.g., genetics) and external factors (e.g., light exposure), and has implications for health and well-being. Here, we present a critical review and synthesis of existing models of chronotype. Our observations reveal that most existing models and, as a consequence, associated measures of chronotype have focused solely or primarily on the sleep dimension, and typically have not incorporated social and environmental influences on chronotype. We propose a multidimensional model of chronotype, integrating individual (biological and psychological), environmental and social factors that appear to interact to determine an individual's true chronotype with potential feedback loops between these factors. This model could be beneficial not only from a basic science perspective but also in the context of understanding health and clinical implications of certain chronotypes as well as designing preventive and therapeutic approaches for related illnesses.

Circadian clock and temporal meal pattern

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

Chrono-Nutrition: Circadian Rhythm and Personalized Nutrition

The human circadian system has a period of approximately 24 h and studies on the consequences of "chornodisruption" have greatly expanded. Lifestyle and environmental factors of modern societies (i.e., artificial lighting, jetlag, shift work, and around-the-clock access to energy-dense food) can induce disruptions of the circadian system and thereby adversely affect individual health. Growing evidence demonstrates a complex reciprocal relationship between metabolism and the circadian system, in which perturbations in one system affect the other one. From a nutritional genomics perspective, genetic variants in clock genes can both influence metabolic health and modify the individual response to diet. Moreover, an interplay between the circadian rhythm, gut microbiome, and epigenome has been demonstrated, with the diet in turn able to modulate this complex link suggesting a remarkable plasticity of the underlying mechanisms. In this view, the study of the impact of the timing of eating by matching elements from nutritional research with chrono-biology, that is, chrono-nutrition, could have significant implications for personalized nutrition in terms of reducing the prevalence and burden of chronic diseases. This review provides an overview of the current evidence on the interactions between the circadian system and nutrition, highlighting how this link could in turn influence the epigenome and microbiome. In addition, possible nutritional strategies to manage circadian-aligned feeding are suggested.

Breakfast Size and Prevalence of Metabolic Syndrome in the European Prospective Investigation into Cancer and Nutrition (EPIC) Spanish Cohort

BACKGROUND

Recent evidence suggest that energy distribution during the daytimecould be a potential determinant for the development of metabolic syndrome (MetS).

OBJECTIVE

To cross-sectionally assess the association between breakfast size and the prevalence of MetS in Spanish adults.

METHODS

Our study included a subset of 3644 participants from the European Prospective Investigation into Cancer and Nutrition Spain study recontacted between 2017-2018. Information on diet, sociodemographic, lifestyle, sleep quality, and chronotype was collected using standardized questionnaires, while anthropometric and blood pressure data were measured in a face-to-face personal interview by a nurse. MetS was defined according to the Adult Treatment Panel III (ATPIII) definition by measuring serum levels of total cholesterol, tryglycerides and glucose. Breakfast size was calculated as: (energy from breakfast/total energy intake) * 2000 kcal. To evaluate the association between breakfast size and MetS prevalence, a multivariable logistic regression model adjusted by potential confounders was used to estimate OR and 95% CI.

RESULTS

Prevalence of MetS in our study was 40.7%. The mean breakfast size was 306.6 * 2000 kcal (15% of the total daily energy intake), with 14 (0.4%) participants skipping breakfast. Participants in the highest quartile of breakfast size had a lower MetS prevalence compared to participants in the lowest quartile (OR_Q4vsQ1 = 0.62; 95% CI = 0.51-0.76; p-trend < 0.001). No modification of the estimated ORs by sex, breakfast time, and number of eating occasions per day were observed.

CONCLUSION

Our results suggest that higher breakfast size is associated with lower prevalence of MetS in Spanish adults, supporting the importance of a high energy breakfast. Further prospective studies are necessary to confirm these findings.

Associations of chronotype and social jetlag with eating jetlag and their changes among German students during the first COVID-19 lockdown. The Chronotype and Nutrition study

Due to their biologically later chronotype, young students are vulnerable to a discrepant sleeping pattern between work- and free days, coined social jetlag (SJL). This study examined whether a later chronotype and/or a larger SJL are related to an analogous discrepancy in meal timing defined as eating jetlag (EJL) and whether chronotype and/or changes in SJL during the first COVID-19 related lockdown in Germany associated with changes in EJL. Baseline data were collected from September 2019-January 2020 among 317 students (58% females) aged 18-25 years of which a total of 156 students (67% females) completed an online follow-up survey in June-July 2020 (1st lockdown). Data were collected on daily routines, timing of meals/snacks, and physical activity. Chronotype was determined using the Munich ChronoType Questionnaire; SJL and EJL correspond to the difference in the daily midpoint of sleep/eating duration between work- and free days. Multivariable linear regression revealed that students with a later chronotype or a larger SJL experienced a larger EJL (p_adjusted = 0.0124 and p_adjusted<0.0001). A later chronotype at baseline and reductions in SJL during lockdown associated with concurrent reductions in EJL (p_adjusted = 0.027 and p_adjusted<0.0001). In conclusion, students with a later chronotype exhibit a more erratic meal pattern, which associates with SJL. During lockdown, flexible daily schedules allowed students to align the meal timing with their inner clock.

Chronotype Differences in Body Composition, Dietary Intake and Eating Behavior Outcomes: A Scoping Systematic Review

The timing and nutritional composition of food intake are important zeitgebers for the biological clocks in humans. Thus, eating at an inappropriate time (e.g., during the night) may have a desynchronizing effect on the biological clocks and, in the long term, may result in adverse health outcomes (e.g., weight gain, obesity, and poor metabolic function). Being a very late or early chronotype not only determines preferred sleep and wake times but may also influence subsequent mealtimes, which may affect the circadian timing system. In recent years, an increased number of studies have examined the relation between chronotype and health outcomes, with a main focus on absolute food intake and metabolic markers and, to a lesser extent, on dietary intake distribution and eating behavior. Therefore, this review aimed to systematically determine whether chronotype indirectly affects eating behaviors, dietary intake (timing, choice, nutrients), and biomarkers leading to body composition outcomes in healthy adults. A systematic literature search on electronic databases (PubMed, CINAHL, MEDLINE, SCOPUS, Cochrane library) was performed (International Prospective Register of Systematic Reviews number: CRD42020219754). Only studies that included healthy adults (aged >18 y), classified according to chronotype and body composition profiles, using outcomes of dietary intake, eating behavior, and/or biomarkers, were considered. Of 4404 articles, 24 met the inclusion criteria. The results revealed that late [evening type (ET)] compared with early [morning type (MT)] chronotypes were more likely to be overweight/obese with poorer metabolic health. Both MT and ET had similar energy and macronutrient intakes, consuming food during their preferred sleep-wake timing: later for ET than MT. Most of the energy and macronutrient intakes were distributed toward nighttime for ET and exacerbated by unhealthy eating behaviors and unfavorable dietary intakes. These findings from our systematic review give further insight why higher rates of overweight/obesity and unhealthier metabolic biomarkers are more likely to occur in ET.

Role of Circadian Clock on the Pathogenesis and Lifestyle Management in Non-Alcoholic Fatty Liver Disease

Several features of the modern lifestyle, such as weekly schedules or irregular daily eating patterns, have become major drivers of global health problems, including non-alcoholic fatty liver disease (NAFLD). Sleep is an essential component of human well-being, and it has been observed that when circadian rhythms are disrupted, or when sleep quality decreases, an individual's overall health may worsen. In addition, the discrepancy between the circadian and social clock, due to weekly work/study schedules, is called social jetlag and has also been associated with adverse metabolic profiles. Current management of NAFLD is based on dietary intake and physical activity, with circadian preferences and other environmental factors also needing to be taken into account. In this regard, dietary approaches based on chrononutrition, such as intermittent fasting or time-restricted feeding, have proven to be useful in realigning lifestyle behaviors with circadian biological rhythms. However, more studies are needed to apply these dietary strategies in the treatment of these patients. In this review, we focus on the impact of circadian rhythms and the role of sleep patterns on the pathogenesis and development of NAFLD, as well as the consideration of chrononutrition for the precision nutrition management of patients with NAFLD.

Normal lark, deviant owl: The relationship between chronotype and compliance with COVID-19 mitigation measures

Current evidence suggests that preventive measures, such as social distancing and wearing face masks, are critical to contain the spread of COVID-19. The recent burgeoning literature has empirically examined how a wide range of facet-level personality and individual-differences variables are associated with people's adherence to COVID-19 regulations. However, there lacks direct evidence regarding the role of chronotype in compliance with pandemic safety measures. According to the eveningness epidemiological liability hypothesis, people of later chronotype are more likely to breach COVID-19 restrictions. Despite this hypothesis shedding considerable light on the potential role of chronotype in the abidance of the virus-mitigating measures, it has not been rigorously tested using empirical data. To fill this gap, the present research investigated the link between morningness-eveningness and compliance with COVID-19 containment policies in Chinese samples. Two studies using multiple populations (students and community adults) and diverse measures of adherence to public health guidelines (self-report and actual behavior) consistently show that individuals who orient towards morningness display a higher level of compliance with COVID-19 prevention than people who orient towards eveningness. Overall, these findings present the first empirical confirmation of the eveningness epidemiological liability hypothesis, highlighting the role of chronotype in adherence to COVID-19 prevention guidelines.

Association between Breakfast Meal Categories and Timing of Physical Activity of Japanese Workers

Background: Breakfast is the most important meal of the day and has been associated with longevity. Regular breakfast consumers often have a healthy lifestyle, including a healthy diet and regular physical activity. Methods: We examined the association between breakfast type, chronotype (morningness-eveningness), and physical activity in 3395 Japanese workers using a cross-sectional web survey. Results: Participants who ate Japanese breakfasts showed an early chronotype, while those who ate breakfast cereal exhibited a later chronotype. Physical activity was positively associated with adopting a Japanese breakfast style. Japanese breakfast eaters performed physical activities from 6:00–9:00 compared with other breakfast eaters. Conclusion: Our findings suggest that eating a Japanese breakfast is associated with an earlier chronotype (morningness) and higher physical activity.

Association of Japanese Breakfast Intake with Macro- and Micronutrients and Morning Chronotype

(1) Background: Dietary intake may have a remarkable effect on sleep because skipping breakfast and having a late dinner affects many sleep parameters. Breakfast is the most important meal of the day for children and adults to maintain morning chronotype. We examine whether breakfast style is associated with nutrient intake and sleep factors. (2) Methods: This cross-sectional analysis, with a large sample size of 2671 (766 men and 1805 women aged 20–60 years after data brush-up), was based on data obtained from an online survey. Correlation analysis was performed using Spearman’s rank correlation test. The Kruskal–Wallis’s test followed by post hoc Dunn’s multiple comparison test was used to evaluate the interaction between sleep factors and breakfast categories. Multiple regression analyses were performed to identify variables associated with multiple confounding factors. Dietary data were analyzed using approximately one-month average dietary records from the application. The basic characteristics of the participants (age, sex, and BMI) and other lifestyle-related factors (sleep and physical activity) were obtained accordingly. Sleep parameters including the timing of weekday sleep onset, weekday wake-up, weekend (free day) sleep onset, weekend wake-up, sleep, and midpoints of sleep phase were calculated for each participant. We categorized participants’ breakfast types into five groups: (1) Japanese meal, where breakfast may contain Japanese ingredients such as rice; (2) Western meal, where breakfast may contain bread; (3) alternating eating patterns of Japanese and Western meals; (4) cereals and supplements, where breakfast may contain cereals or supplements and energy bars; and (5) skipped breakfast (no breakfast). (3) Results: The midpoint values of the sleep phase on weekends adjusted for sleep debt on work days (MSFsc) related to chronotype were higher in women, suggesting that they may prefer eveningness. Participants with obesity, young age, and low physical activity preferred eveningness with longer sleep durations. Intake of Japanese-style breakfast was significantly associated with early wake-up time on both weekdays and weekends. Cereal-style breakfast intake was significantly associated with late wake-up on both weekdays and weekends. Intake of macronutrients such as protein, fat, carbohydrate, and sodium at breakfast time was positively and strongly associated with the intake of Japanese breakfast, whereas macronutrients were negatively associated with the intake of cereal breakfast. Among micronutrients, vitamin K was positively correlated with Japanese breakfast and negatively correlated with cereal breakfast; (4) Conclusions: Japanese-style breakfast is associated not only with morning preference but also with high intake of macro- and micronutrients.

Association of time of breakfast and nighttime fasting duration with breast cancer risk in the multicase-control study in Spain

Circadian nutritional behaviors, defined by the daily eating/fasting cycle, have been linked with breast cancer. This study aimed to further disentangle the association of nighttime fasting duration and time of breakfast with breast cancer risk. We analyzed data from 1,181 breast cancer cases and 1,326 population controls from the Spanish multicase-control study (MCC-Spain), 2008-2013. We collected circadian nutritional behaviors at mid-age via a telephonic interview. We applied logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CIs) for the association of nighttime fasting duration and time of breakfast with breast cancer risk in all women and stratified by menopausal status. Models were adjusted for age, center, education, family history of breast cancer, age at menarche, number of children, breastfeeding, age at first child, body mass index (BMI), contraceptive use, and hormonal replacement therapy (HRT). A later time of breakfast was associated with a non-significant increased risk of breast cancer (OR = 1.05, 95% CI: 0.95-1.16, per hour increase). This association was stronger among premenopausal women, among whom each hour later, the time of breakfast was associated with an 18% increase in breast cancer risk (OR = 1.18, 95% CI: 1.01-1.40). The association was not observed in postmenopausal women. We did not observe an association between nighttime fasting duration and breast cancer risk after adjusting for the time of breakfast. In this study, late breakfast was associated with increased breast cancer risk, especially among premenopausal women, compared with early breakfast. Aside from nutritional quality, circadian nutritional behaviors should be further studied in relation to cancer.

Prospective study of breakfast frequency and timing and the risk of incident type 2 diabetes in community-dwelling older adults: the Cardiovascular Health Study

BACKGROUND

No evidence-based recommendations regarding optimal breakfast frequency and timing and type 2 diabetes mellitus (T2DM) exist for older adults because of limited studies.

OBJECTIVES

We sought to prospectively assess relations between breakfast frequency and timing and T2DM risk among older adults and determine whether these depended on sex or cardiometabolic risk factors.

METHODS

Weekly breakfast frequency and usual daily breakfast time were assessed by questionnaire at baseline in 3747 older adults (aged ≥ 65 y) from the Cardiovascular Health Study (CHS) who were free of cancer and T2DM and followed for 17.6 y. Multivariable-adjusted hazard ratios (aHRs) with 95% CIs estimated from Cox proportional hazards models were used to quantify associations with T2DM.

RESULTS

Most CHS participants (median age: 74 y; IQR: 71-78 y) consumed breakfast daily (85.5%), and 73% had their first daily eating occasion between 07:00 and 09:00, both of which were associated with higher socioeconomic status, factors that are indicative of a healthier lifestyle, and lower levels of cardiometabolic risk indicators at baseline. During follow-up, 547 T2DM cases were documented. No strong evidence was observed linking breakfast frequency and risk of T2DM. Compared with participants whose breakfast timing (first eating occasion of the day) was 07:00-09:00, those who broke fast after 09:00 had an aHR for T2DM of 0.71 (95% CI: 0.51, 0.99). This association was present in participants with impaired fasting glucose at baseline (aHR: 0.61; 95% CI: 0.39, 0.95) but not in those without (aHR: 0.83; 95% CI: 0.50, 1.38). No associations between eating frequency or timing and T2DM were observed within other prespecified subgroups.

CONCLUSIONS

Eating breakfast daily was not associated with either higher or lower risk of T2DM in this cohort of older adults, whereas a later (after 09:00) daily first eating occasion time was associated with lower T2DM risk in participants with impaired fasting glucose at baseline.This trial was registered at clinicaltrials.gov as NCT00005133.

Association of chronotype with eating habits and anthropometric measures in a sample of Iranian adults

There is a lack of consistency in the literature that shows a relationship between chronotype, habits of eating and obesity in Iranian adults. This cross-sectional study was conducted on 850 individuals aged ≥ 18 years, selected from health houses of Tehran, Iran. Chronotype was assessed by Horne and Ostberg morningness-eveningness questionnaire. Specific eating habits, including breakfast skipping, intakes of fruits and vegetables, fast food, processed meats, soft drinks, coffee and tea, were assessed by dietary recalls. Weight, height, BMI, waist circumference, waist to hip ratio, waist to height ratio, visceral adiposity index, body roundness index and body adiposity index were based on measured values. We used logistic regression to investigate the association between chronotypes and anthropometric measures as well as eating habits. Morning- and intermediate/evening-type chronotypes accounted for 51·4 and 48·6 % of the total individuals, respectively. Moreover, intermediate/evening-type chronotypes were shown to have a lower education of diploma (53 %), employed (49·9 %) and smokers (11·6 %) compared with morning types (both sexes). We found that intermediate/evening-type chronotypes might not be significantly related to higher anthropometric measures and following unhealthy eating habits after controlling for confounders in men and women (all P > 0·05). Overall, both anthropometric measures and specific eating habits were not related to chronotype among Iranian adults. Further studies are needed to clarify these relations and to consider sleep disturbances.

Racial and Ethnic Differences in Eating Duration and Meal Timing: Findings from NHANES 2011-2018

Background: In addition to quantity and quality, meal timing and eating duration are additional dietary characteristics that impact cardiometabolic health. Given that cardiometabolic health disparities exist among racial and ethnic groups, we examined whether meal timing and eating duration are additional diet-related differences among racial and ethnic groups. Methods: Participants (n = 13,084) were adults (≥20 years) from the National Health and Nutrition Examination (NHANES, 2011−2018) Survey. Times of first and last meal and the interval between them (eating duration) were derived from two 24-h dietary recalls. Multiple linear regression analyses compared these variables among race and ethnicity after adjusting for potential confounders. Results: Compared to non-Hispanic White adults, the first mealtime was significantly later for Mexican American (23 min), Non-Hispanic Asian (15 min), Non-Hispanic Black (46 min), and Other Hispanic (20 min) and Other Racial (14 min) adults (all p < 0.05). Mexican American and Non-Hispanic Asian adults had a significantly different last mealtime by 13 min earlier and 25 min later, respectively, compared to Non-Hispanic White adults. Compared to Non-Hispanic White adults, the mean eating duration was shorter for other Hispanic (20 min), Mexican American (36 min), and Non-Hispanic Black (49 min) adults. Conclusions: Meal timing and eating duration are additional dietary characteristics that vary significantly among racial and ethnic groups.

[Time-restricted eating as a novel strategy for treatment of obesity and it's comorbid conditions]

The article provides a review of the current literature about time-restricted eating (TRE) as a new tool for the treatment of obesity and comorbid conditions. The search for new nutritional strategies in obesity, one of which is TRE, is due to the weak adherence of patients to hypocaloric diets in the long term, as well as the available data on the importance of -desynchronization of food intake with natural circadian rhythms in the development and progression of obesity and cardio--metabolic complications. The article describes the main mechanisms that regulate the circadian rhythms of food intake and nutrient absorption, substantiates the importance of adhering to a physiological diet for maintaining metabolic health. The main part of the review is devoted to reviewing the currently available researches on the effectiveness of various strategies of intermittent energy restriction for weight loss and the correction of metabolic parameters. Potential mechanisms of  the -effect of TRE on health are discussed, including those mediated by an unintentional decrease in caloric intake and changes in eating behavior, and differences in the effectiveness of early and late TRE. The article contains a detailed discussion of the potential problems and contradictions associated with the use of time-restricted eating in clinical practice, namely: the limitations and inconsistencies of the available clinical trials, the lack of data on long-term efficacy and safety, social and psychological limitations that impede the widespread use of TRE.

Frequency of Breakfast Eating and Obesity Prevalence in Primary School Teachers

There is a lack of research using objective measures about teachers’ physical characteristics and lifestyle. The purpose of the study was to evaluate the relationship between frequency of breakfast consumption and body size, body composition, blood pressure and lifestyle factors in teachers from Hungary. The study analyzed data collected from 99 female primary school teachers (50.6 ± 6.6 year) before the COVID-19 pandemic. Anthropometric and resting blood pressure measurements were taken for each participant. Questionnaires were used to assess lifestyle factors (i.e., physical activity level, smoking status and eating breakfast). The frequency of eating breakfast was classified as rarely or never (0–2 days), some days (3–5 days) and regularly (6–7 days). Sixty-five percent of female teachers consumed breakfast 6–7 days/week, and this regular eating habit was positively associated with a lower risk of obesity (OR 0.29; CI: 0.10–0.80). In our sample, a higher frequency of breakfast consumption was not significantly associated with smoking (OR 2.65; CI: 0.17–1.37), hypertension (OR 0.61; CI: 0.23–1.65) and inactivity (OR 2.80; CI: 0.26–1.84). A beneficial effect of eating breakfast regularly was found on body composition in female teachers. Further studies should focus on the health behaviors of teachers and their relationship with physical activity or diagnosed diseases in urban and rural areas.

Consumption of home-prepared meal at workplace as a predictor of glycated haemoglobin among people with type 2 diabetes in Hong Kong: a mixed-methods study

OBJECTIVES

There is increasing attention on association between eating patterns and diabetes control following global changes in eating patterns. There had been very limited research on the eating patterns of diabetic patients with employment, although working age population has seen the highest increase in diabetes incidence. This study aimed to identify workplace eating patterns in relation to glycaemic control among type 2 diabetic patients with employment.

METHODS

This is a sequential mixed-methods study. The exploratory qualitative study involved focus group interviews with 31 type 2 diabetic patients with employment, which guided the design of a subsequent cross-sectional investigation involving 185 patients with employment. Thematic analysis was conducted on the qualitative data to identify workplace eating patterns most relevant to glycaemic control. Hierarchical multiple linear regression was performed to examine association between workplace eating pattern and glycaemic control, proxied by HbA1c.

RESULTS

The focus group interviews identified frequency in the consumption of home-prepared meals (HPM) and meal hours as the major workplace eating patterns that affected glycaemic control. The cross-sectional study confirmed that regular consumption of HPM at workplace could explain variance of HbA1c, independent of socio-demographic factors, lifestyle factors and disease condition, with R² = 0.146, F(14, 170) = 2.075, p = 0.015; adjusted R² = 0.076. Patients who were female, in non-skilled occupation, on shift, with fixed work location and had break during work were more likely to consume HPM.

CONCLUSIONS

Consumption of HPM at workplace should be promoted to facilitate better glycaemic control by type 2 diabetic patients with employment, possibly through more practical dietary advice, and workplace accommodation in terms of space and facilities. In the context of COVID-19 pandemic, consumption of HPM also meant additional protection for diabetic patients through reducing close contact exposures in restaurants.

Attitude toward breakfast mediates the associations of wake time and appetite for breakfast with frequency of eating breakfast

PURPOSE

We investigated associations among attitude toward breakfast, appetite for breakfast, wake time, personality traits, self-esteem, and frequency of eating breakfast in university students and proposed a model of factors affecting the frequency of eating breakfast.

METHODS

The participants, 555 Japanese university students (177 men, 378 women), completed a questionnaire about their height and weight, living with family, wake time, frequency of eating breakfast, appetite for breakfast, attitude toward breakfast, personality traits, and self-esteem. Appetite for breakfast was evaluated with a four-point Likert-type scale. Attitude toward breakfast was assessed with a 13-item questionnaire using a five-point Likert-type scale; responses to the items were summed, and divided by the number of items to produce a score.

RESULTS

Multiple linear regression analysis showed that frequency of eating breakfast was positively associated with appetite for breakfast and attitude toward breakfast, and inversely associated with wake time. Wake time was inversely associated with attitude toward breakfast, and appetite for breakfast was positively associated with attitude toward breakfast. Structural equation modeling showed that the structured model based on the multiple regression analysis was a good fit for both men (chi-square value to the degrees of freedom [χ²/df] = 1.096, root mean square error of approximation [RMSEA] = 0.023) and women (χ²/df = 1.510, RMSEA = 0.037).

CONCLUSIONS

These results suggest that wake time and appetite for breakfast are directly associated with frequency of eating breakfast. Attitude toward breakfast mediates the indirect association between frequency of eating breakfast and both wake time and appetite for breakfast.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

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.

Breakfast Protein Quality and Muscle Strength in Japanese Older Adults: A Community-Based Longitudinal Study

OBJECTIVES

The amount of breakfast protein intake is important for maintaining muscle strength. However, the effect of breakfast protein quality (ie, bioavailability) remains unclear. We investigated the association between breakfast protein quality and the incidence of muscle weakness.

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

Healthy older adults age 60-83 years without stroke, arthritis, Parkinson disease, or muscle weakness at baseline (maximum follow-up period and participations were 9.2 years and 5 times, respectively).

METHODS

Weakness was defined by the Asian Working Group for Sarcopenia 2019 criteria, using grip strength. Breakfast protein quality was evaluated using the protein digestibility-corrected amino acid score (PDCAAS), where higher scores represent higher quality, calculated from 3-day dietary records. Participants were classified according to sex-stratified tertiles of breakfast PDCAAS (ie, low to high groups). The association between PDCAAS and incident weakness was analyzed using the generalized estimating equation, after adjusting for sex, age, follow-up time, grip strength, body mass index, physical activity, cognition, education, smoking, economics, medical history, lunch and dinner PDCAASs, and energy and protein intake during 3 regular meals at baseline.

RESULTS

Overall, 14.4% of the initial sample was excluded owing to a diagnosis of weakness-related diseases, and 58.3% (n = 701) had at least 1 follow-up measurement for inclusion in the analysis. The mean ± SD follow-up period was 6.9 ± 2.1 years; the cumulative number of participants was 3019, and 282 developed weakness. Using the low PDCAAS group as the reference, the adjusted odds ratios (95% CIs) for incident weakness in the middle and high PDCAAS groups were 0.71 (0.43-1.18) and 0.50 (0.29-0.86), respectively.

CONCLUSIONS AND IMPLICATIONS

Higher breakfast protein quality was associated with a reduction in incident weakness in older adults, independent of protein intake. These findings may highlight the role of protein quality for muscle health in older adults.

Interaction of cry1 gene polymorphisms and dominant food patterns on obesity: A cross-sectional study

Background:

Evidence suggests that there is some relationship between circadian clock gene variants and obesity. However, there are few examinations supporting this observation in human subjects. This study was aimed to investigate the interaction between Cry1 circadian gene polymorphism and major dietary patterns on obesity measurements.

Methods:

Healthy overweight and obese women aged 18–53 years old were recruited from health centers in Tehran, Iran by a multistage cluster random sampling method (n = 377). Major dietary patterns were elicited after assessing the intake of 16 food groups using a valid and reliable 147-item food frequency questionnaire (FFQ). Anthropometric measurements were performed for each and every participant. Body composition was analyzed using bioelectrical impedance analysis (BIA). Socio-demographic and physical activity data were also collected by a validated Farsi demographic questionnaire and the international physical activity questionnaire (IPAQ). The Cry1 rs2287161 polymorphism were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Generalized linear models were used for interaction analysis.

Results:

Two major dietary patterns, including healthy and unhealthy dietary pattern (HDP and UDP, respectively) were determined using factor analysis. Our study showed a significant higher weight (P = 0.003), body mass index (BMI) (P = 0.042), hip circumference (P = 0.052), and body fat mass (P = 0.028) in carriers of C allele compared with G allele. Moreover, a significant gene-diet interaction was observed between being a carrier of C allele and BMI (P = 0.099 for CC genotype; P = 0.1 for CG genotype) and fat mass (P = 0.1 for CG genotype).

Conclusions:

The current study suggests a significant interaction of Cry1 rs2287161 gene polymorphisms in people following a healthy dietary pattern on BMI and fat mass among carriers of C allele compared to carriers of G allele.

The association between metabolic parameters and evening chronotype and social jetlag in non-shift workers: A meta-analysis

AIMS

The aim of the study was to evaluate the association between evening chronotype and social jetlag (SJL) with obesity, blood glucose and lipid levels in non-shift working adults.

METHODS

The databases of MEDLINE, EMBASE and Cochrane Reviews were searched for studies analyzing the metabolic parameters among groups of different chronotypes or SJL until Feb 2022. Weighted mean difference (WMD) and 95% confidence intervals (CI) were used to analyze the association between these parameters and chronotypes or SJL.

RESULTS

A total of 27 studies were included in this meta-analysis. Compared with morning chronotype, the participants with evening chronotype had higher body mass index (BMI) (WMD= 0.44 kg/m², 95%CI, 0.30 to 0.57 kg/m², p<0.001), higher fasting blood glucose level (WMD= 5.83mg/dl, 95%CI, 3.27to 8.38 mg/dl, p<0.001), higher total cholesterol level (WMD= 6.63mg/dl, 95%CI, 0.69 to 12.56 mg/dl, p=0.03), and lower high density lipoprotein cholesterol (HDL-C) level (WMD= -1.80mg/dl, 95%CI, -2.30 to -1.31 mg/dl, p<0.001). Compared with the participants with small SJL, the participants with large SJL had larger waist circumference (WMD= 0.80cm, 95%CI, 0.77 to 0.83cm, p<0.001).

CONCLUSIONS

Evening chronotype and SJL were associated with obesity and unfavorable metabolic parameters of glucose and lipid metabolism.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022303401.