Frequency and timing of meals and changes in body mass index: Analysis of the data from the Adventist Health Study-2

Authors: Hana Kahleová 1,2;  Jan Irene Lloren 1;  Andrew Mashchak 1;  Martin Hill 3;  Gary Fraser 1
Authors‘ workplace: Loma Linda University, School of Public Health, CA, USA 1;  Centrum diabetologie IKEM, Praha 2;  Endokrinologický ústav, Praha 3
Published in: Vnitř Lék 2016; 62(Suppl 4): 15-20
Category: Original Contributions


Our study focuses on examining the relationship between the frequency and timing of meals and changes in BMI in the Adventist Health Study-2 (AHS-2) which represents a relatively healthy population in North America.

A longitudinal analysis was undertaken using data from 48 673 individuals monitored over an average period of 7.43 ± 1.24 years. The number of meals per day, length of nighttime fasting, eating breakfast and timing of the largest meal of the day (breakfast 5–11 a.m., lunch noon–4 p.m. or supper/dinner 5–11 p.m.) were used as independent variables. The primary output was the change in body mass index (BMI) once in a year. Linear regression analyses were adjusted for all important demographic factors and lifestyle factors.

Consumption of 1 and 2 meals a day was associated with decrease in BMI (-0.04; 95% CI -0.06 to -0.03 and -0.02; 95% CI -0.03 to -0,01 kg.m-2 per year, respectively). On the other hand, consumption of 3 or more meals a day was associated with increase in BMI, in a linear relation (p < 0.001). BMI of those who skipped breakfast increased (0.029; 95% CI 0.021–0.037 kg.m-2 per year; p = 0.002) as compared to no BMI change in those who had breakfast (-0.0002; 95% CI -0.005 to + 0.004 kg.m-2 per year). Those, whose largest meal of the day was breakfast, recorded no significant change in BMI (-0.002 95% CI -0.008 to +0.004 kg.m-2 per year). On the contrary, the largest supper was associated with the greatest increase in BMI (0.034; 95% CI 0.029–0.040 kg.m-2 per year).

Our results indicate that eating less frequently, consuming breakfast and having the largest meal in the morning hours may be effective measures to prevent weight gain.

Key words:
body mass index (BMI) – frequency and timing of meals – body mass regulation – breakfast


1. Visscher TL, Seidell JC. The public health impact of obesity. Annu Rev Public Health 2001; 22: 355–375.

2. Keast DR, Nicklas TA, O’Neil CE. Snacking is associated with reduced risk of overweight and reduced abdominal obesity in adolescents: National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Clin Nutr 2010; 92(2): 428–435. Dostupné z DOI: <>.

3. van der Heijden AAWA, Hu FB, Rimm EB et al. A prospective study of breakfast consumption and weight gain among U.S. men. Obes (Silver Spring) 2007; 15(10): 2463–2469.

4. Howarth NC, Huang TT-K, Roberts SB et al. Eating patterns and dietary composition in relation to BMI in younger and older adults. Int J Obes 2007; 31(4): 675–684.

5. Koopman KE, Caan MWA, Nederveen AJ et al. Hypercaloric diets with increased meal frequency, but not meal size, increase intrahepatic triglycerides: a randomized controlled trial. Hepatology 2014; 60(2): 545–553. Dostupné z DOI: <>.

6. Mekary RA, Giovannucci E, Willett WC et al. Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency and snacking. Am J Clin Nutr 2012; 95(5): 1182–1189. Dostupné z DOI: <>.

7. Mekary RA, Giovannucci E, Cahill L et al. Eating patterns and type 2 diabetes risk in older women: breakfast consumption and eating frequency. Am J Clin Nutr 2013; 98(2): 436–443. Dostupné z DOI: <>.

8. Larson N, Story M. A review of snacking patterns among children and adolescents: what are the implications of snacking for weight status? Child Obes 2013; 9(2): 104–115.

9. Duval K, Strychar I, Cyr MJ et al. Physical activity is a confounding factor of the relation between eating frequency and body composition. Am J Clin Nutr 2008; 88(5): 1200–1205.

10. Ohkawara K, Cornier MA, Kohrt WM et al. Effects of increased meal frequency on fat oxidation and perceived hunger. Obes (Silver Spring) 2013; 21(2): 336–343.

11. Mattson MP. Energy Intake, meal frequency and health. A Neurobiological Perspective. Annu Rev Nutr 2005; 25: 237–260.

12. Anson RM, Guo Z, de Cabo R et al. Intermittent fasting dissociates beneficial effects of dietary restriction on glucose metabolism and neuronal resistance to injury from calorie intake. Proc Natl Acad Sci USA 2003; 100(10): 6216–6220.

13. Hatori M, Vollmers C, Zarrinpar A et al. Time-restricted feeding without reducing caloric intake prevents metabolic diseases in mice fed a high-fat diet. Cell Metab 2012; 15(6): 848–860. Dostupné z DOI: <>.

14. Sherman H, Genzer Y, Cohen R et al. Timed high-fat diet resets circadian metabolism and prevents obesity. FASEB J 2012; 26(8): 3493–3502. Dostupné z DOI: <–208868>.

15. Pedersen CR, Hagemann I, Bock T et al. Intermittent feeding and fasting reduces diabetes incidence in BB rats. Autoimmunity 1999; 30(4): 243–250.

16. Anson RM, Jones B, de Cabod R. The diet restriction paradigm: a brief review of the effects of every-other-day feeding. Age (Dordr) 2005; 27: 17–25. Dostupné z DOI: <–005–3286–2>.

17. Wang ZQ, Bell-Farrow AD, Sonntag W et al. Effect of age and caloric restriction on insulin receptor binding and glucose transporter levels in aging rats. Exp Gerontol 1997; 32(6): 671–684.

18. Goodrick CL, Ingram DK, Reynolds MA et al. Effects of Intermittent Feeding Upon Growth and Life Span in Rats. Gerontology 1982; 28(4): 233–241.

19. Garaulet M, Gómez-Abellán P, Alburquerque-Béjar JJ et al. Timing of food intake predicts weight loss effectiveness. Int J Obes (Lond) 2013; 37(4): 604–611. Dostupné z DOI: <>.

20. Ruge T, Hodson L, Cheeseman J et al. Fasted to fed trafficking of Fatty acids in human adipose tissue reveals a novel regulatory step for enhanced fat storage. J Clin Endocrinol Metab 2009; 94(5): 1781–1788. Dostupné z DOI: <–2090>.

21. Purslow LR, Sandhu MS, Forouhi N et al. Energy intake at breakfast and weight change: prospective study of 6.764 middle-aged men and women. Am J Epidemiol 2008; 167(2): 188–192.

22. Timlin MT, Pereira MA. Breakfast frequency and quality in the etiology of adult obesity and chronic diseases. Nutr Rev 2007; 65(6 Pt 1): 268–281.

23. Tani Y, Asakura K, Sasaki S et al. Higher proportion of total and fat energy intake during the morning may reduce absolute intake of energy within the day. An observational study in free-living Japanese adults. Appetite 2015; 92: 66–73. Dostupné z DOI: <>.

24. U.S. Department of Agriculture; U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed. U.S. Government Printing Office: Washington, DC 2011.

25. Butler TL, Fraser GE, Beeson WL et al. Cohort profile: The Adventist Health Study-2 (AHS-2). Int J Epidemiol 2008; 37(2): 260–265.

26. Jaceldo-Siegl K, Knutsen SF, Sabaté J et al. Validation of nutrient intake using an FFQ and repeated 24 h recalls in black and white subjects of the Adventist Health Study-2 (AHS-2). Public Health Nutr 2010; 13(6): 812–819. Dostupné z DOI: <>.

27. Hartmann C, Siegrist M, van der Horst K. Snack frequency: associations with healthy and unhealthy food choices. Public Health Nutr 2013; 16(8): 1487–1496. Dostupné z DOI: <>.

28. Yannakoulia M, Melistas L, Solomou E et al. Association of eating frequency with body fatness in pre- and postmenopausal women. Obes (Silver Spring) 2007; 15(1): 100–106.

29. Ma Y, Bertone ER, Stanek EJ et al. Association between eating patterns and obesity in a free-living US adult population. Am J Epidemiol 2003; 158(1): 85–92.

30. Odegaard AO, Jacobs DR, Steffen LM et al. Breakfast frequency and development of metabolic risk. Diabetes Care 2013; 36(10): 3100–3106. Dostupné z DOI: <–0316>.

31. Jakubowicz D, Barnea M, Wainstein J et al. High caloric intake at breakfast vs. dinner differentially influences weight loss of overweight and obese women. Obes (Silver Spring) 2013; 21(12): 2504–2512. Dostupné z DOI: <>.

32. Keim NL, Van Loan MD, Horn WF et al. Weight loss is greater with consumption of large morning meals and fat-free mass is preserved with large evening meals in women on a controlled weight reduction regimen. J Nutr 1997; 127(1): 75–82.

33. Wu T, Fu O, Yao L et al. Differential responses of peripheral circadian clocks to a short-term feeding stimulus. Mol Biol Rep 2012; 39(10): 9783–9789. Dostupné z DOI: <–012–1844–0>.

34. Kawakami Y, Yamanaka-Okumura H, Sakuma M et al. Gene expression profiling in peripheral white blood cells in response to the intake of food with different glycemic index using a DNA microarray. J Nutrigenet Nutrigenomics 2013; 6(3): 154–168. Dostupné z DOI: <>.

35. Pereira MA, Erickson E, McKee P et al. Breakfast frequency and quality may affect glycemia and appetite in adults and children. J Nutr 2011; 141(1): 163–168. Dostupné z DOI: <>.

36. Betts JA, Richardson JD, Chowdhury EA et al. The causal role of breakfast in energy balance and health: a randomized controlled trial in lean adults. Am J Clin Nutr 2014; 100(2): 539–547. Dostupné z DOI: <>.

37. Bandín C, Scheer F, Luque AJ et al. Meal timing affects glucose tolerance. substrate oxidation and circadian-related variables: A randomized. crossover trial. Int J Obes 2015; 39(5): 828–833. Dostupné z DOI: <>.

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