and On behalf of the American Heart Association Obesity Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council

Originally published30 Jan 2017Circulation. 2017;135:e96–e121

Other version(s) of this article

You are viewing the most recent version of this article. Previous versions:
- January 1, 2017: Previous Version 1

Abstract

Eating patterns are increasingly varied. Typical breakfast, lunch, and dinner meals are difficult to distinguish because skipping meals and snacking have become more prevalent. Such eating styles can have various effects on cardiometabolic health markers, namely obesity, lipid profile, insulin resistance, and blood pressure. In this statement, we review the cardiometabolic health effects of specific eating patterns: skipping breakfast, intermittent fasting, meal frequency (number of daily eating occasions), and timing of eating occasions. Furthermore, we propose definitions for meals, snacks, and eating occasions for use in research. Finally, data suggest that irregular eating patterns appear less favorable for achieving a healthy cardiometabolic profile. Intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiometabolic risk factor management.

Footnotes

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 7, 2016, and the American Heart Association Executive Committee on October 25, 2016. A copy of the document is available at http://professional.heart.org/statements by using either “Search for Guidelines & Statements” or the “Browse by Topic” area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.

The American Heart Association requests that this document be cited as follows: St-Onge M-P, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, Varady K; on behalf of the American Heart Association Obesity Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation. 2017;135:e96–e121. doi: 10.1161/CIR.0000000000000476.

Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the “Guidelines & Statements” drop-down menu, then click “Publication Development.”

Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright-Permission-Guidelines_UCM_300404_Article.jsp. A link to the “Copyright Permissions Request Form” appears on the right side of the page.

Circulation is available at http://circ.ahajournals.org.

References

1. Kant AK, Graubard BI. 40-Year trends in meal and snack eating behaviors of American adults.J Acad Nutr Diet. 2015;115:50–63. doi: 10.1016/j.jand.2014.06.354.Crossref Medline Google Scholar
2. Gill S, Panda S. A smartphone app reveals erratic diurnal eating patterns in humans that can be modulated for health benefits.Cell Metab. 2015;22:789–798. doi: 10.1016/j.cmet.2015.09.005.Crossref Medline Google Scholar
3. Garaulet M, Gómez-Abellán P. Timing of food intake and obesity: a novel association.Physiol Behav. 2014;134:44–50. doi: 10.1016/j.physbeh.2014.01.001.Crossref Medline Google Scholar
4. Oosterman JE, Kalsbeek A, la Fleur SE, Belsham DD. Impact of nutrients on circadian rhythmicity.Am J Physiol Regul Integr Comp Physiol. 2015;308:R337–R350. doi: 10.1152/ajpregu.00322.2014.Crossref Medline Google Scholar
5. Kovac J, Husse J, Oster H. A time to fast, a time to feast: the crosstalk between metabolism and the circadian clock.Mol Cells. 2009;28:75–80. doi: 10.1007/s10059-009-0113-0.Crossref Medline Google Scholar
6. Vollmers C, Gill S, DiTacchio L, Pulivarthy SR, Le HD, Panda S. Time of feeding and the intrinsic circadian clock drive rhythms in hepatic gene expression.Proc Natl Acad Sci U S A. 2009;106:21453–21458. doi: 10.1073/pnas.0909591106.Crossref Medline Google Scholar
7. Gnocchi D, Pedrelli M, Hurt-Camejo E, Parini P. Lipids around the clock: focus on circadian rhythms and lipid metabolism.Biology (Basel). 2015;4:104–132. doi: 10.3390/biology4010104.Medline Google Scholar
8. Inoue I, Shinoda Y, Ikeda M, Hayashi K, Kanazawa K, Nomura M, Matsunaga T, Xu H, Kawai S, Awata T, Komoda T, Katayama S. CLOCK/BMAL1 is involved in lipid metabolism via transactivation of the peroxisome proliferator-activated receptor (PPAR) response element.J Atheroscler Thromb. 2005;12:169–174.Crossref Medline Google Scholar
9. O’Neil CE, Byrd-Bredbenner C, Hayes D, Jana L, Klinger SE, Stephenson-Martin S. The role of breakfast in health: definition and criteria for a quality breakfast.J Acad Nutr Diet. 2014;114(suppl):S8–S26. doi: 10.1016/j.jand.2014.08.022.Crossref Medline Google Scholar
10. Cho S, Dietrich M, Brown CJ, Clark CA, Block G. The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III).J Am Coll Nutr. 2003;22:296–302.Crossref Medline Google Scholar
11. Greenwood JL, Stanford JB. Preventing or improving obesity by addressing specific eating patterns.J Am Board Fam Med. 2008;21:135–140. doi: 10.3122/jabfm.2008.02.070034.Crossref Medline Google Scholar
12. Haines PS, Guilkey DK, Popkin BM. Trends in breakfast consumption of US adults between 1965 and 1991.J Am Diet Assoc. 1996;96:464–470.Crossref Medline Google Scholar
13. Ruxton CH, Kirk TR. Breakfast: a review of associations with measures of dietary intake, physiology and biochemistry.Br J Nutr. 1997;78:199–213.Crossref Medline Google Scholar
14. Siega-Riz AM, Popkin BM, Carson T. Differences in food patterns at breakfast by sociodemographic characteristics among a nationally representative sample of adults in the United States.Prev Med. 2000;30:415–424. doi: 10.1006/pmed.2000.0651.Crossref Medline Google Scholar
15. Giovannini M, Agostoni C, Shamir R. Symposium overview: do we all eat breakfast and is it important?Crit Rev Food Sci Nutr. 2010;50:97–99. doi: 10.1080/10408390903467373.Crossref Medline Google Scholar
16. Goyal R, Julka S. Impact of breakfast skipping on the health status of the population.Indian J Endocrinol Metab. 2014;18:683–687. doi: 10.4103/2230-8210.139233.Medline Google Scholar
17. Kent LM, Worsley A. Breakfast size is related to body mass index for men, but not women.Nutr Res. 2010;30:240–245. doi: 10.1016/j.nutres.2010.03.006.Crossref Medline Google Scholar
18. Leidy HJ. The benefits of breakfast consumption to combat obesity and diabetes in young people.Am J Lifestyle Med. 2013;7:99–103.Crossref Google Scholar
19. McCrory MA, Campbell WW. Effects of eating frequency, snacking, and breakfast skipping on energy regulation: symposium overview.J Nutr. 2011;141:144–147. doi: 10.3945/jn.109.114918.Crossref Medline Google Scholar
20. Timlin MT, Pereira MA. Breakfast frequency and quality in the etiology of adult obesity and chronic diseases.Nutr Rev. 2007;65(pt 1):268–281.Crossref Medline Google Scholar
21. Thomas EA, Higgins J, Bessesen DH, McNair B, Cornier MA. Usual breakfast eating habits affect response to breakfast skipping in overweight women.Obesity (Silver Spring). 2015;23:750–759. doi: 10.1002/oby.21049.Crossref Medline Google Scholar
22. Pereira MA, Erickson E, McKee P, Schrankler K, Raatz SK, Lytle LA, Pellegrini AD. Breakfast frequency and quality may affect glycemia and appetite in adults and children.J Nutr. 2011;141:163–168. doi: 10.3945/jn.109.114405.Crossref Medline Google Scholar
23. Moshfegh A, Goldman J, Cleveland L. What we eat in America, NHANES 2001–2002: usual nutrient intakes from food compared to dietary reference intakes.Washington, DC: US Dept of Agriculture, Agricultural Research Service; 2005.Google Scholar
24. Moy FM, Johari S, Ismail Y, Mahad R, Tie FH, Wan Ismail WA. Breakfast skipping and its associated factors among undergraduates in a public university in Kuala Lumpur.Malays J Nutr. 2009;15:165–174.Medline Google Scholar
25. Nishiyama M, Muto T, Minakawa T, Shibata T. The combined unhealthy behaviors of breakfast skipping and smoking are associated with the prevalence of diabetes mellitus.Tohoku J Exp Med. 2009;218:259–264.Crossref Medline Google Scholar
26. Park SH, Jang SY, Kim H, Lee SW. An association rule mining-based framework for understanding lifestyle risk behaviors.PLoS One. 2014;9:e88859. doi: 10.1371/journal.pone.0088859.Crossref Medline Google Scholar
27. Sakata K, Matumura Y, Yoshimura N, Tamaki J, Hashimoto T, Oguri S, Okayama A, Yanagawa H. Relationship between skipping breakfast and cardiovascular disease risk factors in the national nutrition survey data [in Japanese].Nihon Koshu Eisei Zasshi. 2001;48:837–841.Medline Google Scholar
28. Li Y, Nemoto T, Tobimatsu S, Saito M, Ebata M, Munakata H, Nakajima K. Relationship between skipping breakfast and impaired fasting glucose along with cardiovascular and pre-diabetes condition risk factors in apparently health subjects.Endocrinol Stud. 2011;1:e17.Crossref Google Scholar
29. Mekary RA, Giovannucci E, Cahill L, Willett WC, van Dam RM, Hu FB. Eating patterns and type 2 diabetes risk in older women: breakfast consumption and eating frequency.Am J Clin Nutr. 2013;98:436–443. doi: 10.3945/ajcn.112.057521.Crossref Medline Google Scholar
30. Huang CJ, Hu HT, Fan YC, Liao YM, Tsai PS. Associations of breakfast skipping with obesity and health-related quality of life: evidence from a national survey in Taiwan.Int J Obes (Lond). 2010;34:720–725. doi: 10.1038/ijo.2009.285.Crossref Medline Google Scholar
31. Keski-Rahkonen A, Kaprio J, Rissanen A, Virkkunen M, Rose RJ. Breakfast skipping and health-compromising behaviors in adolescents and adults.Eur J Clin Nutr. 2003;57:842–853. doi: 10.1038/sj.ejcn.1601618.Crossref Medline Google Scholar
32. Smith KJ, Gall SL, McNaughton SA, Blizzard L, Dwyer T, Venn AJ. Skipping breakfast: longitudinal associations with cardiometabolic risk factors in the Childhood Determinants of Adult Health Study.Am J Clin Nutr. 2010;92:1316–1325. doi: 10.3945/ajcn.2010.30101.Crossref Medline Google Scholar
33. Song WO, Chun OK, Obayashi S, Cho S, Chung CE. Is consumption of breakfast associated with body mass index in US adults?J Am Diet Assoc. 2005;105:1373–1382. doi: 10.1016/j.jada.2005.06.002.Crossref Medline Google Scholar
34. Smith KJ, McNaughton SA, Cleland VJ, Crawford D, Ball K. Health, behavioral, cognitive, and social correlates of breakfast skipping among women living in socioeconomically disadvantaged neighborhoods.J Nutr. 2013;143:1774–1784. doi: 10.3945/jn.113.181396.Crossref Medline Google Scholar
35. Min C, Noh H, Kang YS, Sim HJ, Baik HW, Song WO, Yoon J, Park YH, Joung H. Skipping breakfast is associated with diet quality and metabolic syndrome risk factors of adults.Nutr Res Pract. 2011;5:455–463. doi: 10.4162/nrp.2011.5.5.455.Crossref Medline Google Scholar
36. Nicklas TA, Myers L, Reger C, Beech B, Berenson GS. Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts.J Am Diet Assoc. 1998;98:1432–1438. doi: 10.1016/S0002-8223(98)00325-3.Crossref Medline Google Scholar
37. Deshmukh-Taskar PR, Radcliffe JD, Liu Y, Nicklas TA. Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002.J Am Coll Nutr. 2010;29:407–418.Crossref Medline Google Scholar
38. Obesity Guidance on the Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children (NICE Clinical Guideline 43).London, England: National Institute for Health and Clinical Excellence; 2006:1–84.Google Scholar
39. Wyatt HR, Grunwald GK, Mosca CL, Klem ML, Wing RR, Hill JO. Long-term weight loss and breakfast in subjects in the National Weight Control Registry.Obes Res. 2002;10:78–82. doi: 10.1038/oby.2002.13.Crossref Medline Google Scholar
40. Bellisle F. Impact of the daily meal pattern on energy balance.Scand J Nutr. 2004;48:114–118.Crossref Google Scholar
41. Fabry P, Hejl Z, Fodor J, Braun T, Zvolankova K. The frequency of meals: its relation to overweight, hypercholesterolaemia, and decreased glucose-tolerance.Lancet. 1964;2:614–615.Crossref Medline Google Scholar
42. Jenkins DJ, Jenkins AL, Wolever TM, Vuksan V, Rao AV, Thompson LU, Josse RG. Low glycemic index: lente carbohydrates and physiological effects of altered food frequency.Am J Clin Nutr. 1994;59(suppl):706S–709S.Crossref Medline Google Scholar
43. Keim NL, Van Loan MD, Horn WF, Barbieri TF, Mayclin PL. Weight loss is greater with consumption of large morning meals and fat-free mass is preserved with large evening meals in women on a controlled weight reduction regimen.J Nutr. 1997;127:75–82.Crossref Medline Google Scholar
44. Reutrakul S, Hood MM, Crowley SJ, Morgan MK, Teodori M, Knutson KL. The relationship between breakfast skipping, chronotype, and glycemic control in type 2 diabetes.Chronobiol Int. 2014;31:64–71. doi: 10.3109/07420528.2013.821614.Crossref Medline Google Scholar
45. Shigeta H, Shigeta M, Nakazawa A, Nakamura N, Yoshikawa T. Lifestyle, obesity, and insulin resistance.Diabetes Care. 2001;24:608.Crossref Medline Google Scholar
46. Stanton JL, Keast DR. Serum cholesterol, fat intake, and breakfast consumption in the United States adult population.J Am Coll Nutr. 1989;8:567–572.Crossref Medline Google Scholar
47. Goon S, Islam MS. Breakfast skipping and obesity risk among urban adults in Bangladesh.Int J Public Health Sci. 2014;3:15–22.Google Scholar
48. Ma Y, Bertone ER, Stanek EJ, Reed GW, Hebert JR, Cohen NL, Merriam PA, Ockene IS. Association between eating patterns and obesity in a free-living US adult population.Am J Epidemiol. 2003;158:85–92.Crossref Medline Google Scholar
49. Marín-Guerrero AC, Gutiérrez-Fisac JL, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F. Eating behaviours and obesity in the adult population of Spain.Br J Nutr. 2008;100:1142–1148. doi: 10.1017/S0007114508966137.Crossref Medline Google Scholar
50. Berg C, Lappas G, Wolk A, Strandhagen E, Torén K, Rosengren A, Thelle D, Lissner L. Eating patterns and portion size associated with obesity in a Swedish population.Appetite. 2009;52:21–26. doi: 10.1016/j.appet.2008.07.008.Crossref Medline Google Scholar
51. Watanabe Y, Saito I, Henmi I, Yoshimura K, Maruyama K, Yamauchi K, Matsuo T, Kato T, Tanigawa T, Kishida T, Asada Y. Skipping breakfast is correlated with obesity.J Rural Med. 2014;9:51–58. doi: 10.2185/jrm.2887.Crossref Medline Google Scholar
52. Deshmukh-Taskar P, Nicklas TA, Radcliffe JD, O’Neil CE, Liu Y. The relationship of breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome in young adults: the National Health and Nutrition Examination Survey (NHANES): 1999-2006.Public Health Nutr. 2013;16:2073–2082. doi: 10.1017/S1368980012004296.Medline Google Scholar
53. Horikawa C, Kodama S, Yachi Y, Heianza Y, Hirasawa R, Ibe Y, Saito K, Shimano H, Yamada N, Sone H. Skipping breakfast and prevalence of overweight and obesity in Asian and Pacific regions: a meta-analysis.Prev Med. 2011;53:260–267. doi: 10.1016/j.ypmed.2011.08.030.Crossref Medline Google Scholar
54. Purslow LR, Sandhu MS, Forouhi N, Young EH, Luben RN, Welch AA, Khaw KT, Bingham SA, Wareham NJ. Energy intake at breakfast and weight change: prospective study of 6,764 middle-aged men and women.Am J Epidemiol. 2008;167:188–192. doi: 10.1093/aje/kwm309.Crossref Medline Google Scholar
55. Odegaard AO, Jacobs DR, Steffen LM, Van Horn L, Ludwig DS, Pereira MA. Breakfast frequency and development of metabolic risk.Diabetes Care. 2013;36:3100–3106. doi: 10.2337/dc13-0316.Crossref Medline Google Scholar
56. van der Heijden AA, Hu FB, Rimm EB, van Dam RM. A prospective study of breakfast consumption and weight gain among U.S. men.Obesity (Silver Spring). 2007;15:2463–2469. doi: 10.1038/oby.2007.292.Crossref Medline Google Scholar
57. Witbracht M, Keim NL, Forester S, Widaman A, Laugero K. Female breakfast skippers display a disrupted cortisol rhythm and elevated blood pressure.Physiol Behav. 2015;140:215–221. doi: 10.1016/j.physbeh.2014.12.044.Crossref Medline Google Scholar
58. Kollannoor-Samuel G, Chhabra J, Fernandez ML, Vega-López S, Pérez SS, Damio G, Calle MC, D’Agostino D, Pérez-Escamilla R. Determinants of fasting plasma glucose and glycosylated hemoglobin among low income Latinos with poorly controlled type 2 diabetes.J Immigr Minor Health. 2011;13:809–817. doi: 10.1007/s10903-010-9428-3.Crossref Medline Google Scholar
59. Bi H, Gan Y, Yang C, Chen Y, Tong X, Lu Z. Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies.Public Health Nutr. 2015;18:3013–3019. doi: 10.1017/S1368980015000257.Crossref Medline Google Scholar
60. Schmidt LE, Rost KM, McGill JB, Santiago JV. The relationship between eating patterns and metabolic control in patients with non-insulin-dependent diabetes mellitus (NIDDM).Diabetes Educ. 1994;20:317–321.Crossref Medline Google Scholar
61. Mekary RA, Giovannucci E, Willett WC, van Dam RM, Hu FB. Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking.Am J Clin Nutr. 2012;95:1182–1189. doi: 10.3945/ajcn.111.028209.Crossref Medline Google Scholar
62. Uemura M, Yatsuya H, Hilawe EH, Li Y, Wang C, Chiang C, Otsuka R, Toyoshima H, Tamakoshi K, Aoyama A. Breakfast skipping is positively associated with incidence of type 2 diabetes mellitus: evidence from the Aichi Workers’ Cohort Study.J Epidemiol. 2015;25:351–358. doi: 10.2188/jea.JE20140109.Crossref Medline Google Scholar
63. Cahill LE, Chiuve SE, Mekary RA, Jensen MK, Flint AJ, Hu FB, Rimm EB. Prospective study of breakfast eating and incident coronary heart disease in a cohort of male US health professionals.Circulation. 2013;128:337–343. doi: 10.1161/CIRCULATIONAHA.113.001474.Link Google Scholar
64. Kubota Y, Iso H, Sawada N, Tsugane S; JPHC Study Group. Association of breakfast intake with incident stroke and coronary heart disease: the Japan Public Health Center-Based Study.Stroke. 2016;47:477–481. doi: 10.1161/STROKEAHA.115.011350.Link Google Scholar
65. Iso H. Changes in coronary heart disease risk among Japanese.Circulation. 2008;118:2725–2729. doi: 10.1161/CIRCULATIONAHA.107.750117.Crossref Medline Google Scholar
66. Suzuki K, Izumi M. The incidence of hemorrhagic stroke in Japan is twice compared with western countries: the Akita stroke registry.Neurol Sci. 2015;36:155–160. doi: 10.1007/s10072-014-1917-z.Crossref Medline Google Scholar
67. Schlundt DG, Hill JO, Sbrocco T, Pope-Cordle J, Sharp T. The role of breakfast in the treatment of obesity: a randomized clinical trial.Am J Clin Nutr. 1992;55:645–651.Crossref Medline Google Scholar
68. Dhurandhar EJ, Dawson J, Alcorn A, Larsen LH, Thomas EA, Cardel M, Bourland AC, Astrup A, St-Onge MP, Hill JO, Apovian CM, Shikany JM, Allison DB. The effectiveness of breakfast recommendations on weight loss: a randomized controlled trial.Am J Clin Nutr. 2014;100:507–513. doi: 10.3945/ajcn.114.089573.Crossref Medline Google Scholar
69. Geliebter A, Astbury NM, Aviram-Friedman R, Yahav E, Hashim S. Skipping breakfast leads to weight loss but also elevated cholesterol compared with consuming daily breakfasts of oat porridge or frosted cornflakes in overweight individuals: a randomised controlled trial.J Nutr Sci. 2014;3:e56. doi: 10.1017/jns.2014.51.Crossref Medline Google Scholar
70. Farshchi HR, Taylor MA, Macdonald IA. Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women.Am J Clin Nutr. 2005;81:388–396.Crossref Medline Google Scholar
71. Jakubowicz D, Barnea M, Wainstein J, Froy O. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women.Obesity (Silver Spring). 2013;21:2504–2512. doi: 10.1002/oby.20460.Crossref Medline Google Scholar
72. Chowdhury EA, Richardson JD, Holman GD, Tsintzas K, Thompson D, Betts JA. The causal role of breakfast in energy balance and health: a randomized controlled trial in obese adults.Am J Clin Nutr. 2016;103:747–756.Crossref Medline Google Scholar
73. Betts JA, Richardson JD, Chowdhury EA, Holman GD, Tsintzas K, Thompson D. The causal role of breakfast in energy balance and health: a randomized controlled trial in lean adults.Am J Clin Nutr. 2014;100:539–547. doi: 10.3945/ajcn.114.083402.Crossref Medline Google Scholar
74. Jakubowicz D, Wainstein J, Ahren B, Landau Z, Bar-Dayan Y, Froy O. Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: a randomized clinical trial.Diabetes Care. 2015;38:1820–1826. doi: 10.2337/dc15-0761.Crossref Medline Google Scholar
75. Astbury NM, Taylor MA, Macdonald IA. Breakfast consumption affects appetite, energy intake, and the metabolic and endocrine responses to foods consumed later in the day in male habitual breakfast eaters.J Nutr. 2011;141:1381–1389. doi: 10.3945/jn.110.128645.Crossref Medline Google Scholar
76. Azadbakht L, Haghighatdoost F, Feizi A, Esmaillzadeh A. Breakfast eating pattern and its association with dietary quality indices and anthropometric measurements in young women in Isfahan.Nutrition. 2013;29:420–425. doi: 10.1016/j.nut.2012.07.008.Crossref Medline Google Scholar
77. Horne BD, Muhlestein JB, May HT, Carlquist JF, Lappé DL, Bair TL, Anderson JL; Intermountain Heart Collaborative Study Group. Relation of routine, periodic fasting to risk of diabetes mellitus, and coronary artery disease in patients undergoing coronary angiography.Am J Cardiol. 2012;109:1558–1562. doi: 10.1016/j.amjcard.2012.01.379.Crossref Medline Google Scholar
78. Holmbäck I, Ericson U, Gullberg B, Wirfält E. A high eating frequency is associated with an overall healthy lifestyle in middle-aged men and women and reduced likelihood of general and central obesity in men.Br J Nutr. 2010;104:1065–1073. doi: 10.1017/S0007114510001753.Crossref Medline Google Scholar
79. Titan SM, Bingham S, Welch A, Luben R, Oakes S, Day N, Khaw KT. Frequency of eating and concentrations of serum cholesterol in the Norfolk population of the European prospective investigation into cancer (EPIC-Norfolk): cross sectional study.BMJ. 2001;323:1286–1288.Crossref Medline Google Scholar
80. Heilbronn LK, Smith SR, Martin CK, Anton SD, Ravussin E. Alternate-day fasting in nonobese subjects: effects on body weight, body composition, and energy metabolism.Am J Clin Nutr. 2005;81:69–73.Crossref Medline Google Scholar
81. Eshghinia S, Mohammadzadeh F. The effects of modified alternate-day fasting diet on weight loss and CAD risk factors in overweight and obese women.J Diabetes Metab Disord. 2013;12:4. doi: 10.1186/2251-6581-12-4.Crossref Medline Google Scholar
82. Johnson JB, Summer W, Cutler RG, Martin B, Hyun DH, Dixit VD, Pearson M, Nassar M, Telljohann R, Maudsley S, Carlson O, John S, Laub DR, Mattson MP. Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflammation in overweight adults with moderate asthma [published correction appears in Free Radic Biol Med. 2007;43:1348].Free Radic Biol Med. 2007;42:665–674. doi: 10.1016/j.freeradbiomed.2006.12.005.Crossref Medline Google Scholar
83. Varady KA, Bhutani S, Church EC, Klempel MC. Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults.Am J Clin Nutr. 2009;90:1138–1143. doi: 10.3945/ajcn.2009.28380.Crossref Medline Google Scholar
84. Klempel MC, Kroeger CM, Varady KA. Alternate day fasting (ADF) with a high-fat diet produces similar weight loss and cardio-protection as ADF with a low-fat diet.Metabolism. 2013;62:137–143. doi: 10.1016/j.metabol.2012.07.002.Crossref Medline Google Scholar
85. Hoddy KK, Kroeger CM, Trepanowski JF, Barnosky A, Bhutani S, Varady KA. Meal timing during alternate day fasting: Impact on body weight and cardiovascular disease risk in obese adults [published correction appears in Obesity (Silver Spring). 2015;23:914].Obesity (Silver Spring). 2014;22:2524–2531. doi: 10.1002/oby.20909.Medline Google Scholar
86. Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Varady KA. Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans.Obesity (Silver Spring). 2013;21:1370–1379. doi: 10.1002/oby.20353.Crossref Medline Google Scholar
87. Varady KA, Bhutani S, Klempel MC, Kroeger CM, Trepanowski JF, Haus JM, Hoddy KK, Calvo Y. Alternate day fasting for weight loss in normal weight and overweight subjects: a randomized controlled trial.Nutr J. 2013;12:146. doi: 10.1186/1475-2891-12-146.Crossref Medline Google Scholar
88. Klempel MC, Kroeger CM, Bhutani S, Trepanowski JF, Varady KA. Intermittent fasting combined with calorie restriction is effective for weight loss and cardio-protection in obese women.Nutr J. 2012;11:98. doi: 10.1186/1475-2891-11-98.Crossref Medline Google Scholar
89. Harvie MN, Pegington M, Mattson MP, Frystyk J, Dillon B, Evans G, Cuzick J, Jebb SA, Martin B, Cutler RG, Son TG, Maudsley S, Carlson OD, Egan JM, Flyvbjerg A, Howell A. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women.Int J Obes (Lond). 2011;35:714–727. doi: 10.1038/ijo.2010.171.Crossref Medline Google Scholar
90. Stote KS, Baer DJ, Spears K, Paul DR, Harris GK, Rumpler WV, Strycula P, Najjar SS, Ferrucci L, Ingram DK, Longo DL, Mattson MP. A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults.Am J Clin Nutr. 2007;85:981–988.Crossref Medline Google Scholar
91. McGrath SA, Gibney MJ. The effects of altered frequency of eating on plasma lipids in free-living healthy males on normal self-selected diets.Eur J Clin Nutr. 1994;48:402–407.Medline Google Scholar
92. Jenkins DJ, Wolever TM, Vuksan V, Brighenti F, Cunnane SC, Rao AV, Jenkins AL, Buckley G, Patten R, Singer W, Corey P, Josse RG. Nibbling versus gorging: metabolic advantages of increased meal frequency.N Engl J Med. 1989;321:929–934. doi: 10.1056/NEJM198910053211403.Crossref Medline Google Scholar
93. Murphy MC, Chapman C, Lovegrove JA, Isherwood SG, Morgan LM, Wright JW, Williams CM. Meal frequency; does it determine postprandial lipaemia?Eur J Clin Nutr. 1996;50:491–497.Medline Google Scholar
94. Arnold LM, Ball MJ, Duncan AW, Mann J. Effect of isoenergetic intake of three or nine meals on plasma lipoproteins and glucose metabolism.Am J Clin Nutr. 1993;57:446–451.Crossref Medline Google Scholar
95. Arnold L, Ball M, Mann J. Metabolic effects of alterations in meal frequency in hypercholesterolaemic individuals.Atherosclerosis. 1994;108:167–174.Crossref Medline Google Scholar
96. Arciero PJ, Ormsbee MJ, Gentile CL, Nindl BC, Brestoff JR, Ruby M. Increased protein intake and meal frequency reduces abdominal fat during energy balance and energy deficit.Obesity (Silver Spring). 2013;21:1357–1366. doi: 10.1002/oby.20296.Crossref Medline Google Scholar
97. Farshchi HR, Taylor MA, Macdonald IA. Regular meal frequency creates more appropriate insulin sensitivity and lipid profiles compared with irregular meal frequency in healthy lean women.Eur J Clin Nutr. 2004;58:1071–1077. doi: 10.1038/sj.ejcn.1601935.Crossref Medline Google Scholar
98. Farshchi HR, Taylor MA, Macdonald IA. Beneficial metabolic effects of regular meal frequency on dietary thermogenesis, insulin sensitivity, and fasting lipid profiles in healthy obese women.Am J Clin Nutr. 2005;81:16–24.Crossref Medline Google Scholar
99. Taylor MA, Garrow JS. Compared with nibbling, neither gorging nor a morning fast affect short-term energy balance in obese patients in a chamber calorimeter.Int J Obes Relat Metab Disord. 2001;25:519–528.Crossref Medline Google Scholar
100. Perrigue MM, Drewnowski A, Wang CY, Neuhouser ML. Higher eating frequency does not decrease appetite in healthy adults.J Nutr. 2016;146:59–64. doi: 10.3945/jn.115.216978.Crossref Medline Google Scholar
101. Wang JB, Patterson RE, Ang A, Emond JA, Shetty N, Arab L. Timing of energy intake during the day is associated with the risk of obesity in adults.J Hum Nutr Diet. 2014;27(suppl 2):255–262. doi: 10.1111/jhn.12141.Crossref Medline Google Scholar
102. Kutsuma A, Nakajima K, Suwa K. Potential association between breakfast skipping and concomitant late-night-dinner eating with metabolic syndrome and proteinuria in the Japanese population.Scientifica (Cairo). 2014;2014:253581. doi: 10.1155/2014/253581.Medline Google Scholar
103. Marinac CR, Sears DD, Natarajan L, Gallo LC, Breen CI, Patterson RE. Frequency and circadian timing of eating may influence biomarkers of inflammation and insulin resistance associated with breast cancer risk.PLoS One. 2015;10:e0136240. doi: 10.1371/journal.pone.0136240.Crossref Medline Google Scholar
104. Tsuchida Y, Hata S, Sone Y. Effects of a late supper on digestion and the absorption of dietary carbohydrates in the following morning.J Physiol Anthropol. 2013;32:9. doi: 10.1186/1880-6805-32-9.Crossref Medline Google Scholar
105. Jakubowicz D, Barnea M, Wainstein J, Froy O. Effects of caloric intake timing on insulin resistance and hyperandrogenism in lean women with polycystic ovary syndrome.Clin Sci (Lond). 2013;125:423–432. doi: 10.1042/CS20130071.Crossref Medline Google Scholar
106. Shariatpanahi ZV, Shariatpanahi MV, Shahbazi S, Hossaini A, Abadi A. Effect of Ramadan fasting on some indices of insulin resistance and components of the metabolic syndrome in healthy male adults.Br J Nutr. 2008;100:147–151. doi: 10.1017/S000711450787231X.Crossref Medline Google Scholar
107. Morgan LM, Shi JW, Hampton SM, Frost G. Effect of meal timing and glycaemic index on glucose control and insulin secretion in healthy volunteers.Br J Nutr. 2012;108:1286–1291. doi: 10.1017/S0007114511006507.Crossref Medline Google Scholar
108. Jakubowicz D, Froy O, Wainstein J, Boaz M. Meal timing and composition influence ghrelin levels, appetite scores and weight loss maintenance in overweight and obese adults [published correction appears in Steroids. 2012;77:887–889].Steroids. 2012;77:323–331. doi: 10.1016/j.steroids.2011.12.006.Crossref Medline Google Scholar
109. Nilsson A, Johansson E, Ekström L, Björck I. Effects of a brown beans evening meal on metabolic risk markers and appetite regulating hormones at a subsequent standardized breakfast: a randomized cross-over study.PLoS One. 2013;8:e59985. doi: 10.1371/journal.pone.0059985.Crossref Medline Google Scholar
110. Hibi M, Masumoto A, Naito Y, Kiuchi K, Yoshimoto Y, Matsumoto M, Katashima M, Oka J, Ikemoto S. Nighttime snacking reduces whole body fat oxidation and increases LDL cholesterol in healthy young women.Am J Physiol Regul Integr Comp Physiol. 2013;304:R94–R101. doi: 10.1152/ajpregu.00115.2012.Crossref Medline Google Scholar
111. Knutsson A, Karlsson B, Ornkloo K, Landström U, Lennernäs M, Eriksson K. Postprandial responses of glucose, insulin and triglycerides: influence of the timing of meal intake during night work.Nutr Health. 2002;16:133–141.Crossref Medline Google Scholar
112. Al-Naimi S, Hampton SM, Richard P, Tzung C, Morgan LM. Postprandial metabolic profiles following meals and snacks eaten during simulated night and day shift work.Chronobiol Int. 2004;21:937–947.Crossref Medline Google Scholar
113. Bandín C, Scheer FA, Luque AJ, Ávila-Gandía V, Zamora S, Madrid JA, Gómez-Abellán P, Garaulet M. Meal timing affects glucose tolerance, substrate oxidation and circadian-related variables: a randomized, crossover trial.Int J Obes (Lond). 2015;39:828–833. doi: 10.1038/ijo.2014.182.Crossref Medline Google Scholar
114. LeCheminant JD, Christenson E, Bailey BW, Tucker LA. Restricting night-time eating reduces daily energy intake in healthy young men: a short-term cross-over study.Br J Nutr. 2013;110:2108–2113. doi: 10.1017/S0007114513001359.Crossref Medline Google Scholar
115. Leech RM, Worsley A, Timperio A, McNaughton SA. Characterizing eating patterns: a comparison of eating occasion definitions.Am J Clin Nutr. 2015;102:1229–1237. doi: 10.3945/ajcn.115.114660.Crossref Medline Google Scholar
116. Murakami K, Livingstone MB. Associations between meal and snack frequency and diet quality and adiposity measures in British adults: findings from the National Diet and Nutrition Survey.Public Health Nutr. 2016;19:1624–1634. doi: 10.1017/S1368980015002979.Crossref Medline Google Scholar
117. Garaulet M, Gómez-Abellán P, Alburquerque-Béjar JJ, Lee YC, Ordovás JM, Scheer FA. Timing of food intake predicts weight loss effectiveness [published correction appears in Int J Obes (Lond). 2013;37:624].Int J Obes (Lond). 2013;37:604–611. doi: 10.1038/ijo.2012.229.Crossref Medline Google Scholar
118. Bellisle F. Meals and snacking, diet quality and energy balance.Physiol Behav. 2014;134:38–43. doi: 10.1016/j.physbeh.2014.03.010.Crossref Medline Google Scholar
119. Larson NI, Nelson MC, Neumark-Sztainer D, Story M, Hannan PJ. Making time for meals: meal structure and associations with dietary intake in young adults.J Am Diet Assoc. 2009;109:72–79. doi: 10.1016/j.jada.2008.10.017.Crossref Medline Google Scholar
120. Pelletier JE, Laska MN. Balancing healthy meals and busy lives: associations between work, school, and family responsibilities and perceived time constraints among young adults.J Nutr Educ Behav. 2012;44:481–489. doi: 10.1016/j.jneb.2012.04.001.Crossref Medline Google Scholar
121. VanKim NA, Erickson DJ, Laska MN. Food shopping profiles and their association with dietary patterns: a latent class analysis.J Acad Nutr Diet. 2015;115:1109–1116. doi: 10.1016/j.jand.2014.12.013.Crossref Medline Google Scholar
122. Marx JM, Hoffmann DA, Musher-Eizenman DR. Meals and snacks: children’s characterizations of food and eating cues.Appetite. 2016;97:1–7. doi: 10.1016/j.appet.2015.11.010.Crossref Medline Google Scholar
123. Wansink B, Payne CR, Shimizu M. “Is this a meal or snack?” Situational cues that drive perceptions.Appetite. 2010;54:214–216. doi: 10.1016/j.appet.2009.09.016.Crossref Medline Google Scholar
124. Mattes RD. Beverages and positive energy balance: the menace is the medium.Int J Obes. 2006;30:S60–S65.Crossref Google Scholar
125. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012.JAMA. 2014;311:806–814. doi: 10.1001/jama.2014.732.Crossref Medline Google Scholar
126. Robinson E, Almiron-Roig E, Rutters F, de Graaf C, Forde CG, Tudur Smith C, Nolan SJ, Jebb SA. A systematic review and meta-analysis examining the effect of eating rate on energy intake and hunger.Am J Clin Nutr. 2014;100:123–151. doi: 10.3945/ajcn.113.081745.Crossref Medline Google Scholar
127. Shah M, Crisp K, Adams-Huet B, Dart L, Bouza B, Franklin B, Phillips M. The effect of eating speed at breakfast on appetite hormone responses and daily food consumption.J Investig Med. 2015;63:22–28. doi: 10.1097/JIM.0000000000000119.Crossref Medline Google Scholar
128. Wang Y, Beydoun MA. The obesity epidemic in the United States: gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis.Epidemiol Rev. 2007;29:6–28.Crossref Medline Google Scholar
129. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Stafford R, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics–2010 update: a report from the American Heart Association [published correction appears in Circulation. 2010;121:e259].Circulation. 2010;121:948–954. doi: 10.1161/CIRCULATIONAHA.109.192666.Link Google Scholar
130. Mensah GA, Brown DW. An overview of cardiovascular disease burden in the United States.Health Aff (Millwood). 2007;26:38–48. doi: 10.1377/hlthaff.26.1.38.Crossref Medline Google Scholar
131. Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States.Circulation. 2005;111:1233–1241. doi: 10.1161/01.CIR.0000158136.76824.04.Crossref Medline Google Scholar
132. Geller SE, Koch A, Pellettieri B, Carnes M. Inclusion, analysis, and reporting of sex and race/ethnicity in clinical trials: have we made progress?J Womens Health (Larchmt). 2011;20:315–320. doi: 10.1089/jwh.2010.2469.Crossref Medline Google Scholar
133. Ayer J, Charakida M, Deanfield JE, Celermajer DS. Lifetime risk: childhood obesity and cardiovascular risk.Eur Heart J. 2015;36:1371–1376. doi: 10.1093/eurheartj/ehv089.Crossref Medline Google Scholar
134. Koletzko B, Toschke AM. Meal patterns and frequencies: do they affect body weight in children and adolescents?Crit Rev Food Sci Nutr. 2010;50:100–105. doi: 10.1080/10408390903467431.Crossref Medline Google Scholar
135. Ritchie LD. Less frequent eating predicts greater BMI and waist circumference in female adolescents.Am J Clin Nutr. 2012;95:290–296. doi: 10.3945/ajcn.111.016881.Crossref Medline Google Scholar
136. Eloranta AM, Lindi V, Schwab U, Kiiskinen S, Venäläinen T, Lakka HM, Laaksonen DE, Lakka TA. Dietary factors associated with metabolic risk score in Finnish children aged 6-8 years: the PANIC study.Eur J Nutr. 2014;53:1431–1439. doi: 10.1007/s00394-013-0646-z.Crossref Medline Google Scholar
137. Panagiotakos DB. Lessons derived from studies in the elderly: the role of nutrition education in cardiovascular disease prevention.Hormones (Athens). 2013;12:325–326.Crossref Medline Google Scholar
138. Locher JL, Goldsby TU, Goss AM, Kilgore ML, Gower B, Ard JD. Calorie restriction in overweight older adults: Do benefits exceed potential risks [published online ahead of print March 17, 2016]?Exp Gerontol. 2016;86:4–13. doi: 10.1016/j.exger.2016.03.009.Crossref Medline Google Scholar

- Recommended
  - Sugar and Cardiovascular Disease
    
    Barbara V. Howard and
    
    Judith Wylie-Rosett
    
    Vol. 106, No. 4 July 2002
  - Low-Calorie Sweetened Beverages and Cardiometabolic Health: A Science Advisory From the American Heart Association
    
    Rachel K. Johnson,
    
    Alice H. Lichtenstein,
    
    Cheryl A.M. Anderson,
    
    Jo Ann Carson,
    
    Jean-Pierre Després,
    
    Frank B. Hu,
    
    Penny M. Kris-Etherton,
    
    Jennifer J. Otten,
    
    Amytis Towfighi,
    
    Judith Wylie-Rosett
    
    and On behalf of the American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Quality of Care and Outcomes Research; and Stroke Council
    
    Vol. 138, No. 9 July 2018
  - Summary of American Heart Association Diet and Lifestyle Recommendations Revision 2006
    
    Alice H. Lichtenstein,
    
    Lawrence J. Appel,
    
    Michael Brands,
    
    Mercedes Carnethon,
    
    Stephen Daniels,
    
    Harold A. Franch,
    
    Barry Franklin,
    
    Penny Kris-Etherton,
    
    William S. Harris,
    
    Barbara Howard,
    
    Njeri Karanja,
    
    Michael Lefevre,
    
    Lawrence Rudel,
    
    Frank Sacks,
    
    Linda Van Horn,
    
    Mary Winston, and
    
    Judith Wylie-Rosett
    
    Vol. 26, No. 10 October 2006
  - Implementing American Heart Association Pediatric and Adult Nutrition Guidelines
    
    Samuel S. Gidding,
    
    Alice H. Lichtenstein,
    
    Myles S. Faith,
    
    Allison Karpyn,
    
    Julie A. Mennella,
    
    Barry Popkin,
    
    Jonelle Rowe,
    
    Linda Van Horn, and
    
    Laurie Whitsel
    
    Vol. 119, No. 8 March 2009
February 28, 2017
Vol 135, Issue 9
Article Information
Metrics

Download: 700
- © 2017 American Heart Association, Inc.
https://doi.org/10.1161/CIR.0000000000000476
- Originally publishedJanuary 30, 2017
Keywords
Subjects
- Statements and Guidelines
- Quality and Outcomes

Jump to

Meal Timing and Frequency: Implications for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association

You are viewing the most recent version of this article. Previous versions:

Abstract

Footnotes

References

Sugar and Cardiovascular Disease

Low-Calorie Sweetened Beverages and Cardiometabolic Health: A Science Advisory From the American Heart Association

Summary of American Heart Association Diet and Lifestyle Recommendations Revision 2006

Implementing American Heart Association Pediatric and Adult Nutrition Guidelines

Article Information

Metrics