Eating frequency is inversely associated with BMI, waist circumference and the proportion of body fat in Korean adults when diet quality is high, but not when it is low: analysis of the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV)

Abstract

The role of eating frequency (EF) in obesity development has been debated, and few studies have investigated Asian populations. Diet quality might affect the association between EF and obesity. Therefore, we investigated the association between EF and obesity indicators in a representative sample of Korean adults with consideration to diet quality. This cross-sectional study used data of 6951 participants aged 19-93 years (male 49·8 %, female 50·2 %) from the Fourth Korean National Health and Nutrition Examination Survey. EF was assessed using a questionnaire, and diet quality was defined as mean adequacy ratio (MAR). To explore the association between EF and obesity indicators, we used multiple linear regression analyses with and without interaction terms between diet quality and EF. EF was inversely associated with each obesity indicator, including body fat percentage (BF%), BMI and waist circumference (WC), showing a significant linear trend (P<0·001 for BF%, WC and BMI). In addition, the association between EF and each obesity indicator was significantly altered according to diet quality (P value of the interaction term EF×diet quality=0·008 in the regression model for BF%, <0·001 for BMI and 0·043 for WC). In the stratified analyses according to diet quality, EF had a significant inverse association with BF%, WC and BMI in the high diet quality groups, but not in the low diet quality groups. This study suggests that EF is inversely associated with the obesity indicators when diet quality is high, but not when it is low in Korean adults.

The impact of a higher eating frequency on the diet quality and nutritional status of women with breast cancer undergoing chemotherapy

“…In the present study, we observed a negative association between the anthropometric parameters and daily EF, especially before the first cycle of CT. Results from previous studies with other populations also suggest that EF may be associated with nutritional status (18)(19)(20) . A recent meta-analysis found that EF was positively associated with reductions in percentage of fat mass, as well as increases in fat-free mass.…”

“…In addition, when establishing EF groups in the present study, women who reported ≥ 4•67 daily eating episodes had lower anthropometric values before the first cycle and after the intermediate cycle of CT. Similarly, Kim et al (18) found that Korean adults with an EF ≥ 5 daily eating episodes compared with <3 episodes had a lower BMI, WC and body fat percentage. However, the literature still presents contradictory results for the ideal number of daily eating episodes and their benefits in nutritional status (22)(23) , providing evidence for the necessity for further studies relating to these variables.…”

“…In addition to diet quality, inverse associations between the number of eating episodes and anthropometric variables were identified (10,17,18) . Studies show better control of body weight and healthy maintenance of biological markers when eating episodes are lower in energy intake and more frequent (19)(20)(21) , but the results are still inconsistent because of variations in methodological factors, especially for the optimal number of meals for anthropometric benefits (22,23) .…”

Meal and snack frequency in relation to diet quality in Japanese adults: a cross-sectional study using different definitions of meals and snacks

“…Epidemiological evidence on the association between total eating frequency (i.e. sum of meal frequency and snack frequency) and overall diet quality does not represent a consistent picture (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) . These studies should be cautiously interpreted in terms of substantial methodological problems.…”

“…These studies should be cautiously interpreted in terms of substantial methodological problems. First, while the assessment of total eating frequency has often relied on a series of non-validated, self-report questions (1)(2)(3)(4)(5)(6) , only a few studies (9)(10)(11)(12)(13)(14) have used comprehensive information on actual dietary habits (using 24-hour dietary recall or dietary record) over multiple days to take into account the relatively large day-to-day variation at the individual level (15) . Second, there is no consensus about what constitutes a snack, a meal or an eating occasion, making it complicated to interpret the literature on this topic.…”