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Cited by 40Dietary Effects on HealthNutritional Studies and DietNutrition, Health and Food Behavior

Irregularity of energy intake at meals: prospective associations with the metabolic syndrome in adults of the 1946 British birth cohort

Open access
Pot, Gerda K., Hardy, Rebecca, Stephen, Alison M.·2016·British Journal of Nutrition
DOI 10.1017/s0007114515004407
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Abstract

Irregularity in eating patterns could be a potential cardiometabolic risk factor. We aimed to study the associations of irregular intake of energy at meals in relation to cardiometabolic risk factors 10 and 17 years later. Variability of energy intake data – derived from 5-d estimated diet diaries of cohort members of the National Survey for Health and Development collected at ages 36 (n 1416), 43 (n 1505) and 53 years (n 1381) – was used as a measure for irregularity. Associations between meal irregularity scores with cardiometabolic risk factors measured 10 and 17 years later were investigated using linear mixed models and logistic regression models. The results showed that irregularity scores changed significantly over the years (P<0·05). At age 36 years, subjects with a more irregular intake of energy at lunch (OR 1·42; 95 % CI 1·05, 1·91) and between meals (OR 1·35; 95 % CI 1·01, 1·82) had an increased risk for the metabolic syndrome 17 years later; at lunch was also associated with an increased waist circumference (OR 1·58; 95 % 1·27, 1·96) and TAG levels (OR 1·33; 95 % CI 1·02, 1·72). At age 43 years, subjects with a more irregular intake at breakfast had an increased risk of the metabolic syndrome 10 years later (OR 1·53; 95 % CI 1·15, 2·04), as well as an increased BMI (OR 1·66; 95 % CI 1·31, 2·10), waist circumference (OR 1·53; 95 % CI 1·23, 1·90) and diastolic blood pressure (OR 1·42; 95 % CI 1·13, 1·78). In conclusion, subjects with a more irregular intake of energy, mostly at breakfast and lunch, appeared to have an increased cardiometabolic risk 10 and 17 years later.

AI snapshot

Written from the paper’s full text.

TL;DR

In the 1946 British birth cohort, greater irregularity of energy intake at meals—especially lunch at age 36 and breakfast at age 43—was prospectively associated with higher odds of metabolic syndrome 10 and 17 years later. Associations were attenuated in sensitivity analyses restricted to plausible energy reporters.

Key findings

  • Meal irregularity scores changed significantly over follow-up (P < 0·05); irregularity of energy intake between meals decreased with increasing age.
  • At age 36 years, more irregular energy intake at lunch was associated with metabolic syndrome 17 years later (OR 1·42; 95 % CI 1·05, 1·91), as was irregular intake between meals (OR 1·35; 95 % CI 1·01, 1·82); lunch irregularity was also associated with increased waist circumference (OR 1·58; 95 % CI 1·27, 1·96) and TAG levels (OR 1·33; 95 % CI 1·02, 1·72).
  • At age 43 years, more irregular energy intake at breakfast was associated with metabolic syndrome 10 years later (OR 1·53; 95 % CI 1·15, 2·04), increased BMI (OR 1·66; 95 % CI 1·31, 2·10), waist circumference (OR 1·53; 95 % CI 1·23, 1·90) and diastolic blood pressure (OR 1·42; 95 % CI 1·13, 1·78).
  • In sensitivity analyses including only plausible reporters, the lunch association at age 36 and the breakfast association at age 43 were attenuated and no longer statistically significant.

Methods

  • Prospective analysis within the MRC National Survey of Health and Development (NSHD), the 1946 British birth cohort; dietary data came from 5-d estimated diet diaries at ages 36 (n 1416), 43 (n 1505) and 53 years (n 1381), with n 1007 completing diaries at all three time points and having metabolic syndrome data at age 53.
  • Meal irregularity scores were calculated per time slot (breakfast, lunch, evening meal, between meals) and as daily total, based on deviation of energy intake per meal slot from the individual’s 5-d mean energy intake for that slot.
  • Linear mixed models examined changes in irregularity scores with age; multiple logistic regression estimated odds of metabolic syndrome at age 53 per tertile of irregularity at ages 36 and 43, adjusted for sex, socio-economic status, marital status, physical activity and smoking, with further adjustment for energy intake at other meals and sensitivity analyses for plausible reporters.

Limitations

  • The paper states that some cohort members may have already developed metabolic syndrome by age 43 years, but these data were not collected; underreporting of dietary intake was possible, and plausible reporters were more likely to report regular intake, which may explain attenuation in restricted analyses.
  • The paper also notes unavoidable sample attrition, possible bias if healthier participants remained in the study, and constrained statistical power from the original sample size, meaning null findings could be type-2 errors.
  • Evident from the text: the observational design cannot establish causality, and the attenuation of key associations among plausible reporters suggests reporting bias and/or reduced power may affect the robustness of findings.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1017/s0007114515004407

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 11 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    At age 36 years, a more irregular intake of energy at lunch was associated with increased waist circumference 17 years later (OR 1.58; 95% CI 1.27, 1.96).

    “at lunch was also associated with an increased waist circumference (OR 1•58; 95 % 1•27, 1•96) and TAG levels (OR 1•33; 95 % CI 1•02, 1•72).”
    Quote in the paperSubstantial claim
  • Findingown data

    At age 43 years, a more irregular intake of energy at breakfast was associated with increased waist circumference 10 years later (OR 1.53; 95% CI 1.23, 1.90).

    “At age 43 years, subjects with a more irregular intake at breakfast had an increased risk of the metabolic syndrome 10 years later (OR 1•53; 95 % CI 1•15, 2•04), as well as an increased BMI (OR 1•66; 95 % CI 1•31, 2•10), waist circumference (OR 1•53; 95 % CI 1•23, 1•90) and diastolic blood pressure (OR 1•42; 95 % CI 1•13, 1•78).”
    Quote in the paperSubstantial claim
  • Findingown data

    At age 36 years, a more irregular intake of energy at lunch was associated with increased odds of having the metabolic syndrome 17 years later (OR 1.42; 95% CI 1.05, 1.91).

    “At age 36 years, a more irregular intake of energy at lunch was associated with increased odds of having the metabolic syndrome 17 years later (Table 2; model 1) (OR 1•42 for highest v. lowest irregularity group, 95 % CI 1•05, 1•91).”
    • Also stated in: § Abstract · plain
      “At age 36 years, subjects with a more irregular intake of energy at lunch (OR 1•42; 95 % CI 1•05, 1•91) and between meals (OR 1•35; 95 % CI 1•01, 1•82) had an increased risk for the metabolic syndrome 17 years later”
    Quote in the paperSubstantial claim
  • Findingown data

    At age 43 years, a more irregular intake of energy at breakfast was associated with increased diastolic blood pressure 10 years later (OR 1.42; 95% CI 1.13, 1.78).

    “At age 43 years, subjects with a more irregular intake at breakfast had an increased risk of the metabolic syndrome 10 years later (OR 1•53; 95 % CI 1•15, 2•04), as well as an increased BMI (OR 1•66; 95 % CI 1•31, 2•10), waist circumference (OR 1•53; 95 % CI 1•23, 1•90) and diastolic blood pressure (OR 1•42; 95 % CI 1•13, 1•78).”
    Quote in the paperSubstantial claim
  • Findingown data

    At age 36 years, a more irregular intake of energy at lunch was associated with increased TAG levels 17 years later (OR 1.33; 95% CI 1.02, 1.72).

    “at lunch was also associated with an increased waist circumference (OR 1•58; 95 % 1•27, 1•96) and TAG levels (OR 1•33; 95 % CI 1•02, 1•72).”
    Quote in the paperSubstantial claim
  • May combine two claims. 13
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Findingown data

    In analyses including only plausible reporters, the association between irregular lunch intake at age 36 and metabolic syndrome 17 years later was reduced and no longer statistically significant.

    “In analyses including only plausible reporters (65 % of the main analytic sample), associations with irregular intake between meals remained; however, the association with irregular intake of energy at lunch was reduced and was no longer statistically significant (Table 2; model 1 plausible).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Energy intakes at the evening meal decreased over time while those between meals increased.

    “Energy intakes at the evening meal decreased over time while those between meals increased.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Dietary intakes changed with age in this cohort.

    “Dietary intakes changed with age in this cohort.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Energy intakes at breakfast and lunch remained fairly stable.

    “Energy intakes at breakfast and lunch remained fairly stable.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    In this cohort, most scores for irregularity of energy intake decreased over the 17-year follow-up, with the greatest drop for energy intake between meals.

    “In this cohort, most scores for irregularity of energy intake decreased over the 17-year follow-up time, with the greatest drop in meal irregularity scores for energy intake between meals.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Irregular intake of energy at lunch at 36 years of age and irregular intake at breakfast at 43 years of age were associated with high BMI at 53 years of age.

    “Irregular intake of energy at lunch at 36 years of age and irregular intake at breakfast at 43 years of age were associated with high BMI at 53 years of age.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Irregular intake of energy at lunch and between meals at age 36 years was associated with increased risk of metabolic syndrome 17 years later, whereas at age 43 years irregular intake at breakfast was associated with metabolic syndrome 10 years later.

    “Irregular intake of energy at lunch and between meals at age 36 years was associated with an increased risk of the metabolic syndrome 17 years later, whereas at age 43 years it was irregular intake at breakfast that was associated with the metabolic syndrome 10 years later.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At age 43 years, the association between irregular breakfast intake and metabolic syndrome 10 years later was attenuated and no longer statistically significant in analyses including only plausible reporters.

    “Sensitivity analyses including plausible reporters only showed that this association was attenuated and was no longer statistically significant (Table 2; model 1 plausible).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For meal irregularity at breakfast, lunch and daily total, a decrease was observed at the most recent age, whereas for the evening meal no linear trends were observed.

    “For meal irregularity at breakfast, lunch and for the daily total, a decrease was observed at the most recent age, whereas for the evening meal no linear trends were observed in irregularity (Fig. 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The analyses may have been lacking statistical power to detect relatively small effects, so some null findings may be type-2 errors.

    “It is possible that our analyses were lacking in the statistical power required to detect relatively small effects and therefore that some of our null findings were type-2 errors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Sensitivity analyses were carried out including plausible reporters only.

    “In addition, to assess the possible impact of under-or over-reporting of energy intake, sensitivity analyses were carried out including plausible reporters only.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A second model also adjusted for energy intake at other meal time slots, and daily total models were adjusted for EAR.

    “For the primary outcome, a second model was fitted, which also adjusted for energy intake at the other meal time slots, and models including the daily total irregularity scores were also adjusted for EAR (model 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Non-fasting blood samples have been found to be indicators of CVD risk when fasting blood samples are unavailable in large observational studies.

    “Measures from non-fasting blood samples have been found to be indicators of CVD risk when the preferred fasting blood samples are unavailable in large observational studies (25,26) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] source

      Not checked in the free run.

    • cites [26] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In healthy lean women, a more regular meal frequency led to improvement in peak insulin concentrations and AUC of insulin.

    “The studies by Farshchi et al. (16) showed that having a more regular meal frequency led to improvement in peak insulin concentrations and AUC of insulin with a more regular meal frequency in healthy lean women.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Some cohort members may have already developed the metabolic syndrome by age 43 years, which could have influenced the findings.

    “It is important to consider that we studied the link between meal irregularity and subsequent prevalence of the metabolic syndrome, and it is possible that some cohort members may have already developed the metabolic syndrome by age 43 years (data not collected), which could have influenced the findings.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The use of 5-d estimated diet diaries is a major strength because they are accepted as the gold standard to estimate dietary intake, particularly energy intake.

    “A major strength of this investigation was the use of detailed dietary information based on 5-d estimated diet diaries, which are currently accepted as the 'gold standard' to estimate dietary intake and in particular energy intake (34) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    All models were adjusted for sex, SES, marital status, physical activity and smoking status as confounding variables.

    “All the models were adjusted for sex, SES, marital status, physical activity and smoking status as confounding variables (model 1).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In healthy obese women, a more regular meal frequency led to lower energy intake and lower fasting total and HDL-cholesterol levels, but no effect on glucose and insulin values.

    “In healthy obese women, they also found that a more regular meal frequency led to lower energy intake and lower fasting total and HDL-cholesterol levels; however, no effect on glucose and insulin values were observed (17) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    This investigation follows cross-sectional analyses in the same cohort at age 53 years showing that cohort members with a more irregular intake of energy, especially at breakfast and between meals, had increased cardiometabolic risk.

    “This investigation follows cross-sectional analyses in the same cohort at age 53 years, showing that cohort members with a more irregular intake of energy, especially at breakfast and between meals, had increased cardiometabolic risk (18) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    These differences remained statistically significant after adjusting for covariates (model 1) and adding the year by compliance.

    “These differences remained statistically significant after adjusting for covariates (model 1) as well as adding the year by compliance (data not shown).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Linear mixed models can handle missing outcomes under the assumption that data are missing at random.

    “Linear mixed models were used to examine changes in irregularity scores of energy intake with age; this method uses all available data over follow-up, takes into account the fact that repeated measures on the same individual are correlated, and it can handle missing outcomes under the assumption that data are missing at random (28) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The same method for detailed dietary assessment was used at multiple time points, making prospective investigations into meal irregularity possible in a relatively large sample.

    “Moreover, the same method for detailed dietary assessment was used at multiple time points, making prospective investigations into meal irregularity possible in a relatively large sample, generating one of the first studies of its kind.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    This is one of the only nutritional epidemiological studies to date to include detailed dietary data to investigate the chronobiological effects of energy intake on cardiometabolic risk factors.

    “This is one of the only nutritional epidemiological studies to date to include detailed dietary data to investigate the chronobiological effects of energy intake on cardiometabolic risk factors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Sample attrition may result in bias if healthier and more health-conscious cohort members are more likely to remain in the study.

    “It is possible that this may result in bias if the healthier and more health-conscious cohort members are more likely to remain in the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Regulating and keeping the number of meals per day constant could minimise fluctuations in insulin concentration and plasma glucose levels.

    “It has been shown that regulating and keeping the number of meals per d constant could minimise fluctuations in insulin concentration and plasma glucose levels (23,24) .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [23]

      Not checked in the free run.

    • cites [24] source

      Not checked in the free run.

25 of 25

  • The authors state this as an assumption.

    Data are missing at random.

    “it can handle missing outcomes under the assumption that data are missing at random (28)”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A systematic review and meta-analysis by Vyas et al. in 2012 showed convincing evidence that people working shifts have an approximately 20 % increased risk of myocardial infarction (RR 1•23 (95 % CI 1•15, 1•31)), coronary events (RR 1•24 (95 % CI 1•10, 1•39)) and ischaemic stroke (RR 1•05 (95 % CI 1•01, 1•09)).

    “A systematic review and meta-analysis by Vyas et al. in 2012 of eleven prospective cohort studies, thirteen retrospective cohort studies and ten case-control studies showed convincing evidence that people working shifts have an approximately 20 % increased risk of myocardial infarction (risk ratios (RR) 1•23 (95 % CI 1•15, 1•31)), coronary events (RR 1•24 (95 % CI 1•10, 1•39)) and ischaemic stroke”

    From Meal irregularity and cardiometabolic consequences: results from observational and intervention studies (2016) · cites this paper as [21]

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. 1994, Med Sci Sports Exerc, 26, 857
  2. 2012, Curr Obes Rep, 2, 93
  3. 2010, J Nutr, 141, 144
  4. 1860, Notes on Nursing
  5. 2013, Applied Longitudinal Data Analysis for Epidemiology. A Practical Guide
  6. 2011, Dietary Recommendations for Energy
  7. 2013, Curr Obes Rep, 3, 91

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Related

Authors
Pot, G. K., Hardy, R., & Stephen, A. M.
Affiliations
  • King's College London (GB)
  • MRC Unit for Lifelong Health and Ageing (GB)
  • University of Surrey (GB)
Corresponding author
Pot, Gerda K.
ORCID
Venue
British Journal of Nutrition
Publisher
Cambridge University Press (CUP)
Published
2015-11-09
Volume
115
Issue
2
Pages
315-323
ISSN
  • 0007-1145 (ISSN-L)
  • 1475-2662
DOI
10.1017/s0007114515004407
OpenAlex
W2096574622
Semantic Scholar
f7bfcd01c31c3f39b66e6ffca0531304cbc75dcf
Cited by
40
References
34
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 7 · 2020: 8 · 2019: 1 · 2018: 1 · 2016: 6
FWCI
1.72
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • British Journal Of Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, other-oa)
  • Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
  • VU Research Portal (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
Medical Research Council (U1200632239)
Topics
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
dietary habits, metabolic syndrome, cardiometabolic risk factors, breakfast, lunch, waist circumference, body mass index, triglycerides, diastolic blood pressure, 1946 British birth cohort
MeSH terms
Adult, Blood Pressure, Energy Intake, Diet, Feeding Behavior, Female, United Kingdom, Health Surveys, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Triglycerides, Cohort Studies, Body Mass Index, Metabolic Syndrome, Waist Circumference, Meals, Breakfast, Lunch

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