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Nutrition in acute and chronic diseases

Meal timing across the day modulates daily energy intake in adult patients with type 2 diabetes

European Journal of Clinical Nutrition volume 76, pages 1470–1477 (2022)Cite this article

Subjects

Abstract

Background/Objectives

We assessed the association between the timing of meals across the day with diet composition and metabolic parameters in patients with type-2 diabetes (T2D).

Subjects/Methods

Eighty adults (55.2 ± 6.8 years, 45% males) patients with T2D (without insulin therapy) were included. Three non-consecutive dietary records assessed food intake. The onset time of each consumed meal/beverage was identified and assigned to one of three periods of the day: Period 1 (P1, 06:00–11:59 h), Period 2 (P2, 12:00–17:59 h), and Period 3 (P3, 18:00–00:30 h).

Results

Energy intake in P1 was lower compared to P2 and P3 (22.8 ± 7.9%, 37.5 ± 9.6%, and 39.7 ± 9.9%, respectively, P < 0.001). The same pattern was found for both total protein and fat intake, but carbohydrate intake was similar among periods. Patients with greater daily energy intake (as % of total energy) in P3 showed increased total food consumption, total energy, protein, and fat intake (all P < 0.05). The opposite pattern was observed in patients with greater daily energy intake in P1 (all P < 0.05). Regression analysis showed that daily energy intake was significantly reduced when a higher proportion of carbohydrates was eaten in P1 (vs. P3, P < 0.04).

Conclusion

Increased energy intake late during the day is related to increased total food and daily energy intake in patients with T2D. A greater proportion of total carbohydrates eaten early during the day relates to lower total energy intake. Our results suggest that earlier food intake may be a nutritional tool for dietary and metabolic control in these patients.

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Fig. 1: Mean energy and macronutrient intake across each period of the day.
Fig. 2: Daily food and energy intake between groups with higher or lower proportion of its total energy intake consumed within each period of the day.

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Data availability

Data are available from the corresponding author on reasonable request.

References

  1. Almoosawi S, Winter J, Prynne CJ, Hardy R, Stephen AM. Daily profiles of energy and nutrient intakes: are eating profiles changing over time? Eur J Clin Nutr. 2012;66:678–86.

    Article  CAS  PubMed  Google Scholar 

  2. Oda H. Chrononutrition. J Nutr Sci Vitaminol. 2015;61:S92–4.

    Article  CAS  PubMed  Google Scholar 

  3. Tahara Y, Shibata S. Chronobiology and nutrition. Neuroscience. 2013;253:78–88.

    Article  CAS  PubMed  Google Scholar 

  4. Tavares LF, Fonseca SC, Garcia Rosa ML, Yokoo EM. Relationship between ultra-processed foods and metabolic syndrome in adolescents from a Brazilian Family Doctor Program. Public Health Nutr. 2012;15:82–87.

    Article  PubMed  Google Scholar 

  5. Martínez Steele E, Juul F, Neri D, Rauber F, Monteiro CA. Dietary share of ultra-processed foods and metabolic syndrome in the US adult population. Prev Med (Balt). 2019;125:40–48.

    Article  Google Scholar 

  6. Corbalán-Tutau MD, Gómez-Abellán P, Madrid JA, Canteras M, Ordovás JM, Garaulet M. Toward a chronobiological characterization of obesity and metabolic syndrome in clinical practice. Clin Nutr. 2015;34:477–83.

    Article  PubMed  Google Scholar 

  7. Bray MS, Tsai JY, Villegas-Montoya C, Boland BB, Blasier Z, Egbejimi O, et al. Time-of-day-dependent dietary fat consumption influences multiple cardiometabolic syndrome parameters in mice. Int J Obes. 2010;34:1589–98.

    Article  CAS  Google Scholar 

  8. Arble DM, Bass J, Laposky AD, Vitaterna MH, Turek FW. Circadian timing of food intake contributes to weight gain. Obes (Silver Spring). 2009;17:2100–2.

    Article  Google Scholar 

  9. Almoosawi S, Prynne CJ, Hardy R, Stephen AM. Time-of-day of energy intake: association with hypertension and blood pressure 10 years later in the 1946 British Birth Cohort. J Hypertens. 2013;31:882–92.

    Article  CAS  PubMed  Google Scholar 

  10. Baron KG, Reid KJ, Kern AS, Zee PC. Role of sleep timing in caloric intake and BMI. Obes (Silver Spring). 2011;19:1374–81.

    Article  Google Scholar 

  11. Baron KG, Reid KJ, Horn LV, Zee PC. Contribution of evening macronutrient intake to total caloric intake and body mass index. Appetite. 2013;60:246–51.

    Article  CAS  PubMed  Google Scholar 

  12. Jakubowicz D, Barnea M, Wainstein J, Froy O. High Caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obes (Silver Spring). 2013;21:2504–12.

    Article  CAS  Google Scholar 

  13. Jamshed H, Beyl RA, Manna DLD, Yang ES, Ravussin E, Peterson CM. Early time-restricted feeding improves 24-hour glucose levels and affects markers of the circadian clock, aging, and autophagy in humans. Nutrients. 2019;11:1234.

    Article  CAS  PubMed Central  Google Scholar 

  14. Chen J-H, Lu LW, Ge Q, Feng D, Yu J, Liu B et al. Missing puzzle pieces of time-restricted-eating (TRE) as a long-term weight-loss strategy in overweight and obese people? A systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2021;1–17.

  15. Henry CJ, Kaur B, Quek RYC. Chrononutrition in the management of diabetes. Nutr Diabetes. 2020;10:6.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bo S, Musso G, Beccuti G, Fadda M, Fedele D, Gambino R, et al. Consuming More of Daily Caloric Intake at Dinner Predisposes to Obesity. A 6-Year Population-Based Prospective Cohort Study. PLoS One. 2014;9:e108467.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Almoosawi S, Prynne CJ, Hardy R, Stephen AM. Diurnal eating rhythms: association with long-term development of diabetes in the 1946 British birth cohort. Nutr Metab Cardiovasc Dis. 2013;23:1025–30.

    Article  CAS  PubMed  Google Scholar 

  18. Jakubowicz D, Wainstein J, Ahren B, Bar-Dayan Y, Landau Z, Rabinovitz HR, et al. High-energy breakfast with low-energy dinner decreases overall daily hyperglycaemia in type 2 diabetic patients: a randomised clinical trial. Diabetologia. 2015;58:912–9.

    Article  CAS  PubMed  Google Scholar 

  19. Jakubowicz D, Wainstein J, Tsameret S, Landau Z. Role of High Energy Breakfast “Big Breakfast Diet” in Clock Gene Regulation of Postprandial Hyperglycemia and Weight Loss in Type 2 Diabetes. Nutr. 2021;13. https://doi.org/10.3390/nu13051558.

  20. World Health Organization. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation. Geneva, 8–11 December 2008. Geneva, 2011 https://doi.org/10.1038/ejcn.2009.139.

  21. Jebb SA. Measurement of soft tissue composition by dual energy X-ray absorptiometry. Br J Nutr. 1997;77:151–63.

    Article  CAS  PubMed  Google Scholar 

  22. Harris JA, Benedict FJ. A biometric study of basal metabolism in man. Carnegie Institute of Washington: Washington DC, 1919.

  23. Food and Nutrition Board Institute of Medicine. Dietary Reference Intakes (DRIs): Estimated Average Requirements. Guiding Principles for Nutrition Labeling and Fortification. Institute of Medicine of the National Academies: Washington, D.C., 2001http://www.nap.edu.

  24. Gibson RS. Principles of nutritional assessment. 2nd ed. Oxford University Press: New York, 2005.

  25. Posner BM, Martin-Munley SS, Smigelski C, Cupples LA, Cobb JL, Schaefer E, et al. Comparison of techniques for estimating nutrient intake: the Framingham Study. Epidemiology. 1992;3:171–7.

    Article  CAS  PubMed  Google Scholar 

  26. Carrasco F, Basfi-fer K, Rojas P, Csendes A, Papapietro K, Codoceo J, et al. Calcium absorption may be affected after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women: a 2-y prospective study. Am J Clin Nutr. 2018;108:24–32.

    Article  PubMed  Google Scholar 

  27. de Castro JM. The time of day of food intake influences overall intake in humans. J Nutr. 2004;134:104–11.

    Article  PubMed  Google Scholar 

  28. Ministry of Health, Chilean Government, Chile. National Survey of Food Consumption. 2014.

  29. Garaulet M, Gomez-Abellan P, Alburquerque-Bejar JJ, Lee YC, Ordovas JM, Scheer FA. Timing of food intake predicts weight loss effectiveness. Int J Obes. 2013;37:604–11.

    Article  CAS  Google Scholar 

  30. American Diabetes Association. Summary of revisions: standards of medical care in diabetes—2019. Diabetes Care. 2019;42:S4 LP–S6.

    Article  Google Scholar 

  31. Ministry of Health, Chilean Government, Chile. Clinical guide for Type 2 diabetes mellitus. Minsal: Santiago, Chile, 2010.

  32. Almoosawi S, Vingeliene S, Karagounis LG, Pot GK, Johnston JD, Mendoza J, et al. Chrono-nutrition: a review of current evidence from observational studies on global trends in time-of-day of energy intake and its association with obesity. Proc Nutr Soc. 2016;75:487–500.

    Article  CAS  PubMed  Google Scholar 

  33. Chen HJ, Chuang SY, Chang HY, Pan WH. Energy intake at different times of the day: Its association with elevated total and LDL cholesterol levels. Nutr Metab Cardiovasc Dis. 2019;29:390–7.

    Article  CAS  PubMed  Google Scholar 

  34. de Castro JM. Circadian rhythms of the spontaneous meal pattern, macronutrient intake, and mood of humans. Physiol Behav. 1987;40:437–46.

    Article  PubMed  Google Scholar 

  35. Tani Y, Asakura K, Sasaki S, Hirota N, Notsu A, Todoriki H, et al. Higher proportion of total and fat energy intake during the morning may reduce absolute intake of energy within the day. An observational study in free-living Japanese adults. Appetite. 2015;92:66–73.

    Article  PubMed  Google Scholar 

  36. de Castro JM. The time of day and the proportions of macronutrients eaten are related to total daily food intake. Br J Nutr. 2007;98:1077–83.

    Article  PubMed  Google Scholar 

  37. Sakai R, Hashimoto Y, Ushigome E, Miki A, Okamura T, Matsugasumi M, et al. Late-night-dinner is associated with poor glycemic control in people with type 2 diabetes: The KAMOGAWA-DM cohort study. Endocr J. 2017;65:395–402.

    Article  Google Scholar 

  38. Imai S, Saito Y, Kajiyama S, Nitta A, Miyawaki T, Matsumoto S, et al. Late-night-dinner deteriorates postprandial glucose and insulin whereas consuming dinner dividedly ameliorates them in patients with type 2 diabetes: A randomized crossover clinical trial. Asia Pac J Clin Nutr. 2020;29:68–76.

    PubMed  Google Scholar 

  39. Scheer FA, Morris CJ, Shea SA. The internal circadian clock increases hunger and appetite in the evening independent of food intake and other behaviors. Obes (Silver Spring). 2013;21:421–3.

    Article  Google Scholar 

  40. Jakubowicz D, Landau Z, Tsameret S, Wainstein J, Raz I, Ahren B, et al. Reduction in glycated hemoglobin and daily insulin dose alongside circadian clock upregulation in patients with type 2 diabetes consuming a three-meal diet: a randomized clinical trial. Diabetes Care. 2019;42:2171 LP–2180.

    Article  Google Scholar 

  41. Almoosawi S, Prynne CJ, Hardy R, Stephen AM. Time-of-day and nutrient composition of eating occasions: prospective association with the metabolic syndrome in the 1946 British birth cohort. Int J Obes. 2013;37:725–31.

    Article  CAS  Google Scholar 

  42. American Diabetes Association. Lifestyle management: standards of medical care in diabetes—2019. Diabetes Care. 2019;42:S46 LP–S60.

    Article  Google Scholar 

  43. Evert AB, Dennison M, Gardner CD, Garvey WT, Lau KHK, MacLeod J, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019;42:731 LP–754.

    Article  Google Scholar 

  44. Jarrett RJ, Keen H. Further observations on the diurnal variation in oral glucose tolerance. Br Med J. 1970;4:334–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Van Cauter E, Polonsky KS, Scheen AJ. Roles of circadian rhythmicity and sleep in human glucose regulation*. 1997;18:716–38.

  46. Sofer S, Eliraz A, Kaplan S, Voet H, Fink G, Kima T, et al. Greater weight loss and hormonal changes after 6 months diet with carbohydrates eaten mostly at dinner. Obesity. 2011;19:2006–14.

    Article  CAS  PubMed  Google Scholar 

  47. Kessler K, Hornemann S, Petzke KJ, Kemper M, Kramer A, Pfeiffer AFH, et al. The effect of diurnal distribution of carbohydrates and fat on glycaemic control in humans: a randomized controlled trial. Sci Rep. 2017;7:44170.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Leung GKW, Huggins CE, Bonham MP. Effect of meal timing on postprandial glucose responses to a low glycemic index meal: A crossover trial in healthy volunteers. Clin Nutr. 2019;38:465–71.

    Article  CAS  PubMed  Google Scholar 

  49. 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. Steroids. 2012;77:323–31.

    Article  CAS  PubMed  Google Scholar 

  50. 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. 2013;125:423–32.

    Article  CAS  Google Scholar 

  51. Nouripour F, Mazloom Z, Fararouei M, Zamani A. Protein and carbohydrate distribution among the meals: Effect on metabolic parameters of patients with type 2 diabetes: a single-blinded randomized controlled trial. Br J Nutr. 2021;125:1007–16.

    Article  CAS  PubMed  Google Scholar 

  52. Hébert JR, Hurley TG, Steck SE, Miller DR, Tabung FK, Peterson KE, et al. Considering the value of dietary assessment data in informing nutrition-related health policy. Adv Nutr. 2014;5:447–55.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Nelson M Methods and validity of dietary assessment. In: Garrow J, James W, Ralph A (eds). Human Nutrition and Dietetics. Churchill Livingstone: London, UK, 2000, pp 311–31.

  54. Bae S-A, Fang MZ, Rustgi V, Zarbl H, Androulakis IP. At the interface of lifestyle, behavior, and circadian rhythms: metabolic implications. Front Nutr. 2019;6:132.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank Manuel Santibáñez for his valuable help in processing dietary records.

Funding

This work was supported by the Chilean National Fund for Development of Science and Technology (FONDECYT) [research project 1120323].

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Authors and Affiliations

  1. Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile

    Rodrigo Chamorro, Karen Basfi-fer, Pamela Rojas, Fernando Carrasco, Juana Codoceo, Jorge Inostroza & Manuel Ruz

  2. Nutrition and Dietetics School, Faculty of Medicine, University of Chile, Santiago, Chile

    Karen Basfi-fer, Bernardita Sepúlveda & Rut Farías

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Contributions

KB, FC, PR, JC, JI conducted the research; RC, KB, BS, and RF analyzed and interpreted the data; RC and MR wrote the paper. All authors critically reviewed the paper and approved its final version.

Corresponding author

Correspondence to Rodrigo Chamorro.

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Competing interests

MR, PR, FC, KB, and JI were co-authors of the research project Fondecyt 1120323 that funded this study. All other authors have nothing to declare.

Ethical approval

The research protocol was reviewed and approved according to the Declaration of Helsinki by the Institutional Review Board of the Faculty of Medicine, University of Chile, Santiago, Chile (ethical approval number 057-2011). All participants gave written informed consent.

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Chamorro, R., Basfi-fer, K., Sepúlveda, B. et al. Meal timing across the day modulates daily energy intake in adult patients with type 2 diabetes. Eur J Clin Nutr 76, 1470–1477 (2022). https://doi.org/10.1038/s41430-022-01128-z

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