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Meal irregularity and cardiometabolic consequences: results from observational and intervention studies

  • Gerda K. Pot (a1) (a2), Suzana Almoosawi (a3) and Alison M. Stephen (a4)

Studying irregular meal patterns fits in with the latest research focusing not only on what people eat but also when they eat, also called chrono-nutrition. Chrono-nutrition involves studying the impact of nutrition on metabolism via circadian patterns, including three aspects of time: (ir)regularity, frequency and clock time. The present paper aimed to narratively review research on irregular meal patterns and cardiometabolic consequences. Only few cross-sectional studies and prospective cohort studies were identified, and most of these suggested that eating meals irregularly is associated with a higher risk of the metabolic syndrome and cardiometabolic risk factors, including BMI and blood pressure. This was supported by two randomised controlled intervention studies showing that consuming meals regularly for 2 weeks v. an irregular meal pattern, led to beneficial impact on cardiometabolic risk factors as lower peak insulin, lower fasting total and LDL-cholesterol, both in lean and obese women. In conclusion, the limited evidence on meal regularity and cardiometabolic consequences supports the hypothesis that consuming meals irregularly is adversely associated with cardiometabolic risk. However, it also highlights the need for more large-scale studies, including detailed dietary assessment to further advance the understanding of the impact of chrono-nutrition on public health.

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* Corresponding author: G. K. Pot, email
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1. SamuelsonG (2000) Dietary habits and nutritional status in adolescents over Europe. An overview of current studies in the Nordic countries. Eur J Clin Nutr 54, Suppl. 1, S21S28.
2. Berteus ForslundH, TorgersonJS, SjostromL et al. (2005) Snacking frequency in relation to energy intake and food choices in obese men and women compared to a reference population. Int J Obes 29, 711719.
3. NightingaleF (1860) Notes on Nursing. New York: D. Appleton and Company.
4. GarauletM & MadridJA (2010) Chronobiological aspects of nutrition, metabolic syndrome and obesity. Adv Drug Deliv Rev 62, 967978.
5. SummaKC & TurekFW (2014) Chronobiology and obesity: interactions between circadian rhythms and energy regulation. Adv Nutr Int Rev J 5, 312S319S.
6. TaharaY & ShibataS (2013) Chronobiology and nutrition. Neuroscience 253, 7888.
7. ParsonsMJ, MoffittTE, GregoryAM et al. (2014) Social jetlag, obesity and metabolic disorder: investigation in a cohort study. Int J Obes 39, 842848.
8. GreenCB, TakahashiJS & BassJ (2008) The meter of metabolism. Cell 134, 728742.
9. JohnstonJD (2014) Physiological links between circadian rhythms, metabolism and nutrition. Exp Physiol 99, 11331137.
10. DelaboisA (1999) Mincir sur mesure grâce à la chrono-nutrition. Paris: Editions Albin Michel.
11. ErrenTC, PapeHG, ReiterRJ et al. (2008) Chronodisruption and cancer. Naturwissenschaften 95, 367382.
12. WangX-S, ArmstrongMEG, CairnsBJ et al. (2011) Shift work and chronic disease: the epidemiological evidence. Occup Med (Lond) 61, 7889.
13. StraifK, BaanR, GrosseY et al. (2007) Carcinogenicity of shift-work, painting, and fire-fighting. Lancet Oncol 8, 10651066.
14. MegdalSP, KroenkeCH, LadenF et al. (2005) Night work and breast cancer risk: a systematic review and meta-analysis. Eur J Cancer 41, 20232032.
15. SigurdardottirLG, ValdimarsdottirUA, FallK et al. (2012) Circadian disruption, sleep loss, and prostate cancer risk: a systematic review of epidemiologic studies. Cancer Epidemiol Biomarkers Prev 21, 10021011.
16. DavisS & MirickDK (2006) Circadian disruption, shift work and the risk of cancer: a summary of the evidence and studies in Seattle. Cancer Causes Control 17, 539545.
17. StevensRG, HansenJ, CostaG et al. (2011) Considerations of circadian impact for defining ‘shift work’ in cancer studies: IARC Working Group Report. Occup Environ Med 68, 154162.
18. van DrongelenA, BootCRL, MerkusSL et al. (2011) The effects of shift work on body weight change – a systematic review of longitudinal studies. Scand J Work Environ Health 37, 263275.
19. CanutoR, GarcezAS & OlintoMTA (2013) Metabolic syndrome and shift work: a systematic review. Sleep Med Rev 17, 425431.
20. PatelSR & HuFB (2008) Short sleep duration and weight gain: a systematic review. Obesity (Silver Spring) 16, 643653.
21. VyasMV, GargAX, IansavichusAV et al. (2012) Shift work and vascular events: systematic review and meta-analysis. BMJ 345, e4800.
22. LowdenA, MorenoC, HolmbäckU et al. (2010) Eating and shift work – effects on habits, metabolism and performance. Scand J Work Environ Health 36, 150162.
23. DuchonJC & KeranCM (1990) Relationships among shiftworker eating habits, eating satisfaction, and self-reported health in a population of US miners. Work Stress 4, 111120.
24. LennernäsM, HambraeusL & AkerstedtT (1995) Shift related dietary intake in day and shift workers. Appetite 25, 253265.
25. De AssisMAA, KupekE, NahasMV et al. (2003) Food intake and circadian rhythms in shift workers with a high workload. Appetite 40, 175183.
26. PasquaIC & MorenoCRC (2004) The nutritional status and eating habits of shift workers: a chronobiological approach. Chronobiol Int 21, 949960.
27. BalieiroLCT, RossatoLT, WaterhouseJ et al. (2014) Nutritional status and eating habits of bus drivers during the day and night. Chronobiol Int 31, 11231129.
28. de CastroJM (2004) The time of day of food intake influences overall intake in humans. J Nutr 134, 104111.
29. de CastroJM (2009) When, how much and what foods are eaten are related to total daily food intake. Br J Nutr 102, 12281237.
30. RoennebergT, AllebrandtKV, MerrowM et al. (2012) Social jetlag and obesity. Curr Biol 22, 939943.
31. AlmoosawiS, VingelieneS, KaragounisLG et al. (2016) Chrono-nutrition: A review of current evidence from observational studies on global trends in time-of-day of energy intake and its application with obesity. Proc Nutr Soc (In the Press).
32. Sierra-JohnsonJ, UndenAL, LinestrandM et al. (2008) Eating meals irregularly: a novel environmental risk factor for the metabolic syndrome. Obesity (Silver Spring) 16, 13021307.
33. GrundySM, CleemanJI, DanielsSR et al. (2005) Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Executive summary. Cardiol Rev 13, 322327.
34. LeeDS, EvansJC, RobinsSJ et al. (2007) Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 27, 127133.
35. ShinA, LimSY, SungJ et al. (2009) Dietary intake, eating habits, and metabolic syndrome in Korean men. J Am Diet Assoc 109, 633640.
36. PotGK, HardyR & StephenAM (2014) Irregular consumption of energy intake in meals is associated with a higher cardio-metabolic risk in adults of a British birth cohort. Int J Obes 38, 15181524.
37. PotGK, HardyR & StephenAM (2016) Irregularity of energy intake at meals: prospective associations with the metabolic syndrome in adults of the 1946 British birth cohort. Br J Nutr 115, 315323.
38. RichardsM, StephenAM & MishraG (2010) Health returns to cognitive capital in the British 1946 birth cohort. Longit Life Course Stud 1, 281296.
39. WennbergM, GustafssonPE, WennbergP et al. (2016) Irregular eating of meals in adolescence and the metabolic syndrome in adulthood: results from a 27-year prospective cohort. Public Health Nutr 19, 667673.
40. PimentaAM, Bes-RastrolloM, GeaA et al. (2016) Snacking between main meals is associated with a higher risk of metabolic syndrome in a Mediterranean cohort: the SUN Project (Seguimiento Universidad de Navarra). Public Health Nutr 19, 658666.
41. SjöbergA, HallbergL, HöglundD et al. (2003) Meal pattern, food choice, nutrient intake and lifestyle factors in The Göteborg Adolescence Study. Eur J Clin Nutr 57, 15691578.
42. FarshchiHR, TaylorMA & MacdonaldIA (2004) Regular meal frequency creates more appropriate insulin sensitivity and lipid profiles compared with irregular meal frequency in healthy lean women. Eur J Clin Nutr 58, 10711077.
43. FarshchiHR, TaylorMA & MacdonaldIA (2005) Beneficial metabolic effects of regular meal frequency on dietary thermogenesis, insulin sensitivity, and fasting lipid profiles in healthy obese women. Am J Clin Nutr 81, 1624.
44. HalbergF (1989) Some aspects of the chronobiology of nutrition: more work is needed on ‘when to eat’. J Nutr 119, 333343.
45. KantAK, SchatzkinA & Ballard-BarbashR (1997) Evening eating and subsequent long-term weight change in a national cohort. Int J Obes 21, 407412.
46. DrapeauV & GallantAR (2012) Homeostatic and circadian control of food intake: clinical strategies to prevent overconsumption. Curr Obes Rep 2, 93103.
47. StokkanKA, YamazakiS, TeiH et al. (2001) Entrainment of the circadian clock in the liver by feeding. Science 291, 490493.
48. ArbleDM, RamseyKM, BassJ et al. (2010) Circadian disruption and metabolic disease: findings from animal models. Best Pract Res Clin Endocrinol Metab 24, 785800.
49. AoyagiT, ShimbaS & TezukaM (2005) Characteristics of circadian gene expressions in mice white adipose tissue and 3T3-L1 adipocytes. J Heal Sci 51, 2132.
50. PtitsynAA, ZvonicS, ConradSA et al. (2006) Circadian clocks are resounding in peripheral tissues. PLoS Comput Biol 2, e16.
51. TurekFW (2005) Obesity and metabolic syndrome in circadian clock mutant mice. Science 308, 10431045.
52. BassJ & TakahashiJS (2010) Circadian integration of metabolism and energetics. Science 330, 13491354.
53. JohnstonJD (2014) Physiological responses to food intake throughout the day. Nutr Res Rev 27, 107118.
54. GarauletM, Gomez-AbellanP, Alburquerque-BejarJJ et al. (2013) Timing of food intake predicts weight loss effectiveness. Int J Obes 37, 604611.
55. BelinRJ, GreenlandP, AllisonM et al. (2011) Diet quality and the risk of cardiovascular disease: the Women's Health Initiative (WHI). Am J Clin Nutr 94, 4957.
56. TourloukiE, MatalasAL & PanagiotakosDB (2009) Dietary habits and cardiovascular disease risk in middle-aged and elderly populations: a review of evidence. Clin Interv Aging 4, 319330.
57. McCulloughML, FeskanichD, StampferMJ et al. (2002) Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr 76, 12611271.
58. SchoenfeldBJ, AragonAA & KriegerJW (2015) Effects of meal frequency on weight loss and body composition: a meta-analysis. Nutr Rev 73, 6982.
59. Louis-SylvestreJ, LluchA, NeantF et al. (2003) Highlighting the positive impact of increasing feeding frequency on metabolism and weight management. Forum Nutr 56, 126128.
60. HowarthNC, HuangTT-K, RobertsSB et al. (2006) Eating patterns and dietary composition in relation to BMI in younger and older adults. Int J Obes 31, 675684.
61. KoletzkoB & ToschkeAM (2010) Meal patterns and frequencies: do they affect body weight in children and adolescents? Crit Rev Food Sci Nutr 50, 100105.
62. SmithKJ, BlizzardL, McNaughtonSA et al. (2012) Daily eating frequency and cardiometabolic risk factors in young Australian adults: cross-sectional analyses. Br J Nutr 108, 10861094.
63. BergC, LappasG, WolkA et al. (2009) Eating patterns and portion size associated with obesity in a Swedish population. Appetite 52, 2126.
64. PalmerMA, CapraS & BainesSK (2009) Association between eating frequency, weight, and health. Nutr Rev 67, 379390.
65. MurakamiK & LivingstoneMBE (2015) Eating frequency is positively associated with overweight and central obesity in US adults. J Nutr 145, 27152724.
66. StoteKS, BaerDJ, SpearsK et al. (2007) A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults. Am J Clin Nutr 85, 981988.
67. BergC & ForslundHB (2015) The influence of portion size and timing of meals on weight balance and obesity. Curr Obes Rep 4, 1118.
68. ChivaM (2007) Cultural aspects of meals and meal frequency. Br J Nutr 77, S21.
69. LeechRM, WorsleyA, TimperioA et al. (2015) Characterizing eating patterns: a comparison of eating occasion definitions. Am J Clin Nutr 102, 12291237.
70. LeechRM, WorsleyA, TimperioA et al. (2015) Understanding meal patterns: definitions, methodology and impact on nutrient intake and diet quality. Nutr Res Rev 28, 121.
71. BlackAE & ColeTJ (2001) Biased over- or under-reporting is characteristic of individuals whether over time or by different assessment methods. J Am Diet Assoc 101, 7080.
72. LivingstoneMBE & RobsonPJ (2007) Measurement of dietary intake in children. Proc Nutr Soc 59, 279293.
73. McCroryMA & CampbellWW (2010) Effects of eating frequency, snacking, and breakfast skipping on energy regulation: symposium overview. J Nutr 141, 144147.
74. HammonsAJ & FieseBH (2011) Is frequency of shared family meals related to the nutritional health of children and adolescents? Pediatrics 127, e1565e1574.
75. WoodruffSJ & HanningRM (2008) A review of family meal influence on adolescents’ dietary intake. Can J Diet Pract Res 69, 1422.
76. RoennebergT, KuehnleT, JudaM et al. (2007) Epidemiology of the human circadian clock. Sleep Med Rev 11, 429438.
77. World Cancer Research Fund & AICR (2007) Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR.
78. SoferS, StarkAH & MadarZ (2015) Nutrition targeting by food timing: time-related dietary approaches to combat obesity and metabolic syndrome. Adv Nutr 6, 214223.
79. GarauletM & Gómez-AbellánP (2014) Timing of food intake and obesity: a novel association. Physiol Behav 134, 4450.
80. BandínC, Martinez-NicolasA, OrdovásJM et al. (2014) Circadian rhythmicity as a predictor of weight-loss effectiveness. Int J Obes 38, 10831088.
81. LaskaMN, HearstMO, LustK et al. (2015) How we eat what we eat: identifying meal routines and practices most strongly associated with healthy and unhealthy dietary factors among young adults. Public Health Nutr 18, 21352145.
82. AsherG & Sassone-CorsiP (2015) Time for food: the intimate interplay between nutrition, metabolism, and the circadian clock. Cell 161, 8492.
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