ARTICLE INFO | ABSTRACT | |
ORIGINAL ARTICLE | Background: Timing, frequency, and regularity as chrono-nutrition are emerging fields in nutritional epidemiology. The authors investigated the association of irregularity in energy intake, frequency, and overnight fasting with nutrient quality and health. Methods: Iranian adults who attended the health center of Tehran participated in this cross-sectional study. Dietary intake was derived from 3-day 24-h dietary recalls of 850 participants. Weight, height, and blood pressure of the participants were measured, and frequency, irregularity, and overnight fasting were recorded from 24-h dietary recall. Then, intra-class correlation coefficient (ICC) was used to obtain the consistency of time regarding three main meals. Following that, energy density was measured and nutrient density was calculated using the nutrient rich food (NRF 9.3) index. Obesity was defined as body mass index (BMI) >30 kg/m2, and blood pressure was measured. Results: The highest consistency regarding the time of meal was observed at breakfast. Frequency was positively related to the intake of fruit, energy, carbohydrate, and NRF 9.3 index (P<0.05). Overnight fasting was negatively associated with fruit, vegetable, grain, energy intake, and NRF 9.3 index (P<0.05). Moreover, irregularity in energy intake showed a negative and significant association with fruits, vegetables, and NRF9.3 (P<0.05). Frequency was significantly associated with weight and diastolic blood pressure (DBP) after adjustment with covariates (P<0.05) and overnight fasting was negatively related to body weight (P=0.009). Moreover, irregularity in energy intake showed a significant association with systolic blood pressure (SBP) (P=0.03). Conclusions: Frequency and regularity may have a potential positive association with dietary intake which is not associated with BMI. Nutrient density is higher among the participants with a higher number of eating occasions, more regular eaters, and shorter overnight fasting. Keywords: Feeding-related behaviors; Meals, Fasting; Nutrients; Obesity. |
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Article history: Received: 15 Oct 2022 Revised: 27 Nov 2022 Accepted: 27 Dec 2022 |
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*Corresponding author: s_shabbidar@tums.ac.ir Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences. Postal code: 7186615488 Tel: +98 21 88955975 |
Table 1. Baseline characteristics of the participants. | |||
Variables | Total | Men | Women |
Educated (bachelor degree or higher degrees) | 297 (34.3)a | 81(55.2) | 216 (30.6) |
Activity score | |||
Low | 442 (51.9) | 73 (49.4) | 369 (52.5) |
Moderate | 323 (38.6) | 61 (41.6) | 262 (32.7) |
High | 78 (8.5) | 12 (8.9) | 66 (14.8) |
Occupation | |||
Employee | 308 (36.2) | 114(77.5) | 194 (27.3) |
Unemployed | 538 (73.8) | 34 (22.5) | 504 (72.7) |
Marriage | |||
Married | 679 (80.5) | 115(31.8) | 564 (80.2) |
Others | 164(19.5) | 30 (78.2) | 134 (19.8) |
Lifestyle (Living alone) | 61(8.1) | 14 (7.5) | 37 (5.3) |
Smoking | |||
Not smoking | 802 (94.3) | 127 (97.4) | 675 (87.4) |
Quit smoking | 5 (1.7) | 3 (2.3) | 2 (1.3) |
Smoker | 29 (4.0) | 11 (0.7) | 17 (11.3) |
Medical condition | |||
Underlying disease | 109 (14.4) | 14 (34.1) | 95 (33.8) |
Apparently Healthy | 741 (67.9) | 93 (63.29) | 621 (33.0) |
Skipped breakfast | 60 (7.5) | 19 (12.2) | 41(7.1) |
Skipped lunch | 62 (7.4) | 11 (7.3) | 52 (8.4) |
Skipped dinner | 60 (7.5) | 15 (10.1) | 45 (7.6) |
Consumed breakfast all days | 790 (92.9) | 128 (87.4) | 662 (91.2) |
Consumed lunch all days | 778(92.6) | 136 (92.5) | 651(92.6) |
Consumed dinner all days | 790 (92.9) | 132 (89.6) | 658 (93.6) |
Consuming all 3 meals all days | 678 (79.8) | 111 (75.5) | 567 (80.7) |
Taking dietary supplement | 201(23.7) | 26 (19.1) | 175 (24.6) |
Obese or overweight (Body mass index>25 kg/m2) | 216 (25.7) | 33 (22.4) | 183 (26.3) |
Age (years) | 42.23 ±11.21b | 42.08 ±10.87 | 42.85 ±10.97 |
Systolic blood pressure (mmHg) | 118.14 ± 12.75 | 119.68 ±12.26 | 117.32 ± 14.10 |
Diastolic blood pressure (mmHg) | 80.85 ± 6.74 | 81.53 ±6.80 | 80.38 ± 6.71 |
Energy intake (kcal/day) | 1676.7 ± 376.8 | 1786 ±398.8 | 1666.5 ± 385.3 |
Energy density | 1.08 ± 0.28 | 1.07 ± 0.25 | 1.08 ± 0.30 |
Nutrient rich food 9.3 index | 46.45 ±15.32 | 46.35±15.32 | 46.45 ±14.32 |
Eating occasions (numbers/day) | 5.98 ± 0.92 | 5.90 ±0.94 | 6.00 ± 0.94 |
Frequency main meals (numbers/day) | 2.92 ± 0.17 | 2.90 ±0.20 | 2.92± 0.17 |
Frequency snacks (numbers/day) | 3.15 ± 0.87 | 3.17 ± 0.89 | 3.15 ±0.86 |
Time of first eating occasions (hh:mm) | 7:32 ± 1:04 | 7:32 ± 0:59 | 7:33 ± 1:05 |
Time of last eating occasions (hh:mm) | 22:17 ± 1:54 | 22:19 ± 1:48 | 22:17 ± 1:52 |
Interval first eating occasions and wake up (hh:mm) | 1:32 ± 0:54 | 1:32 ± 0:54 | 1:33 ± 0:54 |
Interval last eating occasions and sleep (hh:mm) | 1:20 ± 1:07 | 1:15 ± 1:18 | 1:17 ± 1:05 |
Interval time of lunch with time of breakfast (hh:mm) | 5:50 ± 0:52 | 5:58 ± 0:50 | 5:49 ± 0:53 |
Interval time of dinner with time of lunch (hh:mm) | 6:52 ± 0:43 | 6:48 ± 0:43 | 6:52 ± 0: 44 |
Overnight fasting (hh:mm)c | 10:01 ± 1:14 | 10:04 ± 1:10 | 10:00 ± 1:06 |
Intra-individual consistency in time of breakfast | 0.21 | 0.32 | 0. 19 |
Intra-individual consistency in time of lunch | 0.09 | 0.07 | 0.09 |
Intra-individual consistency in time of dinner | 0.06 | 0.05 | 0.08 |
Table 2. Baseline characteristics of the participants across the categories of meal frequency, irregularity score energy intake, and fasting period length. | |||||||||||||
Variables | Frequency meals (meal numbers/day) | Overnight fasting (hours/day) | Irregularity score energy intake | ||||||||||
T1(<5) | T2(5-7) | T3 (>7) | P-valueb | T1 (<8) | T2 (8-10) | T3 (>10) | P-value | T1(≤14) | T2 (14-24) | T3 (≥24) | P-value | ||
Sex Male |
59(36.7)a |
64(39.8) |
40(24.5) |
0.17 | 47(28.5) |
54(33.3) |
61(37.2) |
0. 69 | 34(24.4) |
60(39.2) |
42(29.4) |
0.06 | |
Female | 208(30.5) | 262(38.4) | 216(31.1) | 216(31.5) | 246(35.9) | 224 (32.7) | 162(22.1) | 313(55.2) | 168(22.9) | ||||
Education Educated |
111(37.4) |
101(34.2) |
85(28.4) |
0.02 | 89(30.1) |
97(32.8) |
110(30.3) |
0.28 | 35(10.3) |
196(58.4) |
93(31.3) |
0.45 | |
Under diploma | 155(28.3) | 220(40.2) | 172(31.4) | 174(31.8) | 174(36.4) | 175(31.8) | 109(21.8) | 177(53.7) | 137(24.5) | ||||
Activity score Low |
136(30.8) |
173(39.1) |
133(33.7) |
0.51 | 146(33.0) |
147(33.3) |
149(33.7) |
0.28 | 94(20.4) |
199(55.7) |
94(23.9) |
0.23 | |
Moderate | 107(33.1) | 120(37.2) | 95(29.7) | 91(28.3) | 117(36.3) | 114(35.4) | 55(20.2) | 119(50.6) | 75(29.2) | ||||
High | 22(28.9) | 28(36.8) | 26(34.2) | 25(32.9) | 31(40.8) | 20(35.6) | 10(7.2) | 39(61.0) | 25(21.8) | ||||
Occupation Employed |
111(36.1) |
116(37.7) |
81(26.2) |
0.06 | 86(28.8) |
107(34.1) |
114(36.1) |
*0.03 | 55(20.6) |
106(52.1) |
73(27.3) |
0.32 | |
Housekeeper | 123(27.4) | 177(40.2) | 143(32.4) | 142(32.1) | 167(27.3) | 134(30.6) | 102(32.8) | 107(35.3) | 100(31.9) | ||||
Unemployed | 32(34.8) | 28(31.4) | 164(34.8) | 35(38.2) | 21(22.8) | 36(39.0) | 8(10.2) | 50(68.1) | 16(21.7) | ||||
Marriage Married |
208(31.3) |
261(36.5) |
210(32.2) |
0.52 | 213(31.3) |
249(36.5) |
217(32.2) |
0.06 | 118(24.3) |
206(47.5) |
123(27.2) |
0.83 | |
Non married | 58(32.5) | 60(37.9) | 47(30.6) | 50(32.5) | 47(38.9) | 69(38.6) | 76(12.4) | 167(74.1) | 86(34.5) | ||||
Living alone | 16(38.1) | 14(33.3) | 12(28.6) | 0.59 | 18(42.9) | 17(40.5) | 7(16.7) | 0.14 | 9(20.8) | 29(65.8) | 6(15.4) | 0.27 | |
Smoking status Not smoking |
250(31.7) |
304(37.4) |
248(30.9) |
0.34 | 245(30.2) |
285(36.3) |
269(33.5) |
0.44 | 153(23.7) |
221(55.9) |
107(20.4) |
0.15 | |
Quit smoking | 5(35.7) | 8(57.0) | 1(7.3) | 4(28.7) | 3(22.6) | 7(50.7) | 1(7.1) | 12(85.8) | 1(7.1) | ||||
Smoker | 11(39.6) | 9(32.0) | 8(28.4) | 12(41.4) | 8(24.3) | 8(24.3) | 2(7.8) | 24(84.4) | 2(7.8) | ||||
Medical condition Underlying disease |
101(30.1) |
134(39.1) |
102(30.8) |
0.86 | 111(32.3) |
107(31.5) |
122(35.9) |
0.42 | 83(21.1) |
136(49.4) |
100(28.4) |
0.28 | |
Apparently healthy | 163(31.9) | 192(37.2) | 157(30.9) | 150(33.6) | 155(34.8) | 141(31.6) | 83(19.6) | 237(69.2) | 80(17.2) | ||||
Obesity status Normal |
84(24.1) |
106(35.5) |
99(30.4) |
0.41 | 95(32.6) |
99(35.8) |
95(332.6) |
0.20 | 57(14.1) |
145(69.6) |
51(11.4) |
0.39 | |
Overweight | 115(36.0) | 128(36.2) | 96(27.8) | 106(30.1) | 119(34.2) | 125(36.7) | 87(12.1) | 121(65.1) | 101(19.8) | ||||
Obesity | 73(32.2) | 87(40.4) | 63(27.4) | 76(35.1) | 82(39.1) | 52(26.8) | 51(16.9) | 105(63.5) | 57(18.6) | ||||
a: n(%); b: Chi-square test. | |||||||||||||
Table 3. Multivariable-adjusted means for dietary intake across the categories of meal frequency, irregularity score energy intake, and fasting period length. | ||||||||||||
Variables | Frequency meals(Meals numbers/day) | Overnight fasting (hours/day) | Irregularity score energy intake | |||||||||
T1(<5) | T2(5-7) | T3(>7) | P-value | T1(<8) | T2(8-10) | T3(>10) | P-value | T1(≤14) | T2(14-24) | T3(≥24) | P- value | |
Nutrient food rich 9.3 indexb | 42.9 ± 13.8a | 47.9±13.4 | 49.9 ± 15.8 | >0.001 | 47.7 ± 15.2 | 47.3 ± 14.2 | 42.9 ± 13.2 | 0.006 | 47.5 ± 15.2 | 46.2 ± 13.8 | 44.9±13.2 | 0.04 |
Fruit(g/day) b | 89.5 ± 70.1 | 108.0±69.8 | 124.0 ± 68.2 | >0.001 | 115.0 ± 67.1 | 111.0 ± 71.8 | 95.3 ±70.2 | 0.02 | 109.0 ±78.9 | 114.0 ± 64.2 | 98.0 ±70.6 | 0.01 |
Vegetable(g/day) | 125 ± 74.9 | 143±74.5 | 152.0 ± 71.4 | 0.004 | 143.0 ± 72.6 | 148.0 ± 71.0 | 130.0 ± 74.8 | 0.03 | 147.0 ± 44.3 | 141.0± 4.8 | 131.0± 4.5 | 0.04 |
Dairy(g/day) b | 145.1 ± 95.7 | 158±97.7 | 54.2 ± 92.1 | 0.66 | 157.0 ± 91.5 | 153.1± 97.1 | 148.0 ± 90.7 | 0.7 | 161.0± 96.0 | 157.0 ± 96.1 | 156.0±101.0 | 0.64 |
Grains*(g/day) b | 288 ± 90.0 | 310±40.5 | 298.0 ± 43.5 | 0.13 | 293.0 ± 87.5 | 303.0 ± 86.2 | 266.0 ± 85.5 | >0.001 | 308 ± 93.2 | 305.1 ± 88.4 | 319.0 ± 93.7 | 0.18 |
Meats(g/day) b | 51.8 ± 34.5 | 54.7±39.5 | 51.3 ± 30.1 | 0.43 | 51.0 ± 36.5 | 52.5 ±31.8 | 55.3 ± 37.2 | 0.19 | 81.1 ±39.8 | 77.3 ± 40.9 | 78.1±36.3 | 0.65 |
Carbohydrate(g/day) | 220.1 ± 64.4 | 258±78.3 | 270.2 ± 100 | 0.02 | 254 ± 90.6 | 252.0 ±108.0 | 238.0 ± 102 | 0.86 | 262.0±105.0 | 256.0 ± 93.6 | 254.0±156.0 | 0.58 |
Protein(g/day) b | 57.9 ± 14.3 | 59.2±16.9 | 56.5 ± 15.5 | 0.30 | 54.9 ± 14.3 | 59.2 ± 12.9 | 51.5±15.5 | 0.42 | 59.2 ±14.3 | 60.4 ±14.5 | 58.3 ±14.8 | 0.65 |
Fat(g/day) b | 52.5 ± 20.8 | 58.9±39.0 | 58.7 ± 28.5 | 0.49 | 58.1 ±38.8 | 53.8 ± 28.4 | 51.3 ± 29.1 | 0.43 | 55.4 ±15.3 | 59.5 ± 32.3 | 59.6±19.2 | 0.32 |
Total energy intake (kcal/day)c | 1557±331 | 1756±258 | 1796±284 | >0.001 | 1796±415 | 1765±381 | 1629±376 | 0.04 | 1721±382 | 1746±371 | 1687±354 | 0.20 |
a: Mean±SD; b: Adjusted for sex, age, obesity, energy intake; c: Adjusted for sex, age, obesity. |
Table 4. Multivariable-adjusted means for anthropometric measures across the categories of meal frequency, irregularity score energy intake, and fasting period length. | ||||||||||||||
Variables | Frequency meals (meal numbers/day) | Overnight Fasting (hours/day) | Irregularity score energy intake | |||||||||||
T1(<5) | T2(5-7) | T3(>7) | P-value | T1(<8) | T2(8-10) | T3(>10) | P-value | T1(≤14) | T2(14-24) | T3(≥24) | P-value | |||
(N=267) | (N=326) | (N=257) | (N=264) | (N=300) | (N=285) | (N=196) | (N=374) | (N=210) | ||||||
Weight (kg) | ||||||||||||||
Model 1 | 73.5±15.2 | 73.4±16.5 | 70.1±12.4 | 0.02 | 73.6±12.8 | 72.7±14.5 | 70.5±11.5 | 0.03 | 71.4±12.3 | 72.3±14.1 | 71.7±12.3 | 0.72 | ||
Model 2 | 74.4±15.3 | 73.2±14.2 | 71.3±12.1 | 0.03 | 74.8±15.5 | 73.5±14.3 | 70.4±10.8 | 0.01 | 73.3±12.8 | 72.6±14.3 | 73.3±11.3 | 0.53 | ||
Model 3 | 74.2±14.4 | 73.2±15.5 | 70.6±12.0 | 0.05 | 74.2±15.3 | 73.4±14.3 | 70.3±12.4 | 0.009 | 72.2±12.4 | 73.5±14.5 | 72.3±13.2 | 0.49 | ||
Body mass index (kg/cm2) | ||||||||||||||
Model 1 | 27.5±4.2 | 27.4±4.5 | 26.1±4.4 | 0.44 | 27.4±5.8 | 27.7±4.6 | 26.5±4.5 | 0.11 | 27.0±4.2 | 27.4±4.5 | 27.7±4.3 | 0.87 | ||
Model 2 | 27.4±4.1 | 27.2±4.2 | 27.3±4.5 | 0.77 | 27.8±5. 5 | 27.5±4.3 | 26.4±3.8 | 0.21 | 27.4±4.3 | 27.1±4.3 | 27.4±4.4 | 0.88 | ||
Model 3 | 27.2±4.4 | 27.2±4.5 | 27.6±4.01 | 0.60 | 27.2±5.3 | 27.4±4.3 | 26..3±3.4 | 0.23 | 27.3±4.6 | 27.4±4.3 | 27.1±4.6 | 0.65 | ||
Waist circumference (cm) | ||||||||||||||
Model 1 | 88.5±12.2 | 90.4±11.5 | 88.2±10.4 | 0.06 | 90.5±12.8 | 89.7±11.6 | 87.5±10.5 | 0.06 | 99.5±10.3 | 89.4±11.3 | 89.9±10.3 | 077 | ||
Model 2 | 89.4±11.1 | 90.2±11.2 | 89.3±11.3 | 0.65 | 91.8±12.5 | 89.5±11.3 | 87.4±10.8 | 0.14 | 89.5±11.4 | 90.4±11.2 | 89.8±10.4 | 0.56 | ||
Model 3 | 89.2±11.0 | 90.2±11.5 | 89.6±4.0 | 0.21 | 91.2±11.3 | 89.4±10.3 | 88.3±10.4 | 0.17 | 89.5±10.3 | 90.5±10.3 | 89.9±10.3 | 0.41 | ||
Waist to hip ratio
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Model 1 | 0.85±0.07 | 0.87±0.15 | 0.85±0.01 | 0.04 | 0.87±0.07 | 0.86±0.15 | 0.85±0.07 | 0.03 | 0.86±0.03 | 0.86±0.07 | 0.86±0.03 | 0.82 | ||
Model 2 | 0.86±0.06 | 0.87±0.13 | 0.86±0.08 | 0.12 | 0.87±0.16 | 0.86±0.03 | 0.85±0.08 | 0.05 | 0.87±0.06 | 0.86±0.06 | 0.86±0.06 | 0.53 | ||
Model 3 | 0.86±0.06 | 0.87±0.16 | 0.86±0.03 | 0.10 | 0.87±0.15 | 0.86±0.06 | 0.85±0.03 | 0.07 | 0.87±0.09 | 0.86±0.06 | 0.86±0.05 | 0.47 | ||
Systolic blood pressure (mmHg) | ||||||||||||||
Model 1 | 116.5±15.3 | 119.3±16.2 | 118.5±16.4 | 0.02 | 119.5±14.3 | 117.3±15.2 | 117.5±15.4 | 0.32 | 115.3±14.4 | 118.5±14..9 | 121.1±14.2 | 0.02 | ||
Model 2 | 117.4±13.4 | 119.4±15.5 | 119.5±16.4 | 0.08 | 119.4±14.3 | 117.4±15.5 | 117.5±15.4 | 0.54 | 115.9±14.3 | 118.3±14.3 | 121.4±16.3 | 0.03 | ||
Model 3 | 117.2±13.1 | 119.4±15.2 | 119.1±16.6 | 0.12 | 119.2±14.1 | 117.4±15.2 | 116.1±15.6 | 0.42 | 115.4±14.7 | 118.2±14.1 | 121.7±16.8 | 0.03 | ||
Diastolic blood pressure (mmHg) | ||||||||||||||
Model 1 | 78.3±9.8 | 80.3±9.6 | 78.2±9.3 | 0.05 | 79.3±10.8 | 78.3±9.6 | 78.2±9.0 | 0.44 | 78.8±8.1 | 78.5±9.4 | 80.4±10.5 | 0.09 | ||
Model 2 | 78.4±9.7 | 80.5±9.0 | 78.1±9.1 | 0.03 | 79.4±10.7 | 78.5±9.4 | 78.1±9.1 | 0.39 | 78.3± 8.2 | 78.6±9.7 | 80.8±10.5 | 0.10 | ||
Model 3 | 78.4±9.9 | 80.1±9.6 | 78.3±9.3 | 0.05 | 79.4±9.9 | 78.1±9.6 | 78.3±9.2 | 0.33 | 78.8±9.5 | 78.5±9.4 | 80.4±10.5 | 0.12 | ||
Model 1 was adjusted for age (continuous) and sex. Model 2 was additionally adjusted for marital status, education, physical activity, and smoking. Model 3 was further adjusted for dietary intake of fruits, vegetables, dairy, grains, and energy intake. | ||||||||||||||
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