Temporal Dietary Patterns Are Associated with Obesity in US Adults

Abstract

The integration of time with dietary patterns throughout a day, or temporal dietary patterns (TDPs), have been linked with dietary quality but relations to health are unknown. The association between TDPs and selected health status indicators and obesity, type 2 diabetes (T2D), and metabolic syndrome (MetS) was determined. The first-day 24-h dietary recall from 1627 nonpregnant US adult participants aged 20-65 y from the NHANES 2003-2006 was used to determine timing, amount of energy intake, and sequence of eating occasions (EOs). Modified dynamic time warping (MDTW) and kernel k-means algorithm clustered participants into 4 groups representing distinct TDPs. Multivariate regression models determined associations between TDPs and health status, controlling for potential confounders, and adjusting for the survey design and multiple comparisons (P<0.05/6). A cluster representing a TDP with evenly spaced, energy balanced EOs reaching ≤1200kcal between 06:00 to 10:00, 12:00 to 15:00, and 18:00 to 22:00, had statistically significant and clinically meaningful lower mean BMI (P<0.0001), waist circumference (WC) (P<0.0001), and 75% lower odds of obesity compared with 3 other clusters representing patterns with much higher peaks of energy: 1000-2400kcal between 15:00 and 18:00 (OR: 5.3; 95% CI: 2.8, 10.1), 800-2400kcal between 11:00 and 15:00 (OR: 4.4; 95% CI: 2.5, 7.9), and 1000-2600kcal between 18:00 and 23:00 (OR: 6.7; 95% CI: 3.9, 11.6). Individuals with a TDP characterized by evenly spaced, energy balanced EOs had significantly lower mean BMI, WC, and odds of obesity compared with the other patterns with higher energy intake peaks at different times throughout the day, providing evidence that incorporating time with other aspects of a dietary pattern may be important to health status.