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

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.T he patterns of meal and snack eating behavior in American adults have changed over the past 40 years. Based on NHANES (National Health and Nutrition Examination Survey) data from 1971 to 1974 to 2009 to 2010 (n=62 298), women 20 to 74 years of age reported a decrease in 24-hour meal-derived total energy intake (TEI) from 82% in the 1970s to 77% in 2009 to 2010 and an increase in the proportion of TEI consumed from snacks from 18% to 23%.1 Similar trends were reported among men. The proportion of men and women who reported consuming all 3 standard meals declined over this period (from 73% to 59% in men; from 75% to 63% in women), 1 reflecting changes in eating patterns rather than changes in eating frequency. Indeed, the traditional breakfast-lunch-dinner pattern was not observed in a population of healthy, non-shift-working adults. 2 In that study, the number of eating occasions, defined as consumption of any food or beverage providing at least 5 kcal, was ≈4.2 times a day in the lowest decile and 10.5 times a day for the top decile. There were only 5 hours during the 24-hour day when <1% of all eating occasions occurred: between 1 and 6 am. This study clearly demonstrated that adults in the United States eat around the clock. Because feeding and fasting entrain clock genes, which regulate all aspects of metabolism, meal timing can have serious implications for the development of cardiovascular disease (CVD), type 2 diabetes mellitus, and obesity. 3,4 The circadian rhythms of the body are controlled by the central clock located in the suprachiasmatic nucleus of the hypothalamus but also by clocks of peripheral organs. Although the master clock is strongly entrained by light, clocks of peripheral organs are additionally responsive to food supply, and temporal restriction of food can reset clock gene rhythms. In mice, food given in the normal sleeping period can uncouple peripheral clocks from the master clock. 5 In fact, time-restricted feeding CLINICAL STATEMENTS AND GUIDELINESin mice alters the robustness and coherence of rhythmic gene transcripts, 6 which may be relevant for cardiom...

Sleep timing is associated with self-reported dietary patterns in 9- to 15-year-olds

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Lysosomes Mediate Benefits of Intermittent Fasting in Cardiometabolic Disease: The Janitor Is the Undercover Boss

“…Whether dietary strategies can prevent or even reverse cardiometabolic disease has profound implications for public health. In particular, strategies that emphasize fasting, or various regimens of abstinence from food, have emerged as a way to prevent or even reverse cardiometabolic disease (39, 72, 119, 205). …”

Nutritional support and dietary interventions for women with polycystic ovary syndrome

“…[122][123][124][125] Furthermore, it has been suggested that increased meal frequency may increase postprandial glucose, insulin, IR and blood lipids and may have a negative impact on the fatty acid composition of serum phospholipids. [126][127][128][129] In contrast, others propose that increased meal frequency may exert a beneficial effect on body weight and indices of glycemic control, which may be attributed to nutrient load spreading, producing lower postprandial insulin concentrations, hunger reduction, inhibitory effects of free fatty acids on glucose uptake suppression and increased glucose clearance from the circulation with a significant economy in insulin secretion. 130,131 In a 24-week crossover RCT, our group reported a beneficial effect of a six-meal pattern, without energy restriction, on amelioration of post-oral glucose tolerance test (OGTT) insulin sensitivity and reduction in subjective hunger in lean and obese women with PCOS compared to a three-meal pattern.…”

“…136 The American Heart Association in their recent scientific statement concluded that meal frequency and timing may be important parameters in the nutrition management of chronic diseases, leading to healthier lifestyle and reduction in cardiometabolic risk factors. 128 …”