The impact of meal timing on body composition: The role of Chrononutrition O impacto do horário das refeições na composição corporal: O papel da Crononutrição
Rita Barracosa da Costa Silva ORIENTADO POR: Dr.ª Maria Raquel Soares de Carvalho Roriz COORIENTADO POR: Prof. Doutor Nuno Pedro Garcia Fernandes Bento Borges REVISÃO TEMÁTICA 1.º CICLO EM CIÊNCIAS DA NUTRIÇÃO | UNIDADE CURRICULAR ESTÁGIO FACULDADE DE CIÊNCIAS DA NUTRIÇÃO E ALIMENTAÇÃO DA UNIVERSIDADE DO PORTO
TC PORTO, 2021
i
Abstract
Chrononutrition is an emerging research topic in nutrition that embraces
the relationship established between temporal eating patterns, daily circadian
rhythms and metabolic health. Preliminary data from observational and
experimental studies suggest that changes in the timing of food intake can impact
body composition and the success of weight loss approaches, regardless of total
daily energy intake and dietary composition, raising the question if when to eat
matters as much as food quantity and quality. This narrative review assesses the
effect of food intake timing on body composition in adults and briefly explores the
mechanisms underlying the impact of meal timing on body composition.
In conclusion, recent data supports that late eating may impair the success
of weight loss strategies and morning loaded energy distribution seems to be a
valuable approach for weight control. In detail, higher morning diet induced
thermogenesis, circadian misalignment, genetic variants, metabolic changes,
differences in sleep duration and individual´s chronotype may be implicated in
the observed differences in weight loss between late and early eaters.
Novel therapeutic strategies should consider this contributor in the
prevention of the obesity pandemic and dietary guidelines should be pointed at
meal timing as an alternative approach to encourage bodyweight control.
Keywords: Chrononutrition, circadian rhythm, meal timing, body composition,
obesity
ii
Resumo
A Crononutrição é um tema de pesquisa emergente na nutrição que abrange
a relação estabelecida entre os padrões temporais de alimentação, os ritmos
circadianos e a saúde metabólica. Dados preliminares de estudos observacionais e
experimentais sugerem que, alterações no padrão de ingestão alimentar podem
impactar a composição corporal e o sucesso das estratégias de perda de peso,
independentemente da ingestão energética total e da composição nutricional,
levantando a questão se quando comer importa tanto quanto a qualidade e
quantidade alimentar. Esta revisão narrativa avalia o efeito do horário das
refeições na composição corporal em adultos e explora os mecanismos subjacentes
ao impacto do horário da ingestão alimentar na composição corporal.
Em suma, dados recentes apoiam que, a ingestão alimentar diária tardia,
pode prejudicar o sucesso das estratégias de perda de peso e a maior distribuição
de energia pela manhã parece ser uma estratégia valiosa para o controlo de peso.
Em particular, o aumento matinal do efeito térmico dos alimentos, a disrupção do
ciclo circadiano, as variantes genéticas, as alterações metabólicas, as diferenças
na duração e padrão do sono e o cronótipo do indivíduo podem estar implicados
nas diferenças observadas na perda de peso entre os comedores matinais e tardios.
Novas estratégias terapêuticas devem considerar este fator na prevenção
da pandemia da obesidade e deverão ser criadas recomendações direcionadas para
o horário das refeições como estratégia promotora do controlo de peso corporal.
Palavras-Chave: Crononutrição, ritmo circadiano, horário das refeições,
composição corporal, obesidade
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Abbreviations
BMI – Body mass index
CRD – Circadian Rhythm disruption
DIT – Diet induced thermogenesis
DLMO – Dim-light-melatonin-onset
DG – Dinner group
LG – Lunch group
MCQT – Munich Chronotype Questionnaire
MEQ - Horne-Östberg Morningness-Eveningness Questionnaire RMR – Resting metabolic rate
RQ – Respiratory quotient
SCN – Suprachiasmatic nucleus
TDEI – Total daily energy intake
TDEE – Total daily energy expenditure
TEF – Thermic effect of food
WC – Waist circumference
95% CI – 95% Confidence interval
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Summary
Abstract and keyword ........................................................................ i
Resumo e palavras-chave ................................................................... ii
Abbreviations ................................................................................ iii
Summary ..................................................................................... iv
1. Introduction ............................................................................. 1
2. Methods .................................................................................. 2
3. Circadian clocks and rhythms ........................................................ 3
3.1. Anatomical and molecular clock networks ...................................... 3
3.2. Circadian rhythm disruption .................................................... 3
3.3. Assessment of an individual´s chronotype .................................... 5
3.4. Circadian rhythm’s role in metabolism and nutrient uptake .............. 6
4. Effect of timing of food intake on changes in body composition ............... 7
5. Physiological mechanisms underlying the impact of meal timing on
bodyweight ................................................................................. 11
6. Critical Analysis ...................................................................... 13
7. Conclusions ............................................................................ 15
8. References ............................................................................ 16
1
1. Introduction
Several physiological processes in the human body, including energy regulation
and metabolism, are managed by endogenous circadian rhythms. These rhythms
control many metabolically relevant hormones such as cortisol, insulin, ghrelin
and leptin(1). Food is considered a major synchronizer of peripheral circadian
clocks and delayed feeding can disrupt optimal physiology and metabolism(2, 3).
Even though body weight is mainly determined by total daily energy intake (TDEI)
and total daily energy expenditure (TDEE), recent data suggest that not only what
and how much we eat, but when we eat plays a role in body composition(4).
In the last years, growing evidence suggests an association between timing of
food intake and obesity in humans and animals, proposing that changes in meal
timing can impact body composition and the effectiveness of weight loss
strategies(3), independently of TDEI and dietary composition(5).
Modern life demands changes in eating patterns causing delayed morning meals
and evening-loaded-energy intake(6). For instance, late lunch eating(7), breakfast
skipping(8, 9) and having the largest meal later in the day (4, 7, 10-18) have been
associated with increased markers of adiposity. Recent data in humans suggest
that consuming a larger proportion of TDEI earlier in the day, may be more
beneficial for weight loss, under iso-caloric conditions(3, 19). The mechanisms
underlying the impact of meal timing on body composition are not yet clear,
although it may outcome from behavioural adaptations or circadian variations in
physiology and energy metabolism(19).
2
Proper nutrition, where TDEI is aligned with TDEE and feeding/fasting cycles
are synchronized with clock-regulated metabolic changes, helps maintain
behavioural and physiological circadian rhythms and health(20).
This study aims to review meta-analysis, systematic-reviews, observational and
experimental studies in humans assessing the effect of different meal timings on
body composition in adults and explore the mechanisms underlying the impact of
timing of food intake on body composition.
2. Methods
The construction of the search strategy was performed using database-specific
subject headings and keywords in PubMed and Scopus. The heading terms included
combinations of “meal timing” or “timing of food” or “food timing” or
“chrononutrition” with “body mass index” (BMI) or “obesity” or “body weight” or
“body composition” or “body fat”. Articles published until May 2021 were
selected, whose title or abstract addressed issues related to the topic. This search
strategy was supplemented by hand searching the references cited in the targeted
articles. Searches were limited to meta-analysis, systematic reviews, clinical trials
and observational studies. Studies that met all the following inclusion criteria
were embraced: (1) different meal timing, patterns or habits (early eaters/late
eaters or different timing of daily energy intake distribution) impact in the risk of
obesity, overweight or changes in BMI, body weight or body composition was
reported; (2) included healthy volunteers or individuals with obesity/overweight
and other comorbidities; (3) included participants with 18 years or more. The
references were exported to the bibliographic reference management program,
EndNote X9, duplicates were eliminated, and the full texts were obtained.
3
3. Circadian clocks and rhythms
3.1. Anatomical and molecular clock networks
Circadian rhythm (from the Latin circa and diem, about a day) also known as
biological/circadian clock refers to behavioural, physiological, molecular and
metabolism fluctuations within a cycle length around 24h(12, 21-23). It is divided
into 2 parts: (1) a master clock in the suprachiasmatic nucleus (SCN) in the anterior
hypothalamus and (2) the peripheral clocks throughout body tissues including
liver, pancreas, skeletal muscle and adipose tissue(19, 21-23).
Each circadian phase is determined via internal and external factors, a process
known as entrainment(22). The master clock is primarily entrained by light signals
via a monosynaptic pathway from intrinsically photosensitive retinal ganglion cells
in the inner retinae to the SCN and regulate many body functions (e.g., core body
temperature, blood pressure and sleep)(22, 24). Whereas the peripheral clocks
integrate inputs from the central clock, external factors (light exposure,
sleep/awake cycles, physical activity and feeding/fasting) and metabolites
regulating several metabolic processes (e.g., metabolism and glucose
homeostasis)(19-22, 24, 25). Recently, the timing of food consumption appears to be
one of the external factors that stimulate the peripheral clocks, known as
zeitgebers(22). Not only postprandial responses depend on circadian regulation as
well as food intake can itself entrain circadian clocks in the liver, gut, intestine
and adipose tissue(19).
3.2. Circadian rhythm disruption
Humans are a diurnal species, and the light phases stimulate wakefulness and
feeding and darkness initiates sleeping and fasting. This implies that an irregular
4
exposure to light, a change in eating time or sleep deprivation can disrupt daily
rhythms(24). Therefore, circadian rhythm disruption (CRD) can be defined as a
misalignment in the timing of and/or change in the duration of ambient
illumination, sleep, and period of eating from a reference range(24).
Misalignments in circadian rhythms may lead to a disturbance of body
homeostasis(26), impair metabolism pathways, worsen glycemic control and
undesirably affect factors involved in energy balance and weight loss, increasing
the risk of diabetes, obesity and metabolic disorders(19, 22, 24, 27).
In populations with chronic CRD, such as shift workers, there is an increased
risk of obesity, higher rates of type 2 diabetes, cardiovascular disease and
metabolic syndrome(2, 6). An increased TDEI could explain the observed tend to
weight gain in this population, however evidence from two recent meta-analyses
suggests that shift-workers are 23% more likely to have overweight/obesity and
the risk of having abdominal obesity was 35% higher(26), regardless of the amount
of TDEI(27). The authors suggested that factors such as CRD, meal timing, poorer
food quality, use of sugar and caffeine to improve alertness, an increase in
snacking behaviour, evening loaded energy intake and diurnal variations of TDEE
might be underlying the increased overweight and obesity rates in this population
(24, 26-28).
However, circadian disruption is not only limited to shift workers. Recent data
found that minor but chronic shifts in mealtimes and sleep pattern on weekdays
versus weekends, denominated eating jet lag, can induce a mild kind of
misalignment and has been associated with higher BMI, adiposity, odds of being
obese, metabolic syndrome, type 2 diabetes(6, 24) and unhealthy eating habits(29).
5
In a cross-sectional study, in a population with obesity-related chronic diseases,
eating jet lag has been associated with later mealtimes consumption for breakfast,
afternoon snack and dinner, higher caloric intakes and poorer diet quality (with
higher total and saturated fat and cholesterol)(30). Rugerio et al. in another cross-
sectional study with a sample of 1106 young adults reported that eating jet lag
above 3.5h was associated with higher BMI (1,34 kg/m2 95% CI: [0,026;2,40];
p=0,015), when adjusted for age, gender, nationality, physical activity, diet
quality and sleep duration(24).
3.3. Assessment of an individual´s chronotype
Chronotype refers to an individual’s circadian phenotype that reflects
preference for morningness or eveningness. It is a subjective measurement based
on the timing of reported behaviors related to the sleep-awake cycle. It can be
assessed by multiple methods, such as from biological measures as dim-light-
melatonin-onset (DLMO), to validated questionnaires based on self-reported
information, such as the Munich Chronotype Questionnaire (MCTQ), the Horne-
Östberg Morningness-Eveningness Questionnaire (MEQ), the reduced Morningness-
Eveningness Questionnaire, the Composite Scale of Morningness, and the
Preferences Scale. DLMO is the most reliable measure of the circadian phase in
humans and consists of the measurement of melatonin in samples of blood, saliva
or urine collected under dim-light conditions in the hours before typical sleep
onset. Other methods range from metabolomics and transcriptomics approaches
to noninvasive techniques that estimate chronotype based on motor activity, body
position and body temperature(31).
6
An emergent number of evidence have examined the link between an
individual’s chronotype and dietary intake(32). In fact, evening types present a
lower adherence towards a healthy diet(33), higher odds of skipping breakfast(34),
delayed meal timing(35), a lower intake of vegetables and fruits(36) and a greater
preference for alcohol, sugary food and beverages(37).
3.4. Circadian rhythm’s role in metabolism and nutrient uptake
Circadian rhythms influence a large number of genes involved in rate-limiting
steps of metabolism(19, 38, 39).
The thermic effect of food (TEF), also entitled diet induced thermogenesis
(DIT), is defined as the increase in resting metabolic rate (RMR) after the ingestion
of a meal(5) and is reportedly higher in the morning compared to the evening(5, 19,
20, 40). DIT accounts for a small fraction of the TEE (~10%)(5) and has 2 components:
(1) obligatory (energy expenditure needed for digestion, absorption and nutrient
storage) and (2) facultative (energy expenditure related to increased postprandial
sympathetic nervous system activity)(5, 38, 41). Richter et al. in a single-blind,
randomized, crossover design in a sample of 16 healthy young men, showed that
DIT is 2,5 times higher after breakfast than dinner unrelatedly to high or low-
calorie meals and regardless of influence of sleep disturbances and carbohydrates
preloads. This study also reveals that an eating pattern with an extensive
breakfast and a less caloric dinner has a favourable effect on glucose
metabolism(41). In another randomized crossover trial, the same standard meal
(100g white bread, 100g ham, 50g cheese, 125g yoghurt, 200ml fruit juice, plus
25g protein supplement) ingested in the morning (8am) and in the evening (8pm),
7
resulted in after-meal RMR and DIT values significantly higher after the morning
meal, under calorimetric evaluation(5).
Nutrient oxidation is also under circadian control. Respiratory quotient (RQ),
an index of macronutrient oxidation, peaks in the biological morning, suggesting
higher carbohydrate oxidation, and lowers during the biological evening, implying
greater lipid oxidation later in the day(40, 42). The consumption of identical meals
at different times of the day, results in higher plasmatic levels of glucose, and
free fatty acid in the evening, indicating a lower absorption and storage of
nutrients later in the day(5). Circadian clock gene regulation in peripheral tissues
is responsible for reducing nutrient uptake in the evening, allowing more readily
available energy to prepare for the beginning of fasting(38). Moreover, early insulin
secretion after a meal is meaningfully superior in the morning, to promote
efficient nutrient storage during this phase of the day, whereas insulin sensitivity
decreases throughout the day(5, 43). Also, faster gastric emptying and
gastrointestinal motility and improved intestinal absorption are observed in the
morning compared to the evening(19, 20).
These findings robustly corroborate the role of circadian regulation in energy
metabolism and nutrient uptake and mismatched behaviours related to these
endogenous processes can consequently result in unfavourable health outcomes(6).
4. Effect of timing of food intake on changes in body composition
Due to circadian variations in energy uptake and utilization, the same meal
eaten at different times of the day may produce distinct responses(12).
In a 20-week weight loss intervention, in a sample of 420 overweight/obese
individuals, those with an overall food intake earlier in the day (before 3pm) lost
8
twice as much weight that participants consuming their largest meal after 3pm
and displayed faster weight loss rate after 5th week treatment despite similar
TDEI, TDEE, dietary composition, physical activity, appetite hormones and sleep
duration(7). Surprisingly, there were no significant differences for lunch and dinner
energy intake between early and later eaters, however late eaters had less caloric
breakfasts (p=0.031) and skipped this meal more often than early eaters (6,6%
versus 2,6%; p=0.039). Late eaters were more evening types (lower MEQ score)
than early eaters, as evaluated by the MEQ (p=0.032)(7).
In another 12-week weight loss intervention, 93 overweight and obese women
with metabolic syndrome were randomized to two isocaloric diets (1400 kcal)
differing in the distribution of calories during the day. The breakfast group had
higher energy breakfast and lower energy dinner (700 kcal breakfast, 500 kcal
lunch, 200 kcal dinner) and the dinner group had low-energy breakfast and high
energy dinner (200 kcal breakfast, 500 kcal lunch, 700 kcal dinner). Jakubowicz
et al. found in the breakfast group, versus the dinner group, a 2,5 times greater
weight loss (-8.7 ± 1.4 vs. -3.6 ±1.5 kg, respectively), a greater reduction in BMI
(10% vs. 5%, respectively) and a greater waist circumference (WC) reduction (-8.5
± 1.9 vs. -3.9 ± 1.4 cm, respectively), both at 6 and 12-week follow-ups(14).
Madjd et al. in a two-arm randomized clinical trial, compared the effects of a
high energy intake at lunch, the lunch group (LG) (breakfast 15% + snacks 15% +
lunch 50% + dinner 20%) with a high energy intake at dinner, the dinner group (DG)
(breakfast 15% + snacks 15% + lunch 20% + dinner 50%) in 69 overweight and obese
women in a 12-week weight loss intervention. The authors observed a significant
weight reduction in both groups after the intervention. The LG had greater
9
reductions in weight (LG: -5.85 ± 1.96 kg; DG: -4.35 ± 1.98 kg; p=0.003) and
greater decline in BMI (LG: 2.27 ± 0.76 kg/m2; DG: 1.68 ± 0.76 kg/m2; p=0.003),
while no significant differences were found in WC between the groups. As
expected, estimated energy intake measurements showed a significant reduction
over the time in both groups, and there were no significant differences between
groups for TDEI and macronutrients from baseline to 12 weeks(13). These findings
corroborate the idea that having the main meal at lunch when compared to dinner
appears to be an important factor to consider in weight loss treatments.
In the US Adventist Health Study 2 (N=50 660), the authors aimed to
longitudinally investigate the link between meal timing and frequency and
changes in BMI per year (kg.m-2.y-1), among healthy population in the United States
and Canada, in a follow-up period of 7 years. Individuals who consumed breakfast
as the major meal of the day experienced the largest relative reduction in BMI
(−0.04 kg.m-2.y-1, 95% CI [ −0.05; −0.03]) compared with those who had their
largest meal at dinner. Consuming the main meal at lunch compared to dinner,
was also associated with decreased BMI (−0.02 kg.m-2.y-1, 95% CI [−0.03 to
−0.01])(15).
A meta-analysis of observational and experimental studies showed a minor
trend between higher BMI and greater evening intake (p=0.06), in observational
data. Even though most of the clinical trials indicated that a less caloric evening
meal resulted in greater weight loss, the meta-analysis of these studies revealed
no significant differences between early and late eaters (95% CI [ −2.52; 0,75]
p=0.29). Due to high heterogeneity (I2 = 93%) and considering the small sample of
experimental studies (N=5), the authors were unable to make a meaningful
10
interpretation concerning the relationship between the evening meal and its
effect on weight loss(4). The authors considered the high heterogeneity as a
limitation of the study and reflected about the fact that the clinical trial with
lower risk of bias(13) demonstrated that a reduced evening energy intake can
increase weight loss(4).
Regarding body fat, higher levels of adiposity have been cross-sectionally
associated with a mid-point of calorie intake, defined as the time at which 50% of
TDEI was reached, happening closer to DLMO. Also, non-lean individuals have
shown to consume a greater proportion of TDEI at a later circadian phase, when
compared to lean participants(16, 17). Even though no associations in calorie
midpoint nor last calorie intake were found when measured by clock time(16, 17),
Xiao et al. discovered that a greater energy distribution closer to bedtime
increased the risk of being overweight or obese by 82% (OR=1,82 95% CI [1,07-
3,08]), mainly in people with a later chronotype, assed by MCQ. This data supports
the idea that higher energy intake after waking up and lower dietary feeding near
bedtime is associated with lower BMI, with differences between chronotypes.
However, these results were not adjusted to possible confounders such as
smoking, medical factors or sleep disorders(18). Lombardo et al. randomized 36
individuals into two groups during 3 months (G1:70% breakfast + morning snack+
lunch and 30% afternoon snack + dinner and G2: 55% breakfast+ morning snack +
lunch and 45% afternoon snack + dinner) to evaluate the effect of two hypocaloric
Mediterranean diets in body composition assessed by dual-energy X-ray
absorptiometry. The authors found significant improvements for both groups,
however G1 had greater weight loss (G1: −8.2 ± 3.0 kg; G2: −6.5 ± 3.4 kg; p=0.028),
11
waist circumference reduction (G1: −7 ± 0.6 cm; G2: −5 ± 0.3 cm; p=0.033), and
fat mass loss (G1: −6.8 ± 2.1 kg, G2: −4.5 ± 2.9 kg, p=0.031; mean ± SD). These
data reinforce that a low-calorie Mediterranean diet with an upper amount of
energy in the first part of the day could determine a greater reduction in major
obesity-related metabolic parameters(44).
5. Physiological mechanisms underlying the impact of meal timing on
bodyweight
Even though the mechanisms underlying the impact of meal timing on
bodyweight remain unclear, some hypotheses have been suggested(45):
(1) The time when a meal is consumed affects the thermogenic response and
must be considered in the energy balance(19, 41, 46). Previous studies have
shown that DIT is higher in the morning comparative to the evening, after
identical meals(5, 41). The higher obligatory DIT in the morning, can be
explained since various gastrointestinal functions exhibits circadian
rhythmicity, including faster morning gastric emptying and increased
intestinal absorption of peptides, lipids and carbohydrates at the beginning
of the active phase(19). The elevated facultative DIT earlier in the day may
be a result of higher concentrations of adrenaline and noradrenaline during
this time of the day, which increases the metabolic rate and the RQ(41, 47).
Under controlled laboratory conditions, using indirect calorimetry, the DIT
is 40% higher after breakfast than after dinner(41).
12
(2) Misalignment between food timing and light/dark cycles can impair satiety
mechanisms throughout leptin and ghrelin(41, 48) and affect thyroid
hormones(49) inducing higher caloric intake(45).
(3) Modification of gene expression in genes responsible for evening eating
preference and weight loss resistance (e.g., SIRT1, CLOCK 3111T/C(50), and
Perilipin1(51)).
(4) The association between evening eating and weight gain can be explained
because insulin sensitivity and glucose tolerance decline gradually
throughout the day with insulin sensitivity reaching a nadir in the
evening(14).
(5) When sleep is restricted and food is provided ad libitum, in controlled
laboratory conditions, participants increase their TDEI, and this extra
consumption of energy occurs after dinner and closer to or after DLMO(52-
54), which contributes to an obesogenic ambient(43). A recent systematic
review, meta-analysis and meta-regression with a cumulative total of
5171710 participants collected from 153 studies revealed that short
sleepers (<6h of sleep) were 38% more likely to have obesity(55).
(6) The individual chronotype may be another factor involved in this equation.
The majority of the studies, considering the chronotype, have shown that
late eaters were more evening types and previous studies suggested that
evening types have more susceptibility to gain weight and have more
struggle to lose it(56, 57). In individuals with morning chronotypes (high
caloric intake during morning hours) the odds of being obese decrease by
13
50%, while in evening chronotypes (individuals who eat during the two hours
before sleep) the probability of being obese increases five times(58).
6. Critical Analysis
Clarifying the effect of meal timing on body composition is highly complex and
presents a challenge in the field of nutrition. This narrative review is in line with
prior findings revealing that timed caloric intake can impact body weight and
adiposity markers(4, 7, 13-18). In the present study, later eating in the day was
negatively associated with the success of weight loss therapies and morning loaded
energy intake revealed to be a bright approach to control body weight. Supporting
these conclusions, Garaulet et al. revealed that late lunch eaters lost fewer
weight and displayed a slower weight-loss rate during the treatment(7). Other
studies corroborate the hypothesis that individuals with high energy breakfast lose
more weight and have a greater WC reduction, when compared with high energy
at dinner(14, 15) and high energy lunch results in greater reductions in weight and
BMI comparing to high energy dinner(13, 15). Even though one meta-analysis
included in this study considered it difficult to draw a clear conclusion, the high
heterogeneity and small number of experimental studies could be responsible for
it(4). Regarding body fat, McHill et al. found that non-lean individuals consume a
greater proportion of TDEI at a later circadian phase, when compared to lean
participants, assessed by DLMO(16, 17) and Lombardo et al. showed that those who
consume most of the energy in the first time of the day lost more body fat. As
plausible mechanisms, eating closer to or after DLMO may decrease TEF(16, 46),
which would contribute to a positive energy balance and weight gain. Also,
misalignment between food timing and light/dark cycles can impair satiety
14
mechanisms and induce higher caloric intake(41, 45, 48, 49). Other factors such as
genetic variants(50, 51), metabolic changes(14), differences in sleep duration(52-54)
and individual´s chronotype (56-58) may be implicated in the observed differences
in body composition between late and early eaters.
Regarding circadian rhythm disruption, the strongest evidence of metabolic
misalignment is in night shift-workers. Data from two meta-analyses proposes that
these individuals are more likely to be obese, independently of TDEI(25, 26).
Surprisingly, milder circadian disruption in individuals with eating jet lag was also
associated with overweight and obesity(6, 24, 30). Zéron-Rugerio et al. found that
BMI was 1.34 kg/m2 higher in subjects who reported more than 3.5 h of eating jet
lag(24). In these populations, later mealtime consumption and poorer diet can
explain the differences in body weight between the groups(6, 24, 30), however, the
majority of the studies related to eating jet lag were cross-sectional. In future
research it will be imperative to confirm the direction of these associations and
evaluate the impact of the chronic variability in meal timing on bodyweight over
the time. Regarding this is an emerging topic, one of the main limitations has been
the lack of standardized definition for ‘meals’ and ‘snacks’, which may result in
inconsistent findings when the outcomes of interest are timing, frequency or
regularity of food intake. The majority of the studies have focused on conventional
meal categories (i.e., breakfast, lunch, and dinner), which differ cross-culturally,
and may not reflect the real eating pattern of diverse people. Furthermore,
considering the exogenous clock time to assess the link between timing of food
intake and individual´s circadian rhythms may not be physiologically significant to
accurately characterize meal timing in the context of the internal circadian timing
15
system. Another challenge has been failure to adjust for energy misreporting in
several studies and the lack of well-defined evidence considering the underlying
mechanisms for greater weight loss with earlier meal consumption. Finally, future
research should emphasis on human clinical trials and aimed to clarify the role of
eating time in mechanisms of energy balance, such as in TDEI, appetite and TDEE,
such as RMR, TEF and physical activity. Upcoming interventions should also assess
the individual´s chronotype, as a valuable addition to the evidence, given the
higher risk of adverse cardiometabolic health in evening chronotypes.
7. Conclusions
In conclusion, literature describing the impact of meal time is in its early
stages, however there is an increasing number of publications exposing the effect
of meal timing on obesity and adiposity markers(4, 7, 13-18). Early evidence supports
that late eating may impair the success of weight loss strategies and morning
loaded energy distribution seems to be a helpful approach for weight control. In
theory, morning enhanced DIT, circadian misalignment with consequent impaired
satiety mechanisms, genetic variants, metabolic changes, differences in sleep
duration and individual´s chronotype may be implicated in the observed
differences in weight loss between late and early eaters. These findings emphasize
the relevance of taking into account the internal circadian timing of food
consumption. Novel therapeutic approaches should combine not only the daily
caloric intake, macronutrient distribution and physical activity but as well
implementing dietary guidelines directed at meal timing and at the reduction of
the variability between meal timing on weekends versus weekdays for the
prevention of obesity among general population.
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