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Chrono-nutrition: A review of current evidence from observational studies on global trends in time-of-day of energy intake and its association with obesity

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The importance of the circadian rhythm in regulating human food intake behaviour and metabolism has long been recognised. However, little is known as to how energy intake is distributed over the day in existing populations, and its potential association with obesity. The present review describes global trends in time-of-day of energy intake in the general population based on data from cross-sectional surveys and longitudinal cohorts. Evidence of the association between time-of-day of energy intake and obesity is also summarised. Overall, there were a limited number of cross-sectional surveys and longitudinal cohorts that provided data on time-of-day of energy intake. In the identified studies, a wide variation in time-of-day of energy intake was observed, with patterns of energy distribution varying greatly by country and geographical area. In relation to obesity, eight cross-sectional surveys and two longitudinal cohorts were identified. The association between time-of-day of energy intake and obesity varied widely, with several studies reporting a positive link between evening energy intake and obesity. In conclusion, the current review summarises global trends in time-of-day of energy intake. The large variations across countries and global regions could have important implications to health, emphasising the need to understand the socio-environmental factors guiding such differences in eating patterns. Evidence of the association between time-of-day of energy intake and BMI also varied. Further larger scale collaborations between various countries and regions are needed to sum data from existing surveys and cohorts, and guide our understanding of the role of chrono-nutrition in health.
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Proceedings of the Nutrition Society
The Joint Winter Meeting between the Nutrition Society and the Royal Society of Medicine held at The Royal Society of Medicine,
London on 89 December 2015
Conference on Roles of sleep and circadian rhythms in the origin and nutritional
management of obesity and metabolic disease
Symposium 3: Importance of meal timing
Chrono-nutrition: a review of current evidence from observational studies
on global trends in time-of-day of energy intake and its association
with obesity
S. Almoosawi
1,3
*, S. Vingeliene
2
, L. G. Karagounis
3,4
and G. K. Pot
5,6
1
Institute of Health and Society and Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne
NE2 4HH, UK
2
Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK
3
Department of Nutrition and Health Research, Nestle Research Centre, Lausanne 1000, Switzerland
4
School of Physical Education and Sports Science, University of Thessaly, Trikala, Greece
5
Diabetes and Nutritional Sciences Division, Kings College London, London SE1 9NH, UK
6
Department of Health and Life, Faculty of Earth and Life Sciences, VU University Amsterdam, 1081 HV,
The Netherlands
The importance of the circadian rhythm in regulating human food intake behaviour and
metabolism has long been recognised. However, little is known as to how energy intake is
distributed over the day in existing populations, and its potential association with obesity.
The present review describes global trends in time-of-day of energy intake in the general
population based on data from cross-sectional surveys and longitudinal cohorts. Evidence
of the association between time-of-day of energy intake and obesity is also summarised.
Overall, there were a limited number of cross-sectional surveys and longitudinal cohorts
that provided data on time-of-day of energy intake. In the identied studies, a wide variation
in time-of-day of energy intake was observed, with patterns of energy distribution varying
greatly by country and geographical area. In relation to obesity, eight cross-sectional surveys
and two longitudinal cohorts were identied. The association between time-of-day of energy
intake and obesity varied widely, with several studies reporting a positive link between even-
ing energy intake and obesity. In conclusion, the current review summarises global trends in
time-of-day of energy intake. The large variations across countries and global regions could
have important implications to health, emphasising the need to understand the socio-
environmental factors guiding such differences in eating patterns. Evidence of the associ-
ation between time-of-day of energy intake and BMI also varied. Further larger scale colla-
borations between various countries and regions are needed to sum data from existing
surveys and cohorts, and guide our understanding of the role of chrono-nutrition in health.
Circadian rhythms: Chrono-nutrition: Temporal trends: Obesity
Circadian rhythms are cyclical endogenous processes
that occur with a periodicity of approximately 24 h.
Research carried out in the 1970s identied a region in
the brain of mammals within the anterior hypothalamus
known as the suprachiasmatic nucleus. The suprachias-
matic nucleus also known as the master clock is
*Corresponding author: S. Almoosawi, email suzana.almoosawi@rdls.nestle.com
Abbreviation: TEI, total daily energy intake.
Proceedings of the Nutrition Society, Page 1 of 14 doi:10.1017/S0029665116000306
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Proceedings of the Nutrition Society
synchronised to geophysical time via photic activation of
the retinal ganglion cells. In this way, the suprachiasmat-
ic nucleus can synchronise oscillators present within the
cells of most organs and tissues, therefore inuencing
several physiological processes
(1)
. So although the im-
portance of circadian rhythms in regulating mammalian
physiological responses has been recognised for a long
time
(2)
, its impact on nutrition and metabolism is rela-
tively new and is an area of evolving interest
(3)
.
It is now well recognised that food intake, appetite,
digestion and metabolism each exhibit circadian pat-
terns
(4)
. Food intake itself serves as a regulator of the cir-
cadian clock, particularly the peripheral circadian clock
in tissues such as the liver and the intestine
(57)
.
Conversely, the central circadian clock, entrained by
the darklight cycle, is known to extend its effect on
food absorption. More specically, small peptides
cleaved in the intestine from dietary protein have been
shown to be transported in a circadian-driven process
(8)
.
Similar observations have been made for glucose
(9)
and
lipid transport
(10)
. However, despite our ever-growing
knowledge of circadian rhythms, we still need to gain fur-
ther insight into how the nutrient content of a mixed
meal (macronutrient, micronutrient and energy content)
may interact to benet/compromise health.
The debate as to when to eat is imbedded in human
history. Ancient Greeks consumed three to four meals,
with breakfast and the evening meal being deemed
most important
(11)
. In Roman times, breakfast was con-
sumed at dawn although greater emphasis was given to
eating later in the day particularly amongst the upper so-
cial classes
(11)
. By contrast, the poorer social classes ate
their meals in line with the patterns of manual labour
and thus consistent with the nightday cycle
(11)
. In the
Islamic world, meal timing was also often dictated by
the darklight cycle. Consuming a meal before sunrise
was deemed to be a sacred ritual that prepared the
human body for fast and promoted health. Accordingly,
the famous physician Avicenna recommended eating two
meals a day, one taken prior to sunrise and the second
taken in the evening at dusk
(12)
. The ancient physicians
of Andalusia also believed in the importance of consum-
ing two to three meals a day separated by 612 h inter-
vals depending on the nature of the individual and
their health status
(12)
. By the middle-ages, however, eat-
ing breakfast in Europe was seen as a sinful act, and phy-
sicians warned against eating breakfast as it was thought
to be detrimental to health
(13)
. It was not until later in the
16th century that breakfast became recognised as an es-
sential meal
(13)
, and proverbs such as Eat breakfast
yourself, share lunch with a friend and give dinner
away to your enemyor Eat breakfast like a king,
lunch like a prince and dinner like a pauperbecame
prevalent.
Recent evidence obtained from both randomised
controlled trials and observational studies have indeed
documented the importance of breakfast consumption
and its associated benets to health
(14)
. Several studies
have also investigated the relationship between night eat-
ing and cardiometabolic disorders, including obesity
(15)
.
Furthermore, the way the overall energy load is
distributed across the day has also been shown to result
in altered physiological adaptations
(16,17)
. The exact rea-
son for this is not clear. However, recent evidence has
emerged suggesting that various genes involved in sub-
strate metabolism such as dietary lipids are under direct
control of the circadian rhythm dictating their metabolic
fate towards oxidation or storage
(18)
.
Such studies highlight the importance of understand-
ing the role of circadian rhythms and chronobiology in
nutrition and how these may alter the physiological sta-
tus. The exact driver behind such alterations is not
clear. Nonetheless, given the complex interplay between
the various eating occasions and the fact that energy in-
take at one eating occasion is not independent of intake
at previous or subsequent occasions, it is critical to con-
sider a broader approach that encompasses the so-called
circadian rhythms of eating and in which timing of en-
ergy intake is considered across the full spectrum of eat-
ing occasions.
Against, this background, the current review aimed:
(1) to describe current trends in energy intake across
the day in the general population worldwide and contrast
differences in time-of-day of energy intake across the
life-course, and different sexes, and (2) to systematically
review the association between time-of-day of energy in-
take in relation to metabolic disease, particularly obesity.
Identifying observational studies
The present review included observational studies that
used a cross-sectional or longitudinal design and which
had quantitative data on energy intake at different eating
occasions, wherein eating occasions were categorised into
either pre-dened meal slots, self-dened or statistically
dened. All published studies that used a quantied diet-
ary assessment method (24 h recall, food records, diet
history) to estimate energy intake at different eating
occasions were included. We excluded qualitative studies
that assessed frequency of eating occasions, or that sim-
ply reported proportions of meal consumers or skippers,
as well as methodological and validation studies. Studies
that looked at specic population groups (i.e. athletes) or
patients were also excluded. We did not consider studies
that assessed energy intake at specic eating occasions
(i.e. breakfast) without reporting energy intake at other
eating occasions.
Characteristics of observational studies
Overall, 1660 titles were identied using the search terms
(see supplementary material), of which fty were dupli-
cates. An additional three titles were identied using
manual searches of reference lists. Based on assessment
of titles, a total of twenty-ve abstracts were identied
as potentially relevant. Of the latter studies, ve studies
were excluded because the main outcome of interest
was comparing energy intake from snacks v.
meals
(1923)
. One other study focused on meal and
snack patterns and daily eating frequency
(24)
. Overall,
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eleven full-text articles were included in the present re-
view
(2535)
. These studies are summarised in Table 1.
There was a wide variation in the dietary assessment
methods, with the majority of studies using food records
and 24 h recalls. Moreover, the denition of eating occa-
sions varied widely. In most studies, eating occasions
consisted of pre-dened meal slots
(25,26)
, and in a few
occasions survey members self-reported the type of eat-
ing occasion with the aid of a list containing standardised
meal and snack names. Sjoberg et al.
(35)
used a diet his-
tory method alongside an interview with a dietitian. The
questionnaire used as part of the diet history method had
a quantitative element and was divided into sections to
cover breakfast, lunch, dinner and in-between meals eat-
ing occasions. Meals were dened based on the locations
and time of intake during the day, thereby taking into
consideration the elements of whenand where.
Accordingly, breakfast was dened as intake in the
morning before school, while lunch was considered as in-
take during lunch break at school and dinner as the main
meal in the afternoon after schools. By contrast,
Howarth et al.
(36)
assessed eating patterns based on
data collected from two 24 h dietary recalls. Eating occa-
sions were standardised using a statistical method that
incorporated both self-reported denitions of eating
occasions with a statistical approach incorporated a
time element. For instance, two or more meals consumed
within 59 min of each other were deemed to be one eating
occasion
(36)
. Similarly, if a brunch was reported or mul-
tiple same meals (i.e. two dinners), an a priori criterion
was used to recode these eating occasions to ensure
standardisation across all survey members. One study
did not specify how eating occasions were dened
(28)
.
Eating occasions reported outside the main meals
(breakfast, lunch and dinner) were labelled as snacks
and combined into one category. Only one study did
not combine the between-meals eating occasions to one
category, which permitted evaluation of energy intake
between meals and whether there were differences in
energy intake at mid-morning, mid-afternoon and late-
evening eating occasions
(25)
.
In relation to obesity, 962 publications were identied
using the search strategy (see supplementary material).
After removing forty-four duplicates, 918 titles remained.
Of these, fourteen articles were selected for further
screening. An additional article was identied using
manual searches. A total of ten full-text articles were
found to be eligible and therefore included in the review
(Table 2).
In relation to studies on obesity, various dietary as-
sessment methods were used to assess the association be-
tween the time-of-day of energy or macronutrient intake
and BMI. The number of dietary data days also varied
from as few as 17 d. BMI was assessed as a continuous
variable expressed as kg/m
2
or as z-scores in some stud-
ies
(27,3740)
, whilst in others BMI was treated as a categor-
ical variable
(41,42)
. One study selected subcutaneous and
visceral fat as an outcome of interest
(43)
. In the majority
of studies, time-of-day of energy intake was assessed by
dividing eating occasions into four main groups (break-
fast, lunch, dinner and snacks).
Table 1. Characteristics of studies included in the review on time-of-day of energy intake (n11)
First author
Publication
year Study name Type of study Country NMethod of dietary assessment
Study
population
Age range
(year)
Geographic
distribution
Almoosawi et al. 2012 MRC NSHD Longitudinal UK 1253 5-d estimated diet diaries Adults 3653 National
Vossenaar et al. 2009 Cross-sectional Guatemala 449 24 h prospective diary Schoolchildren 810 Local
Howarth et al. 2007 Continuing Survey of
Food Intake
Repeated
cross-sectional
USA 2685 2 × 24 h recall Adults and
elderly
2090 Local
Stockman et al. 2005 Cross-sectional Canada 180 3-d food records Adolescents
(boys)
1418 Local
Sjoberg et al. 2003 Goteborg
Adolescence Study
Cross-sectional Sweden 1245 Diet history validated against
7-d estimated food record
Adolescents 1516 Local
Winkler et al. 1999 MONICA Cross-sectional Germany 899 7-d estimated diet diaries Adults (men) 4564 Regional
Brombach 2001 EVA Cross-sectional Germany 43 3-d food records Elderly 6494 Local
Schlettwein-gsell
et al.
1999 Seneca Repeated
cross-sectional
Europe 2600 Structured interview including
an estimated 3 d food record
Elderly 775 European
Lafay et al. 1998 FLVS Cross-sectional France 2364 1-d food record for <14 years
and 3-d food record for 14
years
Children and
adults
270 Local
De Henauw et al. 1997 Cross-sectional Belgium 1321 24 h recall Children 612 Regional
Skinner et al. 1985 Cross-sectional USA 225 1-d food records Adolescents 1618 Local
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Global trends in time-of-day of energy intake
There was a wide variation in the contribution of differ-
ent eating occasions to energy intake across the studies
(Table 3). Overall, four different patterns of energy distri-
bution could be observed in these studies (Fig. 1). These
patterns differed by country and geographical area
(Fig. 2).
For instance, Vossenaar et al. assessed the distribution
of energy, macro- and micronutrient intakes in a cross-
sectional sample of school children in Guatemala attend-
ing third and fourth grades
(26)
. In this survey, lunch
contributed the greatest proportion of daily energy in-
take, while breakfast and dinner contributed an equal
proportion of daily energy intake
(26)
. Macronutrients fol-
lowed a similar pattern of distribution as energy, whilst
the distribution of micronutrients varied. Accordingly,
lunch provided a greater proportion of all macro-
nutrients, vitamin C and Zn, whereas breakfast provided
more vitamins A and D, thiamine, riboavin, folate Ca
and Fe
(26)
. Poland followed a similar pattern of distri-
bution with breakfast and dinner contributing approxi-
mately an equal proportion of energy intake and lunch
providing the greatest contributor to energy intake over
the day
(30)
.
However in France, Switzerland, Italy and Northern
Ireland, the pattern of energy distribution differed in
both adults and children in that the proportion of energy
intake increased progressively reaching a peak at lunch
and declining thereafter. As such, lunch contributed the
greatest proportion of energy intake followed by dinner
and breakfast
(30,33)
.
In Sweden, energy distribution followed a different
pattern. In a cross-sectional survey conducted by
Sjoberg et al., dietary data were collected from 611
boys and 634 girls attending grade nine in Goteborg,
Sweden
(35)
. Breakfast and dinner were found to contrib-
ute the greatest proportion of energy intake across the
day, whilst lunch contributed the lowest proportion of
energy intake over the day.
In the UK, USA, Germany, Canada, Denmark,
Netherlands and Belgium, the pattern of energy distribu-
tion varied from the earlier studies. Accordingly, in the
UK, the proportion of daily energy intake increased
gradually across the day, with breakfast providing the
lowest proportion of energy intake while dinner contrib-
uted the greatest proportion of energy intake
(25)
. This
eating pattern was observed at different follow-ups in
the MRC 1946 British Birth Cohort. This corresponds
to changes in distribution of energy intake between the
years 1982, 1989 and 1999, which translates to when co-
hort members were aged 36, 43 and 53 years. On average,
dinner contributed over 40 % of daily energy intake
(25)
.
This is was markedly higher than in any of the other sur-
veys. Macronutrient intake also followed a pattern simi-
lar to energy distribution in this cohort
(25)
.
Similar observations were made in the USDA
Continuing Survey of Food Intake by Individuals, col-
lected in 19941996, where energy intake was assessed
using two 24 h food recalls. In this repeated cross-
sectional survey, both younger survey members (2059
Table 2. Characteristics of studies included in the review on time-of-day of energy intake and obesity (n12)
First author
Publication
year
Study
name Type of study Country N
Method of dietary
assessment
Study
population
Age range
(year)
Geographic
distribution Outcome of interest
Aljuraiban et al. 2015 INTERMAP Cross-sectional USA/
UK
4680 4 × 24 h Adults 4059 Two-countries BMI
Kondoh et al. 2014 Pooled
cross-sectional
study
Japan 301 38-day record Adult men 2165 National Subcutaneous and
visceral fat
Almoosawi et al. 2013 NSHD Longitudinal UK 1488 5 d food record Adults 4353 National Waist circumference
Wang et al. 2013 Cross-sectional USA 239 3 × 24 h Adults 2169 Local BMI
Dubois et al. 2008 Cross-sectional Canada 2103 24 h Children 4 Local Overweight
Lioret et al. 2008 INCA1 Cross-sectional France 748 7-d record Children 311 National Overweight
Howarth et al. 2007 CSFII Cross-sectional USA 2685 2 × 24 h Adults and
elderly
2090 National BMI
Thompson et al. 2006 Longitudinal USA 101 7-d record Children 812 Local BMI z-score
Maffeis et al. 2000 Cross-sectional Italy 735 diet history Children 711 Regional BMI
Summerbell et al. 1996 Cross-sectional UK 220 7-d weighed
record
Adolescents to
elderly
1391 Local BMI
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Table 3. Proportion of energy intake at breakfast, lunch, dinner and snacks based on eligible studies (n11)
Study Publication year Region Country (population) NBreakfast Lunch Dinners Snacks Daily energy intake (kcal)
Almoosawi et al. 2012 North Europe UK (adults (36 years)) 1253 17 31 46 6 2067
2012 North Europe UK (adults (43 years)) 1253 16 31 48 5 2167
2012 North Europe UK (adults (53 years)) 1253 17 30 48 5 2003
Vossenaar et al. 2009 South America Guatemala (boys) 217 24 31 23 21 1979
2009 South America Guatemala (girls) 232 23 29 23 24 1924
Howarth et al. 2007 North America USA (older) 893 20 25 38 17 2391
2007 North America USA (younger) 1792 16 26 38 20 2005
Stockman et al. 2005 North America Canada (boys) 180 18 26 34 22 2624
Sjoberg et al. 2003 North Europe Sweden (boys) 611 21 16 26 37 2146
2003 North Europe Sweden (girls) 634 20 17 28 35 3085
Brombach 2001 Western Europe Germany(women) 43 21 32 25 22
Schlettwein-gsell et al. 1999 Eastern Europe Poland (men) 19 28 33 27 12 2032
1999 North Europe Denmark (men) 101 19 25 35 21 1936
1999 North Europe Netherlands (men) 114 15 21 33 31 1816
1999 North Europe Northern Ireland (men) 22 32 30 16 2127
1999 Southern Europe Italy (men) 97 11 45 37 7
1999 Western Europe France-Chateau Renault-Amboise (men) 142 18 45 30 7
1999 Western Europe France-Haguenau (men) 109 19 39 30 12 2414
1999 Western Europe Switzerland (men) 123 19 39 33 9 2032
1999 Eastern Europe Poland (women) 23 30 26 25 9 1577
1999 North Europe Denmark (women) 101 17 24 36 23 1506
1999 North Europe Netherlands (women) 124 13 22 33 32 1410
1999 North Europe Northern Ireland (women) 20 33 28 19 1697
1999 Southern Europe Italy (women) 93 13 45 34 8
1999 Western Europe France-Chateau Renault-Amboise (women) 137 17 48 29 6
1999 Western Europe France-Haguenau (women) 110 20 37 30 13 1793
1999 Western Europe Switzerland (women) 126 18 43 28 11 1577
Lafay et al. 1998 Western Europe France (>40 years) 94 16 44 34 2 1812
1998 Western Europe France (>40 years) 156 17 41 32 3 2166
1998 Western Europe France (4 years) 72 18 32 27 8 1514
1998 Western Europe France (4 years) 64 19 31 26 8 1503
1998 Western Europe France (1114 years) 164 19 33 30 6 2155
1998 Western Europe France (1114 years) 142 19 33 28 6 2446
1998 Western Europe France (1518 years) 64 18 37 30 5 2160
1998 Western Europe France (1518 years) 66 19 38 28 5 2787
1998 Western Europe France (1930 years) 75 15 39 35 4 1795
1998 Western Europe France (1930 years) 48 18 38 33 4 2650
1998 Western Europe France (3140 years) 393 15 41 36 3 181
1998 Western Europe France (3140 years) 322 17 40 34 3 2374
1998 Western Europe France (57 years) 168 18 32 27 7 1788
1998 Western Europe France (57 years) 168 18 33 27 7 1992
1998 Western Europe France (810 years) 165 18 33 29 7 1884
1998 Western Europe France (810 years) 203 19 33 30 6 2193
De Henauw et al. 1997 North Europe Belgium (children) 1321 18 30 33 20 2006
Winkler et al. 1992 Western Europe Germany (men) 899 17 29 33 21 2609
Skinner et al. 1985 North America USA (boys) 114 12 25 31 30 3071
1985 North America USA (girls) 111 11 24 35 33 2063
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years) and older survey members (6090 years) were
found to increase energy intake over the day
(27)
.
In Canada, data were available from a small-scale
study wherein 180 healthy adolescent males aged 1418
years were recruited from local high schools and commu-
nity groups. Adolescents completed a 3-d food record.
Breakfast contributed 18 % of total daily energy intake
(TEI), followed by lunch (26 % TEI), and dinner at
34 % (TEI)
(28)
. This pattern of energy distribution was
consistent with the pattern observed in the UK and
USA. Likewise in Germany, breakfast, lunch, and dinner
contributed to TEI in the following proportions, respect-
ively: 17, 29 and 33 %
(44)
. Denmark
(30)
, Netherlands
(30)
and Belgium
(32)
followed a similar pattern with the pro-
portion of energy intake increasing progressively through
the day.
Fig. 1. Patterns of energy distribution based on eligible studies (n11). Meals are ranked according to their
contribution to energy intake over the day.
Fig. 2. Proportion of daily energy intake at breakfast, lunch, dinner and snacks according to global regions
(n11). Bars represent weighed means. Northern Europe region does not include data from Northern Ireland as
sample size was not provided for calculation of weighed average.
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Breakfast, snacks and meals: contribution to total
energy intake
The lowest proportion of e nergy from breakfast was observed
in US children (11 % TEI in girls, 12 % TEI in boys) and
Italian adults (11 % TEI in men, 13 % TEI in women)
(30)
.
By contrast, the proportion of TEI from breakfast was high-
est in Swedish boys (21 % TEI), Guatemalan children (22 %
TEI in girls, 24 % TEI in boys) and Polish adults (28 % TEI in
men, 30 % TEI in women; see Figs 3 and 4).
In most countries, snacks contributed a larger proportion
of energy intake through the day than breakfast. Swedish
adolescents and Dutch men and women
(30)
reported obtain-
ing the greatest proportion of energy from snacks, whereas
adults from the UK
(25)
, France and Italy reported the low-
est proportion of energy intake from snacks
(30)
.
Secular trends in time-of-day of energy intake and
differences according to age and sex
There were limited data of secular trends in time-of-day
of energy intake. In the UK, data from the MRC 1946
British Birth Cohort demonstrated a trend towards
increased energy intake later in the day between 1982
and 1999 corresponding to ages 36 and 53 years
(25)
.
There were some variationsin energy intake across differ-
ent eating occasions amongst younger and older people. For
instance, in France, the contribution of lunch and dinner to
daily energy intake increased progressively from ages 4 years
and below, to ages 41 and above
(33)
.IntheUSA,both
younger adults and older adults obtained 38 % of their en-
ergy intake from dinner, although the younger group had
a larger difference in energy intake between breakfast and
dinner (15·9 % energy at breakfast v.38·3 % of daily energy
at dinner), compared with the older group (20·4%energyat
breakfast v.38·1 % of daily energy at dinner)
(27)
.
Few studies examined differences in time-of-day of en-
ergy intake between men and women. On average, girls
obtained a lower proportion of energy intake at breakfast
compared with boys in both Guatemala
(26)
and
Sweden
(35)
. In Guatemala, on average, girls obtained a
greater percentage of energy from snacks
(35)
, while in
Sweden, girls obtained a greater proportion of energy
at dinner compared with boys
(35)
. In the UK, women
reported obtaining a greater proportion of energy intake
at breakfast than men at age 36 years
(25)
.
There were no marked sex-differences in the propor-
tion of energy intake from breakfast or snacks in the
countries surveyed by the Seneca Study
(30)
. However,
men from Poland reported a greater proportion of energy
intake at lunch (33 % TEI) compared with Polish women
(26 % TEI). Likewise, Swiss men reported a greater pro-
portion of energy intake at dinner (33 % TEI) compared
with Swiss women (28 % TEI)
(30)
.
Time-of-day of energy intake in relation to BMI
There was a wide variation in the reported association
between time-of-day of energy intake and obesity.
Aljuraiban et al. assessed time-of-day by examining
the ratio of evening-to-morning energy intake in the
INTERMAP study
(37)
. Accordingly, morning intake
was dened as mean energy intake from 06.00 hours to
11.55 hours, while evening intake was dened as mean
energy intake from 18.00 hours to 23.55 hours. Times
were selected based on when 98 % of the US and UK
INTERMAP survey members consumed morning and
evening meals. Additionally, survey members were
divided into quartiles of the ratio of evening:morning
energy intake (<1·0, 1·0to<1·5, 1·5to<2·0, 2·0).
Based on the ndings of this study, survey members
with <1·0 compared with >2·0 ratio of evening:morning
energy intake had lower total energy intake and
dietary energy density, and better nutrient quality of
individual foods and nutrient density of the overall
diet, as assessed using Nutrient Rich Food Index 9.3
(NRF9.3)
(45)
. BMI was also found to be positively asso-
ciated with evening:morning energy intake ratio, with
a2SD difference in ratio of evening:morning energy in-
take being associated with a 0·2 kg/m
2
increase in BMI,
after adjustment for sex, age and population sample
(37)
.
There was a tendency for individuals to have fewer eating
occasions with increasing ratio of evening:morning en-
ergy intake, although this was NS
(37)
.
Kondoh et al. pooled cross-sectional data from three
interventions which included a total of 301 Japanese
men aged 2165 years. Energy intake was divided into
four eating occasions: breakfast, lunch, supper and
between-meal intake. The association between each eat-
ing occasion and visceral and subcutaneous adiposity
was assessed in multiple linear regression models after
adjustment for age. Only between-meal energy intake
was associated positively with subcutaneous fat. No
adjustments for sociodemographic or other sample char-
acteristics were conducted.
In a longitudinal analysis of the association between
time-of-day of macronutrient intake and the metabolic
syndrome, increasing carbohydrate intake at the expense
of carbohydrate at age 43 years was associated with
lower waist circumference at age 53 years
(46)
.
In another small cross-sectional study, time-of-day of
energy intake was assessed using three 24 h dietary
recalls and stratied by time-of-day into three categories:
morning (00.0011.00 hours), midday (11.0017.00
hours) and evening (17.0000.00 hours)
(47)
. Data on
time-of-day of beverage intake was not collected and,
as such, energy intake from beverages was assumed to
be evenly distributed across the eating occasions. The
proportion of daily energy intake at morning, midday
and evening was calculated, and participants were stra-
tied into two categories; those reporting <33 % of
total energy intake at morning, midday and evening,
and those reporting 33 % of total energy intake at
morning, midday and evening. In the crude analysis,
higher proportion of energy intake at midday was asso-
ciated with a healthy BMI. The odds of having a BMI
25 kg/m
2
was almost double in men reporting a higher
proportion of energy intake in the evening in the overall
sample, after adjustment for age, sex, race and educa-
tion, TEI and physical activity. However, once only
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Proceedings of the Nutrition Society
men with self-reported energy intake within ±25 % of
total energy expenditure as assessed by doubly-labelled
water were included in the analysis, the odds of
having a BMI 25 kg/m
2
was lower in men reporting a
higher proportion of energy intake at midday but not
evening.
By contrast, in a cross-sectional study investigating the
association between eating behaviours (eating speed and
energy intake at main meals) in pre-school children (n
1138; age range 3·16·7 years), each 418·4 kJ (100 kcal)
increase in energy intake at lunch increased the likeli-
hood of overweight by a factor of 1·445
(48)
.
Fig. 3. Proportion of daily energy intake at breakfast, lunch, dinner and snacks in children.
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Proceedings of the Nutrition Society
The association between breakfast skipping, BMI and
time-of-day of energy intake was examined in the
Longitudinal Study of Child Development in Quebec,
when children were aged 4456 months
(41)
. Breakfast
skipping was dened as eating breakfast on fewer than
7 d/week. Differences in energy and macronutrient intake
Fig. 4. Proportion of daily energy intake at breakfast, lunch, dinner and snacks in adults.
Global trends in time-of-day of energy intake and its association with obesity 9
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Proceedings of the Nutrition Society
at breakfast, morning snack, lunch, afternoon snack, din-
ner, and evening snack, as assessed using a 24 h recall,
were compared amongst breakfast skippers and eaters.
Overall, breakfast skippers were found to have lower en-
ergy intake at breakfast and over the day, as well as
higher energy intake at lunch, afternoon snack and even-
ing snack. Breakfast skippers reported having lower en-
ergy intake from main meal and greater energy intake
from between meals. Furthermore, overweight/obesity
in breakfast skippers was related to a higher energy
and carbohydrate intake at dinner
(41)
.
In a representative sample of French children aged 3
11 years (n748), 7-d dietary records were collected as
part of a cross-sectional survey
(42)
. Eating occasions
were categorised into four categories: breakfast, main
meals (lunch and dinner) and snacks (any eating occasion
other than breakfast and main meals). Overweight,
dened using the International Obesity Task Force cut-
points, was associated with a higher proportion of daily
energy intake from main meals and snacks
(42)
.
Howarth et al. compared the association between eat-
ing patterns, including time-of-day of energy intake, and
BMI in younger (2059 years, n1792), and older (6090
years, n893) participants of the Continuing Survey of
Food Intakes by Individuals
(27)
. Data were collected be-
tween 1994 and 1996. Higher BMI was associated with a
higher TEI and higher intakes at all eating occasions in
participants reporting plausible energy intake. The pro-
portion of energy intake at different eating occasions
was, however not assessed
(27)
.
In a convenience sample of 101 girls selected from a
longitudinal growth and development study, dietary
data were collected using a 7-d food record at baseline
when cohort members were aged 812 years and at a
follow-up when the same girls where aged 1119
years
(38)
. Given that participants reported atypical eating
patterns dietary events were classied based on
time-of-day, frequency and amount of energy intake.
Using data on time-of-day, dietary events were classied
as morning (06.0010.59 hours), afternoon (11.0016.59
hours) and evening/night (17.0005.59 hours). After con-
trolling for baseline BMI z-score, the mean percentage of
daily energy intake at evening/night was positively asso-
ciated with change in BMI z-score
(38)
.
Maffeis found a correlation between proportion of en-
ergy intake at breakfast, dinner and night snack and per-
centage fat mass in children
(39)
. There was a signicant
correlation between energy intakes at different eating
occasions. Proportion of daily energy intake at dinner
explained 2 % of the variation in childrens BMI after ad-
justment for sex, energy intake/BMR ratio and parental
BMI.
In another small-scale study, eating patterns were
assessed in 220 individuals who completed 7-d weighed
dietary records
(40)
. In the latter study, 187 records were
obtained from three independent studies, and data were
reanalysed. These studies provided data on three age
groups in the British population: Elderly group (n88),
Middle-aged group (n40), Working age group (n59).
A fourth study of 1314-year olds living in Croydon
was carried out from which thirty-three usable diet
records were collected to produce the Adolescent
group. Greater energy intake at breakfast was associated
with a lower BMI in the Adolescent group. In the
Middle-aged group, greater energy intakes at breakfast
and lower energy intakes during the evening were asso-
ciated with a lower BMI. However, only the association
between breakfast energy and BMI in the Adolescent
group remained signicant after including individuals
with plausible energy intakes.
Summary of the evidence and current challenges
The present review provides a summary of published
data on the time-of-day of energy intake in Northern
and Southern Europe, and in North and South
America. Despite the limited number of studies pub-
lished in this eld, data suggest that there are four pat-
terns of energy distribution over the day. These
patterns varied by country and geographical area.
Although the factors contributing to such geographical
differences in time-of-day of energy intake are not
clear, they may potentially reect sociocultural habits
or beliefs related to eating behaviour. For instance, the
fact that lunch is the most important meal of the day is
characteristic of France and the Mediterranean re-
gion
(49)
, and serves as a reection of the French beliefs
of the importance of the pleasurable and social aspects
of eating
(50)
. Consequently, the French tend to eat to-
gether as a household more regularly and to follow a
regular meal pattern of three meals daily
(49)
. By contrast,
in central England, individual ethics and convenience
drive food choices and intake, which is then translated
as increased consumption of ready-prepared and take-
away meals, as well as higher intake of energy-dense
snack foods such as crisps
(49)
. Indeed, such reliance on
individual ethics and convenience may potentially favour
an individual pattern of consumption where people pre-
pare and consume meals alone and eat away from
home
(49)
. This is particularly concerning given the estab-
lished association of family meals with better diet quality
and meal structure
(51)
. The absence of the latter might ex-
plain the greater prevalence of meal skipping in England
compared with France
(49)
. This said, although a shift to-
wards greater energy intake at the evening meal has been
reported in France in recent decades
(49)
due to changing
working patterns
(52)
, the destructure of French eating
patterns is not yet on par with the patterns observed in
England
(49)
. This highlights the need for further studies
to determine the sociocultural and socio-economic fac-
tors that govern time-of-day of energy intake. For in-
stance in relation to breakfast, it is now well recognised
that amongst children; girls, older adolescents, children
from families within the lower socio-economic groups
and those living in single-parent families are more likely
to skip breakfast
(53)
.
In relation to in-between meal energy intake, evidence
from the literature demonstrated that the contribution of
snacks to energy intake varied from as high as 37 % of
TEI in Swedish boys
(35)
to as low as 23 % of TEI in
French adults
(33)
. In most countries, snacks provided a
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Proceedings of the Nutrition Society
similar contribution to TEI as breakfast or more. The
implications of the varying energy intake from snacks
in relation to cardio-metabolic risk factors warrant inves-
tigation. However, it is important to mention that the
majority of studies did not differentiate between mid-
morning, mid-afternoon or late-evening eating occasions,
with most studies aggregating in-between meal energy in-
take into one snackcategory. This raises several chal-
lenges as the proportion of TEI at different time points
might be more relevant than the total energy intake
from snacks. Consistent with the latter hypothesis, it
has previously been reported that consuming a small
snack at night (23.00 hours) for 2 weeks, compared to
a morning snack (10.00 hours), leads to a decline in
24 h fat oxidation
(54)
.
In addition to the time-of-day of snack intake, the
composition of snacks taken in-between meals might
equally be important. For instance, in a study examining
snacking behaviour in Scottish school children, 77 % of
children reported eating biscuits, cakes and pastries;
whilst 72 % ate crisps and savoury snacks; 70 % ate con-
fectionery; and 69 % ate fruit as part of a snack
(55)
. In the
USA, desserts, salty foods and sugar-sweetened bev-
erages are the greatest contributors to energy intake
from snacks
(56)
. By contrast in France, snacking is
reported to be rare amongst adults, and when it does
occur, it consists mainly of foods such as bread, cheese,
yoghurts and fresh fruit rather than cakes, sweet biscuits
or confectionery
(57)
. This again emphasises potential
socio-cultural values related to eating behaviour.
With regard to secular trends, only one study had lon-
gitudinal data on time-of-day of energy intake. In the
present study, a trend was observed towards increased
energy intake later in the day between 1982 and 1999,
corresponding to ages 36 and 53 years,
(25)
. The present
study was, however, limited because it was based on
data from a birth cohort. This rendered it impossible to
differentiate secular trends from age trends. Differentiat-
ing secular and age trends is important to elucidate
whether the recent increase in obesity prevalence is asso-
ciated with a global trend towards increased energy in-
take later in the day, or whether it is related to
life-style changes related to ageing.
Only a few studies examined differences in time-of-
day of energy intake across different age groups.
Accordingly, it was observed that, in France, lunch and
dinner meals contribute a greater proportion of TEI in
adults compared with children
(33)
. Similarly, in USA,
there was a greater disparity between the proportion of
energy intake at breakfast v. dinner in younger adults
compared with older adults
(27)
, which might reect
greater breakfast skipping and a larger proportion of
energy intake later in the day. As discussed previously,
such differences might be inuenced by various socio-
environmental factors. This emphasises the need for
investigating the context of eating occasions, and under-
standing how factors such as with whomand where
inuence time-of-day of energy intake.
In the context of obesity, there were a limited number
of studies investigating the association between time-of-
day of energy intake and obesity. Moreover, there was
a large heterogeneity in terms of the population studied,
dietary assessment methods used, sample size, and choice
of markers of obesity. Of the ten studies included in the
second part of the present review, one study found an as-
sociation between breakfast and BMI
(40)
. Another study
reported an association between lunch time intake and
BMI
(48)
. However, the present study only assessed energy
intake at lunch and did not observe or collect data on
other eating occasions. Four studies identied evening
energy intake as being an important eating occa-
sion
(38,39,41,47)
. Out of these four, one study reported
that the association between evening intake and BMI
was affected by breakfast habits wherein individuals
who did not consume breakfast on all days (breakfast
skippers), had higher BMI with increasing energy and
carbohydrate intake in the evening
(41)
. Similarly, one of
the studies reported that the mean percentage of daily en-
ergy intake at evening/night is associated with a longitu-
dinal increase in BMI z-score in girls
(38)
. Likewise, Wang
et al. found that the association between evening intake
and BMI diminished after removing individuals who
may have potentially mis-reported their energy intake
(47)
.
A further two studies reported an association between
energy intake between meals and subcutaneous fat and
BMI, respectively
(42,43)
. On the balance of this evidence,
it could be speculated that evening energy intake is a
major risk factor for obesity. However, additional data
from cross-sectional and longitudinal surveys will be
required to conrm such ndings. Given the heterogen-
eity of the studies included in the present review, it was
not possible to conduct a meta-analysis of the data.
Moreover, it is important in future to differentiate be-
tween mid-morning, mid-afternoon and evening snacks,
as it is likely that the time-of-day of snack intake is rele-
vant to obesity risk.
It is noteworthy that one study found that energy
intake at all occasions is associated with BMI
(27)
.
However, in the latter study, absolute energy intake at
every eating occasion was assessed without adjustment
for intake at other eating occasions. It is likely that the
use of absolute intake rather than proportion of TEI
masks the association between time-of-day of energy in-
take and BMI
(27)
. This highlights the importance of con-
trolling energy intake at other eating occasions when
investigating the relationship between time-of-day of en-
ergy intake and obesity. Indeed in a recent clinical trial
investigating the effect of redistributing the TEI on
weight loss, the authors reported greater weight and
waist circumference loss as well as improved insulinae-
mia, glycaemia and TAG levels in overweight and
obese women when greater energy consumption occurred
in the morning compared with the evening
(58)
. Therefore,
the timing and distribution of the TEI across the day play
an important role in relation to cardio-metabolic risk fac-
tors. It has previously been reported that glucose homeo-
stasis naturally uctuates across the day indicating that is
governed by the internal circadian system, and is thought
to involve changes in insulin signalling
(59)
. Similarly,
lipid metabolism has also been reported to be under
the inuence of the circadian clock. For example, plasma
TAG concentrations are elevated during the biological
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Proceedings of the Nutrition Society
night and the postprandial response following a night-
time meal is amplied compared with the same meal con-
sumed during the day
(60)
.
Observational studies have also reported similar
ndings. In addition to individual eating occasions,
Aljuraiban et al.
(37)
pointed towards the importance of
the ratio of evening:morning energy intake. This
nding is important as it suggests the need for novel
approaches to examine the relationship between time-
of-day of energy intake and BMI. This could be further
reinforced by Dubois et al.
(41)
who suggested that evening
intake affects BMI differently based on whether indivi-
duals were regular or irregular consumers of breakfast.
There was little data on how time-of-day of macronu-
trient intake inuences BMI. To our knowledge, time-
of-day of macronutrient intake is critical to obesity,
given that lipid and glucose metabolism are inuenced
by the circadian rhythm, a topic reviewed in a recent art-
icle by Oosterman et al
(61)
. Consistent with this, a longi-
tudinal association between carbohydrate intake at
breakfast and the abdominal obesity component of the
metabolic syndrome was observed in the 1946 British
Birth Cohort
(46)
. Likewise Dubois et al. reported that
overweight/obesity in breakfast skippers was related to
a higher carbohydrate intake at dinner
(41)
. Collectively,
ndings from both randomised controlled clinical trials
and longitudinal observational studies highlight the un-
equivocal role of the distribution of TEI across the day
plays on outcomes cardiometabolic disease risk factors,
including waist circumference and body weight
(41)
.
Gaps in the literature and future research
Findings from the present review are limited by the small
number of published data in time-of day of energy intake
and the inconsistencies in the denition of eating patterns
or the so-called circadian rhythms of energy intake, as
well as obesity. Such limitations could be overcome in
the future by including unpublished results from other
cross-sectional surveys across the globe.
Although a number of studies investigated the distri-
bution of energy intake across the eating occasions,
there were few data as to the potential patterns of energy
distribution or so-called meal patterns that could be
observed in the studied populations. Indeed, in all of
the earlier studies, average intake of survey members at
the three main meals and snacks taken between meals
was provided. However, with the exception of Winkler
et al.
(29)
, none of the earlier studies examined variation
in energy patterns over the day nor evaluated differences
in meal patterns in their population. This renders it dif-
cult to postulate as to whether there are variations to this
traditional pattern. Although outside the scope of the
present review, Kerver et al. identied ve patterns of
meal and snack intake in the Third National Health
and Nutrition Examination Survey
(24)
. Accordingly,
7·6 % of US adults reported consuming lunch, dinner
and two snacks, 8·3 % consumed breakfast, lunch, dinner
and no snacks, 13·1 % consumed breakfast, dinner and
two snacks, 15·4 % consumed breakfast, lunch, dinner
and one snack, and 31·6 % consumed breakfast, lunch,
dinner and two or more snacks
(24)
. To date, it remains
unclear as to whether there are specic patterns of energy
distribution that could be more benecial or detrimental
for health. Consequently, there is a need to elucidate how
these meal patterns have changed over time, and what
factors inuence time-of-day of energy intake. As
observed in the present review, there are differences in
the contribution of the main meals to energy intake
across the surveys. The latter raises the question as to
what meal should ideally be contributing the greatest
proportion of energy intake over the day. Although, evi-
dence exists to suggest that a greater energy intake later
in the evening is detrimental to health and is associated
with increased obesity, we are still far from understand-
ing whether, in relation to metabolic health, energy
should be distributed equally across the day or whether
it should be distributed with a descending pattern
where breakfast contributes the greatest proportion of
energy, followed by lunch and dinner. Evidence form
human studies appears to indicate that satiety decreases
progressively over the day, potentially implicating the
need to consume a greater proportion of energy earlier
in the day
(62)
. However, recent evidence from animal
models indicates that living organisms are biphasic and
that, physiologically, eating two main meals a day (a big-
ger breakfast with a smaller dinner) but not one meal/d
(breakfast only) helps control body weight and fat
accumulation
(63)
.
To date, only selected countries have recommenda-
tions on the distribution of energy over the day, whilst
more dietary recommendations provide nutrient- and
food-based guidelines. As such, further research is
required to shape future dietary guidelines.
One main limitation of the studies included in the pre-
sent review is that eating occasions were dened using
various methods such as using pre-dened meal slots,
self-dened meal slots and statistically dened methods.
There were inconsistencies in the denition of eating pat-
terns or the so-called circadian rhythms of eating. Several
studies described eating pattern as meal regularity or fre-
quency. In other studies, dietary patterns was synonym-
ously used as eating patterns and vice versa
(64)
. This
highlights the need for a consensus to be reached in the
denition of eating patterns. Furthermore, there is a
need to develop novel statistical methods to investigate
the relationship between time-of-day of energy intake
and obesity, as intake at one eating occasion is likely to
be inuenced by energy intake at another eating occa-
sion. Incorporating knowledge of time of energy intake
as well as time of energy intake in relation to the bio-
logical clock and time of awakening is important.
Finally, it is noteworthy that of the data presented in
the present review, only a small number of studies re-
presented nationally relevant data from on-going surveil-
lance studies. As such, ndings from the present review
might not summarise current trends in time-of-day of
energy intake. Future studies should address the rela-
tionship between current trends in time-of-day of energy
intake and cardio-metabolic health outcomes, particular-
ly obesity.
S. Almoosawi et al.12
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Proceedings of the Nutrition Society
Conclusion
The present review provides an indication of how energy
intake is distributed over the day across the globe.
Evidence of the association between time-of-day of
energy and obesity was limited indicating the need for
larger-scale collaborations between various countries
and regions in order to sum the data from existing sur-
veys and cohorts, and guide our understanding of the
role of chrono-nutrition in health.
Supplementary material
The supplementary material for this article can be found
at http://dx.doi.org/10.1017/S0029665116000306
Financial Support
None.
Conicts of Interest
None.
Authorship
S. A. and S. V. conceptualised the study and conducted
the literature search. L. G. K. and G. K. P. provided
scientic input and assisted with data interpretation.
All authors contributed jointly to the writing of this
paper.
References
1. Johnston JD (2014) Physiological responses to food intake
throughout the day. Nutr Res Rev 27, 107118.
2. Mendoza J (2007) Circadian clocks: setting time by food.
J Neuroendocrinol 19, 127137.
3. Halberg F (1989) Some aspects of the chronobiology of nu-
trition more work is needed on when to eat. J Nutr 119,
333343.
4. Waterhouse J, Minors D, Atkinson G et al. (1997)
Chronobiology and meal times: internal and external fac-
tors. B J Nutr 77, Suppl. 1, S29S38.
5. Damiola F, Le Minh N, Preitner N et al. (2000) Restricted
feeding uncouples circadian oscillators in peripheral tissues
from the central pacemaker in the suprachiasmatic nucleus.
Genes Dev 14, 29502961.
6. Hara R, Wan K, Wakamatsu H et al. (2001) Restricted
feeding entrains liver clock without participation of the
suprachiasmatic nucleus. Genes Cell 6, 269278.
7. Froy O, Chapnik N & Miskin R (2005) Mouse intestinal
cryptdins exhibit circadian oscillation. FASEB J 19,
19201922.
8. Qandeel HG, Duenes JA, Zheng Y et al. (2009) Diurnal ex-
pression and function of peptide transporter 1 (PEPT1).
J Surg Res 156, 123128.
9. Iwashina I, Mochizuki K, Inamochi Y et al. (2011) Clock
genes regulate the feeding schedule-dependent diurnal
rhythm changes in hexose transporter gene expressions
through the binding of BMAL1 to the promoter/enhancer
and transcribed regions. J Nutr Biochem 22, 334343.
10. Pan X & Hussain MM (2007) Diurnal regulation of micro-
somal triglyceride transfer protein and plasma lipid levels.
J Biol Chem 282, 2470724719.
11. Matalas A, Zampelas A, Stavrinos V et al. (editors) (2001)
The Mediterranean Diet: Constituents and Health
Promotion. Florida: CRC Press.
12. Salas-Salvado J, Huetos-Solano MD, Garcia-Lorda P et al.
(2006) Diet and dietetics in al-Andalus. Br J Nutr 96,
Suppl. 1, S100S104.
13. Anderson HA (2013) Breakfast: A History.Plymouth:Rowman
and Littleeld.
14. Betts JA, Richardson JD, Chowdhury EA et al. (2014) The
causal role of breakfast in energy balance and health: a ran-
domized controlled trial in lean adults. Am J Clin Nutr 100,
539547.
15. Madzima TA, Panton LB, Fretti SK et al. (2014) Night-
time consumption of protein or carbohydrate results in
increased morning resting energy expenditure in active
college-aged men. Br J Nutr 111,7177.
16. Kinsey AW, Eddy WR, Madzima TA et al. (2014)
Inuence of night-time protein and carbohydrate intake
on appetite and cardiometabolic risk in sedentary over-
weight and obese women. Br J Nutr 112, 320327.
17. Ormsbee MJ, Kinsey AW, Eddy WR et al. (2014) The
inuence of nighttime feeding of carbohydrate or protein
combined with exercise training on appetite and cardiome-
tabolic risk in young obese women. Appl Physiol Nutr
Metab 40,3745.
18. Hodge BA, Wen Y, Riley LA et al. (2015) The endogenous
molecular clock orchestrates the temporal separation of sub-
strate metabolism in skeletal muscle. Skeletal Muscle 5, 17.
19. Ovaskainen ML, Tapanainen H & Pakkala H (2010)
Changes in the contribution of snacks to the daily energy
intake of Finnish adults. Appetite 54, 623626.
20. Popkin BM & Duffey KJ (2010) Does hunger and satiety
drive eating anymore? Increasing eating occasions and de-
creasing time between eating occasions in the United
States. Am J Clin Nutr 91, 13421347.
21. Zizza CA, Tayie FA & Lino M (2007) Benets of snacking
in older Americans. J Am Diet Assoc 107, 800806.
22. Jahns L, Siega-Riz AM & Popkin BM (2001) The increas-
ing prevalence of snacking among US children from 1977
to 1996. J Pediatr 138, 493498.
23. Ovaskainen ML, Reinivuo H, Tapanainen H et al. (2006)
Snacks as an element of energy intake and food consump-
tion. Eur J Clin Nutr 60, 494501.
24. Kerver JM, Yang EJ, Obayashi S et al. (2006) Meal and
snack patterns are associated with dietary intake of energy
and nutrients in US adults. J Am Dietetic Assoc 106,4653.
25. Almoosawi S, Winter J, Prynne CJ et al. (2012) Daily
proles of energy and nutrient intakes: are eating proles
changing over time? Eur J Clin Nutr 66, 678686.
26. Vossenaar M, Montenegro-Bethancourt G, Kuijper LD
et al. (2009) Distribution of macro- and micronutrient
intakes in relation to the meal pattern of third- and fourth-
grade schoolchildren in the city of Quetzaltenango,
Guatemala. Publ Health Nutr 12, 13301342.
27. Howarth NC, Huang TT, Roberts SB et al. (2007) Eating
patterns and dietary composition in relation to BMI in
younger and older adults. Int J Obes Relat Metab Disord
31, 675684.
Global trends in time-of-day of energy intake and its association with obesity 13
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Proceedings of the Nutrition Society
28. Stockman NK, Schenkel TC, Brown JN et al. (2005)
Comparison of energy and nutrient intakes among meals
and snacks of adolescent males. Prevent Med 41, 203210.
29. Winkler G, Doring A & Keil U (1999) Meal patterns in
middle-aged men in Southern Germany: results from the
MONICA Augsburg dietary survey 1984/85. Appetite 32,
3337.
30. Schlettwein-gsell D, Decarli B & de Groot L (1999) Meal
patterns in the SENECA study of nutrition and the elderly
in Europe: assessment method and preliminary results on
the role of the midday meal. Appetite 32,1522.
31. Brombach C (2001) The EVA-study: meal patterns of
women over 65 years. J Nutr Health Aging 5, 263265.
32. De Henauw S, Wilms L, Mertens J et al. (1997) Overall and
meal-specic macronutrient intake in Belgian primary
school children. Ann Nutr Metab 41,8997.
33. Lafay L, Vray M, Boute D et al. (1998) Food and nutri-
tional data for a population from northern France: the
Fleurbaix Laventie Ville Sante (FLVS) Study. Revue
dépidémiologie et de santé publique 46, 263275.
34. Skinner JD, Salvetti NN, Ezell JM et al. (1985)
Appalachian adolescentseating patterns and nutrient
intakes. J Am Diet Assoc 85, 10931099.
35. Sjoberg A, Hallberg L, Hoglund D et al. (2003) Meal pat-
tern, food choice, nutrient intake and lifestyle factors in
The Goteborg Adolescence Study. Eur J Clin Nutr 57,
15691578.
36. Howarth NC, Huang TT, Roberts SB et al. (2007) Eating
patterns and dietary composition in relation to BMI in
younger and older adults. Int J Obes 31, 675684.
37. Aljuraiban GS, Chan Q, Oude Griep LM et al. (2015) The
impact of eating frequency and time of intake on nutrient
quality and Body Mass Index: the INTERMAP study, a
population-based study. JAcadNutrDietetic115,528536.
38. Thompson OM, Ballew C, Resnicow K et al. (2006)
Dietary pattern as a predictor of change in BMI z-score
among girls. Int J Obes Relat Metab Disord 30, 176182.
39. Maffeis C, Provera S, Filippi L et al. (2000) Distribution of
food intake as a risk factor for childhood obesity. Int J
Obes Relat Metab Disord 24,7581.
40. Summerbell CD, Moody RC, Shanks J et al. (1996)
Relationship between feeding pattern and body mass
index in 220 free-living people in four age groups. Eur J
Clin Nutr 50, 513519.
41. Dubois L, Girard M, Potvin Kent M et al. (2009) Breakfast
skipping is associated with differences in meal patterns,
macronutrient intakes and overweight among pre-school
children. Publ Health Nutr 12,1928.
42. Lioret S, Touvier M, Lafay L et al. (2008) Are eating occasions
and their energy content related to child overweight and socio-
economic status? Obesity (Silver Spring, Md) 16, 25182523.
43. Kondoh T, Takase H, Yamaguchi TF et al. (2014)
Association of dietary factors with abdominal subcutane-
ous and visceral adiposity in Japanese men. Obes Res
Clin Pract 8, e16e25.
44. Winkler G, Doring A & Keil U (1992) Food intake and nu-
trient sources in the diet of middle-aged men in southern
Germany: results from the WHO MONICA Augsburg
Dietary Survey 1984/85. Ann Nutr Metab 36,1222.
45. Drewnowski A (2009) Dening nutrient density: develop-
ment and validation of the nutrient rich foods index.
J Am Coll Nutr 28, 421S426S.
46. Almoosawi S, Prynne CJ, Hardy R et al. (2013) Time-of-
day and nutrient composition of eating occasions:
prospective association with the metabolic syndrome in
the 1946 British birth cohort. Int J Obes 37, 725731.
47. Wang JB, Patterson RE, Ang A et al. (2014) Timing of en-
ergy intake during the day is associated with the risk of
obesity in adults. J Hum Nutr Dietetic 27, 255262.
48. Lin M, Pan L, Tang L et al. (2014) Association of eating
speed and energy intake of main meals with overweight
in Chinese pre-school children. Publ Health Nutr 17,
20292036.
49. Pettinger C, Holdsworth M & Gerber M (2006) Meal pat-
terns and cooking practices in Southern France and Central
England. Publ Health Nutr 9, 10201026.
50. Pettinger C, Holdsworth M & Gerber M (2004) Psycho-
social inuences on food choice in Southern France and
Central England. Appetite 42, 307316.
51. Larson N, Fulkerson J, Story M et al. (2013) Shared meals
among young adults are associated with better diet quality
and predicted by family meal patterns during adolescence.
Publ Health Nutr 16, 883893.
52. Corella D & Ordovas JM (2014) How does the
Mediterranean diet promote cardiovascular health?
Current progress toward molecular mechanisms: gene-diet
interactions at the genomic, transcriptomic, and epige-
nomic levels provide novel insights into new mechanisms.
BioEssays: News Rev Mol Cell Dev Biol 36, 526537.
53. Vereecken C, Dupuy M, Rasmussen M et al. (2009)
Breakfast consumption and its socio-demographic and
lifestyle correlates in schoolchildren in 41 countries partici-
pating in the HBSC study. Int J Publ Health 54, Suppl. 2,
180190.
54. Hibi M, Masumoto A, Naito Y et al. (2013) Nighttime
snacking reduces whole body fat oxidation and increases
LDL cholesterol in healthy young women. Am J Physiol
Regul Integrat Compar Physiol 304, R94R101.
55. Macdiarmid J, Loe J, Craig LC et al. (2009) Meal and
snacking patterns of school-aged children in Scotland.
Eur J Clin Nutr 63, 12971304.
56. Piernas C & Popkin BM (2010) Snacking increased among
US adults between 1977 and 2006. J Nutr 140, 325332.
57. Pettinger C (2000) Snacking behaviour in Southern France
and the UK. Health Inequal Eur p. 378.
58. Jakubowicz D, Barnea M, Wainstein J et al. (2013) High
caloric intake at breakfast vs. dinner differentially
inuences weight loss of overweight and obese women.
Obesity (Silver Spring, MD) 21, 25042512.
59. Van Cauter E, Polonsky KS & Scheen AJ (1997) Roles of
circadian rhythmicity and sleep in human glucose regula-
tion. Endocr Rev 18, 716738.
60. Morgan L, Hampton S, Gibbs M et al. (2003) Circadian
aspects of postprandial metabolism. Chronobiol Int 20,
795808.
61. Oosterman JE, Kalsbeek A, la Fleur SE et al. (2015)
Impact of nutrients on circadian rhythmicity. Am J
Physiol Regul Integr Compar Physiol 308, R337R350.
62. de Castro JM (2004) The time of day of food intake
inuences overall intake in humans. J Nutr 134, 104111.
63. Fuse Y, Hirao A, Kuroda H et al. (2012) Differential roles
of breakfast only (one meal per day) and a bigger breakfast
with a small dinner (two meals per day) in mice fed a high-
fat diet with regard to induced obesity and lipid metabol-
ism. J Circad Rhythms 10,4.
64. Thompson OM, Ballew C, Resnicow K et al. (2006)
Dietary pattern as a predictor of change in BMI z-score
among girls. Int J Obes 30, 176182.
S. Almoosawi et al.14
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... Recent evidence from chronobiology, an area of science based on the time processes of individuals, 4 has recognized circadian and temporal aspects of the human body as new factors capable of influencing nutritional intake and health, defining an emerging area called chrononuutrition. 5,6 Within this topic, the term chronotype is used to describe a person's natural tendency for the timing of sleep and activity patterns-such as to working, studying, engaging in physical activities, and eating-throughout the day. 7 Chronotype, which is used to classify individuals into morning or evening types, has been postulated to be an important influencer of food intake. ...
... 5 Chronotype is influenced by both genetic and environmental factors 8 and is usually assessed by multiple methodologies. 6,[9][10][11][12] The evening chronotype has also been associated with an increased risk of metabolic diseases. 13 The first validated questionnaire for assessing morningness/eveningness characteristics was developed by Horne and Ostberg 14 in 1976 and used selfdescription by participants to estimate phase preferences in circadian rhythms. ...
... Nutrition Reviews V R Vol. 00(0): [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] in insulin level across the entire misalignment cycle, indicating a possible exaggerated postprandial glucose response. Moreover, 37% of study participants exposed to circadian misalignment had meal responses consistent with a prediabetic or diabetic state. ...
Article
Context Recent studies show that dietary habits and obesity seem to be influenced by chronotype, which reflects an individual’s preference for the timing of sleeping, eating, and activity in a 24-hour period. Objective This review aimed to analyze the association of chronotype with dietary habits, namely energy and macronutrient intakes, meal timing, and eating patterns, as well as with obesity. Data Sources PubMed/MEDLINE, LILACS, and Google Scholar databases were searched between 2004 and 2020. Study selection was performed by 2 authors independently; disagreements on eligibility of articles were resolved by a third author. After assessment of 12 060 abstracts, 43 studies (21 articles on obesity; 13 on food consumption, meal timing, and eating patterns; and 9 that addressed both obesity and dietary behavior) were included. Data Extraction A standard form was used to extract study design, country, number of participants, method of chronotype determination, and main findings. Data Analysis Approximately 95% of included studies showed an association between eveningness and at least 1 unhealthy eating habit. Morningness was associated with regular consumption of fresh and minimally processed foods. In addition, about 47% of studies showed a higher association between late types and obesity. Conclusion Late types are more likely to present unhealthy eating habits, such as eating late at night, skipping breakfast often, and eating processed/ultraprocessed foods, while early types are more likely to have healthy and protective habits, such as eating early and eating predominantly fresh/minimally processed foods. Intermediate types tend to have a pattern of health and eating more similar to early types than to late types. Late types are also more likely to present higher weight and body mass index than early or intermediate types. Systematic Review Registration PROSPERO registration no. CRD42021256078.
... Examining dietary patterns and intake at each meal level to assess the overall diet may be more pertinent when considering the synergies and interactions during digestion and metabolism [7]. A limited number of studies have suggested that the amount and type of food intake, as well as the circadian timing of food intake, are associated with health status [8], such as obesity [9], metabolic syndrome [10], hyperglycemia [11], non-alcoholic fatty liver disease [9], and muscle strength [12]. Information on diet-health relationships at each meal level would be more relevant for formulating meaningful dietary guidelines and public health messages, as well as for developing effective intervention strategies for promoting healthy eating habits. ...
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We examined the relative validity of food intake for each meal type (breakfast, lunch, dinner, and snacks) and overall food intake obtained through the Meal-based Diet History Questionnaire (MDHQ). In total, 222 Japanese adults (111 for each sex) aged 30–76 years completed the web version of the MDHQ and then the 4-non-consecutive-day weighed dietary record (DR). The number of major food groups (n = 24 in total) for which no statistically significant difference was observed between median intakes estimated using the DR and MDHQ ranged from 8 (snacks) to 12 (dinner) among women, and from 8 (breakfast) to 13 (lunch) among men. The median values of the Spearman’s correlation coefficients between the MDHQ and DR estimates ranged from 0.28 (dinner) to 0.54 (breakfast) among women, and from 0.24 (dinner) and 0.60 (breakfast) among men. Bland–Altman analyses generally showed wide limits of agreement and proportional bias. Similar results were obtained using the paper version of the MDHQ, which was completed after conducting the DR. In conclusion, the MDHQ has a satisfactory ability to estimate median intake and rank individuals according to consumption for many food groups, despite a limited ability to estimate food group intakes on an individual level.
... When children get older, eating occasions (EO) in western countries are usually three main meals per day (breakfast, lunch and supper) and an additional oneto-three snacks between main meals. The quantity and composition of food as well as the time when food is consumed varies markedly across countries [9][10][11]. Furthermore, first results of studies examining time-varying food intake suggest that dietary intakes at different times of the day might have differential effects on weight gain [12,13]. ...
Article
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Purpose We aimed to characterize the distribution of energy and macronutrient intakes across eating occasions (EO) in European children from preschool to school age. Methods Data from 3-day weighed food records were collected from children at ages 3, 4, 5, 6 and 8 years from Belgium, Germany, Italy, Poland and Spain. Food intakes were assigned to EO based on country-specific daytimes for breakfast, lunch, supper and snacks (morning, afternoon). The average energy and nutrient intakes were expressed as percentage of total energy intake (%E). Nutrients were additionally expressed as percentage per EO (%E EO ). Foods were assigned to food groups; variation in intake was calculated via coefficient of variation (CV). We analyzed age trends in diurnal intake using mixed-effects beta regression. Results The 740 healthy children included in the analysis consumed the largest proportion of daily energy at lunch (31%E ± 8, M ± SD) and supper (26%E ± 8), followed by breakfast (19%E ± 7) and snacks [afternoon (16%E ± 8); morning (8%E ± 7)], with the most variable intake at morning snack (CV = 0.9). The nutrient composition at lunch and supper was highest for fat (36 ± 9%E Lunch ; 39 ± 11%E Supper ) and protein (18 ± 5%E Lunch ; 18 ± 6%E Supper ) and at breakfast and snacks for carbohydrates (54 ± 12%E Breakfast ; 62 ± 12%E Snacks ). High-sugar content foods were consumed in relatively large proportions at breakfast and snacks. Food intakes varied significantly with age, with lower snack intakes at later ages ( p < 0.001). Conclusion Possibly unhealthy EOs with high-fat intakes and high-sugar-content foods were observed. Changes in nutrient composition of EOs may be beneficial for health. Trial registry: ClinicalTrials.gov: NCT00338689; 19/June/2006.
... Also, one study conducted by Garaulet in 2014 on obese people showed that less weight loss is observed in the group who had their lunch late (after 3 pm) than people who ate their lunch before 3 pm [13]. Studies conducted on experimental animals have shown that animals become obese when they eat at the "wrong time", though they seem to eat and consume the same amount of energy [24]. Regarding the results of previous studies and their emphasis on the role of chronotype plus eating time on obesity [25], in our study we challenged the effect of chronotype and genotype through eating time on obesity. ...
Article
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Background Circadian Locomotor Output Cycles Kaput (CLOCK), an essential element of the positive regulatory arm in the human biological clock, is involved in metabolic regulation. The aim was to investigate the behavioral (sleep duration, food timing, dietary intake, appetite and chronobiologic characteristics) and hormonal (plasma ghrelin and Glucagon-like peptide-1 concentrations) factors that could explain the previously reported association between the CLOCK 3111 T/C SNP and obesity. Methods This cross-sectional study included 403 subjects, overweight and/or obesity, aged 20- 50 years from Iran. The CLOCK rs1801260 data were measured by the PCR–RFLP method. Dietary intake, food timing, sleep duration, appetite and Chrono-type were assessed using validated questionnaires. Ghrelin and GLP-1 were measured by ELIZA in plasma samples. Participants were also divided into three groups based on BMI. Logistic regression models and general linear regression models were used to assess the association between CLOCK genotype and study parameters. Univariate linear regression models were used to assess the interaction between CLOCK and VAS, Food timing, chronotype and sleep on food intakes. Results After controlling for confounding factors, there was a significant difference between genotypes for physical activity (P = 0.001), waist circumference (P˂0.05), BMI (˂0.01), weight (P = 0.001), GLP-1 (P = 0.02), ghrelin (P = 0.04), appetite (P˂0.001), chronotype (P˂0.001), sleep (P˂0.001), food timing (P˂0.001), energy (P˂0.05), carbohydrate (P˂0.05) and fat intake (P˂0.001). Our findings also show that people with the minor allele C who ate lunch after 3 PM and breakfast after 9 AM are more prone to obesity (P˂0.05). furthermore, there was significant interactions between C allele carrier group and high appetite on fat intake (Pinteraction = 0.041), eat lunch after 3 PM on energy intake (Pinteraction = 0.039) and morning type on fat intake (Pinteraction = 0.021). Conclusion Sleep reduction, changes in ghrelin and GLP-1 levels, changes in eating behaviors and evening preference that characterized CLOCK 3111C can all contribute to obesity. Furthermore, the data demonstrate a clear relationship between the timing of food intake and obesity. Our results support the hypothesis that the influence of the CLOCK gene may extend to a wide range of variables related to human behaviors.
... A través de la evidencia actual se ha observado que algunos hábitos saludables como: el consumo del desayuno, comer en horarios correspondientes a los diferentes tiempos de comida durante el día, no comer en horarios nocturnos o cercanos al ciclo del sueño, así como el dormir en el horario adecuado y la cantidad de horas suficiente, además de evitar la utilización excesiva de pantallas o aparatos electrónicos y realizar actividad física regularmente, mantiene la crononutrición de un organismo estable y se disminuye la probabilidad de aparición de ECNT y de obesidad a futuro 14,15,16 . ...
Article
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Introduction: The circadian rhythm is responsible for regulating important metabolic and endocrine functions. “Chrononutrition” explains the importance of time and types of food based on circadian rhythm. Obesity is one of the biggest public health problems. Objective: To describe the relation between chrono-nutrition and obesity. Methods: A systematic review was performed using PubMed, Scielo and Medline databases of articles published between 2014 to 2019 in humans. Nineteen articles were obtained and four articles met inclusion criteria. Results: Higher Body Mass Index (BMI) and weight circumference (WC) values were observed in people who skipped breakfast and ate less than 3 hours before bed. Children 4 years of age with higher energy intakes at lunch and dinner were more likely to be overweight or obese at 7 years. Skipping breakfast and eating dinner later was negatively associated with body weight. Among adolescents, eating main meals late was associated with an increase in BMI and WC. In normal weight subjects, regardless of whether they ate early or late, if eating was aligned with their circadian rhythm, they did not suffer major changes in weight. This was not the case for subjects with excess weight. Conclusions: A diet not aligned with the circadian rhythm, may increase the probability of generating obesity in the medium and long term. However, evidence is still needed.
... In terms of dietary intervention, calorie restriction is primarily the main component to induce weight loss [9]. In addition, emerging research to demonstrate the plausible role of chrono-nutrition in obesity is ongoing [10]. ...
Article
Full-text available
This paper describes the development of an integrated chrono-nutrition weight reduction program and the evaluation of the attendance, retention, satisfaction and compliance towards the chrono-nutrition components among morning and evening chronotypes for overweight/obese non-shift workers. The present study was conducted in two phases: Phase I was composed of needs assessments on the chronotypes’ dietary patterns and chrono-nutrition through a scoping review and integrating the chrono-nutrition components (temporal eating pattern, meal timing and sleeping habits) alongside the existing weight reduction module, SLIMSHAPE™. Phase II consisted of a feasibility study to evaluate the integrated chrono-nutrition weight reduction program (SLIMSHAPE™ Chrono). A total of 91 overweight/obese non-shift workers participated in the 12-week weight reduction program (Age: 39.6 ± 6.3 years; 74.7% women; BMI: 31.2 ± 4.5 kg/m2). Low attrition rate was recorded, with 85 participants (93.4%) completing the pre- and post-intervention assessments. Overall, morning and evening chronotypes had increased their % energy intake in the early eating window (MT: 64.8 vs. 67.2%, ET: 62.7 vs. 65.6%, Mean difference (MD): 2.8, 95%CI: 0.3, 5.1, p = 0.028) and reduced their intake in the late eating window (MT: 35.2 vs. 32.8%, ET: 37.3 vs. 34.4%, MD: −2.8, 95%CI: −5.1, −0.3, p = 0.028) and earlier midpoint of eating (MT: 14:02 vs. 13:49; ET: 14:27 vs. 14:18, 95%CI: −0.4, −0.02, p = 0.029) and had a reduced night eating syndrome score (MT: 10.0 vs. 8.9; ET: 10.7 vs. 8.9, MD: −1.5, 95%CI: −2.5, −0.5, p = 0.004). There was no significant change in the first (MT: 08:12 vs. 08:04, ET: 08:24 vs. 08:22, MD: −0.1, 95%CI: −0.2, 0.03, p = 0.170) and last mealtime (MT: 19:52 vs. 19:33, ET: 20:29 vs. 20:14, MD: −0.3, 95%CI: −0.6, −0.04, p = 0.081), eating duration (MT: 11.7 vs. 11.5 h, ET: 12.1 vs. 11.9 h, MD: −0.2, 95%CI: −0.6, 0.2, p = 0.251) and the elapse time between sleep onset and last meal (MT: 3.1 vs. 3.5 h, ET: 3.5 vs. 3.2 h, MD: 0.1, 95%CI: −0.3, 0.4, p = 0.678). In terms of sleep, evening chronotypes increased their sleep duration (MD: 0.8 h, 95% CI: 0.4, 1.2, p < 0.001) and reduced social jetlag (MD: 19 min, 95% CI: 1.7, 36.3, p = 0.031) post-intervention compared to morning chronotypes. The integrated chrono-nutrition weight reduction program among morning and evening chronotypes improved the temporal pattern of energy intake, meal timing, night eating syndrome and sleep habits post-intervention. The chrono-nutrition practice could be a potentially modifiable behavior as an adjunct strategy in weight management.
... The largest meal size was found in P2, which is in line with the fact that lunch, the main meal in the Chilean and other countries in the South American region population [31,32], is commonly found at this time of day. This pattern agrees with the reported meal pattern of the Chilean population, including breakfast, lunch, and teatimebut not dinner -as the three main meals daily consumed by more than 80% at the national level [28]. ...
Article
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Background/Objectives We assessed the association between the timing of meals across the day with diet composition and metabolic parameters in patients with type-2 diabetes (T2D). Subjects/Methods Eighty adults (55.2 ± 6.8 years, 45% males) patients with T2D (without insulin therapy) were included. Three non-consecutive dietary records assessed food intake. The onset time of each consumed meal/beverage was identified and assigned to one of three periods of the day: Period 1 (P1, 06:00–11:59 h), Period 2 (P2, 12:00–17:59 h), and Period 3 (P3, 18:00–00:30 h). Results Energy intake in P1 was lower compared to P2 and P3 (22.8 ± 7.9%, 37.5 ± 9.6%, and 39.7 ± 9.9%, respectively, P < 0.001). The same pattern was found for both total protein and fat intake, but carbohydrate intake was similar among periods. Patients with greater daily energy intake (as % of total energy) in P3 showed increased total food consumption, total energy, protein, and fat intake (all P < 0.05). The opposite pattern was observed in patients with greater daily energy intake in P1 (all P < 0.05). Regression analysis showed that daily energy intake was significantly reduced when a higher proportion of carbohydrates was eaten in P1 (vs. P3, P < 0.04). Conclusion Increased energy intake late during the day is related to increased total food and daily energy intake in patients with T2D. A greater proportion of total carbohydrates eaten early during the day relates to lower total energy intake. Our results suggest that earlier food intake may be a nutritional tool for dietary and metabolic control in these patients.
Article
Modern lifestyle is generally associated with the consumption of three main meals per day, one of which is typically in the evening or at night. It is also well established that consumption of meals in the later part of the day, notably in the evenings, is associated with circadian desynchrony, which in turn increases the risk of non‐communicable diseases, particularly cardiometabolic diseases. While it is not feasible to avoid food consumption during the evenings altogether, there is an opportunity to provide chrono‐specific, diet‐based solutions to mitigate some of these risks. To date, there has been substantial progress in the understanding of chrononutrition, with evidence derived mainly from in vitro and in vivo animal studies. Some of these approaches include the manipulation of the quality and quantity of certain nutrients to be consumed at specific times of the day, as well as incorporating certain dietary components (macronutrients, micronutrients, or non‐nutrient bioactives, including polyphenols) with the ability to modulate circadian rhythmicity. However, robust human studies are generally lacking. In this review, the study has consolidated and critically appraised the current evidence base, with an aim to translate these findings to improve cardiometabolic health and provides recommendations to move this field forward. Eating later in the day is associated with circadian desynchrony, which can increase cardiometabolic disease risk. This review highlights diet‐based approaches to mitigate such risks via 1) the manipulation of quality and quantity of certain nutrients consumed at specific times during the day, 2) the incorporation of certain dietary components as zeitgebers/chronobiotics with the ability to directly modulate circadian rhythms.
Chapter
Circadian rhythms are integral to life at all levels. However, only in the last few decades have their roles and importance in promoting health and implications for preventing disease begun to be fully explored. Circadian rhythms have a profound effect on daily living in all organisms and strongly influence everything from the cell cycle and gene expression for numerous genes up through human behaviors such as timing of food consumption and how nutrients are utilized, including in mounting effective inflammatory and immune responses. The effect of circadian rhythm disruption, both in the brain's central clock, known as the suprachiasmatic nucleus (SCN), and peripheral tissues, has been studied extensively. Of late, there has been growing interest in the relationship between diet (both quality and timing) and various circadian rhythms, primarily in peripheral tissues. In this chapter we provide an overview of the molecular and genetic underpinnings of the SCN and a molecular overview to peripheral rhythms, providing a biological framework through which behaviors act to influence inflammation. We discuss chrononutrition, as well as various fasting diets and their association with inflammation. We highlight sleep's and chronotype's relationship with circadian rhythms, diet, and inflammation, respectively. Finally, we discuss these relationships from a shift-working perspective, as shift workers commonly experience circadian disruption and abnormal eating times, which may lead to chronic systemic inflammation and inability to mount a competent immune response.
Article
Chronic low-grade inflammation is an underlying risk factor for numerous chronic diseases, including cancer. Eating earlier in the day has been associated with a reduction in levels of inflammatory markers and inflammation-related health outcomes (e.g., obesity, metabolic disorders). This cross-sectional study of 249 obese African-American women examined the effect of various mealtime-related factors associated with macronutrient consumption in relation to chronic inflammation and Breast Imaging Reporting and Data System (BI-RAD) readings. During 2011 and 2013, a single 24-hour dietary recall was administered, blood samples were assayed for c-reactive protein (CRP) and interleukin-6 (IL-6), and BI-RAD ratings were assessed to determine the influence of mealtime on chronic inflammation and breast cancer risk score. Multiple linear and logistic regression models were used to assess these relationships. Higher carbohydrate consumption at breakfast was associated with a significantly lower CRP vs. higher carbohydrate consumption at dinner (6.99, vs. 9.56 mg/L, respectively, p = .03). Additionally, every 1-unit increase in percent energy consumed after 5PM resulted in a BI-RAD reading indicating a possibly suspicious abnormality (OR: 1.053, 95% CI: 1.003-1.105), suggesting an increase in breast cancer risk. Timing of energy and macronutrient intake may have important implications for reducing the risk of diseases associated with chronic inflammation.
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Objective: To evaluate whether meal patterns and cooking practices in Central England and Mediterranean France conform to popular stereotypes, eating together as a household, preparation of meals, food purchasing patterns, cooking practices and eating out were investigated. Design: Cross-sectional studies conducted simultaneously in April 2001 using self-administered postal questionnaires. Setting: England (Nottingham, East Midlands) and France (Montpellier, Languedoc-Roussillon). Subjects: A stratified random sample of 1000 males and 1000 females aged 18-65 years was generated from the electoral roll in each country. The final sample comprised 826 subjects in England (58% males, 42% females; mean age 44 years) and 766 subjects in France (42% males, 58% females; mean age 42 years). Analyses were conducted on samples standardised for sociodemographic differences. Results: The French cooked from raw ingredients most often (P < 0.001), ate together as a household more regularly (P < 0.001) and were most likely to follow a regular meal pattern of three meals a day. On the other hand, the English relied more on ready-prepared (P < 0.001) and take-away (P < 0.001) meals, as well as on energy-dense snack foods such as crisps (P < 0.001). Females in both countries reported having most responsibility for preparing meals. Conclusions: Some of the study's findings confirm popular stereotypes of French and English food cultures, as the importance of the convivial aspects of eating, as well as more traditional practices such as cooking meals from basic ingredients, structured mealtimes and less between-meal snacking, remain more prominent within the French population. This may contribute to the differences in prevalence of obesity seen between the two countries.
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Book
Adults living in certain olive-growing areas of the Mediterranean Basin display high life expectancies and rates of chronic disease that are among the lowest in the world. These benefits are achieved despite socioeconomic indicators that are often much lower than those of more industrial nations in North America and Europe. Attention has focused on diet as the cardinal factor since food consumption patterns are closely tied to the incidence and severity of chronic debilitating diseases. The Mediterranean Diet: Constituents and Health Promotion explores in detail the relationship among the Mediterranean Diet, nutritional status, and disease and evaluates the nutritional practices that minimize or slow the incidence and progress of major diseases, especially heart disease and cancer. During the past ten years the Mediterranean Diet has been the subject of constant attention, debate, and controversy. It is the subject of ongoing studies as a cultural model for dietary improvement and health promotion in the United States and Europe. Divided into three sections, the book provides this information: Background: Learn about the history of the Mediterranean Diet and food patterns from the ancient Greeks through the present. This section also discusses the diet’s classical antecedents and definition, paying particular attention to the characteristics, dietary patterns, and epidemiological aspects. Dietary Constituents: Discover the specific food components and commodities that constitute the Mediterranean Diet such as fats and oils; fruits, vegetables, legumes, and grains; milk and dairy products; meat and meat products; and alcoholic beverages. Health Promotion and Disease Prevention: Examine how the Mediterranean Diet promotes good health with regard to diabetes and obesity, coronary heart disease, cancer, and longevity. Also included are chapters offering dietary recommendations based on the current understanding of the diet, suggested future research and applications, and a useful summary chapter. The Mediterranean Diet: Constituents and Health Promotion provides a clear overview of this timely and controversial subject.