We examined whether energy and macronutrient intake from different meals was associated with changes in cardiometabolic risk (CMR) factors in children. CMR score (CMRS) was computed by summing Z-scores of waist circumference, the average of systolic and diastolic blood pressure, fasting glucose, high-density lipoprotein cholesterol (multiplying by −1), and triglycerides. We included 5517 children aged 6-13 years from six major cities in China. Five meal patterns were identified according to energy intake: balanced, breakfast dominant, lunch dominant, dinner dominant, and snack dominant patterns. These patterns were not significantly associated with changes in CMR factors. Carbohydrate intake (% energy) at lunch was positively associated with the change in CMRS (beta coefficient (95% CI): (0.777 (0.509, 1.046) in quintile 5 versus quintile 1). A positive association between carbohydrate intake at dinner and change in CMRS was observed. High protein intake at both lunch and dinner was associated with a favorable change in CMRS. Moderate fat intake at lunch was associated with a lower increase in CMRS. Meal patterns driven by energy were not significantly associated with CMR factors; however, a low carbohydrate-high protein-moderate fat lunch and low carbohydrate-high protein dinner were associated with favorable changes in CMRS in children.Evidence from recent studies in adults has shown that meal patterns play an important role in the development of CMR factors [12,13]. Eating three meals (breakfast, lunch, and dinner) plus snacks per day is a norm and may be an optimal choice for health [14]. Previous studies have shown that skipping meals, especially breakfast, was associated with a higher prevalence of CMR factors [15][16][17], whereas a higher meal frequency was associated with a lower risk of obesity, high cholesterol, and diabetes in adults [18][19][20]. More recent research in adults has shown that three to four meals per day were associated with lower CMR, compared with one to two, or six or more meals per day [13]. Some studies have demonstrated that a late-night meal is associated with poorer diet quality and adiposity among adults [21,22]. The meal composition of macronutrients may also play an important role in metabolic health, given that diets high in protein and low in carbohydrates are associated with lower CMR in adults [23,24]. However, data on whether meal timing and composition are predictive of changes in CMR factors in children are limited.The present study examined the association of different meal patterns, driven by energy intake, with changes in CMR factors in a large sample of Chinese children. We also examined whether energy, carbohydrate, protein, and fat consumed at breakfast, lunch, dinner, and as a snack was associated with the change in CMR.
Materials and Methods
Participant SelectionThe nutrition-based comprehensive intervention study on childhood obesity in China is a multicenter, randomized cluster controlled trial, and the study has been detailed elsewhere [25]. Briefly, the st...