Development, validation and reliability of the Chrononutrition Profile - Questionnaire

Construct validity and test-retest reliability of a chrononutrition questionnaire for shift work and non-shift work populations

The irregular eating patterns of both shift workers and evening chronotypes adversely affect cardiometabolic health. A tool that conveniently captures temporal patterns of eating alongside an indicator of circadian rhythm such as chronotype will enable researchers to explore relationships with diverse health outcome measures. We aimed to investigate the test-retest reliability and convergent validity of a Chrononutrition Questionnaire (CNQ) that captures temporal patterns of eating and chronotype in the general population (non-shift workers, university students, retirees, unemployed individuals) and shift work population. Participants attended two face-to-face/virtual sessions and completed the CNQ and food/sleep/work diaries. Outcomes included subjective chronotype, wake/sleep/mid-sleep time, sleep duration, meal/snack regularity, meal/snack/total frequency, times of first/last/largest eating occasions (EO), main meal (MM) 1/2/3, and duration of eating window (DEW). 116 participants enrolled (44.5 ± 16.5 years, BMI: 27.3 ± 5.8 kg/m2, 73% female, 52% general population); 105 completed the study. Reliability was acceptable for chronotype, sleep, and all temporal eating patterns except on night shifts. Convergent validity was good for chronotype and sleep except for certain shift/shift-free days. Generally, meal/snack regularity and frequency, and times of first/last EO showed good validity for the general population but not shift workers. Validity was good for DEW (except work-free days and afternoon shifts) and times of MM 1/2/3 (except afternoon and night shifts), while time of largest EO had poor validity. The CNQ has good test-retest reliability and acceptable convergent validity for the general and shift work population, although it will benefit from further validation, especially regarding regularity, frequency, and times of first and last eating occasions across more days amongst a larger sample size of shift workers. Use of the CNQ by researchers will expand our current understanding of chrononutrition as relationships between timing of food intake and the multitude of health outcomes are examined.

Maternal dietary and environmental factors associated with infant circadian rhythm, growth, and temperament: Research protocol for a prospective cohort study

Introduction: Emerging evidence has been explored to determine the factors affecting the development of infant circadian rhythm. While fetal programming happens during the pregnancy period, external environmental cues and infant nutritional programming can have substantial effects on the infant circadian rhythm. Understanding prenatal and postnatal factors determining infant circadian rhythm can improve future interventions in optimizing maternal and infant health. Methods: This is a prospective observational cohort study, targeting 216 pregnant women from government maternity clinics in Kuala Lumpur, Malaysia. Pregnant women will be recruited at third trimester (baseline), and follow up at 3 months, and 6 months. A subsample will be collected for salivary cortisol analysis to determine circadian rhythm of the mother and infant at third trimester and 3 months. Data of eating misalignment, light exposure, chronotype, infant temperament, sleep quality, and mood will be collected via validated questionnaires. Anthropometric data and birth outcomes will be collected from antenatal and postnatal health records. Summary: Studies on infant circadian rhythm development have yet to be explored and established, hence this study presents a novel approach to identify the factors from prenatal to postnatal periods on infant circadian rhythm and its influence on growth and temperament. Findings from this study will provide insights in the critical timing which has larger effects on infant circadian rhythm development for future interventions to be conducted.

Association of largest meal timing and eating frequency with body mass index and obesity

BACKGROUND AND AIMS

The circadian pattern of eating behaviors has garnered increasing interest as a strategy for obesity prevention and weight loss. It is believed that the benefits stem from aligning food intake with the body's natural daily rhythms. However, the existing body of evidence is limited in scale and scope and there has been insufficient evaluation of temporal eating behaviors, such as the specific time of day in which the highest calorie consumption occurs, meal frequency, and distribution. This research aims to explore the association between the timing of the largest meal of the day and eating frequency with Body Mass Index (BMI) and obesity.

METHODS

Participants (n = 2050, 18-65y) were part of an exploratory cross-sectional and population-based research, with data collection in a virtual environment. Linear regression analyses and restricted cubic splines evaluated differences in BMI associated with independent eating variables [timing of the largest meal, number of meals/day (as continuous and categorical: ≤3 or >3/day), and each largest meal of the day (breakfast/lunch/dinner)]. Logistic regression models were fitted to assess Odds Ratios (OR) and 95 % Confidence Intervals (CI) of obesity associated with the same independent variables.

RESULTS

Our main findings were that the timing of the largest meal and reporting dinner as the largest meal were associated with higher values of BMI (respectively, 0.07 kg/m2 and 0.85 kg/m2) and increased odds of obesity [respectively OR(95%CI):1.04(1.01,1.08), and OR(95%CI):1.67(1.18,2.38)]. Those who realized more than 3 meals/day presented lower values of BMI (-0.14 kg/m2) and 32 % lower odds of having obesity [OR(95%CI):0.68(0.52,0.89)]. Reporting lunch as the largest meal also protected against obesity [OR(95%CI):0.71(0.54,0.93)]. These associations were statistically significant and independent of sex, age, marital status, education level, diet quality, sleep duration, and weekly frequency of physical exercise.

CONCLUSION

Having the largest meal earlier in the day, concentrating the majority of caloric intake during lunch, and consuming more than three meals a day, may present a promising intervention for preventing and treating obesity/overweight.

Development, validation, and reliability of the Chrononutrition Profile Questionnaire-Pregnancy (CPQ-P)

BACKGROUND

During pregnancy, physiological changes can affect eating and sleeping habits, which may eventually have negative consequences for maternal and foetal health. To better understand these changes, it is essential to develop a reliable questionnaire that addresses lifestyle habits such as snacking and daytime napping. This study aimed to determine the validity and reliability of the Chrononutrition Profile Questionnaire-Pregnancy (CPQ-P).

METHODS

A total of 399 women in their second and third trimester of pregnancy were recruited from government maternal and child health clinics in Kuala Lumpur and Putrajaya and completed a self-administered online questionnaire. Content validity was conducted with an expert panel consisting of 4 members. Confirmatory factor analysis (CFA) using maximum likelihood was conducted to determine the construct validity. Internal consistency was determined by Cronbach's alpha coefficient (CAC), while the test-retest reliability was conducted using intraclass correlation coefficient (ICC).

RESULTS

The questionnaire had an appropriate content validity index of 0.91. The CPQ-P consists of 22 items, measuring 5 constructs, including morning chrono-habits, sleeping habits, evening eating, temporal eating, and pregnancy symptoms. The factor model showed good fit with χ2/df = 2.486, GFI = 0.893, CFI = 0.912, and RMSEA = 0.065. The 22 items in CPQ-P showed fair to excellent test-retest reliability (ICC: 0.42 to 0.98). The 5 constructs in CPQ-P were found to have a good to excellent internal consistency (α = 0.612-0.963).

CONCLUSIONS

The CPQ-P is a valid and reliable tool for assessing lifestyle habits during pregnancy. The questionnaire can be used to identify areas where pregnant women may need additional support or intervention to adopt healthy behaviours and reduce the risk of adverse maternal and foetal outcomes.

TRIAL REGISTRATION

NCT05700136 (clinicaltrials.gov). Trial registration date: 26/01/2023.

Conceptualization and Assessment of 24-H Timing of Eating and Energy Intake: A Methodological Systematic Review of the Chronic Disease Literature

Timing of eating (TOE) and energy intake (TOEI) has important implications for chronic disease risk beyond diet quality. The 2020 Dietary Guidelines Advisory Committee recommended developing consistent terminology to address the lack of TOE/TOEI standardization. The primary objective of this methodological systematic review was to characterize the conceptualization and assessment of TOE/TOEI within the chronic disease literature (International Prospective Register of Systematic Reviews registration number: CRD42021236621). Literature searches in Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Embase, PubMed, and Scopus were limited to English language publications from 2000 to August 2022. Eligible studies reported the association between TOE/TOEI and obesity, cardiovascular disease, type 2 diabetes mellitus, cancer, or a related clinical risk factor among adults (≥19 y) in observational and intervention studies. A qualitative synthesis described and compared TOE/TOEI conceptualization, definitions, and assessment methods across studies. Of the 7579 unique publications identified, 259 studies (observational [51.4 %], intervention [47.5 %], or both [1.2 %]) were eligible for inclusion. Key findings indicated that most studies (49.6 %) were conducted in the context of obesity and body weight. TOE/TOEI variables or assigned conditions conceptualized interrelated aspects of time and eating or energy intake in varying ways. Common TOE/TOEI conceptualizations included the following: 1) timepoint (specific time to represent when intake occurs, such as time of breakfast [74.8 %]); 2) duration (length of time or interval when intake does/does not occur, such as "eating window" [56.5 %]); 3) distribution (proportion of daily intake at a given time interval, such as "percentage of energy before noon" [29.8 %]); and 4) cluster (grouping individuals based on temporal ingestive characteristics [5.0 %]). Assessment, definition, and operationalization of 24-h TOE/TOEI variables varied widely across studies. Observational studies most often used surveys or questionnaires (28.9 %), whereas interventions used virtual or in-person meetings (23.8 %) to assess TOE/TOEI adherence. Overall, the diversity of terminology and methods solidifies the need for standardization to guide future research in chrononutrition and to facilitate inter-study comparisons.

Sleep and circadian hygiene practices association with sleep quality among Brazilian adults

Objective

To investigate the association of sleep and circadian hygiene practices (sleep-promoting and sleep-disturbing behaviors) with sleep quality indicators.

Methods

Participants (n = 2050; 18-65 y) were part of virtual population-based research. Logistic regression models were fitted to assess differences in the OR (95% CI) of poor quality with sleep-promoting/disturbing practices (time-of-day of exercise, pre-bedtime routine, naps, electronic devices with illuminated screens, caffeine and alcohol consumption, and smoking). Linear regression analyses evaluated differences in sleep duration, latency, and awakenings associated with the same variables. Restricted cubic splines were used to study the shape of the association of screen time before bed with sleep duration, latency, and awakenings. Analyses were adjusted for age, sex, region, marital status, educational level, evening diet quality, and BMI.

Results

Evening use of electronic devices with illuminated screens showed a negative effect on all sleep parameters. Reporting dinner as the largest meal and evening caffeine consumption was associated with shorter sleep duration and longer sleep latency. Smokers had higher odds of longer latency. A protective effect of morning exercises was demonstrated on sleep quality, latency, and awakenings. Alcohol consumers presented lower odds of poor quality and lower frequency of awakenings. Pre-bedtime practices showed no or negative effect on sleep outcomes.

Conclusions

Recommendations to promote sleep quality and prevent sleep-related problems, with corresponding circadian health benefits, should include engaging in regular exercise, preferably in the morning, and avoiding naps, heavy meals close to bedtime, caffeine, smoking, and evening screen exposure.

Chrononutrition behaviors, sugar-sweetened beverage consumption, sleep quality and the association with body mass index among Malaysian women

The present study aimed to determine the association between chrononutrition behaviors, sugar-sweetened beverage intake, and sleep quality among Malaysian women. A cross-sectional study using a validated, self-administered Chrononutrition Profile Questionnaire, Beverage Questionnaire and Sleep Quality Index were conducted among 934 Malaysian women. Multinomial logistic regression was performed to obtain odds ratios of being overweight/underweight and to test the association with poor sleep quality. 40% of Malaysian women were either overweight or obese and 65.4% had poor sleep quality. We found that breakfast skipping (OR: 4.101; CI: 2.378-7.070), poor evening eating (OR: 4.073; CI: 1.631-10.186), and eating the largest meal at night (OR: 6.970; CI: 1.944-24.994) increased the odds of being underweight. On the other hand, the daily consumption of 100% fruit juices (OR: 1.668; CI: 1.058-1.731), daily consumption of sweetened coffee or tea (OR: 1.707; CI: 1.162-2.508) and consumption of diet soft drinks by 6 times or fewer (OR: 1.484; CI: 1.066-2.064) are associated with increased odds of being overweight. However, when adjusted, only poor evening latency (AOR: 16.638; CI: 1.986-139.383) revealed an increased odd of being underweight. The highest odds predicting poor sleep quality were found for eating the largest meal during dinner (OR: 3.696; CI: 1.967-6.945) and (AOR: 2.194; CI: 1.119-4.304) when adjusted. Hence, the result indicates that multifactorial impacts on women's body weight and recommendations to adjust chrononutrition and sugar-sweetened beverages intake in lifestyle must be done carefully considering other parameters together.

Association between circadian clock gene expressions and meal timing in young and older adults

Ageing is associated with a decline in circadian clock systems, which correlates with the development of ageing-associated diseases. Chrononutrition is a field of chronobiology that examines the relationship between the timing of meal/nutrition and circadian clock systems. Although there is growing evidence regarding the role of chrononutrition in the prevention of lifestyle and ageing-related diseases, the optimal timing of meal intake to regulate the circadian clock in humans remains unknown. In this study, we investigated the relationship between clock gene expression and meal timing in young and older adults. In this cross-sectional study, we enrolled 51 healthy young men and 35 healthy older men (age, mean±standard deviation: 24 ± 4 and 70 ± 4 y, respectively). Under daily living conditions, beard follicle cells were collected at 4-h intervals over a 24-h period to evaluate clock gene expression. Participants were asked to record the timing of habitual sleep and wake-up, breakfast, lunch, and dinner. From these data, we calculated "From bedtime to breakfast time," "From wake up to first meal time," and "From dinner to bed time." NR1D1 and PER3 expressions in older adults at 06:00 h were significantly higher than those in young adults (P = 0.001). There were significant differences in the peak time for NR1D2 (P = 0.003) and PER3 (P = 0.049) expression between young and older adults. "From bedtime to breakfast time" was significantly longer in older adults than in young adults. In contrast, "From dinner to bed time" was significantly shorter in older adults than in young adults. Moreover, higher rhythmicity of NR1D1 correlated with longer "From bedtime to breakfast time" (r =  -0.470, P = 0.002) and shorter "From wake up to first meal time" in young adults (r = 0.302, P = 0.032). Higher rhythmicity of PER3 correlated with longer "From bedtime to breakfast time" in older adults (r =  -0.342, P = 0.045). These results suggest that the peak time of clock gene expression in older adults may be phase-advanced compared to that in young adults. In addition, a longer fasting duration from bedtime to breakfast in both young and older adults and earlier intake of meals after waking up in young adults may correlate with robust clock gene expression rhythms.

Eating window and eating habits of adults in China: A cross-sectional study

Objective

Previous studies have demonstrated that eating time and habits play key roles in human health. However, there is a paucity of research on the epidemiology of eating window and eating habits in China. This study aimed to investigate the relationship between eating window and eating habits among adults in mainland China and explore the factors influencing these parameters.

Design

Cross-sectional study.

Setting

A questionnaire comprising demographic data, metabolic index, eating window and eating habits was administered via the Internet.

Participants

1596 adults from mainland China.

Results

Eating window of all participants was 13.03 ± 2.02 h (mean ± standard deviation [SD]), which was longer than previously reported in smaller more controlled studies from China. Area of residence and occupation were significant factors influencing eating window after controlling for other factors (area of residence: β, -0.499; 95% confidence interval [CI], -0.897 to -0.101, p = 0.014; occupation: β, -0.309, 95% CI, -0.496 to -0.121, p = 0.001). Participants typically commenced eating at 08:00 h (interquartile range [IQR]: 8:00-9:00) and ceased eating at 20:00 h (IQR: 20:00-22:00). Regular meals which mean two or three meals per day regularly constituted the dominant eating pattern of participants (n = 1233, 77.3%) and 819 (51.1%) participants preferred cooking for themselves.

Conclusion

This study revealed that eating window of adults in China generally around 13 h. Area of residence and occupation were the main factors influencing eating window. Our data provide a foundation for future studies on eating window and eating habits in China.

Weight status of working adults: The effects of eating misalignment, chronotype, and eating jetlag during mandatory confinement

This study aimed to examine the association between chronotype, eating jetlag, and eating misalignment with weight status among Malaysian adults during the COVID-19 restriction. This online cross-sectional study included 175 working adults recruited from March to July 2020. The chronotype was assessed using Morningness Eveningness Questionnaire (MEQ) while eating jetlag and mealtime variability were measured using Chrononutrition Profile Questionnaire (CPQ). Multiple linear regression demonstrated that lower breakfast frequency (β=-0.258, p = .002) and longer eating duration (β = 0.393, p < .001) were associated with later first eating events on workfree days. Both intermediate (β = 0.543, p < .001) and evening chronotypes (β = 0.523, p = .001) tend to eat their first meals later compared to morning person. Similar patterns were observed for overall eating jetlaggers in which lower breakfast frequency (β=-0.022, p = .011), longer eating duration (β = 0.293, p < .001), intermediate chronotype (β = 0.512, p < .001), and evening chronotype (β = 0.495, p = .003) were associated with eating later meals on workfree days. Additionally, higher BMI was also associated with eating later meals on workfree days (β = 0.181, p = .025). During movement restriction, discrepancies of mealtimes during work and workfree days offer new insight into modern eating habits that can influence weight status and general eating habits such as breakfast skipping and total daily eating duration. Population meal timing variability was affected during movement restrictions, and it was closely related to weight status.

Translation, adaptation and validation of the Chrononutrition Profile - Questionnaire (CP-Q) in Brazilian Portuguese

Chrononutrition is a science that studies the relationship between mealtimes and sleep/wake habits. However, these behaviors are not evaluated by a single questionnaire. Therefore, this study aimed to translate and culturally adapt the Chrononutrition Profile - Questionnaire (CP-Q) into Portuguese and validate the Brazilian version. The translation and cultural adaptation process consisted of: translation; synthesis of translations; backtranslation; expert committee and pre-test. The validation was performed with 635 participants (32.4 ± 11.2 years) who answered the CPQ-Brazil and Pittsburgh Sleep Quality Index (PSQI); Munich Chronotype Questionnaire (MCTQ); Night Eating questionnaire; Quality of life and health index (SF-36) and 24 h-recall. The participants were mostly female, single, from the northeastern region, a eutrophic profile, and average quality of life score of 55.8 ± 17.9. Moderate to strong correlations were observed in the sleep/wake schedules between CPQ-Brazil, PSQI and MCTQ, both for work/study days and free days. The correlations between largest meal, skipping breakfast, eating window, nocturnal latency, and last eating event with the same variables in the 24 h-recall showed moderate to strong positive correlations. The translation, adaptation, validation and reproducibility of the CP-Q generates a valid and reliable questionnaire to assess the sleep/wake and eating habits in the Brazilian population.

Chrononutrition behavior during the COVID-19 pandemic and its relationship with body weight among college students

Introduction

Students in colleges are exposed to unhealthy lifestyles and poor dietary choices. They are at risk of being overweight, skipping meals, and developing eating disorders. However, there is a paucity of information on their chrononutrition behavior, which is very important, especially concerning the timing of food consumption across the day. Therefore, the present study aimed to investigate chrononutrition behavior and its potential association with body weight status among college students in Malaysia.

Methods

This cross-sectional study was conducted on 409 college students aged above 18 in Malaysia. The chrononutrition behavior was assessed using the validated Chrononutrition Profile Questionnaire (CP-Q). The questionnaire was distributed using an online platform. Participants self-reported their body weight and height, and the Body Mass Index (BMI) was computed. Data were analyzed using the SPSS software.

Results

A total of 409 participants were recruited, with a mean age of 21.5 ± 2.2 years. The prevalence of underweight, normal, and overweight was 24.7, 49.4, and 25.9%, respectively. The chrononutrition behavior revealed that participants ate breakfast about four times/week (mean 4.27 ± 2.43 days), and only 135 (33.0%) consumed breakfast daily. The largest meal consumed was during lunch (75.8%), and the mean of snacking after the last meal was 3.23 ± 2.01 days. The prevalence of night eating was low, and most participants (70.9) did not wake up at night to eat. The frequency, however, was significantly higher in the underweight group compared to the normal weight group (p < 0.05). We observed a significant association between BMI and eating window, evening latency, evening eating, and night eating. It was found that the underweight had a poor eating window (p < 0.01), poor evening latency (p < 0.01), poor evening eating (p < 0.01), and poor night eating (p < 0.05) compared to those with normal and overweight BMI groups. In contrast to predictions, poor chrononutrition behavior was more likely to predict being underweight compared to normal (p < 0.05).

Conclusion

Underweight young adults are more likely to have poor chrononutrition behavior. The results of the present study suggest that future nutrition education should also focus on the chrononutrition behavior of college students.

Chrononutrition is associated with melatonin and cortisol rhythm during pregnancy: Findings from MY-CARE cohort study

Chrononutrition has been suggested to have an entrainment effect on circadian rhythm which is crucial for metabolic health. Investigating how chrononutrition affects maternal circadian rhythm can shed light on its role during pregnancy. This study aims to determine chrononutrition characteristics of healthy primigravida during pregnancy and its association with melatonin and cortisol rhythm across gestation. A total of 70 healthy primigravidas were recruited from ten randomly selected government maternal and child clinics in Kuala Lumpur, Malaysia. During the second and third trimesters, chrononutrition characteristics including meal timing, frequency, eating window, breakfast skipping, and late-night eating were determined using a 3-day food record. Pregnant women provided salivary samples at five time-points over a 24 h period for melatonin and cortisol assay. Consistently across the second and third trimesters, both melatonin and cortisol showed a rhythmic change over the day. Melatonin levels displayed an increment toward the night whilst cortisol levels declined over the day. Majority observed a shorter eating window (≤12 h) during the second and third trimesters (66 and 55%, respectively). Results showed 23 and 28% skipped breakfast whereas 45 and 37% ate within 2 h pre-bedtime. During the third trimester, a longer eating window was associated with lower melatonin mean (β = -0.40, p = 0.006), peak (β = -0.42, p = 0.006), and AUC_G (β = -0.44, p = 0.003). During both trimesters, a lower awakening cortisol level was observed in pregnant women who skipped breakfast (β = -0.33, p = 0.029; β = -0.29, p = 0.044). Only during the second trimester, breakfast-skipping was significantly associated with a greater cortisol amplitude (β = 0.43, p = 0.003). Findings suggest that certain chrononutrition components, particularly eating window and breakfast skipping have a significant influence on maternal melatonin and cortisol rhythm. Dietary intervention targeting these characteristics may be useful in maintaining maternal circadian rhythm.

Adaptation and Validation of the Malay-Chrononutrition Profile Questionnaire to Assess Chrononutrition Behavior of Young Adults in Malaysia

Background

Chrononutrition studies how biological rhythms and nutrition are associated with human health. However, a validated assessment in Malaysia is still absent.

Objectives

To create a translation of the Chrononutrition Profile Questionnaire (CPQ), test its validity and reliability, and determine the general chrononutrition behaviors among Malaysian young adults.

Methods

The Malay-CPQ was distributed to respondents through online platforms (n = 110), and data analyses were performed. The data were analyzed for their validity using content validity index (CVI) and face validity index (FVI), whereas intraclass correlation coefficient (ICC) was used to determine test-retest reliability.

Results

Our results showed both CVI and FVI of Malay-CPQ were 1, indicating excellent content translation, while the ICC values ranged from moderate to good (0.50-0.90). The Cronbach α values for all items ranged from moderate to good (0.50-0.90), and the Bland-Altman analysis showed a P value >0.05, indicating agreement of the item between repeated measurements. The chrononutrition behaviors among Malaysian young adults presented fair to good scores for all behavior patterns: eating window, breakfast skipping, evening eating, night eating, and largest meal, except evening latency, being mostly at the poor score (>80% responses).

Conclusions

The Malay-CPQ is a valid and reliable tool to assess the Malaysian chrononutrition profile. However, further testing on Malay-CPQ should be conducted in a different setting in Malaysia for cross-validation studies.

Morning individuals in Saudi Arabia have higher self-regulation of eating behavior compared to evening types

Chronotype is a manifestation of an individual's circadian system, which can be presented as a preference for morningness or eveningness. Evening chronotype has been linked to unhealthy dietary habits. These habits are partially from poor self-regulation of eating behavior (SREB). SREB is a goal-directed process that helps resist food temptation and achieve desired dietary outcomes. It is unclear whether chronotype is associated with SREB. This study aims to investigate the association between chronotypes and SREB. A total of 599 adults (18-50 years) enrolled in this cross-sectional study. Participants received an online questionnaire that collected sociodemographic, anthropometrics, chronotype through the validated reduced Morningness-Eveningness Questionnaire (rMEQ) and SREB using the SREB Questionnaire. ANOVA, Chi-square and multivariate logistic regression were used. In adjusted models, morning types had 85% higher SREB compared to evening types (p = 0.003, OR = 1.85). Evening types found fried foods (p = 0.003), chips (p = 0.005) and French fries (p = 0.018) more tempting than morning types. These findings show a link between chronotype and SREB. Strategies focusing on SREB may help evening types improve dietary habits. Further studies are required to clarify the underlying mechanisms for these associations. This may have important implications for lifestyle and behavioral change policy.

Chronotype, chrononutrition and glucose tolerance among prediabetic individuals: research protocol for a prospective longitudinal study Chrono-DM™

BACKGROUND

Chronotype and chrononutrition, both are emerging research interests in nutritional epidemiology. However, its association with glycemic control in the Asia population is less clear. A better understanding of how activity/eating time can influence glucose levels in Asian prediabetic individuals may improve strategies for blood glucose control in Asian countries. The present paper describes the research protocol which aims to determine the associations of chronotype and chrononutrition with glucose tolerance among Malaysian prediabetic individuals.

METHODS

This is a prospective longitudinal study named Chrono-DM™, that targets to recruit 166 newly diagnosed prediabetic individuals from the community clinics in Malacca, Malaysia. Respondents will be followed-up for 6 months: (1) baseline (1^st oral glucose tolerance test (OGTT)); (2) second visit (at 3^rd month); and (3) third visit (2^nd OGTT at 6^th month). Data collection includes sociodemographic and anthropometry measurements (weight, height, body fat, visceral fat, waist and hip circumference). Dietary intake and meal timing are collected using the 3-day dietary record while data on sleep pattern, light exposure, chronotype and chrononutrition will be collected using validated questionnaires. Physical activity will be recorded using a validated IPAQ questionnaire and pedometer during periods of using continuous glucose monitoring (CGM) sensor. CGM, fasting blood sugar (FBS), OGTT and HbA1c are performed to assess glycemic outcomes.

DISCUSSION

The Chrono-DM™ study represents a novel approach to determining the association of chronotype and chrononutrition with glycemic control. We anticipate that this study will not only review the association of chronotype with glycemia measure but also provide greater insight into optimal meal time for glycemic control among prediabetic individuals in the Asian population.

TRIAL REGISTRATION

NCT05163964 (Clinicaltrial.gov). Trial registration date:  20 December 2021.

The Effect of Personality on Chrononutrition during the COVID-19 Lockdown in Qatar

The COVID-19 lockdown has had a significant impact on people’s lives worldwide. This study aimed to investigate the effect of personality on chrononutrition during the COVID-19 lockdown. Using a cross-sectional design, a convenient sample of 543 adults in Qatar completed an online questionnaire using validated tools to assess personality and chrononutrition behaviors during the first COVID-19 lockdown. Participants scoring high in openness were more likely to eat at night (mean difference (MD) = 0.41, 95% confidence interval (CI): 0.10, 0.72) compared to those scoring high in agreeableness, while those scoring high in extraversion and openness had a shorter eating window (MD = −76.6, 95%CI: −146.3, −6.93 and MD = −29.8, 95%CI: −56.5, −3.01, respectively). Participants high in extraversion had longer evening latency (MD = 66.3, 95%CI: 25.4, 107.3) and evening eating (MD = −62.0, 95%CI: −114.0, −9.0) compared those high in agreeableness. Participants high in conscientiousness showed evidence of first eating event misalignment during the weekend (MD = 22.0, 95%CI: 0.15, 43.9) and last eating event misalignment during weekdays (MD = −27.8, 95%CI: −47.3, −8.41) compared to those high in agreeableness. Lastly, participants high in openness showed evidence of eating window misalignment during the weekend (MD = 30.6, 95%CI: 5.01, 56.2). This study suggests that personality traits can inform personalized nutritional approaches when aiming for healthy habits during unexpected periods, such as the COVID-19 pandemic.

Development and validation of the Chrononutrition Profile - Diary

The circadian timing of food intake (i.e., chrononutrition) has been linked to various markers of health status, such as body weight and insulin sensitivity. However, a valid assessment of day-to-day, within-person patterns in chrononutrition has not yet been developed. This paper details the development and initial validity testing of the Chrononutrition Profile - Diary (CP-D). The CP-D assesses 6 components of chrononutrition that are likely to influence health (breakfast skipping, largest meal, evening eating, evening latency, night eating, and eating window). This measure demonstrated preliminary evidence of convergent validity with the ASA24 (Automated Self-Administered 24-hour dietary assessment tool). The CP-D is designed for use by both healthcare professionals and researchers. It can serve as an independent assessment of day-to-day patterns of chrononutrition, and can also be used along with existing dietary measures to provide a comprehensive assessment of participants' and patients' daily eating behaviors and meal timing patterns.

Evaluation of the Chrononutrition Profile - Questionnaire in an online community sample of adults

Chrononutrition (i.e., circadian timing of food intake) has been linked to indicators of health status such as body weight and insulin resistance. A measure of general chrononutrition patterns, the Chrononutrition Profile - Questionnaire, has been developed and preliminary evidence of validity and reliability of the measure has been documented in a homogenous group of undergraduates. However, this measure has not yet been validated in an online, community-based sample. The present study therefore aimed to evaluate the validity of the Chrononutrition Profile - Questionnaire in a web-based community sample. Analyses suggested that the Chrononutrition Profile - Questionnaire displays acceptable validity for use in diverse community samples of adults, with moderate to strong correlations (r = 0.39-0.91) between the Chrononutrition Profile - Questionnaire and measures of dietary intake and sleep. This measure is suitable for use in a variety of settings, by stakeholders and scientists, and may contribute to future development of health behavior interventions and research programs centered around chrononutrition.

Late chronotypes, late mealtimes. Chrononutrition and sleep habits during the COVID-19 lockdown in Italy

The emerging field of chrononutrition provides useful information on how we manage food intake across the day. The COVID-19 emergency, and the corresponding restrictive measures, produced an unprecedented change in individual daily rhythms, possibly including the distribution of mealtimes. Designed as a cross-sectional study based on an online survey, this study aims to assess the chrononutrition profiles (Chrononutrition Profile Questionnaire, CP-Q) in a sample of 1298 Italian participants, during the first COVID-19 lockdown, and to explore the relationship with chronotype (reduced Morningness-Eveningness Questionnaire, rMEQ), sleep quality (Pittsburgh Sleep Quality Index, PSQI) and socio-demographics. Our findings confirm a change in eating habits for 58% of participants, in terms of mealtimes or content of meals. Being an evening chronotype and experiencing poor sleep imply a higher likelihood of changing eating habits, including a delay in the timing of meals. Also, under these unprecedented circumstances, we report that the timing of breakfast is a valuable proxy capable of estimating the chronotype. From a public health perspective, the adoption of this straightforward and low-cost proxy of chronotype might help in the early detection of vulnerable subgroups in the general population, eventually useful during prolonged stressful conditions, as the one caused by COVID-19 pandemic.

Poor sleep quality and unhealthy lifestyle during the lockdown: an Italian study

Background

The lockdown measure implemented to face the 2019 Coronavirus Disease (COVID-19) first wave deeply modified the lifestyle of the Italian population. Despite its efficacy in limiting the number of infections, forced home confinement was paralleled by sleep/wake cycle disruptions, psychological distress and maladaptive coping strategies (i.e., unhealthy behaviours, such as tobacco and alcohol consumption). Under these unprecedented stress conditions, we explored a possible association between poor sleep quality and increased likelihood of engaging in an unhealthy lifestyle.

Methods

A cross-sectional study was conducted by disseminating an online survey via social networks and e-mail. We collected information on demographics, COVID-19-related data, sleep quality, chronotype, circadian misalignment, and lifestyle before and during the lockdown (i.e., consumption of cigarettes, alcoholic beverages, coffee, hypnotics, comfort food and fresh food; practice of physical activity). A global healthiness score was computed to assess participants’ modifications in lifestyle since the beginning of the lockdown.

Results

1297 respondents were included in the study: 414 (31.9%) from Northern Italy, 723 (55.8%) from Central Italy, 160 (12.3%) from Southern Italy. The following variables were found to be significant predictors of the adoption of an unhealthy lifestyle since the beginning of the lockdown: poor sleep quality, high BMI and considering the measures adopted by the government to fight the pandemic as excessive. Living in Northern Italy, instead, was associated with healthier habits compared to living in Central Italy.

Conclusions

Poor sleepers may represent the share of the general population who paid the highest price for social isolation. Further investigations are required to explore the role of sleep quality assessment in the identification of individuals vulnerable to unhealthy behaviours under stressful conditions.

Is chronotype associated with dietary intake and weight gain during pregnancy? A prospective and longitudinal study

OBJECTIVES

The effects of chronotype on dietary intake and weight gain during pregnancy have not been addressed in the literature. The aim of this study was to analyze the effect of chronotype on eating patterns, energy, and macronutrient intake and distribution, as well as weight gain during pregnancy.

METHODS

This was a prospective cohort study carried out with 100 pregnant women in the first, second, and third gestational trimesters. Dietary intake was assessed by three 24-h dietary recalls in each trimester, totaling nine recalls. Energy and macronutrient intake and distribution were evaluated at meals throughout the day. Chronotype was derived from midsleep time on free days, and the scores obtained were categorized into tertiles. Recommendations from the Institute of Medicine were used to assess the adequacy of weight gain. Generalized estimating equation models were used to determine the effects of chronotype and gestational trimester on eating patterns, daily energy, macronutrient distribution, and weight gain.

RESULTS

Pregnant women with values for midsleep time on free days indicative of eveningness have breakfast later and also have higher energy and carbohydrate intake at dinner than "morning" women. Pregnant "morning" women showed better diet quality in terms of milk and dairy and saturated fat. Also, despite the tendency for all tertiles to gain excess weight during pregnancy, we found that pregnant women with a tendency to eveningness had worse adequacy of gestational weight gain in the third trimester than "morning" women (2.24 ± 0.25 versus 1.22 ± 0.14, P < 0.001).

CONCLUSION

Pregnant women with a tendency to eveningness consume breakfast later in the day and exhibit greater consumption of energy and carbohydrates in the evening, as well as a worse standard of gestational weight gain in the third trimester. Our results emphasize the importance of considering chrononutrition variables in prenatal nutritional guidelines to promote maternal and fetal health.

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

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

An examination of eating misalignment: The discrepancy between preferred and actual timing of food intake

Both internal (e.g., preferences) and external (e.g., social) factors guide chrononutrition (i.e., the timing of food intake), but the nature and variability of chrononutrition preferences (i.e., preferred timing of food intake) have not been empirically evaluated. The present study aimed to characterize the variability and range of chrononutrition preferences and to evaluate the extent of eating misalignment, defined as the discrepancy between chrononutrition preferences and chrononutrition behaviors. 192 undergraduate students aged 18 to 31 years self-enrolled in an online questionnaire study. Participants provided demographic information and completed the Chrononutrition Profile - Questionnaire to evaluate chrononutrition preferences, chrononutrition behaviors, and eating misalignment. Results indicated high inter-individual variability in chrononutrition preferences and eating misalignment, with extreme cases of eating misalignment across all chrononutrition facets. This study is the first to confirm that when individuals want to eat may differ from when they actually eat. With additional research, these constructs may be meaningful to consider, together with other aspects of chrononutrition, in the development of future chrononutrition-based intervention efforts.