Cited by 102Nutritional Studies and DietDietary Effects on HealthNutrition, Health and Food Behavior

Irregular consumption of energy intake in meals is associated with a higher cardiometabolic risk in adults of a British birth cohort

Open access
Pot, G K, Hardy, R, Stephen, A M·2014·International Journal of Obesity

Abstract

Background/Objectives:A potential risk factor for cardiometabolic diseases is irregular or inconsistent eating, however, research on this topic is scarce. We aimed to study associations between irregular consumption of energy intake in meals and cardiometabolic risk factors.Subject and Methods:Dietary intake data were derived from 5-day estimated diet diaries of 1768 participants of the National Survey of Health and Development. Energy intakes during predefined meals (breakfast, lunch, dinner, between meals) and daily totals were analyzed using a score for irregularity based on the deviation from the 5-day mean energy intake. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for having the metabolic syndrome or one of its components. Models were adjusted for sex, physical activity, socioeconomic status, marital status and smoking.Results:Irregularity scores of energy intake ranged from 0–160 and were highest for between meals. An increased risk of the metabolic syndrome was associated with more irregular energy intake during breakfast (OR=1.34 (0.99, 1.81); P trend=0.04) and between meals (OR=1.36 (1.01, 1.85); P trend=0.04). Moreover, increased waist circumference was associated with irregular energy intake during breakfast (OR=1.90 (1.47, 2.45); P trend <0.01), evening meal (OR=1.36 (1.06, 1.75); P trend=0.02) and daily total (OR=1.34 (1.04, 1.72); P trend=0.01). No significant associations were found for the other components of the metabolic syndrome.Conclusions:Individuals with a more irregular intake of energy, especially during breakfast and between meals, appeared to have an increased cardiometabolic risk.

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Written from the paper’s full text.

TL;DR

In 1768 British birth cohort participants aged 53, irregular energy intake at breakfast and between meals was associated with higher odds of metabolic syndrome, and irregular intake at several meals was associated with higher waist circumference and BMI. No significant associations were found for the other ATP-III metabolic syndrome components in the main analyses.

Key findings

  • Irregularity scores ranged from 0–160 for breakfast, lunch, evening meal, and between meals, and 0–79 for daily total; scores were highest for between meals.
  • Metabolic syndrome was associated with more 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); after further adjustment for energy intake at other meals, breakfast OR was 1.38 (1.01–1.87; p trend 0.03) and between meals OR was 1.38 (1.01–1.86; p trend 0.04).
  • Increased waist circumference was associated with irregular energy intake at breakfast (OR 1.90, 1.47–2.45), evening meal (OR 1.36, 1.06–1.75), and daily total (OR 1.34, 1.04–1.72). Increased BMI was associated with irregular intake at breakfast (OR 1.46, 1.14–1.87), evening meal (OR 1.62, 1.27–2.06), between meals (OR 1.35, 1.06–1.72), and daily total (OR 1.45, 1.14–1.85).
  • No significant associations were found for the other ATP-III metabolic syndrome components in the main analyses; secondary linear models reported higher plasma triglycerides with irregular breakfast intake.

Methods

  • Longitudinal birth cohort study using the MRC National Survey of Health and Development (NSHD); 1768 participants at age 53 had dietary and metabolic syndrome data. Dietary intake came from 5-day estimated diet diaries, with predefined meal slots collapsed into breakfast, lunch, evening meal, and between meals.
  • Irregularity score per meal was the absolute difference of individual energy intake from the 5-day mean for that meal, divided by the 5-day mean, multiplied by 100, and averaged over 5 days; daily total was calculated similarly. Logistic regression estimated odds ratios for metabolic syndrome, its components, and BMI, adjusted for sex, socio-economic status, marital status, physical activity, and smoking; a second model further adjusted for energy intake at other meals or estimated energy requirements. Linear regression explored continuous components. Sensitivity analyses included only plausible reporters (n=1441, 83%).

Limitations

  • Stated: metabolic syndrome data were missing for 366 individuals, mainly due to missing HDL cholesterol (n=361), and non-fasting blood samples were used for triglycerides; those with missing data had higher BMI and waist circumference, smoked more, and were less physically active, possibly leading to regression dilution bias.
  • Stated: predefined meal slots are subjective and may not suit subgroups such as shift workers, for whom data were unavailable; the single-age cohort limits generalizability to other ages and populations.
  • Stated and evident: multiple testing could produce false positives, though the authors argue the meal irregularity tests are correlated; the observational design cannot establish causality, and self-reported 5-day diet diaries may not capture long-term eating patterns, with under-reporting possibly attenuating results.

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

Integrity signals

Registry

Crossref · 10.1038/ijo.2014.51

Cites

38 of 38 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Increased waist circumference is associated with more irregular energy intake at evening meal (model 1 OR 1.36, 95% CI 1.06-1.75).

    “evening meal (OR 1.36 (1.06; 1.75); p trend 0.02)”
    • Also stated in: § Cardio-metabolic risk factors · plain
      “at evening meals (model 1: OR 1.36 (1.06; 1.75); p for trend <0.01)”
    Quote in the paperSubstantial claim
  • Findingown data

    More irregular energy intake between meals is associated with a higher risk of the metabolic syndrome (model 1 OR 1.36, 95% CI 1.01-1.85; p trend 0.04).

    “between meals (OR 1.36 (1.01-1.85); p trend 0.04)”
    • Also stated in: § Cardio-metabolic risk factors · plain
      “as was an irregular intake of energy between meals (model 1: OR 1.36 (1.01; 1.85); p for trend 0.04)”
    Quote in the paperSubstantial claim
  • Findingown data

    Cohort members with a more irregular daily pattern of energy intake consumed less energy during breakfast, lunch, and evening meal compared to those with a more regular daily pattern (p trend <0.05).

    “Cohort members with a more irregular daily pattern of energy intake consumed less energy during breakfast, lunch, and during the evening meal compared to those with a more regular daily pattern (p trend <0.05).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Increased BMI is associated with more irregular energy intake at breakfast (model 1 OR 1.46, 95% CI 1.14-1.87; p trend <0.01).

    “increased BMI was associated with a more irregular intake of energy at breakfast (model 1: OR 1.46 (1.14; 1.87); p for trend <0.01)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Increased BMI is associated with more irregular energy intake at evening meal (model 1 OR 1.62, 95% CI 1.27-2.06; p trend <0.001).

    “evening meal (model 1: OR 1.62 (1.27; 2.06); p for trend <0.001)”
    Quote in the paperNot a substantial claim
  • May combine two claims. 16
  • Classified as probably not a substantial claim. 15
  • The quote only partly states this claim. 1
  • May combine two claims.

    Findingown data

    A sensitivity analysis comparing those with missing data to the total population showed similar dietary intakes of energy, macronutrients and alcohol, but those with missing data for the metabolic syndrome seemed to have a higher BMI and waist circumference, smoked a little more and were somewhat less physically active.

    “A sensitivity analysis comparing those with missing data to the total population showed similar dietary intakes of energy, macronutrients and alcohol (data not shown), however, those with missing data for the metabolic syndrome seemed to have a higher BMI and waist circumference, smoked a little more and were somewhat less physically active.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    In linear regression, more irregular energy intake during all mealtimes was associated with higher waist circumference; after adjustment for sex, physical activity, SES, marital status and smoking, this remained statistically significant for all meals except lunch.

    “Cohort members with a more irregular energy intake during all mealtimes had higher waist circumferences (Table 4; model 0). After adjusting for sex, physical activity, SES, marital status and smoking, this finding remained statistically significant for all meals except for lunch (Table 4; model 1)”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Irregularity scores of energy intake ranged from 0-160 for breakfast, lunch, evening meal and between meals and 0-79 for the daily total irregularity score.

    “Irregularity score of energy intake ranged from 0-160 for breakfast, lunch, evening meal and between meals and 0-79 for the daily total irregularity score of energy intake.”
    Quote in the paperNot a substantial claim
  • The quote only partly states this claim.

    Findingown data

    No statistically significant associations were observed between irregular energy intake at different meals and systolic BP, diastolic BP, HDL cholesterol, and plasma triglycerides in adjusted models.

    “For systolic and diastolic BP, HDL cholesterol and plasma triglycerides, no statistical significant associations were observed.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The percentage of plausible reporters was 83% of all cohort members and was lowest for those with a more irregular intake of energy (T3:74%) compared to those with a more regular intake (T1:87%).

    “The percentage of plausible reporters was 83% of all cohort members and was lowest for those with a more irregular intake of energy (T3:74%) compared to those with a more regular intake of energy (T1:87%).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The highest irregularity scores of energy intake were found for between meals.

    “the highest irregularity scores of energy intake were found for between meals (Table 2).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    In adjusted linear regression models, no statistically significant associations were observed between meal regularity of energy intake at different meals and systolic BP, diastolic BP, and HDL cholesterol, although unadjusted breakfast irregularity was significantly associated with these outcomes.

    “No statistical significant associations were observed for meal regularity of energy intake at the different meals and systolic BP, diastolic BP, and HDL cholesterol in adjusted models, although the unadjusted model for regularity of energy intake during breakfast was statistically significantly associated with systolic and diastolic BP as well as HDL cholesterol (Table 4, model 0).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Cohort members with a more irregular total daily pattern of energy intake reported lower intakes of energy, carbohydrate, protein (only for g/d), and higher intakes of fat (only for g/d) and alcohol.

    “Cohort members with a more irregular total daily pattern of energy intake had a higher waist circumference and BMI (p for trend <0.05) and reported lower intakes of energy, carbohydrate, protein (only for g/d), and higher intakes of fat (only for g/d) and alcohol (Table 1).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The highest number of married cohort members were in the second tertile and cohort members tended to be more physically active with higher irregular scores of energy intake (p for trend <0.05).

    “the highest number of married cohort members were in the second tertile and cohort members tended to be more physically active with higher irregular scores of energy intake (p for trend <0.05).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Cohort members with a more irregular total daily pattern of energy intake had a higher waist circumference and BMI (p for trend <0.05).

    “Cohort members with a more irregular total daily pattern of energy intake had a higher waist circumference and BMI (p for trend <0.05)”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In linear regression, more irregular energy intake during breakfast, evening meal, between meals and daily total was associated with higher BMI; this remained after adjustment for covariates and further adjustment for energy intakes during other meals.

    “Cohort members with a more irregular energy intake during breakfast, evening meal, between meals and daily total, had higher BMIs (Table 4; model 0). This remained after adjusting for sex, physical activity, SES, marital status and smoking (Table 4; model 1) as well as after further adjustment for energy intakes during the other meals (Table 4; model 2).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    No effect modification by sex was observed for the associations between irregular energy intake and metabolic syndrome, so results were presented for men and women combined.

    “No effect modification by sex was observed and therefore results were presented for men and women combined (Table 3).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Cohort members with a higher daily total irregularity score of energy intake also tended to have higher irregularity scores of energy intake for individual meals.

    “Cohort members with a higher daily total irregularity score of energy intake also tended to have higher irregularity scores of energy intake for individual meals”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    In sensitivity analysis including only plausible reporters, results were similar though somewhat attenuated; for example, irregular energy intake during breakfast was associated with higher risk of the metabolic syndrome (model 1 OR 1.45, 95% CI 1.02-2.06).

    “Sensitivity analyses including only plausible reporters of energy intake (n=1441, 83%) showed similar results though results were somewhat attenuated, for example cohort members with irregular intake of energy during breakfast appeared to have a higher risk of the metabolic syndrome (model 1: OR 1.45 (1.02;2.06)).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Other characteristics such as ratio men to women, SES, and smoking were similar across tertiles of daily total irregularity scores, except for marital status and physical activity.

    “Other characteristics, such as the ratio men to women, SES, and smoking were similar across tertiles of daily total irregularity scores of energy intake except for marital status and physical activity”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    This is the first study investigating meal irregularity using variability in energy intake during meals as a proxy for irregularity.

    “To the best of our knowledge, this is the first study investigating meal irregularity using variability in energy intake during meals as a proxy for irregularity.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The use of a cohort of one age impacts on the generalizability to other populations.

    “Nevertheless, the use of a cohort of one age does impact on the generalizability to other populations”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Farshchi et al. showed that irregular meal consumption resulted in greater insulin resistance and higher fasting lipid profiles of total and LDL cholesterol in lean women, and these effects appeared more pronounced in obese women.

    “The studies of Farshshi et al showed that irregular meal consumption resulted in greater insulin resistance and higher fasting lipid profiles of total and LDL cholesterol in lean women7 and these effects appeared to be more pronounced in obese women8.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Farshchi HR, Taylor MA, Macdonald IA . Regular meal frequency creates more appropriate insulin sensitivity and lipid profiles compared with irregular meal frequency in healthy lean women. Eur J Clin Nutr 2004; 58: 1071–1077. source

      Not checked in the free run.

    • cites [8] Farshchi HR, Taylor MA, Macdonald IA . Beneficial metabolic effects of regular meal frequency on dietary thermogenesis, insulin sensitivity, and fasting lipid profiles in healthy obese women. Am J Clin Nutr 2005; 81: 16–24. source

      Not checked in the free run.

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

    Premisecitation

    Previous observational studies and intervention trials showed beneficial effects of regular meals on cardio-metabolic risk factors and BMI.

    “Previous studies investigated another aspect of regularity, namely regular meal frequency and showed beneficial effects of regular meals on cardio-metabolic risk factors and BMI in both observational studies 5, 22; and intervention trials 7, 8.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [5] Sierra-Johnson J, Unden AL, Linestrand M, Rosell M, Sjogren P, Kolak M et al. Eating meals irregularly: a novel environmental risk factor for the metabolic syndrome. Obesity (Silver Spring) 2008; 16: 1302–1307. source

      Not checked in the free run.

    • cites [22] al-Isa AN . Obesity among Kuwait University students: an explorative study. J R Soc Promot Health 1999; 119: 223–227. source

      Not checked in the free run.

    • cites [7] Farshchi HR, Taylor MA, Macdonald IA . Regular meal frequency creates more appropriate insulin sensitivity and lipid profiles compared with irregular meal frequency in healthy lean women. Eur J Clin Nutr 2004; 58: 1071–1077. source

      Not checked in the free run.

    • cites [8] Farshchi HR, Taylor MA, Macdonald IA . Beneficial metabolic effects of regular meal frequency on dietary thermogenesis, insulin sensitivity, and fasting lipid profiles in healthy obese women. Am J Clin Nutr 2005; 81: 16–24. source

      Not checked in the free run.

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

    Premisecitation

    Overweight or obese people tend to under-report their dietary intake more than people with normal weight.

    “overweight or obese people tend to under-report their dietary intake more than people with a normal weight25.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Lissner L, Heitmann BL, Bengtsson C . Population studies of diet and obesity. Br J Nutr 2000; 83 (Suppl 1): S21–S24. 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 conductcitation

    Dietary intakes were assessed using 5-day estimated diet diaries, which have taken over from weighed assessments as the gold standard for dietary assessment since they provide similar energy intakes.

    “Dietary intakes were assessed using 5-day estimated diet diaries, which have taken over from the now rarely performed weighed assessments as the gold standard for dietary assessment 33, since they provide similar energy intakes 34.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] Thompson FE Subar AF . Dietary assessment methodology. Nutrition in the Prevention and Treatment of Disease, 2nd edn. Elsevier: Amsterdam, The Netherlands, 2008.

      Not checked in the free run.

    • cites [34] Bingham SA, Gill C, Welch A, Cassidy A, Runswick SA, Oakes S et al. Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol 1997; 26 (Suppl 1): S137–S151. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Since the data were derived from a birth cohort, all cohort members were of the same age and age was therefore not a confounding variable.

    “Since the data were derived from a birth cohort, all cohort members were of the same age and age was therefore not a confounding variable.”
    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 conductcitation

    Given multiple tests, there was potential for false positive findings; however, correcting for multiple testing would increase the false negative error rate.

    “On a general note, given the multiple tests there was the potential for false positive findings; however, if corrected for multiple testing and thus reducing the false positive error rate, the false negative error rate would increase which could lead to missing possible important findings 29.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Stalenhoef AF, de Graaf J . Association of fasting and nonfasting serum triglycerides with cardiovascular disease and the role of remnant-like lipoproteins and small dense LDL. Curr Opin Lipidol 2008; 19: 355–361. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Meal irregularity was not predominant for one meal specifically but meal irregularity of energy intake at specific meals could have different metabolic consequences, as most predominant associations were found for breakfast and between meals.

    “suggesting that meal irregularity was not predominant for one meal specifically but that meal irregularity of energy intake at specific meals could have different metabolic consequences as most predominant associations were found for breakfast and between meals.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Study design and conductown data

    A major strength of this study is the use of detailed dietary data in a substantial number of subjects.

    “A major strength of this study is the use of detailed dietary data in a substantial number of subjects”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Interpretationnone given

    This is the first investigation of meal irregularity using such data in relation to cardio-metabolic risk factors.

    “to our knowledge this is the first investigation of meal irregularity using such data in relation to cardio-metabolic risk factors.”
    Quote in the paperSubstantial claim
26 of 26
  • The paper relies on this without support.

    Regular over-consumption of energy could be a potential risk factor for overweight, obesity and other cardio-metabolic risk factors.

    “Despite the possible beneficial effects of regular meal consumption, regular over-consumption of energy could be a potential risk factor for overweight, obesity and other cardio-metabolic risk factors.”
1 of 1

Claims other papers make about this one

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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.

  • Conflicting trend p-values for evening-meal irregularity and waist circumference

    Minor

    The abstract and Results give the same odds ratio and confidence interval for this association but report different trend p-values: 0.02 versus <0.01.

1 of 1

Cites

Flagged first, then by citations

1 of the 39 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Bates B, Lennox AM, Prentice A, Bates C, Swan G . Headline Results from Years 1, 2 and 3 (combined) of the Rolling Programme (2008/2009- 2010/11). National Diet and Nutrition Survey: London, UK, 2012.

Cited by

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Authors
Pot, G. K., Hardy, R., & Stephen, A. M.
Affiliations
  • MRC Elsie Widdowson Laboratory (GB)
  • MRC Unit for Lifelong Health and Ageing (GB)
Corresponding author
Pot, G K
Venue
International Journal of Obesity
Published
2014-03-28
Volume
38
Issue
12
Pages
1518-1524
ISSN
  • 0307-0565 (ISSN-L)
  • 1476-5497
OpenAlex
W2061589065
Cited by
102
References
39
Citations by year
2026: 6 · 2025: 12 · 2024: 13 · 2023: 12 · 2022: 11 · 2021: 10 · 2020: 13 · 2019: 6 · 2018: 4 · 2017: 5 · 2016: 7 · 2015: 3
FWCI
4.95
Type
journal article
Language
en
Open access
Locations
  • International Journal of Obesity (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Open Research (University of Surrey) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
Medical Research Council (U1200632239)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
meal timing, cardiometabolic risk, metabolic syndrome, breakfast, waist circumference, dietary habits, National Survey of Health and Development
MeSH terms
Energy Intake, Cardiovascular Diseases, Diet Surveys, Feeding Behavior, Female, United Kingdom, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Predictive Value of Tests, Surveys and Questionnaires, Risk Factors, Time Factors, Health Behavior, Diet Records, Odds Ratio, Metabolic Syndrome, Waist Circumference, Meals

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