Recommendations Summary
AWM: Eating Frequency and Meal Patterns 2014
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
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Recommendation(s)
AWM: Eating Frequency and Meal Patterns for Weight Loss and Weight Maintenance
For weight loss and weight maintenance, the registered dietitian nutritionist (RDN) should individualize the meal pattern to distribute calories at meals and snacks throughout the day, including breakfast. Research reports inconsistent results regarding the association between eating frequency and body weight, which may be due to the role of portion size, energy density or compensation of energy intake at subsequent eating occasions. The majority of observational research reported that breakfast consumption is associated with a lower BMI and decreased obesity risk, while omitting breakfast is associated with a higher BMI and increased obesity risk. Several studies suggest that cereal-based breakfasts are associated with lower BMI, while breakfasts that are very high in energy are associated with higher BMI.
Rating: Fair
Imperative-
Risks/Harms of Implementing This Recommendation
None.
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Conditions of Application
None.
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Potential Costs Associated with Application
Costs of medical nutrition therapy (MNT) sessions vary; however, MNT sessions are essential for improved outcomes.
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Recommendation Narrative
From the Adult Weight Management Project
- Research reports inconsistent results regarding the association between eating frequency and body weight (Basdevant et al, 1993; Kant et al, 1995; Ma et al, 2003; Forslund et al, 2005; Kant and Graubard, 2006; Howarth et al, 2007; Keski-Rahkonen et al, 2007; Nonino-Borges et al, 2007; Piexoto Mdo et al, 2007; Uchigata et al, 2007; Whybrow et al, 2007; Carels et al, 2008; Marin-Guerrero et al, 2008; Kent and Worsley, 2009; Zaveri and Drummond, 2009; Al-Rethaiaa et al, 2010; Bes-Rastrollo et al, 2010; Holmback et al, 2010; Schusdziarra et al, 2010). This may be due to the role of portion size, energy density or compensation of energy intake at subsequent eating occasions. In addition, the majority of observational research reports an association between higher evening energy intake and increased body weight (Andersson and Rossner, 1996; Summerbell et al, 1996; Forslund et al, 2002; de Zwaan et al, 2006; Morse et al, 2006; Gluck et al, 2008; Berg et al, 2009; Tholin et al, 2009; Lundgren et al, 2010). However, this has not been confirmed in a limited number of intervention studies (Keim et al, 1997; Vander Wal et al, 2006). Further intervention studies are needed on the distribution of calories consumed at meals and snacks throughout the day and its effect on body weight.
- The majority of observational research reported that breakfast consumption is associated with a lower BMI and decreased obesity risk, while omitting breakfast is associated with a higher BMI and increased obesity risk (Cho et al, 2003; Ma et al, 2003; Song et al, 2005; Crossman et al, 2006; Malinauskas et al, 2006; Niemeier et al, 2006; van der Heijden et al, 2007; Kant et al, 2008; Marin-Guerrero et al, 2008; Raynor et al, 2008; Berg et al, 2009; Grujic et al, 2009; Merten et al, 2009; Huang et al, 2010; Perusse-Lachance et al, 2010). Several studies suggest that cereal-based breakfasts are associated with lower BMI (Wyatt et al, 2002; Bazzano et al, 2005; Song et al, 2005), while breakfasts that are very high in energy are associated with higher BMI (Martin et al, 2000; Cho et al, 2003; Kant et al, 2008; Kent and Worsley, 2009). Further research is needed on the relative energy contribution and composition of breakfast.
From the 2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library (NEL) Evidence-Based Systematic Reviews
- What is the relationship between breakfast and body weight?
- Moderate evidence suggests that children who do not eat breakfast are at increased risk of overweight and obesity. The evidence is stronger for adolescents. There is inconsistent evidence that adults who skip breakfast are at increased risk for overweight and obesity.
- What is the relationship between snacking and body weight?
- Limited and inconsistent evidence suggests that snacking is associated with increased body weight.
- What is the relationship between eating frequency and body weight?
- Evidence is insufficient to determine whether frequency of eating has an effect on overweight and obesity in children and adults.
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Recommendation Strength Rationale
The Conclusion Statements from the Adult Weight Management project in support of this recommendation received:
- What is the relationship between eating frequency and weight change (weight loss, weight gain and weight maintenance)? Grade II.
- What is the relationship between breakfast consumption and weight change (weight loss, weight gain and weight maintenance)? Grade II.
The three Conclusion Statements for Energy Balance and Weight Management, Food Environment and Dietary Behaviors in support of this recommendation received grades of Moderate and Limited.
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Minority Opinions
Consensus reached.
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Risks/Harms of Implementing This Recommendation
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Supporting Evidence
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the relationship between eating frequency and weight change (weight loss, weight gain and/or weight maintenance)?
What is the relationship between breakfast consumption and weight change (weight loss, weight gain and/or weight maintenance)?-
References
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Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C. Relationship between feeding pattern and body mass index in 220 free-living people in four age groups. Eur J Clin Nutr. 1996;50:513-519.
Tholin S, Lindroos A, Tynelius P, Akerstedt T, Stunkard AJ, Bulik CM, Rasmussen F. Prevalence of night eating in obese and non-obese twins. Obesity (Silver Spring). 2009 May; 17 (5): 1,050-1,055.
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Al-Rethaiaa AS, Fahmy AE, Al-Shwaiyat NM. Obesity and eating habits among college students in Saudi Arabia: A cross-sectional study. Nutr J 2010; 9: 39.
Bazzano LA, Song Y, Bubes V, Good CK, Manson JE, Liu S. Dietary intake of whole and refined grain breakfast cereals and weight gain in men. Obes Res. 2005, Nov; 13 (11): 1,952-1,960.
Berg C, Lappas G, Wolk A, Strandhagen E, Torén K, Rosengren A, Thelle D, Lissner L Eating patterns and portion size associated with obesity in a Swedish population. Appetite. 2009 Feb; 52 (1): 21-26.
Carels RA, Young KM, Coit C, Clayton AM, Spencer A, Wagner M. Skipping meals and alcohol consumption. The regulation of energy intake and expenditure among weight loss participants. Appetite. 2008 Nov; 51(3): 538-545.
Cho S, Dietrich M, Brown CJP, Clark CA, Block G. The effect of breakfast type on total daily energy intake and body mass index: Results from the Third National Health and Nutrition Examination Survey (NHANES III). J Am Coll Nutr 2003; 22(4):296-302.
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Huang CJ, Hu HT, Fan YC, Liao YM, Tsai PS. Associations of breakfast skipping with obesity and health-related quality of life: Evidence from a national survey in Taiwan. Int J Obes. 2010; 34(4): 720-725.
Kant AK, Graubard BI. Secular trends in patterns of self-reported food consumption of adult Americans: NHANES 1971-1975 to NHANES 1999-2002. Am J Clin Nutr 2006 Nov; 84 (5): 1,215-1,223.
Kant AK, Andon MB, Angelopoulos TJ, Rippe JM. Association of breakfast energy density with diet quality and body mass index in American adults: National Health and Nutrition Examination Surveys, 1999-2004. Am J Clin Nutr. 2008; 88(5): 1,396-1,404.
Kent LM, Worsley A. Trends in BMI, diet and lifestyle between 1976 and 2005 in North Sydney. Asia Pac J Clin Nutr 2009; 18 (3): 453-461.
Kent LM, Worsley A. Breakfast size is related to body mass index for men, but not women. Nutr Res. 2010; 30(4): 240-245.
Ma Y, Bertone ER, Stanek EJ, Reed GW, Hebert JR, Cohen NL, Merriam PA, Ockene IS. Association between eating patterns and obesity in a free-living US adult population. Am J Epidemiol. 2003; 158(1):85-92.
Malinauskas BM, Raedeke TD, Aeby VG, Smith JL, Dallas MB. Dieting practices, weight perceptions and body composition: A comparison of normal weight, overweight and obese college females. Nutr J 2006; 5: 11.
Marín-Guerrero AC, Gutiérrez-Fisac JL, Guallar-Castillón P, Banegas JR, Rodríguez-Artalejo F. Eating behaviours and obesity in the adult population of Spain. Br J Nutr. 2008 Nov; 100(5): 1,142-1,148.
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Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C. Relationship between feeding pattern and body mass index in 220 free-living people in four age groups. Eur J Clin Nutr. 1996;50:513-519.
Uchigata Y, Iwamoto Y. Survey of dietary habits in obese patients with type 2 diabetes treated with either OHA or insulin injections in Japan. Diabetes Res Clin Pract. 2007; 77(3): 371-376.
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References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
United States Department of Agriculture. 2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library (NEL) Evidence-Based Systematic Reviews. Available at http://www.nutritionevidencelibrary.gov/category.cfm?cid=21.
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References