Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia: a systematic review and meta-analysis

BACKGROUND

To ensure a child's full growth, health, and development during infancy and the early years, adequate nutrition is crucial. A crucial window of opportunity for ensuring children's proper growth and development through adequate eating exists during the first two years of life. According to the evidence of the efficacy of interventions, achieving universal coverage of optimal breastfeeding could prevent 13% of deaths in children under the age of 5 worldwide, and using complementary feeding methods appropriately would lead to an additional 6% decrease in under-five mortality.

METHODS

From several electronic databases, all published, unpublished, and gray literature was extracted and exported into EndNote version X20. For further analysis of the review, the retrieved data from the excel sheet were imported into the statistical software program Stata version. Metanalysis was used to determine the prevalence of MAD, and a random effects model was used to estimate the pooled prevalence of MAD. The DerSimonian-Laird Random effects model (REM) was used to combine the determinant factors from all qualifying papers for the meta-analysis, and the heterogeneity was independently assessed using a χ2 test, Q statistics, and matching I2 statistics. To retrieve the extent of publication bias, funnel plots were scattered and tested for asymmetry and, additionally, Egger's test was computed with the user-written "meta bias" command in Stata (version 11) software. To end, sensitivity analyses with trim and fill were performed.

RESULTS

The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia was 22% with (95% CI: 16, 28%) with a random effect model. However, eight papers were filled during trim and fill in order to counteract the small study effect. The overall filled pooled estimate was 7.9% with (95%CI: 11, 14.8%). Maternal education (primary and secondary) is 1.714 (95% CI 1.244,2.363) and 2.150(95% CI: 1.449,3.190), respectively, Ages of children with range of 12-17 months (2.158 (95% CI 1. 9,3.006) and 18-23 months 2.948(95% CI: 1.675,5.190)), Nutrition information ((1.883 (95% CI 1.169,3.032)) media exposure (1.778(95% CI: 1.396,2.265), and maternal knowledge (2.449 (95% CI 1.232, 5.027) were significantly associated with MAD.

CONCLUSION

The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia were low. Maternal education (primary and secondary), ages of child with range of 12-17 month and 18-23 months, mothers having nutrition information, mothers who have media exposure,and mothers having good knowledge were significantly associated with Minimum acceptable diet. The government, NGO, and other stakeholders should focus on improving Minimum acceptable diet among 6 to 23 months of children through promoting with mass media, focuses on nutrition council during critical contact point in health facility, and doing capacity building for the mothers/caregivers.

Meal Frequency Does Not Affect Weight Loss in Overweight/Obese Women but Affects the Body Composition: A Randomized Controlled Trial

OBJECTIVES

Studies showing the relationship between meal frequency, weight loss and anthropometric measurements are contradictory. This study aims to determine the effect of meal frequency on weight loss, anthropometric measurements, and body composition.

METHODS

This is a parallel designed randomized control trial that was conducted with 40 female volunteers between the ages of 19-64 years, with a Body Mass Index (BMI) ≥27 who applied to a private clinic. Participants were randomized in two treatment arms (3 meals + 3 snacks/day (n = 20) vs 3 meals/day (n = 20)) and same dietary energy restriction (-500kcal) was applied for 3 months. Food consumption was questioned with 3 day food records, and anthropometric measurements and body composition were measured before the study and repeated each week till the end of the study by the researcher.

RESULTS

All of the participants completed the study period. Body weight (kg), BMI (kg/m2), total body fat (kg), body fat percentage (%), fat free mass (kg) and waist circumference (cm) decreased, while fat free mass percentage (%) increased significantly in both of the groups at the end of the study (p < 0.05). The rate of difference for body weight, BMI (kg/m2) and waist circumference (cm) were similar among the groups. When difference in body composition analyses was examined, the rate of reduction in total body fat (-18.82 ± 4.97% vs -14.87 ± 7.44%) and body fat percentage (%)(-10.79 ± 4.63% vs -7.68 ± 7.04%) and the rate of increase in fat free mass percentage (%)(7.65 ± 3.16% vs 5.04 ± 3.44%) were significantly higher in 3 meals + 3 snacks group (p < 0.05).

CONCLUSION

When energy restricted and balanced weight loss programs are applied, alteration in body weight, BMI and waist circumference is not affected from meal frequency, but body composition does.

CLINICAL TRIAL NUMBER

NCT05581862 (Date of Trial Registration: 13/10/2022).

Association of main meal frequency and skipping with metabolic syndrome in Korean adults: a cross-sectional study

BACKGROUND

Reduced meal frequency can increase the risk of metabolic syndrome (MetS). However, limited studies have examined the association between meal frequency and skipping meals with MetS. This study aims to analyze the association between main meal frequency and meal skipping with MetS in Korean adults aged ≥ 19 years.

METHODS

In this study, we included data from 22,699 Korean adult participants from the 2016-2020 Korea National Health and Nutrition Examination Survey (KNHANES). The 24-h dietary recall method was used to classify the participants into three groups based on main meal frequency (one, two, or three meals per day) and seven groups based on the type of main meal they skipped. Multivariable logistic regression analysis was conducted to determine the association between main meal frequency and the types of main meals skipped with the odds of MetS and its associated components. Appropriate estimates were accounted for using sampling weights, stratification, and clustering.

RESULTS

The prevalence of MetS in the study population was 33.8%. The average age of the participants was 47.2 years with 42.6% being men, and 57.4% being women. Men who consumed two meals per day had higher odds of MetS than those who consumed three meals per day (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.01-1.33). Women who consumed two meals per day, and skipped breakfast had increased odds of having elevated fasting blood glucose levels (OR 1.18, 95% CI 1.02-1.35), and elevated triglycerides (OR 1.19, 95% CI 1.02-1.39). However, women who skipped dinner had reduced odds of having elevated fasting blood glucose levels (OR 0.74, 95% CI 0.58-0.94).

CONCLUSIONS

Our findings suggest that meal frequency and the type of main meal skipped may be associated with MetS and emphasize the importance of consuming breakfast to prevent MetS.

Socio-cultural influences on children's feeding habits and feeding frequencies in Ouagadougou, Burkina Faso: a retrospective survey

BACKGROUND

From 6 months of age, children need, in addition to breast milk, a complementary food whose nutritional composition meets their needs. However, low consumption of child-specific foods in favor of adult foods has been documented. Thus, the lack of adaptation of children to family feeding conditions has been the source of frequent malnutrition in some low-income countries. In Burkina Faso, little data is available on family-type food consumption by children. The objective was to describe the socio-cultural influences on feeding habits and food consumption frequencies of infants aged 6-23 months in Ouagadougou.

METHODS

The study was conducted from March to June 2022 using a structured questionnaire. A reminder of the previous 24 h' meals was used to assess 618 children's food consumption. Mother-child pairs were selected using the simple random sampling method, and data collection was done by the interview method. Sphinx V5, IBM SPSS Statistics 20.0 and XLSTAT 2016 software were used to process data.

RESULTS

Influences between the consumption of certain foods and the mother's social status were observed. The most consumed foods are simple porridges (67.48%), Tô/rice (65.70%), cookies and cakes (62.94%), juices and sweetened drinks (62.94%). Cowpeas (17.31%), improved porridge (13.92%) and eggs (6.63%) are the least consumed. The most meals frequency was three meals daily (33.98%), and children with the minimum daily meal frequency were 86.41%. Principal component analysis showed that the mother's social status influenced the consumption of imported infant flours, fish soups, fruits, juices and sweetened drinks, cookies and cakes, simple porridge, and tô/rice. Concerning the consumption of local infant porridges, 55.72% of the children who consumed them appreciated positively. However, for 57.75% of the parents, the lack of information limits the consumption rate of this type of flour.

CONCLUSION

High consumption of family-type meals was observed and was influenced by parental social status. In addition, the rate of acceptable meal frequencies was generally high.

Dietary habits are associated with the prevalence of type 2 diabetes: a study among a middle eastern population

Worldwide type 2 diabetes (T2D) prevalence is increasing dramatically. The present study aimed to evaluate the association between dietary habits and T2D in an Iranian adult population using a cross-sectional analysis of the Shahedieh cohort study. Participants were adults aged 35-70 years (n 9261) from Zarch and Shahedieh, Yazd, Iran, who attended the baseline phase of the Shahedieh cohort study. Dietary habits including meal frequency, fried-food consumption, adding salt to prepared meals and grilled-food consumption were assessed by a standard questionnaire. T2D was defined as fasting plasma glucose (FPG) ≥126 mg/dl according to the American Diabetes Association. Multiple logistic regression assessed the association between dietary habits and T2D. Individuals who consumed a meal more than six times per day compared to three times per day had greater odds for T2D (OR 2⋅503, 95 % CI 1⋅651, 3⋅793). These associations remained significant in a fully adjusted model. There was a significant association between greater intakes of fried foods and prevalence of T2D (OR 1⋅294, 95 % CI 1⋅004, 1⋅668) in the adjusted model. No significant associations were observed between other dietary habits (adding salt to prepared meals and grilled-food consumption) and odds of T2D in all crude and adjusted models. In conclusion, we have highlighted the association between meal and fried-food consumption frequencies with risk of T2D. Large longitudinal studies in different ethnicities are needed to confirm these associations.

Effect of live yeast supplementation and feeding frequency in male finishing pigs subjected to heat stress

In growing pigs, reduced growth during heat stress (HS) is mainly related to decreased feed intake. The study aimed to determine whether the reported positive effects of live yeast (LY) supplementation in HS pigs were due to a modified feeding behaviour or energy metabolism, and if these can be replicated by imposing an increased meal frequency. The effect of LY supplementation (0 (NS) v. 100 (LY) g/ton of feed), and of feeding window (FW) (unlimited or Unli, 2FW of 1 h each and 8FW of 15 min each) were measured in entire male finishing pigs (n 36). Ambient temperature was at 22°C during the thermoneutral (TN) period (5 d) and at 28°C during the HS period (5 d). Heat exposure decreased DM intake (DMI) and retained energy (RE) (-627 and -460 kJ·kg BW^-0·60 · d^-1, respectively; P < 0·01). During HS, LY supplementation in Unli pigs decreased inter-meal intervals (P = 0·02) attenuating HS effect on DMI which tended to improve RE (P = 0·09). NS - 8FW had higher DMI and RE than NS - 2FW (P < 0·05) but protein deposition (PD) were similar. Supplemented pigs had higher PD during HS regardless of FW (+18 g · d^-1; P = 0·03). Comparing the 2FW groups, improved heat tolerance of LY-supplemented pigs were due to improved insulin sensitivity (P < 0·05) and latent heat loss capacity after a meal (P < 0·05) allowing them to increase their DMI (via an increased number of meals) and thus their energy efficiency. Imposing an increased meal frequency improved DMI in HS pigs but did not replicate positive effects of LY on PD.

Meal frequency and incidence of type 2 diabetes: a prospective study

Dietary habits play an important role in the development of obesity and type 2 diabetes. However, evidence on association between diet frequency and type 2 diabetes was limited and inconclusive. We aimed to examine the association between meal frequency and risk of type 2 diabetes. The cohort study used data from China Health and Retirement Longitudinal Study of 8874 community-dwelling people aged over 45 years. Participants were classified as eating two meals per day, three meals per day and four meals per day. Multiple Poisson regression models were used to examine risk of 4-year incident type 2 diabetes among people who ate more or less than three meals per day compared with people who ate three meals per day. We documented 706 type 2 diabetes cases during follow-up. After adjustment for known risk factors for type 2 diabetes, except for BMI, participants who ate four meals per day were at a lower risk of type 2 diabetes than those who ate three meals per day (relative risk(RR) = 0·73 (0·58, 0·92)). After further adjustment for baseline BMI, the association was slightly attenuated but remained statistically significant (RR = 0·76 (0·60, 0·97)). Subgroup analysis showed that the fully adjusted RR of type 2 diabetes for people eating four meals per day were 0·66 (0·48, 0·91) and 0·93 (0·65, 1·34) among those had a BMI < 25 and ≥ 25 kg/m², respectively. Eating four meals per day, compared with eating three meals per day was associated with lower risk of developing type 2 diabetes in a Chinese population, particularly in those with a BMI < 25 kg/m².

Joint association of meal frequency and diet quality with metabolic syndrome in Iranian adults

BACKGROUND

Metabolic syndrome (MetS) is a common complication that has been shown in various studies to be related to the frequency and timing of eating. We aimed to evaluate the relationship between meal timing and frequency with diet quality and prevalence of MetS.

STUDY DESIGN

Cross-sectional.

METHODS

We analyzed data from 850 adults (20 to 59 years) and divided the participants into different categories in terms of frequency of eating occasions (EO) (5 ≥ , 6-7 and 7 <), meal (2 ≥ and 3) and snack (2 ≥ , 3 and 4 ≤) in a day. Daily food consumption was assessed using the structured three 24-h recalls. The quality of diet we calculated using the food quality score (FQS). Metabolic syndrome was defined based on the guidelines of the national cholesterol education program adult treatment panel III (ATP III). The covariates-adjusted relationships between exposures and outcomes were investigated using a logistic regression test and two-way ANOVA.

RESULTS

The overall prevalence of MetS in participants was 34.2%. The average FQS was 28.0. Increased frequency of EOs and snacks was related to the higher prevalence of MetS ((OR, 1.72; 95% CI, 1.24, 2.37; P < 0.01) and (OR, 1.34; 95% CI, 1.07, 1.68; P, 0.01), respectively). The adjusted mean of FQS was not significantly different between the EO as well as meals and snack categories. The joint association of EO frequency and snack frequency with diet quality showed a higher chance of having MetS ( (OR, 2.36; 95% CI, 1.19, 4.66; P, 0.01 and (OR, 1.68; 95% CI, 1.06, 2.68; P,0.02), respectively). Also, we observed a higher mean of high density level cholesterol in people with the highest FQS and lowest EO frequency (P,0.02).

CONCLUSION

Our findings suggest that the EO and snack frequency may be associated with the higher chance of MetS. We also found when the frequency of EO increases, the beneficial associations of the diet quality were overshadowed. To confirm our findings, well designed randomised clinical trials are needed.

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

Background

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

Methods

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

Results

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

Conclusion

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

Trial registration

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

Supplementary Information

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Novel trends and concepts in the nutritional management of glycemia in type 2 diabetes mellitus-beyond dietary patterns: a narrative review

A variety of eating patterns are recommended by international guidelines to help people with type 2 diabetes mellitus (T2DM) achieve general health and glycemia goals. Apart from eating patterns, there is evidence that other approaches related to the everyday application of dietary advice, such as meal frequency, breakfast consumption, daily carbohydrate distribution, and order of food consumption during meals, have significant effects on glycemia management. The aims of this review were to examine published diabetes nutrition guidelines concerning specific recommendations with regard to the above approaches, as well as to review evidence from studies that have investigated their effect on glycemia in T2DM. The data suggest that eating breakfast regularly, consuming most carbohydrates at lunch, avoiding large dinners late at night, and applying the carbohydrate-last meal pattern are effective practices towards better nutritional management of T2DM.

Complementary feeding practices and associated factors among mothers of children aged 6-23 months in Ethiopia: Secondary data analysis of Ethiopian mini demographic and health survey 2019

BACKGROUND

Optimal nutrition in early child's life plays a vital role in improving mental and motor development, reduces the possibility of contracting various infectious diseases and related deaths, decreases the risk of obesity, and fosters better overall development. However, 45% of deaths in children under five years of age that occur globally is attributed to nutrition-related factors and the majority of these deaths occur in low-and middle-income countries. Therefore, this study aims to assess complementary feeding practices and associated factors among mothers of children aged 6-23 months in Ethiopia.

METHOD

The study used the Ethiopian mini demographic and health survey 2019 data. A two-stage stratified cluster sampling technique was used to select 1465 mothers of children aged 6-23 months in Ethiopia. Two-level multilevel mixed-effects logistic regression model analysis was computed, and variables with p-value of less than 5% and an adjusted odds ratio with a 95% confidence interval in the final model were reported as statistically significant factors with appropriate complementary feeding practice.

RESULT

The overall prevalence of appropriate complementary feeding practice among mothers of children aged 6-23 months was 9.76%. In our study, mothers who attended primary[AOR = 2.72; 95%CI: 1.47-5.01], secondary[AOR = 2.64; 95%CI: 1.18-5.92] and higher school[AOR = 5.39; 95%CI: 2.29-12.64], being from medium income household[AOR = 2.89; 95%CI: 1.41-5.92], attended 1-3 times ANC visits in index pregnancy[AOR = 0.41; 95%CI: 0.18-0.89], mothers who have 12-17 months[AOR = 1.96; 95%CI: 1.16-3.33] and 18-23 months old children[AOR = 2.61; 95%CI: 1.49-4.54], currently breastfeeding mothers[AOR = 3.69; 95%CI: 1.73-7.91], mothers from pastoralist contextual regions[AOR = 0.29; 95%CI: 0.09-0.91], and mothers who have resided in rural areas[AOR = 0.49; 95%CI: 0.25-0.97] were factors significantly associated with appropriate complementary feeding practice.

CONCLUSION

This study showed low prevalence of appropriate complementary feeding practice. Therefore, the concerned health authorities need to strengthen the existing approaches designed for provision of nutrition education particularly targeting mothers who are unschooled, who have 6-11 months old children, live in pastoralist regions and reside in rural parts of the country, and create strategies that improve maternal job opportunities.

Minimum acceptable diet and associated factors among children aged 6-23 months in Ethiopia

INTRODUCTION

The health and growth of children less than two years of age can be affected by the poor quality of complementary foods and poor feeding practices even with optimal breastfeeding. In Ethiopia, empirical evidence on the minimum acceptable diet and its associated factors is limited. Therefore, this study was aimed to assess the level of minimum acceptable diet and its associated factors among children aged 6-23 months in Addis Ababa Ethiopia.

METHODS

An institution-based Cross-sectional study was conducted among a total of 575 mother-child pairs. A simple random sampling technique was used to recruit participants. For infant and young child feeding practices, the data collection tools were adapted from world health organizations' standardized questionnaire which is developed in 2007. Data entry and analysis were performed using EPI data version 3.1 and SPSS version 20 respectively. Bivariable and multivariable logistic regression analyses were performed to determine predictor variables. Statistical significance was declared at p-value < 0.05.

RESULT

In this study, the level of minimum acceptable diet was found to be 74.6%.. About 90.6 and 80.2% of the children received minimum meal frequency and dietary diversity respectively. Having a husband secondary and above educational level [AOR = 4.789(95%CI:1.917-11.967)], being a housewife [AOR = 0.351(95% CI: 0.150-0.819)], having a history of more than three postnatal follow-ups [AOR = 2.616(95%CI:1.120-6.111], Having mothers age between 25 and 34 years [AOR = 2.051(95%CI:1.267-3.320)], being male child [AOR = 1.585(95%CI:1.052-2.388)] and having children age between 18 and 23 months [AOR = 3.026(95%CI:1.786-5.128)] were some of the factors significantly associated with a minimum acceptable diet.

CONCLUSION

In this study, the minimum acceptable diet among children aged 6-23 months was significantly associated with the educational status of the husband, mother's occupation, history of postnatal follow-up, age of the mother, sex of the child, and age of the child. Thus, attention should be given to educating the father, empowering mothers to have a job, promoting gender equality of feeding, and counseling on the benefit of postnatal care visits. In addition, the ministry of health should work on educating and advocating the benefit of feeding the recommended minimum acceptable diet to break the intergenerational cycle of malnutrition.

Only one in four lactating mothers met the minimum dietary diversity score in the pastoral community, Afar region, Ethiopia: a community-based cross-sectional study

Maternal dietary feeding practice is one of the proxy indicators of maternal nutrient adequacy and it improves outcomes for both mothers and their offspring. The minimum maternal dietary diversity score of lactating women is defined as when the mother ate at least four and above food groups from the nine food groups 24 h preceding the survey regardless of the portion size. Therefore, the present study aimed to determine the minimum dietary diversity score (MDDS) and its predictors among lactating mothers in the Pastoralist community, Ethiopia. A community-based cross-sectional study design was employed on 360 lactating mothers using a multi-stage sampling technique from 5 January 2020 to 10 February 2020. Data were collected using questionnaires and anthropometry measurements. Data were entered using EPI-data 4.6.02 and exported into SPSS version 25. Statistical significance was declared at P-value <0⋅05 at multivariable logistic regression. Only one in four lactating mothers met the MDDS. The majority of them consumed cereals in the preceding 24 h of data collection. The most important predictors were maternal meal frequency (adjusted odds ratio (AOR) 6⋅26; 95 % confidence interval (CI) (3⋅51, 11⋅15)), antenatal care (ANC) follow-up one to three times and four and above times (AOR: 2⋅58; 95 % CI (1⋅24, 5⋅36), 4⋅77 (1⋅90, 11⋅95), respectively) and secondary paternal education (AOR 2⋅97; 95 % CI (1⋅44, 6⋅11)). The MDDS among lactating mothers was low. Paternal education, maternal meal frequency and ANC follow-up were the significant predictors. Therefore, to improve maternal dietary diversity score emphasis should be given to those predictors.

Beneficial effects of a decreased meal frequency on nutrient utilization, secretion of luteinizing hormones and ovarian follicular development in gilts

Background

Replacement gilts are typically fed ad libitum, whereas emerging evidence from human and rodent studies has revealed that time-restricted access to food has health benefits. The objective of this study was to investigate the effect of meal frequency on the metabolic status and ovarian follicular development in gilts.

Methods

A total of 36 gilts (Landrace × Yorkshire) with an age of 150±3 d and a body weight of 77.6±3.8 kg were randomly allocated into one of three groups (n = 12 in each group), and based on the group allocation, the gilts were fed at a frequency of one meal (T1), two meals (T2), or six meals per day (T6) for 14 consecutive weeks. The effects of the meal frequency on growth preference, nutrient utilization, short-chain fatty acid production by gut microbial, the post-meal dynamics in the metabolic status, reproductive hormone secretions, and ovarian follicular development in the gilts were measured.

Results

The gilts in the T1 group presented a higher average daily gain (+ 48 g/d, P < 0.05) and a higher body weight (+ 4.9 kg, P < 0.05) than those in the T6 group. The meal frequency had no effect on the apparent digestibility of dry matter, crude protein, ether extract, ash, and gross energy, with the exception that the T1 gilts exhibited a greater NDF digestibility than the T6 gilts (P < 0.05). The nitrogen balance analysis revealed that the T1 gilts presented decreased urine excretion of nitrogen (− 8.17 g/d, P < 0.05) and higher nitrogen retention (+ 9.81 g/d, P < 0.05), and thus exhibited higher nitrogen utilization than the T6 gilts. The time-course dynamics of glucose, α-amino nitrogen, urea, lactate, and insulin levels in serum revealed that the T1 group exhibited higher utilization of nutrients after a meal than the T2 or T6 gilts. The T1 gilts also had a higher acetate content and SCFAs in feces than the T6 gilts (P < 0.05). The age, body weight and backfat thickness of the gilts at first estrous expression were not affected by the meal frequency, but the gilts in the T1 group had higher levels of serum luteinizing hormone on the 18th day of the 3rd estrus cycle and 17β-estradiol, a larger number of growing follicles and corpora lutea, and higher mRNA expression levels of genes related to follicular development on the 19th day of the 3rd estrus cycle.

Conclusions

The current findings revealed the benefits of a lower meal frequency equal feed intake on nutrient utilization and reproductive function in replacement gilts, and thus provide new insights into the nutritional strategy for replacement gilts, and the dietary pattern for other mammals, such as humans.

The effect of meal frequency on biochemical cardiometabolic factors: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Although several randomized controlled trials (RCTs) have supported the beneficial effects of higher meal frequency (MF) on cardiometabolic risk factors, the putative effects of higher MF on health remain inconclusive. This study systematically reviewed the evidence from RCTs of the effect of higher compared with lower MF on the blood lipid profile, glucose homeostasis, and adipokines.

METHODS

PubMed, Scopus, ISI Web of Science, and the Cochrane database were searched up to October 2020 to retrieve relevant RCTs. A DerSimonian and Laird random effects model was used to pool mean differences and 95% CI for each outcome. The quality of studies and evidence was assessed through standard methods.

RESULTS

Twenty-one RCTs (686 participants) were included in this meta-analysis. Overall results showed a significant improvement in total cholesterol [weighted mean difference (WMD) = -6.08 mg/dl; 95% CI: -10.68, -1.48; P = 0.01; I² = 88%], and low-density cholesterol (LDL-C) (WMD = -6.82 mg/dl; 95% CI: -10.97, -1.60; P = 0.009; I² = 85.7%), while LDL-C to high-density cholesterol ratio (LDL-C: HDL-C) increased (WMD = 0.22; 95% CI: 0.07, 0.36; P = 0.003; I² = 0.0%) in higher MF vs. lower MF. No significant effects were found on measures of glycemic control, apolipoproteins-A1 and B, or leptin. In subgroup analyses, higher MF significantly reduced serum triglyceride (TG), and increased HDL-C, compared with lower MF in interventions > 12 weeks, and decreased serum TC and LDL-C in healthy participants. A significant reduction in LDL-C also was observed in studies where the same foods given both arms, simply divided into different feeding occasions, and in feeding studies, following higher MF compared to lower MF.

CONCLUSION

Our meta-analysis found that higher, compared with lower MF may improve total cholesterol, and LDL-C. The intervention does not affect measures of glycemic control, apolipoproteins-A1 and B, or leptin. However, the GRADE ratings of low credibility of the currently available evidence highlights the need for more high-quality studies in order to reach a firm conclusion.

A latent class analysis of dietary behaviours associated with metabolic syndrome: a retrospective observational cross-sectional study

BACKGROUND

Obesity defined solely by the Body Mass Index (BMI) may not reflect the true heterogeneity of the obese population. This study aimed to classify the dietary behaviours of overweight and obese individuals and to explore the relationship between patterns of dietary behaviour and cardiometabolic risk factors.

METHODS

A total of 259 patients who visited an outpatient weight management clinic at a tertiary hospital and underwent a dietary behaviour assessment between January 2014 and February 2019 were enrolled in the study. Dietary behaviours were assessed in three domains with nine categories, including choice of food (frequently eating out and consumption of instant/fast/takeaway food), eating behaviour (irregular meals; frequent snacking, including eating at night; emotional eating; and overeating/binge eating), and nutrient intake (high-fat/high-calorie foods, salty food, and poorly balanced diet). Latent class analysis (LCA) was used to classify the subjects according to these categories. Associations between latent class and metabolic syndrome were assessed by logistic regression.

RESULTS

The subjects were classified into three LCA-driven classes, including a referent class of healthy but unbalanced eaters (n = 118), a class of emotional eaters (n = 53), and a class of irregular unhealthy eaters (n = 88). Compared with the referent class, emotional eaters had a significantly higher BMI (beta = 3.40, P < 0.001) accompanied by metabolic syndrome (odds ratio 2.88, 95% confidence interval 1.16-7.13).

CONCLUSIONS

Our three LCA-driven obesity phenotypes could be useful for assessment and management of obesity and metabolic syndrome. The association between emotional eaters and higher BMI and metabolic syndrome was stronger than that with other eaters. Thus, emotional regulation strategies might have benefit for emotional eater's diet.

Association of meal skipping with subjective health complaints in children and adolescents: the CASPIAN-V study

PURPOSE

Few studies have assessed the relationship between meal skipping with subjective health complaints in children and adolescents. The aim of our study was to determine the association between meal skipping and subjective health complaints in this population.

METHODS

A total of 14,400 students aged 7-18 years were selected using multistage stratified cluster sampling method from 30 provinces of Iran. Data were collected as a part of the fifth national school-based surveillance program (CASPIAN-V) in Iran. Information about students' lifestyle, health behaviours, health status and health complaints were gathered through a validated questionnaire.

RESULTS

The mean (standard deviation) age of participants was 12.3 (3.2) years old. Breakfast skipping was associated with increased odds of stomachache (OR 1.77, 95% CI 1.56, 2.00), backache (OR 1.68, 95% CI 1.46, 1.92), difficulty in getting to sleep (OR 1.66, 95% CI 1.48, 1.86), feeling nervous (OR 1.59, 95% CI 1.43, 1.76) and irritability (OR 1.29, 95% CI 1.02, 1.25). There were 27, 63, 58 and 107% increase in odds of headache, stomachache, backache and difficulty in getting to sleep by lunch skipping, respectively. While dinner skipping was related to 39, 59 and 52% increase in odds of headache, feeling low and difficulty in getting to sleep, respectively, it was associated with decreased odds of stomachache (OR 0.33, 95% CI 0.25, 0.44).

CONCLUSIONS

Our study suggests that meal skipping is associated with some somatic and psychological health complaints among children; therefore, regular meal consumption, at least three times a day, is highly recommended in this population.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Possible effects of a free, healthy school meal on overall meal frequency among 10-12-year-olds in Norway: the School Meal Project

Objective

To evaluate possible effects of intake of a free, healthy school meal on overall meal frequency among 10–12-year-olds in Norway. This was evaluated using a quasi-experimental school-based intervention study assessing children’s meal frequency retrospectively using a questionnaire in two elementary schools in the southern part of Norway in 2014/15. Multiple logistic regression analyses with breakfast, lunch, dinner, supper as dependent variables were used.

Results

A total of 164 children at baseline; 55 children in the intervention group and 109 children in the control group were included. The serving of a free school meal every day for 1 year did not improve the overall meal frequency in the intervention group compared to the control group. However, children in the intervention group had a lower odds of eating breakfast during weekends compared to the control group in crude analyses [odds ratio (OR) = 0.28 (95% confidence interval (CI) 0.09–0.84)] and in adjusted analyses [adjusted for baseline values, gender and socio-economic status) (OR = 0.15 (95% CI 0.03–0.72)]. Studies including larger study samples and therefore more statistical power are needed to further investigate possible effects of school meals on meal frequency.

Trial registration ISRCTN61703361, Date of registration: December 3rd, 2018, Retrospectively registered

Magnitude and determinants of complementary feeding practices in Ethiopia: A systematic review and meta-analysis

Background & aim

Concurrent estimates on the magnitude and evidence on the determinants of complementary feeding (CF) practices in Ethiopia are currently disparate. Hence, this systematic review and meta-analysis assessed the magnitude and determinants of CF among children age 6–23 months in Ethiopia.

Methods

Studies from various databases published until July 2018 were identified, selected, extracted and assessed for risk of bias by two authors independently. A random-effects model was used to pool the prevalence and odds ratios (ORs).

Results

26 studies with 17, 383 children were included. The pooled prevalence estimate of timely initiated CF, minimum dietary diversity (DD), minimum meal frequency and minimum acceptable diet were 61.0%, 18.0%, 56.0%, and 10.0% respectively. The pooled prevalence of timely initiation and minimum DD were higher in Northern Ethiopia. On the other hand, except for the minimum meal frequency, all the three core indicators of CF were better in urban than rural settings. Child age, maternal and/or paternal education, paternal involvement, maternal DD, antenatal and postnatal care, and place of delivery were the main determinants that can increase appropriate CF practices.

Conclusion

The reported estimates of the prevalence of core CF indicators in Ethiopia remained poor. Therefore, the authors would like to acknowledge the effort that has been done by the minister of health and its partners including Alive & Thrive to improving CF practices in the country, however, these programs should be done more thoroughly, and scaled up by applying and adapting tested, proven approaches and tools in contexts.

Uptake of minimum acceptable diet among children aged 6-23 months in orthodox religion followers during fasting season in rural area, DEMBECHA, north West Ethiopia

Background

Under-nutrition is the cause for poor physical and mental development and has more burden among infants and young children aged between 6 and 23 months. Cultural practices like not providing animal source foods for infants and young child aged between 6 and 23 months were barrier for practicing proper children feeding. The aim of this study was to assess minimum acceptable diet and associated factors among children aged between 6 and 23 months in Orthodox religion during fasting season in rural area, Dembecha, Ethiopia.

Methods

A community-based cross-sectional study was conducted to assess Minimum Acceptable diet.

Random sampling technique was applied to select 506 study participants. Interview was used to collect data on Practice of minimum acceptable diet, minimum dietary diversity, minimum meal frequency and related factors among children aged between 6 and 23 months from mothers / caregivers.

Result

About 8.6% of infants and young children aged between 6 and 23 months received minimum acceptable diet. Education status of mother(AOR = 0.22,95%CI:0.1, 0.48), involvement of mother in decision making (AOR = 0.22,95%CI:0.10,0.48), birth order of index children (AOR = 0.36,95%CI:0.14,0. 94), knowledge on feeding frequency (AOR = 0.3,95% CI:0.16,0.58), and institutional delivery (AOR = 5.13, 95%CI: 1.26, 20.80) were significantly associated with minimum acceptable diet.

Conclusion

Minimum acceptable diet practice was low. Educational status of mother, involvement of mother in decision making, knowledge on feeding frequency and institutional delivery were significantly associated with minimum acceptable diet. This indicates that nutrition education and counseling related to infant and young child feeding practice is not addressed for all mothers. Strengthening mothers’ education on acceptable child feed practice, and working with religion leaders to increase knowledge of mothers on child feed practice are recommended.

Electronic supplementary material

The online version of this article (10.1186/s40795-019-0274-y) contains supplementary material, which is available to authorized users.

Reduced meal frequency alleviates high-fat diet-induced lipid accumulation and inflammation in adipose tissue of pigs under the circumstance of fixed feed allowance

PURPOSE

The present study was conducted to determine whether reduced meal frequency (MF) could restore high-fat diet (HFD)-modified phenotypes and microbiota under the condition of fixed feed allowance.

METHODS

A total of 32 barrows with initial weight of 61.6 ± 0.8 kg were assigned to two diets [control diet (CON) versus HFD] and two meal frequencies [12 equal meals/day (M12) versus 2 equal meals/day (M2)], the trial lasted 8 weeks. The lipid metabolism and inflammatory response in adipose tissue as well as the profiles of intestinal microbiota and bacterial-derived metabolites were determined.

RESULTS

M2 versus M12 feeding regimen decreased perirenal fat weight and serum triglyceride and liposaccharide (LPS) concentrations in HFD-fed pigs (P < 0.05). Reduced MF down-regulated mRNA expression of lipoprotein lipase, CD36 molecule, interleukin 1 beta, tumor necrosis factor alpha, toll-like receptor 4, myeloid differentiation factor 88 (MYD88), and nuclear factor kappa beta 1 as well as protein expression of MYD88 in perirenal fat of HFD-fed pigs (P < 0.05). M2 feeding regimen increased abundance of Prevotella and decreased abundance of Bacteroides in colonic content of HFD-fed pigs (P < 0.05). No difference in short-chain fatty acids (SCFAs) profile in colonic content was observed among four groups (P > 0.05).

CONCLUSION

Our results suggested that M2 versus M12 feeding regimen ameliorated HFD-induced fat deposition and inflammatory response by decreasing fatty acid uptake and deactivating LPS/TLR4 signaling pathway in adipose tissue and restoring microbiota composition in distal intestine, without affecting SCFAs profile in distal luminal content.

Relationship Between Meal Frequency and Gastroesophageal Reflux Disease (GERD) in Iranian Adults

BACKGROUND

The association between frequency of meals and snacks and gastroesophageal reflux disease (GERD) is less studied in Middle-Eastern countries.

AIM

We aimed to determine the relationship between meal and snack frequency with GERD symptoms in a large sample of Iranian adults.

METHODS

In this cross-sectional study, 4669 individuals filled out a questionnaire about their number of meals and snacks. Frequency of total meals was defined by summing up the frequency of main meals and snacks, and participants were categorized into four categories: < 3, 3-5, 6-7 and ≥ 8 meals/day. GERD was defined as having heartburn sometimes or more during the last 3 months. The severity of disease was assessed.

RESULTS

The prevalence of GERD in the study population was 23.7%. There was no significant association between meal or snack frequency and GERD symptoms in the whole population. However, after adjustment of all potential confounders, we found that women who consumed 1-2 or 3-5 snacks per day, compared with those who never had snacks, had a 41% (OR 0.59; 95% CI 0.42-0.84) and 51% (OR 0.49; 95% CI 0.32-0.75) reduced risk of having GERD, respectively. Women who consumed 6-7 or ≥ 8 snacks and meals per day had a 38% (OR 0.62; 95% CI 0.41-0.96) and 43% (OR 0.57; 95% CI 0.34-0.95) risk reduction for GERD compared with those who ate < 3 snacks and meals per day.

CONCLUSION

We found no significant association between meal frequency and GERD symptoms in the whole population. Gender-specific analysis revealed inverse associations between meal and snack frequency and GERD in Iranian women. Further prospective studies are required to confirm these associations.

Effects of 6 vs 3 eucaloric meal patterns on glycaemic control and satiety in people with impaired glucose tolerance or overt type 2 diabetes: A randomized trial

BACKGROUND/OBJECTIVES

The study aimed to compare the effects of two eucaloric meal patterns (3 vs 6 meals/day) on glycaemic control and satiety in subjects with impaired glucose tolerance and plasma glucose (PG) levels 140-199mg/dL at 120min (IGT-A) or PG levels 140-199mg/dL at 120min and >200mg/dL at 30/60/90min post-oral glucose load on 75-g OGTT (IGT-B), or overt treatment-naïve type 2 diabetes (T2D).

SUBJECTS/METHODS

In this randomized crossover study, subjects with IGT-A (n=15, BMI: 32.4±5.2kg/m²), IGT-B (n=20, BMI: 32.5±5kg/m²) or T2D (n=12, BMI: 32.2±5.2kg/m²) followed a weight-maintenance diet (45% carbohydrates, 20% proteins, 35% fats) in 3 or 6 meals/day (each intervention lasting 12 weeks). Anthropometrics, diet compliance and subjective appetite were assessed every 2 weeks. OGTT and measurements of HbA1c and plasma lipids were performed at the beginning and end of each intervention period.

RESULTS

Body weight and physical activity levels remained stable throughout the study. In T2D, HbA1c and PG at 120min post-OGTT decreased with 6 vs 3 meals (P<0.001 vs P=0.02, respectively). The 6-meal intervention also improved post-OGTT hyperinsulinaemia in IGT-A subjects and hyperglycaemia in IGT-B subjects. In all three groups, subjective hunger and desire to eat were reduced with 6 vs 3 meals/day (P<0.05). There were no differences in HOMA-IR or plasma lipids between interventions.

CONCLUSION

Although weight loss remains the key strategy in hyperglycaemia management, dietary measures such as more frequent and smaller meals may be helpful for those not sufficiently motivated to adhere to calorie-restricted diets. Our study shows that 6 vs 3 meals a day can increase glycaemic control in obese patients with early-stage T2D, and may perhaps improve and/or stabilize postprandial glucose regulation in prediabetes subjects.

Complementary feeding practices and associated factors in Damot Weydie District, Welayta zone, South Ethiopia

Background

Each year, more than millions of under-five children die due to under-nutrition, and many of these deaths are associated with inappropriate feeding practices. This study aimed to assess complementary feeding practices in Damot Weydie District, South Ethiopia.

Methods

A community-based cross-sectional study was conducted among four-hundred and one mothers who had children aged 6–23 months in Damot Weydie District. A pretested structured questionnaire was used to collect data using a face-to-face interview. Data were entered into Epi-Data version 3.1 and analysis was done by using Statistical Package for Social Sciences (SPSS) version 20. Multivariable logistic regressions were conducted to determine independent factors associated with complementary feeding practices.

Results

More than half (50.6%) of children were given complementary foods at six months of age. Only 8.5% of young children aged 6–23 months were fed with appropriate complementary foods. The proportion of mothers who reported that they know that a baby of 6–23 months old should be fed two or three times was only 75.8%. Government-employed mothers (adjusted odds ratio (AOR) = 0.14(0.04, 0.50) and mothers who attended postnatal care (AOR = 0.19(0.05, 0.70) were less likely to practice inappropriate complementary feeding. Mothers having children with birth intervals less than 35 months were more likely to practice inappropriate complementary feeding when compared to mothers of children with birth intervals greater than 35 months (AOR = 2.67 (1.22, 5.83).

Conclusions

Considerable proportions of infants and young children were not appropriately fed with complementary foods as per WHO recommendations. Being a government employee mother, attending postnatal care and having a child with birth interval greater than 3 years were associated with appropriate complementary feeding. Therefore, it is important to encourage postnatal care utilization and incorporate complementary feeding advice during postnatal visits. It is critical to raise the awareness of the community about optimal complementary feeding practices with special attention to unemployed and less educated mothers. Additionally, inter-sectoral collaboration should be strengthened to increase the variety of food groups available.

Factors associated with minimal meal frequency and dietary diversity practices among infants and young children in the predominantly agrarian society of Bale zone, Southeast Ethiopia: a community based cross sectional study

Background

Poor infant and young child feeding (IYCF) practices in the first 2 years of age are among major causes of childhood malnutrition, in developing countries including Ethiopia. It results in irreversible outcomes of stunting, poor cognitive development, and significantly increases risks of many chronic and infectious diseases. This study was intended to assess factors associated with minimum meal frequency and minimum dietary diversity practice among children aged 6–23 months in the predominantly agrarian society of Bale zone, Southeast Ethiopia.

Methods

A community based cross sectional study was employed from January to June 2016. An interviewer administered, pretested and structured questionnaire was used to collect data. Multi-stage sampling followed by a systematic random sampling technique was used to include study subjects. Data was entered using Epi info version 3.5.3 and analyzed by SPSS version 20. In the logistic regression, both bivariate and multivariate analyses were carried out to identify factors associated with minimum meal frequency and minimum dietary diversity scores. All variables with P-values of <0.2 in the bivariate were earmarked for the multivariate analysis. Both Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR) were computed at 95% Confidence Interval (CI) to determine the strength of associations. In the multivariate analysis, variables at P–Values of <0.05 were considered as statistically significant with minimum meal frequency and dietary diversity practice.

Result

A total of 801 infants and young children aged 6–23 months and their mothers participated in the study. The overall prevalence of minimum meal frequency and minimum dietary diversity practice was 68.4% [95% CI: 0.652, 0.716] and 28.5% [95% CI: 0.254, 0.316], respectively. Child age (AOR = 0.29; 95% CI: 0.28, 0.94) and parity of mother (AOR = 2.8; 95% CI: 1.11, 7.50) were independently associated with minimal meal frequency. On the other hand, mothers educational level (AOR = 0.52; 95% CI: 0.28, 0.94), child illness in the past 1 week (AOR = 0.44; 95% CI: 0.26, 0.73) and maternal counselling on IYCF practice during postnatal care (PNC) visits (AOR = 2.6; 95% CI: 1.59, 4.45) were factors statistically associated with dietary diversity practice in the study area.

Conclusion and recommendations

Compliance to recommended minimum meal frequency and diversified diets was low in this study community. Minimum meal frequency was associated with the age of child and parity of mother. But, mothers’ education, child illness in the past 1 week, and maternal counseling on IYCF during PNC visits were factors associated with minimum dietary diversity practice. Improving the level of maternal and child health care utilization, increasing the educational level of mothers and providing health and nutrition counseling on IYCF during maternal PNC service visits are vital interventions to improve IYCF practices in the predominantly agrarian society of Bale zone, Southeast Ethiopia.

Population-attributable risk estimates for factors associated with inappropriate complementary feeding practices in The Gambia

OBJECTIVE

The present cross-sectional study aimed to determine population-attributable risk (PAR) estimates for factors associated with inappropriate complementary feeding practices in The Gambia.

DESIGN

The study examined the first and most recent Demographic and Health Survey of The Gambia (GDHS 2013). The four complementary feeding indicators recommended by the WHO were examined against a set of individual-, household- and community-level factors, using multilevel logistic analysis. PAR estimates were obtained for each factor associated with inappropriate complementary feeding practices in the final multivariate logistic regression model.

SETTING

The Gambia.

SUBJECTS

Last-born children (n 2362) aged 6-23 months.

RESULTS

Inadequate meal frequency was attributed to 20 % (95 % CI 15·5 %, 24·2 %) of children belonging to the youngest age group (6-11 months) and 9 % (95 % CI 3·2 %, 12·5 %) of children whose mothers were aged less than 20 years at the time of their birth. Inadequate dietary diversity was attributed to 26 % (95 % CI 1·9 %, 37·8 %) of children who were born at home and 20 % (95 % CI 8·3, 29·5 %) of children whose mothers had no access to the radio. Inadequate introduction of solid, semi-solid or soft foods was attributed to 30 % (95 % CI 7·2 %, 38·9 %) of children from poor households.

CONCLUSIONS

Findings of the study suggest the need for community-based public health nutrition interventions to improve the nutritional status of Gambian children, which should focus on sociocultural and economic factors that negatively impact on complementary feeding practices early in infancy (6-11 months).

Dietary diversity and meal frequency among infant and young children: a community based study

Background

Insufficient quantities, frequencies, and inadequate quality of complementary feedings have a negative effect on child health and growth, especially in the first two years of life. Therefore, the aim of this study was to assess the minimum dietary diversity, meal frequency and its associated factors among infants and young children aged 6–23 months at Dabat District, northwest, Ethiopia.

Methods

A community- based cross-sectional study was conducted from February 15 to March 10, 2016. The simple random sampling method was used to select study participants. An interviewer- administered structured questionnaire was used to collect data. Both Crude and Adjusted Odds Ratio with the corresponding 95% confidence interval were calculated to show the strength of association. In the multivariable analysis, variables with less than 0.05 P-value were considered statistically significant.

Results

The proportion of children who met the minimum dietary diversity and meal frequency were 17% (95% CI: 14.9, 19.4%) and 72.2% (95% CL: 69.3, 75%), respectively. Satisfactory media exposure (AOR = 2.79; 95% CI: 1.74, 4.47), postnatal care visits (AOR = 1.96; 95% CI: 1.32, 2.88), participation in child growth and monitoring follow ups (AOR = 1.65; 95% CI: 1.14, 2.39), age of children (AOR = 2.34; 95% CI: 1.33, 4.11) and age of mothers (AOR = 1.89; 95% CI: 1.09, 3.27) were positively associated with dietary diversity. Similarly, age of children (AOR = 2.38; 95% CI: 1.56, 3.65), household wealth status (AOR = 1.84; 95% CI: 1.27, 2.68), residence (AOR = 3.02; 95% CI: 1.41, 6.48), sources of information (AOR = 1.72; 95% CI:1.14, 2.59) and participation in child growth monitoring folow ups (AOR = 1.57; 95% CI: 1.13, 2.19) were significantly associated with meal frequency.

Conclusion

In this study, the proportion of children who received the minimum dietary diversity and meal frequency were low. Media exposure, age of children, postnatal care visits, and participation in child growth and monitoring follow-ups were significantly associated with dietary diversity. Likewise, wealth status and residence had a significant association with meal frequency. Thus, encouraging all mothers to participate in child monthly growth monitoring programs, intensive media advertising and strengthening counseling of mothers, and postnatal care visit are highly recommended for achieving the recommended dietary practices.

A randomized cross-over study of the effects of macronutrient composition and meal frequency on GLP-1, ghrelin and energy expenditure in humans

OBJECTIVE

Little is known about human postprandial increase of energy expenditure and satiety-associated hormones in relation to both meal frequency and macronutrient composition.

DESIGN

Randomized cross-over study with four conditions for each participant.

METHODS

Seven men and seven women (mean age 23±1.5years) were randomly assigned to the order of intake of a 750kcal drink with the same protein content while having either 20 energy-percent (E%) or 55 E% from carbohydrates and the remaining energy from fat. Participants were also randomized to consume the drinks as one large beverage or as five 150kcal portions every 30min, starting in the fasting state in the morning. Energy expenditure (EE) was determined every 30min by indirect calorimetry. Hormonal responses and suppression of hunger (by visual-analogue scales) were also studied. A p<0.013 was considered statistically significant following Bonferroni-correction.

RESULTS

The area under the curve (AUC) for EE was higher during the 2.5h after the high-carbohydrate drinks (p=0.005 by Wilcoxon) and also after ingesting one drink compared with five (p=0.004). AUC for serum active GLP-1 was higher after single drinks compared with five beverages (p=0.002). Although GLP-1 levels remained particularly high at the end of the test during the low-carbohydrate meals, the AUC did not differ compared with the high-carbohydrate occasions (low-carbohydrate: 58.9±18pg/ml/h, high-carbohydrate: 45.2±16pg/ml/h, p=0.028). Hunger sensations were suppressed more after single beverages compared with five small drinks (p=0.009).

CONCLUSIONS

We found higher EE during 2.5h following one large drink compared with five smaller beverages. Since hunger was also suppressed more efficiently, and serum GLP-1 levels were higher after one compared with five smaller drinks, our findings do not support nibbling to avoid hunger or to keep up EE from morning to noon.

Meal frequency and dietary diversity feeding practices among children 6-23 months of age in Wolaita Sodo town, Southern Ethiopia

BACKGROUND

Child feeding practices are multidimensional, and they change rapidly within short age intervals. Suboptimal complementary feeding practices contribute to a rapid increase in the prevalence of undernutrition in children in the age of 6-23 months. Information on child feeding practices among urban resident is limited in Ethiopia. The aim was to measure minimum meal frequency and dietary diversity and associated factors among children 6-23 months of age in Wolaita Sodo, Ethiopia.

METHODS

A community-based cross-sectional study was carried out to select 623 mothers/caregivers with 6-23 months of children reside in Wolaita Sodo town using systematic sampling from March 02 to 20, 2015. An interviewer-administered questionnaire was used to gather information on socio-demographic, child feeding practices and health-related characteristics. Data were entered to Epi-Data version 3.02 and transported to SPSS version 21 for further analysis. Binary logistic regression was used to see the association between the outcome variables and explanatory variables, and multivariable logistic regression was performed to identify independent predictors of minimum dietary diversity and meal frequency.

RESULTS

The study revealed that the percentage of 6-23 months of children who meet the recommended level of minimum dietary diversity and meal frequency were 27.3 and 68.9%, respectively. Mothers/caregivers who were housewives and government employees feed their children more diversified foods as compared to mothers who were private workers. As compared to children 17-23 months of age, children in the age group of 6-8 and 9-11 months had better probability to meet minimum dietary diversity. Government-employed and illiterate mothers were less likely to feed their children to fulfil the minimum requirement of meal frequency. Children in the age of 9-11 months were also less likely to be fed frequently.

CONCLUSIONS

Even though the study showed better progress as compared to the national prevalence of complementary feeding practices, child feeding practices in the study area were inadequate and not achieving WHO infant and young child feeding recommendations. Strengthening the available strategies and creating new intervention measures to improve socioeconomic status, maternal literacy and occupation opportunity for better practices of child feedings are compulsory actions for the government and policymakers.

Awake, long-term intranasal insulin treatment does not affect object memory, odor discrimination, or reversal learning in mice

Intranasal insulin delivery is currently being used in clinical trials to test for improvement in human memory and cognition, and in particular, for lessening memory loss attributed to neurodegenerative diseases. Studies have reported the effects of short-term intranasal insulin treatment on various behaviors, but less have examined long-term effects. The olfactory bulb contains the highest density of insulin receptors in conjunction with the highest level of insulin transport within the brain. Previous research from our laboratory has demonstrated that acute insulin intranasal delivery (IND) enhanced both short- and long-term memory as well as increased two-odor discrimination in a two-choice paradigm. Herein, we investigated the behavioral and physiological effects of chronic insulin IND. Adult, male C57BL6/J mice were intranasally treated with 5μg/μl of insulin twice daily for 30 and 60days. Metabolic assessment indicated no change in body weight, caloric intake, or energy expenditure following chronic insulin IND, but an increase in the frequency of meal bouts selectively in the dark cycle. Unlike acute insulin IND, which has been shown to cause enhanced performance in odor habituation/dishabituation and two-odor discrimination tasks in mice, chronic insulin IND did not enhance olfactometry-based odorant discrimination or olfactory reversal learning. In an object memory recognition task, insulin IND-treated mice did not perform differently than controls, regardless of task duration. Biochemical analyses of the olfactory bulb revealed a modest 1.3 fold increase in IR kinase phosphorylation but no significant increase in Kv1.3 phosphorylation. Substrate phosphorylation of IR kinase downstream effectors (MAPK/ERK and Akt signaling) proved to be highly variable. These data indicate that chronic administration of insulin IND in mice fails to enhance olfactory ability, object memory recognition, or a majority of systems physiology metabolic factors - as reported to elicit a modulatory effect with acute administration. This leads to two alternative interpretations regarding long-term insulin IND in mice: 1) It causes an initial stage of insulin resistance to dampen the behaviors that would normally be modulated under acute insulin IND, but ability to clear a glucose challenge is still retained, or 2) There is a lack of behavioral modulation at high concentration of insulin attributed to the twice daily intervals of hyperinsulinemia caused by insulin IND administration without any insulin resistance, per se.

Daily meal frequency and associated variables in children and adolescents

OBJECTIVE

To investigate the frequency distribution of daily meals and its relation to demographic, socioeconomic, behavioral, anthropometric and biochemical factors in children and adolescents.

METHODS

This was a cross-sectional study with a representative sample of 708 schoolchildren aged 7-14 years. Data on personal information, socioeconomic status, physical activity and number of meals were obtained through semi-structured questionnaire and consumption by 24-h recall and food record. Weight and height measurements were also performed to calculate the body mass index. Finally, blood samples were collected for analysis of total cholesterol, high- and low density lipoprotein, triglyceride, and glucose levels. Descriptive statistics, the Mann-Whitney test, and Poisson regression were used in statistical analysis.

RESULTS

Meal frequency <4 was associated in children, family income <3 Brazilian minimum wages (PR=5.42; 95% CI: 1.29-22.77; p=0.021) and adolescents, the number of sons in the family >2 (PR=1.53; 95% CI: 1.11-2.11; p=0.010). Even in the age group of 10-14 years, <4 meals was related to higher prevalence of body mass index (PR=1.33; 95% CI: 1.02-1.74; p=0.032) and low-density lipoprotein (PR=1.39; 95% CI: 1.03-1.87; p=0.030) higher after adjustments.

CONCLUSION

Lower frequency of meals was related to lower income in children and adolescents, larger number of sons in the family, and increased values of body mass index and low-density lipoprotein.

Association of meal frequency with metabolic syndrome in Korean adults: from the Korea National Health and Nutrition Examination Survey (KNHANES)

BACKGROUND

Although previous studies have established a close relationship between caloric intake and metabolic syndrome, there is limited research exploring the impact of meal frequency adjusted by caloric intake on metabolic syndrome (MetS).

OBJECTIVE

To evaluate the association of meal frequency and MetS after adjusting for confounding factors including caloric intake in Korean men and women.

METHODS

We analyzed the national representative data of a total 12,389 adults (5171 men, 7218 women) from the Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2012. Subjects were categorized as eating 3 meals/day (MF3) or 2 or fewer meals/day (MF ≤ 2). Daily caloric intake was calculated using CAN-Pro 4.0 (The Korean Nutrition Society, Seoul, Korea).

RESULTS

The prevalence of components of MetS differed significantly according to meal frequency in both men and women. In an unadjusted analysis, the prevalence of MetS in women was significantly higher in the MF3 group than the MF ≤ 2 group (27.5% vs. 17.8%, P < 0.001), whereas the prevalence of MetS in men did not differ between the MF3 and MF ≤ 2 groups (24.6% vs. 22.7%, P = 0.281). However, after adjusting for age, caloric intake, smoking status, alcohol consumption, physical activity, income, and education level, men in the MF ≤ 2 group had an increased risk of metabolic syndrome compared to men in the MF3 group (OR = 1.37, 95%, CI = 1.12-1.67). On the other hand, meal frequency did not affect the risk of metabolic syndrome in women after adjusting for confounding factors including caloric intake (OR = 1.09, 95%, CI = 0.90-1.31).

CONCLUSIONS

This study suggests that lower meal frequency adjusted for caloric intake, physical activity, age, smoking, alcohol, income, and education may be associated with increased risk of MetS in Korean men.

Ramadan model of intermittent fasting for 28 d had no major effect on body composition, glucose metabolism, or cognitive functions in healthy lean men

OBJECTIVES

There has been a parallel increase in the incidence of obesity and diabetes as well as the number of daily meals. However, evidence is lacking regarding the role of intermittent fasting. The aim of this study was to determine the effects of a Ramadan model of intermittent fasting (RIF; 14 h of daytime abstinence from food and drinking) for 28 d on body composition, glucose metabolism, and cognitive function.

METHODS

Ten healthy, lean men were included in a nonrandomized, crossover, intervention study. Testing was performed before a control period of 28 d, as well as before and after 28 d of RIF. Whole-body dual-energy x-ray absorptiometry, magnetic resonance imaging of the abdomen, fitness test, oral glucose tolerance test, and cognitive function tests were performed. As secondary outcome, the participants' physical activity and 72-h glycemic responses were monitored 6 d within each of the periods. Dietary intake, appetite, and mood questionnaires also were assessed.

RESULTS

Comparing Δ differences from testing days; body mass index changes from the control period (Δ mean: 0.2 kg/m², 95% confidence interval [CI], -2 to 0.5) and the RIF period (Δ mean: -0.3 kg/m², 95% CI, -0.6 to -0.1) were significantly different (P < 0.05). Secondary outcomes within the RIF period showed an increased area under curve (AUC) for hunger accompanied by a reduced AUC for satiety (both, P < 0.05), less mean steps per day (P < 0.05), and less positive feelings in the afternoon (P < 0.01) compared with the control period. No changes were observed in any of the other evaluated parameters.

CONCLUSIONS

Free-living participants were able to comply with 14 h of daily daytime abstinence from food and drinking for 28 d with only a minor effect on body mass index and without any effects on body composition, glucose metabolism, and cognitive function.

Cognitive control of meal onset and meal size: Role of dorsal hippocampal-dependent episodic memory

There is a large gap in our understanding of how top-down cognitive processes, such as memory, influence energy intake. Similarly, there is limited knowledge regarding how the brain controls the timing of meals and meal frequency. Understanding how cognition influences ingestive behavior and how the brain controls meal frequency will provide a more complete explanation of the neural mechanisms that regulate energy intake and may also increase our knowledge of the factors that contribute to diet-induced obesity. We hypothesize that dorsal hippocampal neurons, which are critical for memory of personal experiences (i.e., episodic memory), form a memory of a meal, inhibit meal onset during the period following a meal, and limit the amount ingested at the next meal. In support, we describe evidence from human research suggesting that episodic memory of a meal inhibits intake and review data from human and non-human animals showing that impaired hippocampal function is associated with increased intake. We then describe evidence from our laboratory showing that inactivation of dorsal hippocampal neurons decreases the interval between sucrose meals and increases intake at the next meal. We also describe our evidence suggesting that sweet orosensation is sufficient to induce synaptic plasticity in dorsal hippocampal neurons and raise the possibility that impaired dorsal hippocampal function and episodic memory deficits contribute to the development and/or maintenance of diet-induced obesity. Finally, we raise some critical questions that need to be addressed in future research.

Postprandial changes in cardiometabolic disease risk in young Chinese men following isocaloric high or low protein diets, stratified by either high or low meal frequency - a randomized controlled crossover trial

Background

Cardio-Metabolic Disease (CMD) is the leading cause of death globally and particularly in Asia. Postprandial elevation of glycaemia, insulinaemia, triglyceridaemia are associated with an increased risk of CMD. While studies have shown that higher protein intake or increased meal frequency may benefit postprandial metabolism, their combined effect has rarely been investigated using composite mixed meals. We therefore examined the combined effects of increasing meal frequency (2-large vs 6-smaller meals), with high or low-protein (40 % vs 10 % energy from protein respectively) isocaloric mixed meals on a range of postprandial CMD risk markers.

Methods

In a randomized crossover study, 10 healthy Chinese males (Age: 29 ± 7 years; BMI: 21.9 ± 1.7 kg/m²) underwent 4 dietary treatments: CON-2 (2 large Low-Protein meals), CON-6 (6 Small Low-Protein meals), PRO-2 (2 Large High-Protein meals) and PRO-6 (6 Small High-Protein meals). Subjects wore a continuous glucose monitor (CGM) and venous blood samples were obtained at baseline and at regular intervals for 8.5 h to monitor postprandial changes in glucose, insulin, triglycerides and high sensitivity C-reactive protein (hsCRP). Blood pressure was measured at regular intervals pre- and post- meal consumption. Urine was collected to measure excretion of creatinine and F₂-isoprostanes and its metabolites over the 8.5 h postprandial period.

Results

The high-protein meals, irrespective of meal frequency were beneficial for glycaemic health since glucose incremental area under the curve (iAUC) for PRO-2 (185 ± 166 mmol.min.L⁻¹) and PRO-6 (214 ± 188 mmol.min.L⁻¹) were 66 and 60 % lower respectively (both p < 0.05), compared with CON-2 (536 ± 290 mmol.min.L⁻¹). The iAUC for insulin was the lowest for PRO-6 (13.7 ± 7.1 U.min.L⁻¹) as compared with CON-2 (28.4 ± 15.6 U.min.L⁻1), p < 0.001. There were no significant differences in postprandial responses in other measurements between the dietary treatments.

Conclusions

The consumption of composite meals with higher protein content, irrespective of meal frequency appears to be beneficial for postprandial glycemic and insulinemic responses in young, healthy Chinese males. Implications of this study may be useful in the Asian context where the consumption of high glycemic index, carbohydrate meals is prevalent.

Trial registration

NCT02529228.

Meal and snack frequency in relation to diet quality in US children and adolescents: the National Health and Nutrition Examination Survey 2003-2012

OBJECTIVE

To examine the associations of meal frequency (MF) and snack frequency (SF) with diet quality.

DESIGN

Dietary intake was assessed using two 24 h dietary recalls. All eating occasions providing ≥210 kJ of energy were divided into meals or snacks on the basis of contribution to energy intake (≥15 % or <15 %), self-report and time (06.00-09.00, 12.00-14.00 and 17.00-20.00 hours, or others). Diet quality was assessed using the Healthy Eating Index (HEI)-2010.

SETTING

Nationally representative sample of the US population.

SUBJECTS

Children aged 6-11 years (n 4269) and adolescents aged 12-19 years (n 6193) in the National Health and Nutrition Examination Survey 2003-2012.

RESULTS

Irrespective of the definition of meals, higher MF was associated with higher HEI-2010 in both children and adolescents. One additional meal per day increased HEI-2010 by 1·45-3·59 points (all P<0·005). Conversely, the associations for SF were inconsistent. While SF based on energy contribution was positively associated with HEI-2010 in both children and adolescents (0·70 (P=0·001) and 1·00 (P<0·0001) point increase by one additional snack, respectively), there were no associations for SF based on self-report or time. In analyses in which only plausible energy reporters (3425 children and 3753 adolescents) were included, similar results were obtained.

CONCLUSIONS

In a representative sample of US children and adolescents, MF was associated with better diet quality, while the associations for SF varied depending on the definition of snacks. The findings highlight the importance of applying different definitions of meals and snacks when assessing the impact of dietary patterns on health.

iTRAQ-based proteomic analysis reveals alterations in the liver induced by restricted meal frequency in a pig model

OBJECTIVE

The present study was conducted to investigate the effects of meal frequency on metabolite levels in pig plasma and hepatic proteome by isobaric tags for relative and absolute quantitation (iTRAQ) analysis.

METHODS

Twenty-four pigs (60.7 ± 1.0 kg) consumed the same amount of feed either in 2 (M2, n = 12) or 12 (M12, n = 12) meals per day. After an 8-wk feeding period, plasma concentrations of metabolites and hormones, hepatic biochemical traits, and proteome (n = 4 per group) were measured.

RESULTS

Pigs on the M12 regimen had lower average daily gain and gain-to-feed ratio than pigs fed the M2 regimen. The M2 regimen resulted in lower total lipid, glycogen, and triacylglycerol content in the liver and circulating triacylglycerol concentration than that in the M12 pigs. The metabolic hormone concentrations were not affected by meal frequency, with the exception of elevated fibroblast growth factor 21 concentrations in the M2 regimen compared with the M12 regimen. The iTRAQ-based proteomic analysis revealed 35 differentially expressed proteins in the liver between pigs fed two and 12 meals per day, and these differentially expressed proteins were involved in the regulation of general biological process such as glucose and energy metabolism, lipid metabolism, protein and amino acid metabolism, stress response, and cell redox homeostasis.

CONCLUSION

Altogether, the proteomic results provide insights into the mechanism mediating the beneficial effects of restricted meal frequency on the metabolic fitness.

Decreasing the number of small eating occasions (<15 % of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity: a cross-sectional study in British children and adolescents

Evidence of associations between meal frequency (MF) and snack frequency (SF) and diet and obesity in young populations is limited. This cross-sectional study examined MF and SF in relation to dietary intake and adiposity measures in British children aged 4-10 years (n 818) and adolescents aged 11-18 years (n 818). Based on data from a 7-d weighed dietary record, all eating occasions were divided into meals or snacks on the basis of contribution to energy intake (≥15 or <15 %) or time (06.00-10.00, 12.00-15.00 and 18.00-21.00 hours or others). All measures of MF and SF showed positive associations with energy intake, except for MF based on energy contribution in children. Irrespective of the definition of snacks, SF was associated with higher intakes of soft drinks, confectionery and total sugar, lower intakes of cereals, fish, meat, protein, PUFA, starch and dietary fibre, and a lower diet quality (assessed by the Mediterranean diet score, except for SF based on energy contribution in adolescents). MF based on time, but not based on energy contribution, was associated with higher intakes of confectionery and total sugar, lower intakes of fish, protein, PUFA and starch, and, only in children, a lower diet quality. All measures of MF and SF showed no association with adiposity measures. In conclusion, this cross-sectional study in British children and adolescents suggests that decreasing the number of small eating occasions (<15 % of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity.

BMI, eating habits and sleep in relation to salivary counts of mutans streptococci in children - the IDEFICS Sweden study

OBJECTIVE

The objective of the present study was to investigate the association between salivary counts of mutans streptococci (MS) and children's weight status, while considering associated covariates. MS ferments carbohydrates from the diet and contributes to caries by lowering the pH in dental plaque. In adults, high counts of MS in saliva have been associated with overweight, but this has not been shown in children.

DESIGN

Cross-sectional study investigating salivary counts of MS, BMI Z-score, waist circumference, meal frequency, sugar propensity and sleep duration, in children.

SETTING

West Sweden.

SUBJECTS

Children (n 271) aged 4-11 years.

RESULTS

Medium-high counts of MS were positively associated with higher BMI Z-score (OR=1·6; 95% CI 1·1, 2·3). Positive associations were also found between medium-high counts of MS and more frequent meals per day (OR=1·5; 95% CI 1·1, 2·2), greater percentage of sugar-rich foods consumed (OR=1·1; 95% CI 1·0, 1·3) and female sex (OR=2·4; 95% CI 1·1, 5·4). A negative association was found between medium-high counts of MS and longer sleep duration (OR=0·5; 95% CI 0·3, 1·0).

CONCLUSIONS

BMI Z-score was associated with counts of MS. Promoting adequate sleep duration and limiting the intake frequency of sugar-rich foods and beverages could provide multiple benefits in public health interventions aimed at reducing dental caries and childhood overweight.

Potential role of meal frequency as a strategy for weight loss and health in overweight or obese adults

Improved dietary strategies for weight loss are necessary to decrease metabolic disease risk in overweight or obese adults. Varying meal frequency (MF; i.e., increasing or decreasing eating occasions beyond the traditional pattern of three meals daily) has been thought to have an influence on body weight regulation, hunger control, and blood markers of health. It is common practice for weight management clinicians to recommend increasing MF as a strategy for weight management and to improve metabolic parameters. However, limited research exists investigating the effect of MF during controlled hypocaloric dietary interventions. Furthermore, MF literature often speculates with regard to efficacy of MF treatments based on research using normal weight, overweight/obese, or some combination, where much diversity exists within these various populations. In this review, we suggest that normal-weight and overweight/obese populations, as well as free-living versus investigator-controlled research trials, should be studied independently. Therefore, the objective of the present review is to survey the literature to assess whether the alteration of MF influences body weight regulation, hunger control, and/or blood markers of health in overweight/obese participants undergoing a controlled hypocaloric diet to induce weight loss. Findings of this review indicate that there is uncertainty in the literature when interpreting the optimal MF for obesity treatment, where reduced MF may even show more favorable lipid profiles in obese individuals compared with increased MF. Furthermore, the simple relationship of comparing MF with body fatness or body mass index should also consider whether eating frequency is associated with other healthy factors (e.g., increased physical activity).