Meal frequency and energy balance

Abstract

Several epidemiological studies have observed an inverse relationship between people's habitual frequency of eating and body weight, leading to the suggestion that a 'nibbling' meal pattern may help in the avoidance of obesity. A review of all pertinent studies shows that, although many fail to find any significant relationship, the relationship is consistently inverse in those that do observe a relationship. However, this finding is highly vulnerable to the probable confounding effects of post hoe changes in dietary patterns as a consequence of weight gain and to dietary under-reporting which undoubtedly invalidates some of the studies. We conclude that the epidemiological evidence is at best very weak, and almost certainly represents an artefact. A detailed review of the possible mechanistic explanations for a metabolic advantage of nibbling meal patterns failed to reveal significant benefits in respect of energy expenditure. Although some short-term studies suggest that the thermic effect of feeding is higher when an isoenergetic test load is divided into multiple small meals, other studies refute this, and most are neutral. More importantly, studies using whole-body calorimetry and doubly-labelled water to assess total 24h energy expenditure find no difference between nibbling and gorging. Finally, with the exception of a single study, there is no evidence that weight loss on hypoenergetic regimens is altered by meal frequency. We conclude that any effects of meal pattern on the regulation of body weight are liely to be mediated through effects on the food intake side of the energy balance equation. Meal frequency: Nibbling: Gorging: Energy balanceThe present paper reviews the epidemiological studies relating meal frequency to body weight, and attempts to integrate these with the results of physiological investigations on meal frequency and energy metabolism. The paper will focus exclusively on human subjects because, although there is a considerable literature describing the metabolic effects of differing meal patterns in experimental animals (Fabry & Tepperman, 1970;Adams & Morgan, 1981; Bellisle, 1995), there are important ecological differences between the natural feeding patterns of species, and because the human experimental data are adequate to answer the key questions relating to the efficiency of energy utilization in this context. EPIDEMIOLOGICAL ASSOCIATIONS BETWEEN HABITUAL MEAL FREQUENCY AND BODY WEIGHTThe extensive work of Fabry and co-workers (Fabry et al. , 1966Hejda & Fabry, 1964) was the first to demonstrate strong and reproducible inverse relationships between habitual meal frequency and body weight in human subjects. Results from their first large sample study involving 379 Czechoslovakian men aged 60-64 years are illustrated in Fig. 1. Both the proportion of overweight subjects and mean skinfold thicknesses were significantly inversely related to meal frequency. Similar trends were observed in a smaller sample of eighty-nine men aged 30-50 years (Hejda 8z .

Eating patterns and dietary composition in relation to BMI in younger and older adults

“…10,11,[57][58][59][60][61][62][63] Also contrary to previous reports showing breakfast skipping, reduced energy intake at breakfast and/or increased energy intake later in the day being associated with a higher BMI or energy intake, 11,12,14,64 we found no such relationships. Instead, total energy intake, or energy at all meals and snacks rather than any particular eating occasion, was associated with a higher BMI in both age groups.…”

“…15,20,21 One potential explanation for the equivocal findings among studies is dietary reporting bias. As suggested previously, 9,10,22 many of these studies were likely confounded by under-reporting of energy intake. 23,24 This under-reporting, primarily by overweight and obese persons, may be specific to energy-dense snack and dessert-type foods.…”

“…10,11 Breakfast consumption has been suggested to be important for energy regulation; 12,13 however, while some studies have shown a lower percentage of total daily energy intake at breakfast associated with a higher BMI in younger 12 and older 14 persons, others have found no relationship. 13,[15][16][17] Although snacking, usually defined as eating at occasions other than meals (e.g., breakfast, lunch or dinner), is commonly regarded as contributing to excess weight, 18,19 studies on snacking associated with BMI have also yielded mixed results.…”

“…[25][26][27][28] We recently reported that implausible energy intakes affect apparent eating patterns as well, being associated with lower reported meal and snack frequencies, energy densities and portions consumed. 9,10,22 With aging comes a decline in the ability to regulate food intake. For example, older subjects failed to compensate at meals for energy preloads, 29 and did not return to starting body weight after long-term overfeeding or underfeeding as did younger subjects.…”

Appetite dysfunction in obese males: evidence for role of hyperinsulinaemia in passive overconsumption with a high fat diet

“…However, the majority of studies that have investigated dietary intake and obesity show weak, or no correlations between energy intake and body weight. This lack of relationship in intake and obesity can only be ascribed to dietary under-reporting, as reported by numerous authors (Bellisle et al, 1997;Poppitt et al, 1998b;Voss et al, 1998). In this study it appeared that, although there was no change in how the obese group recorded their subjective hunger ratings, considerably more was eaten at the test meal when given a calorically loaded pre-load.…”