Eating Between Meals & Meal Frequency

[NickS]

Thanks Jeff!

[JeffN]

Daily eating frequency and cardiometabolic risk factors in young Australian adults: cross-sectional analyses.
Smith KJ, Blizzard L, McNaughton SA, Gall SL, Dwyer T, Venn AJ.
Br J Nutr. 2012 Sep;108(6):1086-94. Epub 2011 Dec 16.
PMID:22177728

Abstract

Eating frequency may be important in the development of overweight and obesity and other cardiometabolic risk factors; however, the evidence is inconsistent.

The aim of the present study was to examine the associations between the number of eating occasions and cardiometabolic risk factors in a national population-based sample of young adults.

A cohort of 1273 men and 1502 women, aged 26–36 years,

completed a meal pattern chart to record when they had eaten during the previous day (in hourly intervals). The total number of eating occasions was calculated. Diet quality was assessed, waist circumference was measured and a fasting blood sample was taken. Dietary intake was compared with the Australian Guide to Healthy Eating. The associations between the number of eating occasions and cardiometabolic risk factors were calculated using linear regression. Analyses were adjusted for age, education and physical activity.

Most men ate three to five times per d and most women ate four to six times. The proportion of participants meeting dietary recommendations increased with the number of eating occasions. For men, an additional eating occasion was associated with reductions in mean values for waist circumference (-0.75 cm), fasting glucose (-0.02 mmol/l), fasting insulin (-0.34 mU/l; 2.04 pmol/l), TAG (-0.03 mmol/l), total cholesterol (-0.08 mmol/l) and LDL-cholesterol (-0.06 mmol/l). Adjustment for waist circumference attenuated the results. Significant trends were not observed for women.

In conclusion, a higher number of eating occasions were associated with reduced cardiometabolic risk factors in men. Many associations were mediated by waist circumference.

[JeffN]

In regard to listening to our bodies, there is a well known concept called "Hidden Hunger" which is a major global problem accounting for 10% of the global health burden.

Hidden hunger is defined as a chronic lack of vitamins and minerals. It is a deficiency of micro-nutrients. Yet, Hidden Hunger, which has been well studied, has no visible warning signs, so that people who suffer from it may not even be aware of it. It has no symptoms.

Interesting, as this is the exact opposite of what people are saying when they say they are listening to their body.

You can read more about Hidden Hunger here..

http://web.archive.org/web/201304271404 ... .asp?x=573

What is Hidden Hunger?

Hidden hunger is unlike the hunger that comes from a lack of food. It is a chronic lack of vitamins and minerals that often has no visible warning signs, so that people who suffer from it may not even be aware of it. Its consequences are nevertheless disastrous: hidden hunger can lead to mental impairment, poor health and productivity, or even death. One in three people in the world suffer from hidden hunger. Women and children from the lower income groups in developing countries are often the most affected.

In Health
Jeff

[JeffN]

On the myth that breakfast is the most important meal.


NY Times article

Myths Surround Breakfast and Weight
http://well.blogs.nytimes.com/2013/09/1 ... nd-weight/


The Study

Belief beyond the evidence: using the proposed effect of breakfast on obesity to show 2 practices that distort scientific evidence.
Am J Clin Nutr. 2013 Sep 4.

http://www.ncbi.nlm.nih.gov/pubmed/24004890

Abstract

BACKGROUND: Various intentional and unintentional factors influence beliefs beyond what scientific evidence justifies. Two such factors are research lacking probative value (RLPV) and biased research reporting (BRR).

OBJECTIVE: We investigated the prevalence of RLPV and BRR in research about the proposition that skipping breakfast causes weight gain, which is called the proposed effect of breakfast on obesity (PEBO) in this article.

DESIGN: Studies related to the PEBO were synthesized by using a cumulative meta-analysis. Abstracts from these studies were also rated for the improper use of causal language and biased interpretations. In separate analyses, articles that cited an observational study about the PEBO were rated for the inappropriate use of causal language, and articles that cited a randomized controlled trial (RCT) about the PEBO were rated for misleadingly citing the RCT.

RESULTS: The current body of scientific knowledge indicates that the PEBO is only presumed true. The observational literature on the PEBO has gratuitously established the association, but not the causal relation, between skipping breakfast and obesity (final cumulative meta-analysis P value <10-42), which is evidence of RLPV. Four examples of BRR are evident in the PEBO literature as follows: 1) biased interpretation of one's own results, 2) improper use of causal language in describing one's own results, 3) misleadingly citing others' results, and 4) improper use of causal language in citing others' work.

CONCLUSIONS: The belief in the PEBO exceeds the strength of scientific evidence. The scientific record is distorted by RLPV and BRR. RLPV is a suboptimal use of collective scientific resources.

PMID: 24004890

[JeffN]

The Latest Research On (Meal Frequency &) Intermittent Fasting - The Diane Rehm Show

http://thedianerehmshow.org/shows/2014- ... -fasting-0

Dr. Michael Mosley physician, science journalist and author. (5/2 Diet - Fasting 2 Non Consecutive Days Per Week Fasting)

Dr. Mark Mattson researcher, National Institute on Aging. EOD (Every Other Day or Alternate Day Fasting)

Dr. Valter Longo director, University of Southern California Longevity Institute. (4-5 Consecutive Days Per Month Fasting)

On their plans (Dr Fontana & Dr Varady are two other researchers in the field)

Luigi Fontana:
Advocates fasting (within the context of 24 hours) for as long as possible. He suggests that if you have to consume 5/600 calories then they should be consumed as one meal, very early in the morning so as to maximise the length of the fast.

Valter Longo:
With regard to IGF-1 reduction it is better to do 4 days of (consecutive) fasting every few months and then skip meals during the week to maintain weight and try to adopt a plant based low protein diet. An alternative to the 4 days fasting is just to fast on 2 days at a time as in the 5-2 plan but you must also try to move to a healthy diet, plant based and low protein.

Krista A. Varady:
With regard to how you should eat (if at all), on a fast day: So far, we have performed studies permitting people to eat 600 kcal bethween 12pm-2pm. We find that this strategy works well for most people (whereas a complete fast for 24 h does not). We have yet to run a study where we allow people to consume the 600 kcal as 6x100kcal (or 3 x 200 kcal) smaller meals throughout the day. However, we are planning to run this study within the next year. Krista Varady says ‘eating the 500 calorie allowance throughout the day would prevent a persons body going into a fasted state’. Since it is the fasted state that is so beneficial to us, this information is critical.

Mark P. Mattson:
1. A complete fast (no food) with hydration maintained with non-caloric beverages will be superior to consuming 600 calories on the fasting days.
2. Eating the 600 calories at one meal will be superior to eating several smaller meals spread throughout the day. By eating only one meal, the body goes essentially 24 hours with no food. This results in adaptive cellular stress responses which we believe is particularly good for the brain.
3. In the case of the 5:2 diet, we do not know whether better health benefits are realized with two consecutive days of fasting versus any two days of fasting during the week.

What I found most interesting is..., (all of which reinforce my comments in this thread)...

- all the versions worked with fasting being defined as a either a period of eating ~500 calories per day or total abstinence

- whichever routine implemented, the subjects adapted in about 2 weeks and rarely expeienced hunger, though this was hardest on the 5 days per month plan.

- as Dr Mosley said, the most important thing is for each individual to find the regime within the basic guidelines that works best for them.

I agree.

In Health
Jeff

[JeffN]

Meal skipping and variables related to energy balance in adults: A brief review, with emphasis on the breakfast meal.
Physiol Behav. 2014 May 10. pii: S0031-9384(14)00260-1. doi: 10.1016/j.physbeh.2014.05.005. [Epub ahead of print]
PMID:24825781

http://www.sciencedirect.com/science/ar ... 8414002601

Abstract

A popular notion regarding habitual meal skipping is that it leads to weight gain; however, there is little support for this idea in the scientific literature.

Here we review the evidence both for and against this notion in adults (=/>18 y), with, out of practicality, a primary focus on the breakfast meal.

To date, few randomized controlled trials and prospective studies have been conducted on breakfast skipping and energy balance. Three acute feeding studies have been published which show equivocal results and do not strongly support an effect of breakfast skipping on variables related to energy balance. Four longer-term studies lasting 2-3 weeks have been published and are consistent with the acute feeding trials in that breakfast skipping or eating treatments did not materially impact weight change. Four prospective studies in which participants were followed over 3.7-10 years do suggest a potential role for skipping breakfast in weight gain. However, observational studies do not imply causality; therefore, longer term experimental trials are needed before a definitive conclusion can be made concerning the role of breakfast skipping in weight change.

In Health
Jeff

[JeffN]

The Impact of Eating Frequency and Time of Intake on Nutrient Quality and Body Mass Index: The INTERMAP Study, a Population-Based Study
Journal of the Academy of Nutrition and Dietetics
DOI: http://dx.doi.org/10.1016/j.jand.2014.11.017

ABSTRACT

Background:
Epidemiologic evidence is sparse on the effect of dietary behaviors and diet quality on body mass index (BMI; calculated as kg/m2), which can be important drivers of the obesity epidemic.

Objective:
This study investigated the relationships of frequency of eating and time of intake to energy density, nutrient quality, and BMI using data from the International Study on Macro/Micronutrients and Blood Pressure including 2,696 men and women aged 40 to 59 years from the United States and the United Kingdom.

Design:
The International Study on Macro/Micronutrients and Blood Pressure is a cross- sectional investigation with four 24-hour dietary recalls and BMI measurements con- ducted between 1996 and 1999. Consumption of solid foods was aggregated into eating occasion. Nutrient density is expressed using the Nutrient Rich Food Index 9.3. The ratio of evening/morning energy intake was calculated; mean values of four visits were used. Statistical analyses performed Characteristics across eating occasion categories are presented as adjusted mean with corresponding 95% CI. Multiple linear regression models were used to examine associations of eating occasions, ratio of evening/morning energy intake, dietary energy density, and Nutrient Rich Food Index 9.3 with BMI.

Results:
Compared to participants with fewer than four eating occasions in 24 hours, those with six or more eating occasions in 24 hours had lower mean BMI (27.3 vs 29.0), total energy intake (2,129 vs 2,472 kcal/24 hours), dietary energy density (1.5 vs 2.1 kcal/g), and higher Nutrient Rich Food Index 9.3 (34.3 vs 28.1). In multiple regression analyses, higher evening intake relative to morning intake was directly associated with BMI; how- ever, this did not influence the relationship between eating frequency and BMI.

Conclusions:
Our results suggest that a larger number of small meals may be associated with improved diet quality and lower BMI. This may have implications for behavioral approaches to controlling the obesity epidemic.

[JeffN]

This one is not open access. I am posting the abstract and copying the conclusion from the study here.

Metabolic impacts of altering meal frequency and timing - Does when we eat matter?
Biochimie. 2015 Jul 29. pii: S0300-9084(15)00233-3. doi: 10.1016/j.biochi.2015.07.025.


Abstract
Obesity prevalence continues to rise throughout the developed world, as a result of positive energy balance and reduced physical activity. At present, there is still a perception within the general community, and amongst some nutritionists, that eating multiple small meals spaced throughout the day is beneficial for weight control and metabolic health. However, intervention trials do not generally support the epidemiological evidence, and data is emerging to suggest that increasing the fasting period between meals may beneficially impact body weight and metabolic health. To date, this evidence is of short term duration, and it is becoming increasingly apparent that meal timing must also be considered if we are to ensure optimal health benefits in response to this dietary pattern. The purpose of this review is to summate the existing human literature on modifying meal frequency and timing on body weight control, appetite regulation, energy expenditure, and metabolic health under conditions of energy balance, restriction and surplus. PMID: 26226640



6. Conclusions

Epidemiological reports have shown a favourable relationship between increased meal frequency, weight and metabolic health [6]. However, controlled intervention trials, whilst limited in sample size and duration, have shown little or no beneficial impact of increased meal frequency on body weight and health under either eucaloric or hypo caloric conditions. Further, increased meal frequency was detrimental to metabolic health under conditions of energy excess. This is of concern since the rising rates of obesity indicate that most of the population eats to excess. The American Dietetic Association acknowledges the limited evidence for absolute meal frequency and their position statement for weight management recommends that “total caloric intake should be spread throughout the day, with the consumption of 4–5 meals, including breakfast”. They also recognise the importance of meal timing and suggest that “consumption of more energy throughout the day may be preferable to evening consumption [140]”. Practically, dietary adherence to any intervention remains of primary concern in the population, and it may be that no one dietary recommendation suits all. Eating late in the day or at night disrupts circadian rhythms, and may have adverse effects on weight and health. Modulating meal patterns to best match diurnal rhythms of nutrient metabolism and glucose tolerance may mitigate this risk, particularly in shift workers. Alternate day fasting, where calories are restricted to a single small meal for a few days each week, and interspersed with ad libitum consumption days, may provide a new strategy for weight loss and improved metabolic health in humans. However, whether individuals can adhere to this type of dietary pattern, long term, is unknown. Time restricted feeding has also shown great promise as a tool to mitigate the metabolic sequelae of diet induced obesity in rodents, and further suggests that reducing fasting periods to as little as 13–16 h, overnight, may be of benefit. Evidence for this type of dietary approach, in humans, is currently lacking, although it is clear that time restricting energy intake to later in the day is not optimal for metabolic health. In light of the limited available evidence, randomised, controlled trials are now required to interrogate the effects of ADF and TRF, and their practicality long-term.

[JeffN]

Note: Varady is one of the IF researchers.


Meal frequency and timing: impact on metabolic disease risk.
Varady KA.
Curr Opin Endocrinol Diabetes Obes. 2016 Jul 21. [Epub ahead of print]
PMID: 27455514

Abstract

PURPOSE OF REVIEW:

The purpose of this article is to provide an overview of the most recent human intervention trials that have examined the impact of meal frequency or meal timing on metabolic disease risk factors.

RECENT FINDINGS:

Findings from intervention studies published over the past 12 months indicate that weight loss may be more pronounced with decreased meal frequency (two meals per day) versus increased meal frequency (six meals per day) under hypocaloric conditions. However, under isocaloric conditions, no effect on body weight was noted. Plasma lipid concentrations and glucoregulatory factors (fasting glucose, insulin, and insulin sensitivity) were not affected by alterations in meal frequency. As for meal timing, delaying the lunchtime meal by 3.5 h (from 1.30 p.m. to 4.30 p.m.) has no impact on body weight, but may impair glucose tolerance in young healthy adults.

SUMMARY:

In sum, altering meal frequency has little impact on body weight, plasma lipids, or glucoregulatory factors, whereas eating the majority of calories later in the day may be detrimental for glycemic control. These preliminary findings, however, still require confirmation by longer term, larger scale controlled trials.

[JeffN]

This study came out recently and got quite a bit of attention.

It talked about restricted feeding windows and intermittent fasting. I may post this in both threads.

Here is the link

http://jn.nutrition.org/content/early/2 ... 9.abstract

A colleague wrote one of the authors who I know and has been overseeing the Adventist data for several decades and here is his response..

"I do not disagree with what you wrote. When one eats is probably an incremental effect, but likely to be useful.”

What did he write that was referred to ?

Pretty much a summary of my position as stated in this thread

"Some people just can't maintain a meal plan with fewer meals and some just can't maintain a meal plan with more frequent meals. I am one of the latter, and so, I keep a more limited meal plan but would not insist on that for someone who felt more comfortable with more frequent meals as long as the overall dietary and nutritional pattern is the same.”

What you eat is way more important then when and how often.

Jeff