CoChat
Sign Up
Cited by 155Dietary Effects on HealthDiabetes, Cardiovascular Risks, and LipoproteinsNutrition, Health and Food Behavior

Eating Meals Irregularly: A Novel Environmental Risk Factor for the Metabolic Syndrome

Open access
Sierra‐Johnson, Justo, Undén, Anna‐Lena, Linestrand, Madeleine, Rosell, Magdalena, Sjogren, Per, Kolak, Maria, De Faire, Ulf, Fisher, Rachel M. +1 more·2008·Obesity
DOI 10.1038/oby.2008.203
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: Skipping meals is a common practice in our current society; however, it is not clear whether eating meals regularly is associated with the metabolic syndrome. Objective: Our aim was to assess the association of eating meals regularly with parameters of the metabolic syndrome and insulin resistance in a representative population‐based cohort of 60‐year‐old men and women. Methods and Procedures: A population‐based cross‐sectional study of 3,607 individuals (1,686 men and 1,921 women), aged 60 years, was conducted in Stockholm County, Sweden. Medical history, socioeconomic factors, and lifestyle data were collected by a questionnaire and a medical examination, which included laboratory tests. Results: Of the subjects who were regular eaters, 20% fulfilled the criteria for the metabolic syndrome vs. 27% of subjects who were irregular eaters (P < 0.0001). The adjusted odds ratio (OR) for having the greatest number of components of the metabolic syndrome in subjects who were regular eaters was 0.27 (95% confidence interval (CI), 0.13–0.54) using subjects who did not fulfill any criteria for the metabolic syndrome as a reference group. Eating meals regularly was also inversely related to insulin resistance (OR, 0.68 (95% CI, 0.48–0.97)) and to γ‐glutamyl transferase (OR, 0.52 (95% CI, 0.33–83)) after full adjustment. Discussion: Eating meals regularly is inversely associated to the metabolic syndrome, insulin resistance and (high) serum concentrations of γ‐glutamyl transferase. These findings suggest that eating meals irregularly may be part of several potential environmental risk factors that are associated with the metabolic syndrome and may have future implications in giving dietary advice to prevent and/or treat the syndrome.

AI snapshot

Written from the paper’s full text.

TL;DR

In a population-based cross-sectional study of 60-year-old Stockholm residents, eating meals regularly was independently and inversely associated with the metabolic syndrome, insulin resistance, and high γ-glutamyl transferase concentrations. The authors propose irregular meal eating as a novel environmental risk factor for the metabolic syndrome.

Key findings

  • Of regular eaters, 20% met criteria for the metabolic syndrome vs. 27% of irregular eaters (P < 0.0001); irregular eaters showed a rising prevalence of the number of metabolic syndrome components (18% with five components vs. 8% with none, P < 0.001).
  • After full adjustment (sex, smoking, education, physical activity, alcohol, fruit, vegetable, and fish intake), the OR for metabolic syndrome among regular eaters was 0.58 (95% CI 0.41–0.83); for insulin resistance 0.68 (0.48–0.97); for upper-quartile γ-glutamyl transferase 0.52 (0.33–0.83).
  • The abstract reports an adjusted OR of 0.27 (95% CI 0.13–0.54) for having the greatest number of metabolic syndrome components among regular eaters, using subjects meeting no criteria as reference.
  • In residual linear regression models, meal regularity remained an independent predictor of waist circumference (β = 2.615, P < 0.0001), triglycerides (P = 0.009), fasting glucose (P = 0.010), γ-glutamyl transferase (P = 0.0008), and HOMA-2 (P < 0.0001), and was borderline for HDL-cholesterol (P = 0.054). Waist circumference was the component most strongly related to meal regularity.

Methods

  • Cross-sectional study in Stockholm County, Sweden (August 1997–March 1999): every third man and woman born 1 July 1937–31 June 1938 was invited; 4,232 of 5,460 participated (78% response). After excluding known cardiovascular disease (n = 313), diabetes (n = 297), cancer (n = 36), and missing meal-regularity answers (n = 133), the analytic sample was 3,607 (1,686 men, 1,921 women), all aged 60.
  • Meal regularity was self-reported via questionnaire ("Do you eat regular breakfast, lunch and dinner or evening meal each day?"; never/sometimes/usually/always); "usually/always" = regular, "sometimes/never" = irregular. Metabolic syndrome was defined by the updated ATP-III criteria (≥3 of five components); insulin resistance was the upper quartile of HOMA-2; high γ-glutamyl transferase was the highest sex-specific quartile.
  • Analysis used ANOVA and χ² comparisons, logistic regression adjusted for sex, education, physical activity, smoking, alcohol, and significant dietary components, residual linear regression models, and Kendall's Tau for trend across the number of metabolic syndrome components.

Limitations

  • Stated by the authors: the cross-sectional design cannot prove causality; self-reported questionnaire data have been questioned (though the authors argue meal-pattern questionnaires are likely valid and reliable); residual confounding is possible, which they addressed by adjusting for all significant traditional and environmental risk factors.
  • Evident from the text: the cohort is restricted to 60-year-old men and women in Sweden, and the authors state generalizability only to all persons aged 60 years in Sweden; irregular eaters were a small subgroup (n = 437, ~12% of the sample), and the dietary intake measure was a limited food frequency questionnaire covering only selected foods.

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

Integrity signals

Registry

Crossref · 10.1038/oby.2008.203

Cites

23 of 23 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 15 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Meal regularity was significantly associated with higher γ-glutamyl transferase concentrations (OR 0.52; 95% CI 0.33-0.83).

    “Moreover, meal regularity was also significantly associated with a higher γ-glutamyl transferase concentrations (OR 0.52; 95% CI: 0.33-0.83).”
    Quote in the paperSubstantial claim
  • Findingown data

    29% of irregular eaters met the updated ATP-III criterion for metabolic syndrome, compared to regular eaters.

    “Compared to regular eaters, subjects who were irregular eaters also had significantly greater mean values for the HOMA-2 index, the percentage of subjects (32%) who met the criterion for insulin resistance and the percentage of subjects (29%) who met the updated ATP-III criterion for metabolic syndrome.”
    Quote in the paperSubstantial claim
  • Findingown data

    The adjusted odds ratio for having the metabolic syndrome in regular eaters was 0.58 (95% CI 0.41-0.83).

    “The adjusted odds ratio (OR) for having the metabolic syndrome in subjects who were regular eaters was 0.58 (95% confidence interval (CI): 0.41-0.83).”
    Quote in the paperSubstantial claim
  • Findingown data

    In a subanalysis excluding insulin-resistant subjects, meal regularity remained a significant predictor of the metabolic syndrome after full adjustments (OR 0.58; 95% CI 0.36-0.97, P = 0.033).

    “meal regularity remained a significant predictor of the metabolic syndrome after full adjustments (OR 0.58; 95% CI 0.36-0.97,P = 0.033).”
    Quote in the paperSubstantial claim
  • Findingown data

    Irregular eaters had significantly greater mean HOMA-2 index values than regular eaters.

    “Compared to regular eaters, subjects who were irregular eaters also had significantly greater mean values for the HOMA-2 index, the percentage of subjects (32%) who met the criterion for insulin resistance and the percentage of subjects (29%) who met the updated ATP-III criterion for metabolic syndrome.”
    Quote in the paperSubstantial claim
  • May combine two claims. 11
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 10

  • May combine two claims.

    Findingown data

    Irregular eaters had significantly greater mean weight, waist circumference, sagittal abdominal diameter, and BMI than regular eaters.

    “In contrast, irregular eaters had significantly greater mean weight, waist circumference, sagittal abdominal diameter, BMI, triglycerides, apoB/apoAI ratio, and γ-glutamyl transferase concentrations than regular eaters.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of regular eaters, 20% fulfilled the criteria for the metabolic syndrome, versus 27% of irregular eaters (P < 0.0001).

    “Of the subjects who were regular eaters, 20% fulfilled the criteria for the metabolic syndrome vs. 27% of subjects who were irregular eaters (P < 0.0001).”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Eating meals regularly is independently and inversely associated with the metabolic syndrome after adjustment for traditional risk factors and dietary components.

    “Eating meals regularly is inversely associated to the metabolic syndrome, insulin resistance and (high) serum concentrations of γ-glutamyl transferase.”
    • Also stated in: § relationship between meal regularity and the metabolic syndrome · plain
      “Eating regularly was inversely related to the metabolic syndrome, insulin resistance, and γ-glutamyl transferase concentrations (Table 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After controlling for sex, physical activity, smoking, and dietary factors, meal regularity was an independent predictor of waist circumference, triglycerides, γ-glutamyl transferase, HOMA-2, and borderline for HDL-cholesterol.

    “After controlling for sex, physical activity levels, smoking, and dietary factors, meal regularity was still an independent predictor of waist circumference, triglycerides, γ-glutamyl transferase, HOMA-2, and borderline for HDL-cholesterol (Table 5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Irregular eaters had significantly greater mean triglycerides, apoB/apoAI ratio, and γ-glutamyl transferase concentrations than regular eaters.

    “In contrast, irregular eaters had significantly greater mean weight, waist circumference, sagittal abdominal diameter, BMI, triglycerides, apoB/apoAI ratio, and γ-glutamyl transferase concentrations than regular eaters.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Eating regularly was particularly inversely associated with waist circumference and directly related to HDL-cholesterol.

    “Eating regularly was particularly inversely associated with waist circumference and directly related to HDL-cholesterol.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Regular eaters had significantly higher intake of fruits, vegetables, bony fish, fatty fish, and wine than irregular eaters.

    “In contrast, subjects who were regular eaters had on average a significantly higher intake of fruits, vegetables, bony fish, fatty fish, and wine than those who were irregular eaters.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The frequency of daily eating occasions has long been suspected to affect health outcomes, in particular cardiometabolic risk.

    “The frequency of daily eating occasions has long been suspected to affect health outcomes, in particular cardiometabolic risk (3,4).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] source

      Not checked in the free run.

    • cites [4] source

      Not checked in the free run.

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

    Premisecitation

    The metabolic syndrome is a cluster of coronary heart disease risk factors-central obesity, hypertension, dyslipidemia, and glucose intolerance-that share an association with insulin resistance, which appears to be the primary underlying pathophysiologic disturbance.

    “The metabolic syndrome is a cluster of coronary heart disease risk factors-central obesity, hypertension, dyslipidemia, and glucose intolerance-that share an association with insulin resistance, which appears to be the primary underlying pathophysiologic disturbance (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] source

      Not checked in the free run.

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

    Premisecitation

    Environmental factors proposed to influence the development of insulin resistance include dietary composition, sedentary behavioral patterns, and cognitive attitudes toward food (dietary restraints).

    “Environmental factors that have been proposed to influence the development of insulin resistance are dietary composition, sedentary behavioral patterns, and also cognitive attitudes toward food (i.e., dietary restraints) (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Irregular meal frequency appears to produce a degree of insulin resistance.

    “Studies by Farshchi and colleagues have suggested that irregular meal frequency appears to produce a degree of insulin resistance (11,12).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [11] source

      Not checked in the free run.

    • cites [12] source

      Not checked in the free run.

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

    Premisecitation

    Increased meal frequency is associated with lower fasting total serum cholesterol and low-density lipoprotein levels.

    “An increased meal frequency has been associated with lower (fasting) total serum cholesterol and low-density lipoprotein (LDL) levels (8)(9)(10).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [8] source

      Not checked in the free run.

    • cites [9] source

      Not checked in the free run.

    • cites [10] source

      Not checked in the free run.

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

    Premisecitation

    The prevalence of an irregular meal pattern has increased recently compared to past decades.

    “According to published studies (13,14), the prevalence of an irregular meal pattern has increased recently compared to that in the past decades.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] source

      Not checked in the free run.

    • cites [14] source

      Not checked in the free run.

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

    Study design and conductreasoning

    The final analytic sample was 3,607 subjects (1,686 men and 1,921 women) after exclusions.

    “This resulted in a final analytic sample of 3,607 subjects (1,686 men and 1,921 women).”
    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

    The study population is fairly large with a good response rate (78%), yielding a well-characterized population.

    “The study population is fairly large with a good response rate (78%), yielding a well-characterized population.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    Questionnaires to assess meal patterns may give valid and reliable data, and self-report would not significantly alter the results.

    “Although information from self-reports has been questioned, questionnaires to assess meal patterns may give valid and reliable data, and we would not expect this to significantly alter our results (23).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23]

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Residual confounding was addressed by adjusting for all significant traditional and environmental risk factors using both logistic and linear regression, in which meal regularity kept its significance.

    “Another potential limitation could be the residual confounding in our data; however, we have addressed this by adjusting for all significant traditional and environmental risk factors using both logistic and linear regression, in which meal regularity kept its significance.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The study design made it possible to control effectively for several relevant confounding factors such as age.

    “Also, the study design made it possible to control effectively for several relevant confounding factors such as age.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Of 5,460 invited subjects, 4,232 (78% response rate) participated.

    “Of 5,460 subjects (2,779 men and 2,681 women) invited to participate in the study, 4,232 (78% response rate) participated.”
    Quote in the paperNot a substantial claim
19 of 19

  • The paper relies on this without support.

    No study has evaluated the association between meal frequency and the metabolic syndrome.

    “To our knowledge, no study has evaluated the association between meal frequency and the metabolic syndrome.”

  • The paper relies on this without support.

    This is the first study to assess the relationship between eating meals regularly and the metabolic syndrome.

    “To our knowledge, this is the first study to assess the relationship between eating meals regularly and the metabolic syndrome.”

  • The paper relies on this without support.

    The etiology of the metabolic syndrome is multifactorial, influenced by genetic and environmental factors.

    “The etiology of the metabolic syndrome is multifactorial, influenced by genetic and environmental factors.”

  • The paper relies on this without support.

    Modern lifestyle is increasingly moving away from regular meals, because of wider food availability and eating more meals outside the home.

    “Modern lifestyle is increasingly moving away from regular meals, because of wider food availability and eating more meals outside the home.”
4 of 4

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.

  • HDL-cholesterol regression t ratio does not match its coefficient and standard error

    Major

    Dividing the reported coefficient by its standard error gives −3.6, not −1.93. The discrepancy matters because the reported t ratio accompanies a borderline P value of 0.054.

    Reported -1.93 · recomputed -3.6

  • Abstract gives a different upper confidence limit for γ-glutamyl transferase

    Minor

    The abstract gives an upper 95% confidence limit of 83, whereas the results give 0.83 for the same odds ratio. The abstract's interval would include 1, changing its stated interpretation.

2 of 2

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Sierra‐Johnson, J., Undén, A., Linestrand, M., Rosell, M., Sjogren, P., Kolak, M., De Faire, U., Fisher, R. M., & Hellénius, M.
Affiliations
  • Mayo Clinic (US)
  • Karolinska Institutet (SE)
Corresponding author
Sierra‐Johnson, Justo
ORCID
Venue
Obesity
Publisher
Wiley
Published
2008-06
Volume
16
Issue
6
Pages
1302-1307
ISSN
  • 1930-7381 (ISSN-L)
  • 1930-739X
DOI
10.1038/oby.2008.203
OpenAlex
W2076645100
Semantic Scholar
e156c16b91cf6e9a8dc7e4e0543c5b6d84ab87ad
Cited by
155
References
23
Citations by year
2026: 3 · 2025: 8 · 2024: 13 · 2023: 11 · 2022: 16 · 2021: 12 · 2020: 9 · 2019: 5 · 2018: 4 · 2017: 7 · 2016: 12 · 2015: 7 · 2014: 7 · 2013: 19 · 2012: 9
FWCI
2.94
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1558 d)
Locations
  • Obesity (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Eli Lilly and Company
  • European Foundation for the Study of Diabetes
  • Forskningsrådet för Arbetsliv och Socialvetenskap
  • Hjärt-Lungfonden
  • Karolinska Institutet
  • Stockholms Läns Landsting
  • Vetenskapsrådet
  • Division of Graduate Education
Topics
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
meal skipping, irregular eating, metabolic syndrome, insulin resistance, gamma-glutamyl transferase, environmental risk factors, older adults, dietary recommendations
MeSH terms
Cross-Sectional Studies, Data Collection, Eating, Feeding Behavior, Female, gamma-Glutamyltransferase, Humans, Insulin Resistance, Male, Middle Aged, Risk Factors, Cohort Studies, Logistic Models, Metabolic Syndrome

About these checks

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.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review