Energy and Nutrient Timing for Weight Control: Does Timing of Ingestion Matter?

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

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

Self-Reported Eating-Occasion Frequency and Timing are Reproducible and Relatively Valid in the American Cancer Society Cancer Prevention Study-3 Diet Assessment Substudy

BACKGROUND

Accurate assessment of eating-occasion behaviors, such as timing, frequency, and consumption intervals, is important for evaluating associations with obesity and other chronic diseases.

OBJECTIVES

The main objective of this study was to assess the relative validity of a 24-hour grid approach to assess eating-occasion timing and frequency in comparison to data derived from repeated 24-hour dietary recalls (DRs). A second objective was to assess the 1-year test-retest reproducibility of the 24-hour grid.

METHODS

Between 2015 and 2016, 626 participants in the Cancer Prevention Study-3 (CPS-3) Diet Assessment Substudy (mean age, 52 years; age range, 31-70 years; 64% female; 64% non-Hispanic white, 22% non-Hispanic black, 14% Hispanic) completed 2 grids and up to 6 unannounced, telephone, interviewer-administered DRs over 1 year. Spearman correlations (ρ; 95% CIs) were calculated to assess reproducibility between the repeated eating-occasion grid-derived variables (e.g., numbers of snacks and meals per day, timing of eating occasions) and to assess relative validity by comparing the meal grid and DR-derived summary data separately for weekdays and weekend days.

RESULTS

Reproducibility correlations for eating-occasion variables derived from the eating-occasion grids completed 1 year apart were ≥0.5 for the majority of variables analyzed for both weekdays and weekend days, including numbers of snacks and meals per day and timing of the first and last eating occasions of the day. Relative validity was highest among weekday variables and was ≥0.5 for the majority of variables, with correlations ranging from ρ values of 0.32 (number of meals per day) to 0.68 (hour of the first eating occasion).

CONCLUSIONS

These findings suggest the eating-occasion grid used in CPS-3 has good reproducibility over 1 year and yields estimates comparable to those from a more detailed method of assessment of eating timing and frequency.

Frequency of Eating in the US Population: A Narrative Review of the 2020 Dietary Guidelines Advisory Committee Report

Background

A person's daily nutrient intake and overall nutritional status are determined by a complex interplay of the types and amounts of foods ingested in combination with the timing and frequency of eating.

Objectives

The aim was to summarize frequency of eating occasion data examined by the 2020 Dietary Guidelines Advisory Committee, the macronutrient contributions they provide, and meal frequency relative to dietary quality among the US population (≥2 y), with a focus on sex, age, race/Hispanic origin, and income.

Methods

Demographic and 24-h recall data from the 2013-2016 NHANES were examined. An eating occasion was defined as "any ingestive event (e.g., solid food, beverage, water) that is either energy yielding or non-energy yielding"; all eating occasions were further divided into discrete meals and snacks. Frequency of meals and snacks was defined as "the number of daily EOs [eating occasions]," respectively. Diet quality was assessed via the Healthy Eating Index (HEI)-2015.

Results

Most Americans consume 2 (28%) to 3 (64%) meals on a given day and >90% consume 2 to 3 snacks on that day. Adult, Hispanic, and non-Hispanic Black and lower-income (<131% family poverty-to-income ratio) Americans had a lower frequency of eating than children or adolescents, non-Hispanic White, and non-Hispanic Asian Americans and higher-income Americans, respectively. Americans who reported 3 meals on a given day consumed a diet higher in dietary quality than Americans who consumed 2 meals on a given day (HEI-2015: 61.0 vs. 55.0), regardless of population subgroup.

Conclusions

The frequency of the types of eating occasions differs according to age, race and Hispanic origin, and income. Dietary quality is associated with the number of meals consumed. Healthy dietary patterns can be constructed in a variety of ways to suit different life stages, cultural practices, and income levels; improved diet quality and careful consideration of nutrient density when planning meals are warranted.

Meal Pattern in the Colombian Population: Results of the National Nutrition Survey. ENSIN, 2015

Background

Information on meal patterns (type, number, relative contribution to energy/day (%), time, and location of meals) is limited or nonexistent.

Design

Cross-sectional, nationally representative surveys. Setting. Colombia. Participants. n = 26,115 from 3 to 64 years old. The sample analyzed included 3,127 children between 3 and 4 years old, 13,384 children between 5 and 17 years old, and 9,604 adults between 18 and 64 years old. Data Analysis. Meal patterns were described by age group. Through multiple linear regression, crude and adjusted differences in the categories of the covariates studied were estimated. The number/day of meals was the dependent variable.

Results

The number of meals/day (mean ± SD) was 4.4 ± 0.0, without differences by sex (P = 0.068), current weight (P = 0.336) , or wealth index (P = 0.480), but there were differences in the level of education of the head of the household (P < 0.0001) and the level of food security of the household (P < 0.0001). A total of 96.8% of the population eats 3 or more meals/day (95% CI: 96.2, 97.2). The consumption frequency (mean ± SD) of the three main meals was 0.95 ± 0.0 “times/day,” 1.0 ± 0.0 and 0.95 ± 0.0, for breakfast, lunch, and dinner, respectively. Lunch is the meal that makes the greatest relative contribution to the total energy consumed (energy/day), 33.9% (95% CI: 32.7, 35.1). Breakfast is eaten outside the home by 13.0% of the subjects, lunch by 26.0%, and dinner by 3.8%. The minimum fasting interval is 9 hours and the maximum is 10 hours and 30 minutes. The meal pattern is equivalent to type “A,” with three main meals and two or three intermediate meals (midmorning and midafternoon) taken during 15 hours of the day.

Conclusions

All age groups had more than four meals/day. The number is directly related to socioeconomic level. Lunch is the main meal.

Face Validity of Observed Meal Patterns Reported with 7-Day Diet Diaries in a Large Population-Based Cohort Using Diurnal Variation in Concentration Biomarkers of Dietary Intake

In a cross-sectional analysis of a population-based cohort (United Kingdom, N = 21,318, 1993-1998), we studied how associations between meal patterns and non-fasting triglyceride and glucose concentrations were influenced by the hour of day at which the blood sample was collected to ascertain face validity of reported meal patterns, as well as the influence of reporting bias (assessed using formula of energy expenditure) on this association. Meal size (i.e., reported energy content), mealtime and meal frequency were reported using pre-structured 7-day diet diaries. In ANCOVA, sex-specific means of biomarker concentrations were calculated by hour of blood sample collection for quartiles of reported energy intake at breakfast, lunch and dinner (meal size). Significant interactions were observed between breakfast size, sampling time and triglyceride concentrations and between lunch size, sampling time and triglyceride, as well as glucose concentrations. Those skipping breakfast had the lowest triglyceride concentrations in the morning and those skipping lunch had the lowest triglyceride and glucose concentrations in the afternoon, especially among acceptable energy reporters. Eating and drinking occasion frequency was weakly associated with glucose concentrations in women and positively associated with triglyceride concentrations in both sexes; stronger associations were observed for larger vs. smaller meals and among acceptable energy reporters. Associations between meal patterns and concentration biomarkers can be observed when accounting for diurnal variation and underreporting. These findings support the use of 7-day diet diaries for studying associations between meal patterns and health.

Late bedtime is associated with lower weight loss in patients with severe obesity after sleeve gastrectomy

BACKGROUND

Previous research has shown that sleep can play a role in obesity and weight loss. However, the association of sleep with weight loss in patients with severe obesity after bariatric surgery remains unexplored. We aimed to evaluate the role of sleep in weight loss evolution in a cohort of patients who underwent sleeve gastrectomy.

METHODS

A cohort of 252 patients with severe obesity (75.7% women; age [mean ± SD] 47.7 ± 10.8 years; BMI 44.2 ± 5.9 kg/m²) was followed for 1 year after surgery. Anthropometric, biochemical, physical activity, sleep (bedtime, wakeup time, and sleep duration) and dietary intake variables were collected pre- and post-surgery (1 year). Linear and non-linear regression models were used to examine the associations between sleep variables and weight loss. Participants were grouped into 'early' and 'late' sleepers according to a bedtime threshold (before or after 24:00 h), and the differences in weight loss, physical activity, meal timing, and dietary intake between groups were studied.

RESULTS

1-h increments in bedtime were linearly associated with less excess weight loss (EWL) [-2.23%; 95%CI: -3.37; -0.70; p = 0.005] 1 year after the sleeve gastrectomy. Late sleepers lost less weight (-5.64% of EWL [95%CI: -10.11; -1.17]; p = 0.014) when compared to early sleepers and showed a higher energy intake after 21:00 h (8.66% of total energy intake [95% CI: 4.87; 12.46]; p < 0.001).

CONCLUSIONS

Late bedtime is associated with less success of weight loss 1 year after the sleeve gastrectomy. Late sleepers consumed more of their calories closer to bedtime. Our results highlight the relevance of considering recommendations on bedtime and meal timing for patients after bariatric surgery.

Association of meal timing with dietary quality in a Serbian population sample

Background

The world-wide adoption of Western lifestyles and eating patterns is associated with adverse effects on nutrient intakes. Here we evaluated the relationships between timing of meals and diet quality in Serbia, a Balkan country with a traditional eating pattern that includes the largest meal of the day as a late lunch.

Methods

A dietary survey was done in the Republic of Serbia using a nationally-representative sample of 74 children and 260 non-pregnant adults. Nutrient intakes were calculated from two 24-h recalls. A Dietary Quality Score (DQS) enumerated how many European Union (EU) Science Hub recommendations were met for fruit and vegetables, fiber, saturated fat, sodium, and sugar. We evaluated whether the timing of dietary intakes is associated with DQS and body mass index.

Results

The dietary intakes of children ages 10–17 and adults were similar and were high in total fat intake, with an average of 40% of energy from fat. Mean fruit and vegetable intakes of 473 g/day in adults exceeded the minimal EU recommendation. The most worrisome aspects of the Serbian diet were high intakes of saturated fat, sugar and sodium. Lunch was the meal with the highest mean content of energy, followed by breakfast and dinner, and the average time for lunch was 15:15. Consumption of a higher percentage of calories before 16:00 in adults was associated with higher fruit and vegetable intakes and with higher DQS. The subgroup of adults consuming their largest meal after 20:00 had a lower mean age, more men, and a larger percentage was employed outside of the home. There were no associations of meal timing with BMI, but the prevalence of obesity in this population sample was only 13%.

Conclusions

These results indicate that an earlier meal pattern, and especially consuming the largest meal of the day earlier in the day, was associated with better quality diets. Public health efforts are needed to preserve nutrient intakes as the population shifts away from the traditional Serbian eating pattern. Long-term, deterioration of nutrient intakes could contribute to the increasing rates of obesity that have been observed in Serbia and world-wide.

The efficacy of electronic health interventions targeting improved sleep for achieving prevention of weight gain in adolescents and young to middle-aged adults: A systematic review

Sleep is emerging as a modifiable risk factor in counteracting harmful weight gain. Electronic and mobile devices offer a channel for wide-reaching intervention delivery. This systematic review aimed to determine the efficacy of interventions that included sleep behaviour as part of health promotion for preventing weight gain. Seven databases were searched from 1 January 2000 until 28 June 2019. Eligible studies were controlled trials of weight gain prevention programs that addressed sleep in healthy participants aged 13 to 44 years of age. The primary outcome was change in measured or self-reported weight. From 824 publications located, only six eligible trials with a total of 3,277 participants were identified and all addressed multiple behaviours. One study demonstrated a decrease in weight for the intervention group, and two other studies showed a decreased prevalence of overweight and obesity. Only one trial showed improved sleep duration but failed to show differences in weight. No definitive conclusions concerning the efficacy of electronic weight gain prevention interventions that include sleep can be made, but future trials should provide more detail about intervention techniques used, employ objective sleep and physical activity measures and undertake mediation analysis to judge the contributions of changes in sleep to study outcomes. PROSPERO REGISTRATION: CRD42019121879.

Redox Signaling and Advanced Glycation Endproducts (AGEs) in Diet-Related Diseases

Diets are currently characterized by elevated sugar intake, mainly due to the increased consumption of processed sweetened foods and drinks during the last 40 years. Diet is the main source of advanced glycation endproducts (AGEs). These are toxic compounds formed during the Maillard reaction, which takes place both in vivo, in tissues and fluids under physiological conditions, favored by sugar intake, and ex vivo during food preparation such as baking, cooking, frying or storage. Protein glycation occurs slowly and continuously through life, driving AGE accumulation in tissues during aging. For this reason, AGEs have been proposed as a risk factor in the pathogenesis of diet-related diseases such as diabetes, insulin resistance, cardiovascular diseases, kidney injury, and age-related and neurodegenerative diseases. AGEs are associated with an increase in oxidative stress since they mediate the production of reactive oxygen species (ROS), increasing the intracellular levels of hydrogen peroxide (H₂O₂), superoxide (O₂⁻), and nitric oxide (NO). The interaction of AGEs with the receptor for AGEs (RAGE) enhances oxidative stress through ROS production by NADPH oxidases inside the mitochondria. This affects mitochondrial function and ultimately influences cell metabolism under various pathological conditions. This short review will summarize all evidence that relates AGEs and ROS production, their relationship with diet-related diseases, as well as the latest research about the use of natural compounds with antioxidant properties to prevent the harmful effects of AGEs on health.

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

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

Meal timing and obesity: interactions with macronutrient intake and chronotype

BACKGROUND

Timing of dietary intake may play a role in obesity. However, previous studies produced mixed findings possibly due to inconsistent approaches to characterize meal timing and not taking into account chronotype and macronutrients. To address the aforementioned limitations, we have defined meal timing relative to sleep/wake timing, investigated the relationship between meal timing and body mass index (BMI) dependent on chronotype, and examined the associations.

METHODS

BMI, chronotype, and dietary intakes were measured in 872 middle-to-older-aged adults by six 24-h dietary recalls in 1 year. We defined four time windows of intake relative to sleep timing: morning (within 2 h after getting out of bed), night (within 2 h before bedtime), and two midday periods in between (split by the midpoint of the waking period).

RESULTS

A higher percent of total daily energy intake consumed during the morning window was associated with lower odds of being overweight or obese (odds ratio (95% confidence intervals), 0.53 (0.31, 0.89)). This association was stronger in people with an earlier chronotype (0.32 (0.16, 0.66)). A higher percent of total daily energy intake consumed during the night window was associated with higher odds of being overweight or obese (1.82 (1.07, 3.08)), particularly in people with a later chronotype (4.94 (1.61, 15.14)). These associations were stronger for the intakes of carbohydrates and protein than for fat intake.

CONCLUSION

Our study suggests that higher dietary consumption after waking up and lower consumption close to bedtime associate with lower BMI, but the relationship differs by chronotype. Furthermore, the data demonstrate a clear relationship between the timing of carbohydrate and protein intake and obesity. Our findings highlight the importance of considering timing of intake relative to sleep timing when studying the associations of meal timing with obesity and metabolic health.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS/SETTING

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

MAIN OUTCOME MEASURES

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

STATISTICAL ANALYSES PERFORMED

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

RESULTS

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

CONCLUSION

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

An Evidence-Based Approach to Teaching Obesity Management to Medical Students

Introduction

The need for education of future and current providers in evidence-based management of obesity and the release of new treatment guidelines prompted the development of a resource for use in the education of medical students and residents.

Methods

A self-contained module was developed to provide an overview of recent guidelines for obesity management utilizing evidence-based medicine while debunking popular myths associated with available weight-loss strategies. The module was delivered over 15 months to six groups of learners (N = 180) and was continuously improved through feedback from content experts and the learners. After completion of the module, one subset of learners responded to a three-question survey using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree).

Results

Formal evaluation of the module was completed by a subset of the learners (N = 32, 64% response rate). The majority agreed or strongly agreed with these survey statements: "Overall this module was valuable as an educational tool" (97%, Mdn = 4); "After completion of this module, I am confident of my knowledge on how to manage obesity in adult patients" (84%, Mdn = 4); and "It was easy to navigate the module" (94%, Mdn = 5).

Discussion

This module could be implemented as is at other institutions that strive to educate medical students or residents on the most recent guidelines and evidence-based medicine regarding obesity management.

Dietary Sugars and Endogenous Formation of Advanced Glycation Endproducts: Emerging Mechanisms of Disease

The rapid increase in metabolic diseases, which occurred in the last three decades in both industrialized and developing countries, has been related to the rise in sugar-added foods and sweetened beverages consumption. An emerging topic in the pathogenesis of metabolic diseases related to modern nutrition is the role of Advanced Glycation Endproducts (AGEs). AGEs can be ingested with high temperature processed foods, but also endogenously formed as a consequence of a high dietary sugar intake. Animal models of high sugar consumption, in particular fructose, have reported AGE accumulation in different tissues in association with peripheral insulin resistance and lipid metabolism alterations. The in vitro observation that fructose is one of the most rapid and effective glycating agents when compared to other sugars has prompted the investigation of the in vivo fructose-induced glycation. In particular, the widespread employment of fructose as sweetener has been ascribed by many experimental and observational studies for the enhancement of lipogenesis and intracellular lipid deposition. Indeed, diet-derived AGEs have been demonstrated to interfere with many cell functions such as lipid synthesis, inflammation, antioxidant defences, and mitochondrial metabolism. Moreover, emerging evidence also in humans suggest that this impact of dietary AGEs on different signalling pathways can contribute to the onset of organ damage in liver, skeletal and cardiac muscle, and the brain, affecting not only metabolic control, but global health. Indeed, the most recent reports on the effects of high sugar consumption and diet-derived AGEs on human health reviewed here suggest the need to limit the dietary sources of AGEs, including added sugars, to prevent the development of metabolic diseases and related comorbidities.