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Cited by 134Dietary Effects on HealthNutritional Studies and DietCircadian rhythm and melatonin

Meal irregularity and cardiometabolic consequences: results from observational and intervention studies

Open access
Pot, Gerda K., Almoosawi, Suzana, Stephen, Alison M.·2016·Proceedings of the Nutrition Society
DOI 10.1017/s0029665116000239
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Abstract

Studying irregular meal patterns fits in with the latest research focusing not only on what people eat but also when they eat, also called chrono-nutrition. Chrono-nutrition involves studying the impact of nutrition on metabolism via circadian patterns, including three aspects of time: (ir)regularity, frequency and clock time. The present paper aimed to narratively review research on irregular meal patterns and cardiometabolic consequences. Only few cross-sectional studies and prospective cohort studies were identified, and most of these suggested that eating meals irregularly is associated with a higher risk of the metabolic syndrome and cardiometabolic risk factors, including BMI and blood pressure. This was supported by two randomised controlled intervention studies showing that consuming meals regularly for 2 weeks v.an irregular meal pattern, led to beneficial impact on cardiometabolic risk factors as lower peak insulin, lower fasting total and LDL-cholesterol, both in lean and obese women. In conclusion, the limited evidence on meal regularity and cardiometabolic consequences supports the hypothesis that consuming meals irregularly is adversely associated with cardiometabolic risk. However, it also highlights the need for more large-scale studies, including detailed dietary assessment to further advance the understanding of the impact of chrono-nutrition on public health.

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Written from the paper’s full text.

TL;DR

This narrative review concludes that limited evidence supports an adverse association between irregular meal patterns and cardiometabolic risk, including metabolic syndrome and risk factors. It calls for larger studies with detailed dietary assessment to clarify chrono-nutrition’s public health impact.

Key findings

  • In a cross-sectional study of 3607 Swedish adults, regular eating was inversely associated with metabolic syndrome (OR 0·63; 95 % CI 0·45, 0·88), while irregular eaters had greater mean weight, waist circumference, BMI and TAG and increased prevalence of metabolic syndrome components (P < 0·001). A study of 5337 Korean men found no significant association for meal-time regularity (OR 0·97; 95 % CI 0·71, 1·31), but fast eating (OR 2·23; 95 % CI 1·60, 3·12) and frequent overeating (OR 2·37; 95 % CI 1·85, 3·05) were associated with metabolic syndrome.
  • In the 1946 British birth cohort using 5-d food diaries, cross-sectional analysis at age 53 (n 1768) found higher metabolic syndrome risk with irregular energy intake at breakfast (OR 1·34; 95 % CI 0·99, 1·81; P trend = 0·04) and between meals (OR 1·36; 95 % CI 1·01, 1·85; P trend = 0·04). Prospectively, irregular lunch (OR 1·42; 95 % CI 1·05, 1·91) and between-meal intake (OR 1·35; 95 % CI 1·01, 1·82) at age 36, and irregular breakfast at age 43 (OR 1·53; 95 % CI 1·15, 2·04), predicted later metabolic syndrome.
  • Other cohorts reported: irregular eating at age 16 in 889 participants was associated with metabolic syndrome 27 years later (OR 1·74; 95 % CI 1·12, 2·71), but this was largely explained by unhealthy lifestyle, with only poor breakfast consumption remaining significant; in 6851 Spanish graduates, snacking between meals was associated with metabolic syndrome (RR 1·44; 95 % CI 1·18, 1·77), and an unhealthy snacking pattern with RR 1·66 (95 % CI 1·23, 2·29).
  • Two randomised cross-over trials in 9 lean and 10 obese women found that 14 d of regular eating (6 meals/d) versus irregular eating (3–9 meals/d) led to lower peak insulin and lower fasting total and LDL-cholesterol in lean women; in obese women, regular eating was associated with lower energy intake, greater postprandial thermogenesis, and lower fasting total and LDL-cholesterol.

Methods

  • Narrative review of observational (cross-sectional and prospective cohort) and intervention studies on meal irregularity and cardiometabolic consequences; no systematic search or meta-analysis is described.
  • Evidence is summarised in Table 1; included studies assessed meal regularity by questionnaire or detailed dietary assessment, including 5-d estimated food diaries in the 1946 British birth cohort, with outcomes such as metabolic syndrome and cardiometabolic risk factors.
  • The two included randomised controlled trials by Farshchi et al. used cross-over designs with 14-d phases comparing regular 6 meals/d with irregular 3–9 meals/d in lean and obese women.

Limitations

  • Stated: the evidence is limited and scarce, with few cross-sectional and prospective cohort studies and only two randomised controlled trials; more large-scale observational and intervention studies with detailed dietary assessment are needed.
  • Stated: inconsistent terminology and definitions of meals/eating occasions complicate identification, interpretation and comparison; some studies assessed meal irregularity with a single questionnaire question; dietary underreporting is important; the review could not investigate differences by sex or age group.
  • Evident from the text: as a narrative review it does not provide pooled effect estimates; the included RCTs were very small (n 9 lean women, n 10 obese women) and short (14-d phases), and some observational findings were non-significant or attenuated after adjustment (e.g., Shin meal-time regularity; Wennberg after lifestyle adjustment).

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Integrity signals

Registry

Crossref · 10.1017/s0029665116000239

Cites

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Statistics

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Claims the paper makes

0 of 140 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    When investigating the components of the metabolic syndrome, the strongest associations were found for central obesity (based on waist circumference) and obesity (based on BMI).

    “When investigating the components of the metabolic syndrome, the strongest associations were found for central obesity (based on waist circumference) and obesity (based on BMI).”
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  • Findingown data

    For the other components of the metabolic syndrome, including HDL-cholesterol, TAG and systolic and diastolic blood pressure, no statistical significant associations were found with meal irregularity.

    “For the other components of the metabolic syndrome, including HDL-cholesterol, TAG and systolic and diastolic blood pressure, no statistical significant associations were found with meal irregularity.”
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  • Findingnone given

    Two randomised controlled trials were identified that examined the effects of regular meal frequency.

    “Although no specific randomised controlled trials were identified that studied the effects of meal irregularity and cardiometabolic consequences, two randomised controlled trials were identified that examined the effects of regular meal frequency.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The narrative review's selection of studies is sufficiently comprehensive and representative to support conclusions about meal irregularity and cardiometabolic risk.
  • Findingnone given

    No specific randomised controlled trials were identified that studied the effects of meal irregularity and cardiometabolic consequences.

    “Although no specific randomised controlled trials were identified that studied the effects of meal irregularity and cardiometabolic consequences, two randomised controlled trials were identified that examined the effects of regular meal frequency.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The narrative review's selection of studies is sufficiently comprehensive and representative to support conclusions about meal irregularity and cardiometabolic risk.
  • Findingown data

    At age 43 years, cohort members with a more irregular intake during breakfast had an increased risk of developing the metabolic syndrome 10 years later (OR 1•53 (95 % CI 1•15, 2•04)).

    “At age 43 years, cohort members with a more irregular intake during breakfast had an increased risk of developing the metabolic syndrome 10 years later (OR 1•53 (95 % CI 1•15, 2•04)).”
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    • cites [37] source

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    • Rests on an assumption: The observed associations between meal irregularity and cardiometabolic risk are not entirely due to residual confounding.
  • May combine two claims. 40
  • Classified as probably not a substantial claim. 18

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    Findingown data

    An increased risk of the metabolic syndrome was associated with more irregular energy intake at breakfast (OR 1•34 (95 % CI 0•99, 1•81) comparing the highest tertile of irregularity score with the lowest tertile; P trend = 0•04) and between meals (OR 1•36 (95 % CI 1•01, 1•85); P trend = 0•04).

    “An increased risk of the metabolic syndrome was associated with more irregular energy intake at breakfast (OR 1•34 (95 % CI 0•99, 1•81) comparing the highest tertile of irregularity score with the lowest tertile; P trend = 0•04) and between meals (OR 1•36 (95 % CI 1•01, 1•85); P trend = 0•04).”
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    • cites [36] source

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    • Rests on an assumption: The observed associations between meal irregularity and cardiometabolic risk are not entirely due to residual confounding.

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    Findingown data

    Irregularity scores changed significantly over the years from when the cohort members were aged 36 years (1982) to when the cohort members were 53 years (1999; P linear mixed models <0•05), and the largest changes in meal irregularity were observed for between meals, which declined over time.

    “Results showed that irregularity scores changed significantly over the years from when the cohort members were aged 36 years (1982) to when the cohort members were 53 years (1999; P linear mixed models <0•05), and the largest changes in meal irregularity were observed for between meals, which declined over time.”
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    Premisecitation

    Food consumption patterns have changed markedly over the past decades: more meals are skipped, consumed outside the family context, on-the-go, later in the day and more irregularly.

    “This is reflected in food consumption patterns, which have changed markedly over the past decades: more meals are skipped, consumed outside the family context, on-the-go, later in the day and more irregularly (1,2) .”
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    Premisecitation

    Shift work involving circadian disruption could be considered probably carcinogenic to human subjects.

    “In 2007, the World Health Organisation/ International Agency for Research on Cancer published a brief report based on an expert meeting and concluded that shift work involving circadian disruption could be considered probably carcinogenic to human subjects (13) .”
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    Premisecitation

    Two randomised controlled intervention studies showed that consuming meals regularly for 2 weeks v. an irregular meal pattern led to beneficial impact on cardiometabolic risk factors as lower peak insulin, lower fasting total and LDL-cholesterol, both in lean and obese women.

    “This was supported by two randomised controlled intervention studies showing that consuming meals regularly for 2 weeks v. an irregular meal pattern, led to beneficial impact on cardiometabolic risk factors as lower peak insulin, lower fasting total and LDL-cholesterol, both in lean and obese women.”
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    Premisecitation

    Shift workers had more irregular eating patterns, altered meal frequency, usually impaired quality of dietary intake and the distribution of dietary intake over the day.

    “However, shift workers had more irregular eating patterns, altered meal frequency, usually impaired quality of dietary intake and the distribution of dietary intake over the day.”
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    Premisecitation

    Of the eight studies, five adjusted for potentially relevant confounding variables, and only two of the five were of high quality; these showed a positive association between shift work and body weight gain.

    “Of the eight studies, five adjusted for potentially relevant confounding variables, including age, gender, body weight at baseline and physical activity, and only two of the five were of high quality.These showed a positive association between shift work and body weight gain (18) .”
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    Premisereasoning

    The evidence for a link between shift work and diseases other than cancer is less conclusive, but suggests that those working shifts have an increased risk of weight gain, metabolic syndrome and vascular events.

    “The evidence for a link between shift work and diseases other than cancer is less conclusive, but suggests that those working shifts have an increased risk of weight gain, metabolic syndrome and vascular events.”
    Quote in the paperSubstantial claim

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    Premisecitation

    Eating regularly was inversely associated with the metabolic syndrome (OR 0•63 (95 % CI 0•45, 0•88)) and this was independent of traditional risk factors, such as sex, smoking, education, physical activity and consumption of fruit, vegetables and fish.

    “Moreover, eating regularly was inversely associated with the metabolic syndrome (OR 0•63 (95 % CI 0•45, 0•88)) and this was independent of traditional risk factors, such as sex, smoking, education, physical activity and consumption of fruit, vegetables and fish.”
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    • Rests on an assumption: The observed associations between meal irregularity and cardiometabolic risk are not entirely due to residual confounding.

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    Premisecitation

    A study in ninety-six male Swedish industrial workers found that energy intake and quality of food were not affected by shift work, but that the circadian distribution of food changed and coffee consumption increased.

    “A study in ninety-six male Swedish industrial workers found that energy intake and quality of food were not affected by shift work, but that the circadian distribution of food changed and coffee consumption increased (24) .”
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    Premisecitation

    Eating regularly was particularly inversely associated with waist circumference (OR 0•64 (95 % CI 0•47; 0•88)) and directly related to HDL-cholesterol (OR 0•63 (95 % CI 0•45, 0•91)) and circulating γ-glutamyl transferase concentrations (OR 0•54 (95 % CI 0•35, 0•84)).

    “Eating regularly was particularly inversely associated with waist circumference (OR 0•64 (95 % CI 0•47; 0•88)) and directly related to HDL-cholesterol (OR 0•63 (95 % CI 0•45, 0•91)) and circulating γ-glutamyl transferase concentrations (OR 0•54 (95 % CI 0•35, 0•84)), believed to be a marker of oxidative stress (34) .”
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    Premisecitation

    Only three studies also adjusted for sleep duration and these showed conflicting results.

    “However, only three studies also adjusted for sleep duration and these showed conflicting results.”
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    Premisecitation

    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”
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    Premisecitation

    De Castro demonstrated that dietary intake in the morning is particularly satiating and can reduce the total amount consumed in a day, while eating later in the evening is less satiating and can lead to a greater overall daily intake.

    “De Castro was one of the first nutritional researchers to demonstrate that dietary intake in the morning is particularly satiating and can reduce the total amount consumed in a day, while eating later in the evening is less satiating and can lead to a greater overall daily intake (28) .”
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    Premisecitation

    Participants with the metabolic syndrome were more likely to eat quickly (OR 2•23 (95 % CI 1•60, 3•12) for fast v. slow) and overeat frequently (OR 2•37 (95 % CI 1•85, 3•05) comparing more than four times per week v. less than once weekly).

    “Participants with the metabolic syndrome were more likely to eat quickly (OR 2•23 (95 % CI 1•60, 3•12) for fast v. slow) and overeat frequently (OR 2•37 (95 % CI 1•85, 3•05) comparing more than four times per week v. less than once weekly).”
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    Premisecitation

    Social jetlag is the discrepancy between our internal body clocks and our social clock and this has also been associated with increased risk for non-communicable chronic diseases such as obesity and the metabolic syndrome.

    “Social jetlag is the discrepancy between our internal body clocks and our social clock and this has also been associated with increased risk for non-communicable chronic diseases such as obesity (30) and the metabolic syndrome (7) .”
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    It has been estimated that social jetlag affects more than 80 % of the general population in central Europe.

    “It has been estimated that social jetlag affects more than 80 % of the general population in central Europe (30) , especially people living in urban areas.”
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    Premisecitation

    Irregular eaters had significantly greater mean weight, waist circumference, BMI and TAG than regular eaters.

    “Results showed that irregular eaters had significantly greater mean weight, waist circumference, BMI and TAG than regular eaters.”
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    Premisecitation

    The suprachiasmatic nucleus is thought to be the master clock and is entrained by external cues ('zeitgebers'), mainly light from eyes, as well as age and genes.

    “The suprachiasmatic nucleus is thought to be the master clock and is entrained by external cues ('zeitgebers'), mainly light from eyes, as well as age and genes.”
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    Premisecitation

    The CLOCK SNP, sleep duration or chrono-type (morningness/eveningness) was not associated with weight loss.

    “However, this CLOCK SNP, sleep duration or chrono-type (morningness/eveningness) was not associated with weight loss (54) .”
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    Premisecitation

    In the Wennberg et al. study, the association was largely explained by an unhealthy lifestyle at age 16 years and when correcting for lifestyle factors, the only statistically significant association was observed for poor breakfast consumption.

    “However, they found that this was largely explained by an unhealthy lifestyle at age 16 years and when correcting for lifestyle factors (such as BMI at age 16 years, smoking, alcohol consumption, physical activity and consumption of sweets and pastries at age 16 years), the only statistically significant association was observed for poor breakfast consumption.”
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    Interpretationcitation

    These randomised controlled trials showed that an irregular eating frequency seems to negatively impact fasting lipid and postprandial insulin profiles and thermogenesis.

    “These randomised controlled trials showed that an irregular eating frequency seem to negatively impact fasting lipid and postprandial insulin profiles and thermogenesis, confirming the importance of meal patterns in influencing carbohydrate and lipid metabolism in addition to the amount and composition of food consumed.”
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    Premisecitation

    Peripheral clocks can be entrained by zeitgebers, with dietary intake being a dominant zeitgeber for many of these.

    “In turn, peripheral clocks can be entrained by zeitgebers, with dietary intake being a dominant zeitgeber for many of these (46,47) .”
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    Premisecitation

    Other genes, like Bmal1 and Per1/2 and Cry1/2, were found to form an important transcriptional-translational feedback loop in the circadian system.

    “Other genes, like Bmal1 and Per1/2 and Cry1/2 were found to form an important transcriptional-translational feedback loop in the circadian system (6,52) .”
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    Premisecitation

    Circadian rhythms in the human body are a complex interaction of many circadian patterns, which are thought to be controlled via the central clock, the suprachiasmatic nucleus in the hypothalamus, and by peripheral circadian clocks present in nearly all organs and cells.

    “Circadian rhythms in the human body are a complex interaction of many circadian patterns, which are thought to be controlled in two main ways: via the central clock, the suprachiasmatic nucleus in the hypothalamus, and by peripheral circadian clocks which are present in nearly all organs and cells (6,8) .”
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    Mice lacking the CLOCK gene were hyperphagic, obese and rapidly developed the metabolic syndrome.

    “Mice lacking this gene were hyperphagic, obese and rapidly developed the metabolic syndrome (51) .”
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    The amplitude of some metabolic rhythms is reduced in the obese, although this varies from study to study and by hormone.

    “Interestingly, it appears that the amplitude of some of these rhythms is reduced in the obese, although this varies from study to study and by hormone (9,53) .”
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    The relationship between food intake and circadian rhythms is often reciprocal: circadian systems can drive temporal changes in metabolic pathways and changes in metabolic pathways can alter core molecular components of circadian rhythms.

    “It seems that the relationship between food intake and circadian rhythms are often reciprocal: circadian systems can drive temporal changes in metabolic pathways and changes in metabolic pathways can alter core molecular components of circadian rhythms (53) .”
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    Premisecitation

    Regular eating frequency was associated with lower energy intake, greater postprandial thermogenesis and lower fasting total and LDL-cholesterol in obese women.

    “In addition, the regular eating frequency was associated with lower energy intake, greater postprandial thermogenesis and lower fasting total and LDL-cholesterol (43) .”
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    Premisecitation

    In lean women, fasting glucose and insulin concentrations were not affected by meal frequency, but peak insulin and area under the curve responses to a test meal were higher after the irregular meal routine compared with the regular meal routine.

    “The first study in lean women (BMI 23•7 (SD 7•4) kg/m 2 ) showed that fasting glucose and insulin concentrations were not affected by meal frequency, but peak insulin and area under the curve responses to a test meal were higher after the irregular meal routine compared with the regular meal routine (42) .”
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    Premisecitation

    A recent review in children showed that three of five studies comprising overall 13 998 children and adolescents showed a significant reduction of obesity risk with increasing number of meals, which persisted after adjustment for confounders; two other studies found non-significant trends in the same direction.

    “A recent review in children showed that three of five studies comprising overall 13 998 children and adolescents showed a significant reduction of obesity risk with increasing number of meals, which persisted after adjustment for confounders; two other studies found non-significant trends in the same direction (61) .”
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    Interpretationreasoning

    Disruption of the internal body clock could lead directly to a positive energy balance, which could then lead to metabolic dysfunction.

    “This in turn could lead directly to a positive energy balance, which could then lead to metabolic dysfunction.”
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    In the studies included in Palmer et al.'s review, the definition of eating occasion varied from study to study.

    “In addition, sample sizes were generally small, interventions were relatively short-term and the definition of eating occasion varied from study to study.”
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    The classification of temporal distribution of meals is usually based on cultural norms.

    “The classification of temporal distribution of meals is usually based on cultural norms (67,68) .”
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    Premisecitation

    The differential relationship of eating frequency and cardiometabolic risk factors between men and women was discussed by Smith et al.

    “For example, the differential relationship of eating frequency and cardiometabolic risk factors between men and women was discussed by Smith et al. (62) .”
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    Premisecitation

    Proposed mechanisms that explain the association between meal frequency and obesity include better appetite control, improved glucose homeostasis and an increase in the thermic effect of food.

    “Proposed mechanisms that explain the association between meal frequency and obesity include better appetite control, improved glucose homeostasis and increase in the thermic effect of food (58) .”
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    Interpretationcitation

    Meal irregularity could also be interpreted as being related to meal frequency, as observed in the studies by Farshchi et al., making the distinction between meal irregularity and meal frequency somewhat distorted.

    “However, meal irregularity could also be interpreted as being related to meal frequency, as was observed in the studies by Farshchi et al. (42,43) making the distinction between meal irregularity and meal frequency somewhat distorted.”
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    Smith et al. studied the association between daily eating frequency and cardiometabolic risk factors in 2775 young Australian adults aged 26-36 years and found that a higher number of eating occasions was associated with reduced cardiometabolic risk factors in young men but not in young women.

    “Smith et al. studied the association between daily eating frequency and cardiometabolic risk factors in 2775 young Australian adults aged 26-36 years and found that a higher number of eating occasions was associated with reduced cardiometabolic risk factors in young men but not in young women (62) .”
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    Premisecitation

    The term chrono-nutrition was introduced in 1986 by Delabois but was not much used beyond its application in weight loss diets.

    “The term chrono-nutrition was introduced in 1986 by Delabois (10) but was not much used beyond its application in weight loss diets.”
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    In the pilot study, consuming one meal/d led to more hunger, desire to eat, and higher prospective consumption.

    “Consuming one meal/d decreased cortisol concentrations and led to more hunger, desire to eat, and prospective consumption was estimated higher and feelings of fullness were significantly lower.”
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    In the pilot study, consuming three meals/d increased HDL-cholesterol and decreased TAG.

    “Moreover, they found pro-atherogenic effects (increased total and LDL-cholesterol) and anti-atherogenic effects (increased HDL-cholesterol and decreased TAG) after consuming three meals/d.”
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  • May combine two claims.

    Premisecitation

    With ageing comes a decline in the ability to regulate food intake, e.g. less able to compensate for higher energy intake, due to altered hormonal signals such as cholecystokinin, glucagon-like peptide 1 and peptide YY and impaired senses of taste and smell.

    “With ageing comes a decline in the ability to regulate food intake, e.g. less able to compensate for higher energy intake, due to altered hormonal signals such as cholecystokinin, glucagon-like peptide 1 and peptide YY cholecystokinin, glucagonlike peptide 1, and peptide YY and impaired senses taste and smell (60) , which may explain some these differences observed in children and adults.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] source

      Not checked in the free run.

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

    Study design and conductnone given

    The results of this review did not allow investigation of whether the impact of the timing of eating on cardiometabolic risk could differ in specific groups of the population, e.g. men v. women, or children v. older adults.

    “The results of this review did not allow us to investigate whether the impact of the timing of eating on cardiometabolic risk could differ in specific groups of the population, e.g.men v. women, or children v. older adults although the evidence from experimental studies seems to suggest there could be differences between these groups.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    A review by Leech et al. in 2015 found that most studies included in their review use a participant-identified approach.

    “A review by Leech et al. in 2015 found that most studies included in their review use a participant-identified approach (70) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    Inconsistency in definitions of eating occasions or meals may complicate interpretation and comparison of research results.

    “The inconsistency in definitions of eating occasions or meals may complicate interpretation and comparison of research results.”
    Quote in the paperNot a substantial claim

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

    Interpretationcitation

    Evidence from experimental studies seems to suggest there could be differences between men and women, or children and older adults, in the impact of timing of eating on cardiometabolic risk.

    “The results of this review did not allow us to investigate whether the impact of the timing of eating on cardiometabolic risk could differ in specific groups of the population, e.g.men v. women, or children v. older adults although the evidence from experimental studies seems to suggest there could be differences between these groups.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    A review by McCrory and Campbell in 2011 suggested that when examining eating patterns, such as eating frequency, snacking or breakfast consumption, it is not very meaningful to do so in isolation as in the real world these eating behaviours are very much intertwined.

    “A review by McCrory and Campbell in 2011 suggested that when examining eating patterns, such as eating frequency, snacking or breakfast consumption, it is not very meaningful to do so in isolation as in the real world these eating behaviours are very much intertwined (73) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There are positive associations between family meals and adolescent dietary intake including fruit and vegetables consumption, dairy consumption and less consumption of sugar-sweetened beverages.

    “A recent meta-analysis showed that family meal frequency contributes to more healthy eating among children and adolescents (74) , with positive associations between family meals and adolescent dietary intake including fruit and vegetables consumption, dairy consumption and less consumption of sugar-sweetened beverages (75) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [75]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A recent review by Leech et al. found an association between meal patterns and diet quality, and more specifically an inverse association between breakfast skipping and diet quality.

    “This is supported by the recent review by Leech et al. who found that an association with meal patterns and diet quality, and more specifically an inverse association between breakfast skipping and diet quality (70) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Evidence from the 2007 World Cancer Research Fund/American Institute of Cancer Research report suggests that people are at an increased risk of stomach cancer when consuming meals irregularly as opposed to regular eating, however there was too much heterogeneity amongst the studies to make a firm judgement.

    “The evidence from the 2007 World Cancer Research Fund/American Institute of Cancer Research report on food, nutrition, physical activity and the prevention of cancer suggests that people are at an increased risk of stomach cancer when consuming meals irregularly as opposed to regular eating, however there was too much heterogeneity amongst the studies to make a firm judgement (77) .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A recent review of dietary therapies and innovative time-associated dietary approaches concluded that regular meal eating habits might facilitate maintaining weight while unplanned snacking as well as consuming the major part of the energy intake at the end of the day seem to be unfavourable.

    “A recent review of dietary therapies and innovative time-associated dietary approaches concluded that regular meal eating habits might facilitate maintaining weight while unplanned snacking as well as consuming the major part of the energy intake at the end of the day seem to be unfavourable (67) .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67] source

      Not checked in the free run.

51 of 51

  • The paper relies on this without support.

    The narrative review's selection of studies is sufficiently comprehensive and representative to support conclusions about meal irregularity and cardiometabolic risk.

    “The present paper aimed to narratively review research on irregular meal patterns and cardiometabolic consequences.”

  • The paper relies on this without support.

    The observed associations between meal irregularity and cardiometabolic risk are not entirely due to residual confounding.

    “These irregularity scores were related to the metabolic syndrome using logistic regression models, adjusting for relevant confounding variables (sex, physical activity, socio-economic status, marital status and smoking).”
2 of 2

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?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Wennberg cohort is placed in two different countries

    Minor

    The text places the Wennberg et al. cohort in Norway, but Table 1 places the same 889-participant study in Sweden.

  • Shin study sample size differs between text and table

    Minor

    The text describes the Shin et al. study as including 5337 men, whereas Table 1 lists 7081 men for the same study.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. 2007, Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective
  2. Delabois, 1999, Mincir sur mesure grâce à la chrono-nutrition

Cited by

Sorted by citations

Related

Authors
Pot, G. K., Almoosawi, S., & Stephen, A. M.
Affiliations
  • King's College London (GB)
  • Newcastle University (GB)
  • University of Surrey (GB)
Corresponding author
Pot, Gerda K.
ORCID
Venue
Proceedings of the Nutrition Society
Publisher
Cambridge University Press (CUP)
Published
2016-06-22
Volume
75
Issue
4
Pages
475-486
ISSN
  • 0029-6651 (ISSN-L)
  • 1475-2719
DOI
10.1017/s0029665116000239
OpenAlex
W2470455339
Semantic Scholar
4b4804fd9a0980ec68ff6438664d2fe52b9c18ff
Cited by
134
References
81
Citations by year
2026: 18 · 2025: 16 · 2024: 12 · 2023: 20 · 2022: 21 · 2021: 14 · 2020: 13 · 2019: 7 · 2018: 8 · 2017: 5
FWCI
0.78
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • Proceedings of The Nutrition Society (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion)
  • Open Research (University of Surrey) (submittedVersion)
  • Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords
chrononutrition, circadian rhythm, cardiometabolic risk, metabolic syndrome, meal timing, meal frequency, insulin, LDL cholesterol, blood pressure, body mass index, obesity, dietary intervention
MeSH terms
Blood Pressure, Energy Intake, Cardiovascular Diseases, Circadian Rhythm, Feeding Behavior, Female, Humans, Body Mass Index, Metabolic Syndrome, Meals

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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