Cardio-vascular risk factors: the role of chrono-nutrition and chrono-type

20 November 2019

Gerda Pot PhD

Louis Bolk Institute / King’s College London

g.pot@louisbolk.nl / gerda.pot@kcl.ac.uk

Unsplash.com

No conflicts of interest to declare

2

Also on behalf of Suzana Al Moosawi PhD

• Public health nutritionist

• NNEdPro Global Centre for Health and Nutrition, Cambridge

• Type 2 diabetes and cardio-vascular disease

• Novel applications for statistical methods to capture circadian eating rhythms in epidemiological studies

• suzana.almoosawi@gmail.com

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Outline

• What is chrono-nutrition and why is this so important

• Changes in temporal eating patterns

• Importance of meal frequency and timing

• Industry perspectives

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1. Clock time

2. (Ir)regularity

3. Frequency

Different components of time

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Importance of chrono-nutrition

• In Europe: 17% works in shift, 10 % night shifts and 53% works in weekends (Eur Fed Impr Living and Work conditions, 2010)

• Shift workers at higher risk for developing chronic diseases like obesity, insulin resistance, metabolic syndrome and type 2 diabetes

• Studies in shift workers have found associations between evening or night time energy intake and obesity

• Could this be a missing piece of the puzzle of modifiable risk factors of chronic diseases?

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Night shift work and eating patterns in nurses

• Consistent outcomes

• Later time of last meal

• Eating at night

• Meal irregularity

• Poorer diet quality

Peplonska 2019 Med Pr- Polish

No difference in energy intake

Bonham, Chronobio Int 2016

Cayanan, Chronobio Int 2019

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Is a calorie always a calorie?

Arble et al, 2009 Obesity

Light fed= night for mice

Dark fed= day for mice

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22

24

26

28

30

32

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Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

Light fed Dark fed

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Biological clock

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Circadian variation in glucose

Wijsman et al 2012

Aging Cell, Volume: 12, Issue: 2, Pages: 207-213, First published: 26 December 2012, DOI: (10.1111/acel.12042)

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Circadian patterns of metabolic processes

• Fat oxidation is higher in morning than evening

Fig 4 from Tahara et al 2014 J Pharmacol Sci

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15

4

28

5

41

7

14,1

4

28,3

4,8

44,4

4,5

15,3

3,8

27,1

5,6

44,1

4,1

breakfast Mid-morning Lunch Mid-afternoon Evening meal Extras

36yrs 43yrs 53yrs

*

*

*

Changes in proportion of daily energy intake at different eating occasions in adults (n=1253)

Almoosawi et al, 2012 EJCN

Substitution 5% energy intake from carbohydrate for fat -> 14% lower risk of type 2 diabetes after 10y

Almoosawi et al, 2013 Nutr Metab Cardiovasc Dis

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Clock time: temporal eating patterns (US)

• Changes in meal and snack patterns over past 40 years in American adults (Kant 2015)

• NHANES 1971-2010 n=62,298 participants aged 20-74y

• Remarkable findings

• Absolute amounts of energy increased, relative contribution from snacks increased to a greater degree than main meals

• Relative contribution of breakfast to energy intake remained the same, but lunch was smaller and dinner declined in women

• Clock time of breakfast and lunch (but not dinner) were later

Kant 2015 J Acad Nutr Diet & Kant 2018 Phys & Behav

+ 18-20 min + 8-13 min No change

Breakfast Lunch Dinner

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Temporal or diurnal eating patterns

• Early eating and grazing

• Early main meals and night snacks -> significantly associated with 0.29 kg/m2 BMI increase and 11.6mm waist circumference

Palla et al, 2019 NutrientsPrincipal components analysis (PCA): in UK adolescents from National Diet and Nutrition

Survey 2008-12 (1438 11-18y old, 4-d food diary) (diurnal eating patterns: DEP)

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Daily pattern of energy distribution and weight loss

• Randomized controlled 20-wk study to study the impact of energy distribution timing on weight loss and regularity of sleep onset and wake times (n=420)

• 2 groups

• Early eaters (main meal < 2pm)

• Late eaters (main meal >2pm)

• Late eaters lost less weight and slower rate of weight loss compared with early eaters (p=0.002)

• No differences in energy intake, dietary composition, energy expenditure, appetite hormones and sleep duration

Garaulet 2013, IJO

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Summary so far different components of time

1. Clock time

• Temporal eating patterns changed over years -> more snacking

• Eating earlier in day -> more weight loss

2. (Ir)regularity

3. Frequency

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• Per meal slot (energy intake)

Meal slot Day 1 Day 2 Day 3 Day 4 Day 5 5d Mean μ

Breakfast

Lunch

Dinner

Between meals

Daily total

Score for meal irregularity

Regular Irregular

With

i=day

Meal=predefined timeslot

energy intake (kcal/d)

μ=5d mean

=

energymeali -m 5d energymealéëê

ùûú

m 5d energymeal´100%

æ

è

ççç

ö

ø

÷÷÷i=1

n

å

Pot et al, Int J Obesity 2014, 38(12):1518-24

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0

500

1000

1500

2000

2500

3000

Total energy intake (kcal/d)

T1 (<10.2)

n=589

T2 (10.2-19.4)

n=590

T3 (>19.4)

n=589

Pot et al, Int J Obesity 2014, 38(12):1518-24

Energy intake & BMI per tertile of irregularity score

26,8 26,627,5

0

5

10

15

20

25

30

BMI (kg/m2)

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Metabolic syndrome & meal irregularity

0 0,2 0,4 0,6 0,8 1 1,2 1,4 1,6 1,8 2

Breakfast

Lunch

Evening meal

Between

meals

Daily total

Odds ratio comparing highest tertile with lowest tertile (model 1, adjusted for sex,

physical activity, SES, marital status and smoking)

P trend

0.04

0.64

0.13

0.04

0.47

Pot et al, Int J Obesity 2014, 38(12):1518-24

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Overview results irregularity scores per meal

N=1768 Breakfast Lunch Evening meal

Between meals

Dailytotal

Metabolic syndrome

Increased waistcircumference

Increased BMI

Increased systolic BP

Increased diastolic BP

Decreased HDL cholesterol

Increased triglycerides

Based on p for trend per tertile of irregularity score in model 1 adjusting for sex, physical activity,

SES, marital status and smoking Pot et al, Int J Obesity 2014, 38(12):1518-24

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Summary so far different components of time

1. Clock time

• Temporal eating patterns changed over years -> more snacking

• Eating earlier in day -> more weight loss

2. (Ir)regularity

• Irregular eating associated with more metabolic syndrome and obesity

3. Frequency

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Meal frequency and weight loss

• Meal frequency and weight loss and body composition – Schoenfeld 2015 narrative review

• 15 studies: feeding frequency was positively associated with reductions in fat mass and body fat percentage and fat-free mass- 1 study driving this (Iwao, 1996 n=12)

Nutrition Reviews, Volume 73, Issue 2, February 2015, Pages 69–82, https://doi.org/10.1093/nutrit/nuu017

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Summary so far different components of time

1. Clock time

• Temporal eating patterns changed over years -> more snacking

• Eating earlier in day -> more weight loss

2. (Ir)regularity

• Irregular eating associated with more metabolic syndrome and obesity

3. Frequency

• Mixed findings

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Not everyone is the same..

• Chrono-types: morning larks and night owls

• Evening type are more prone to misalignment of circadian clock resulting from desynchrony between chrono-type and social demands (e.g. work schedules)

• Evening types have been shown to have unhealthier behaviour (diet, sleep and smoking) and adverse metabolic changes e.g. poorer glycaemic control, risk type 2 diabetes

• Evening types: morning lower intakes of energy and macronutrients, in evening higher intakes of energy, sucrose, fat and saturated fat than morning types

Maukonen et al, 2017 Obesity

Lucassen et al, 2013 PLoSOne 8(3):e56519

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Chrono-type: implications for epidemiological studies on chrono-nutrition

Al Moosawi et al, 2019 Adv Nutr

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Industry Context: Emerging Trends in design of minimally-invasive Continuous Glucose Monitoring Devices

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Bigger picture

• Chrono-nutrition is part of Lifestyle medicine: using nutrition and lifestyle as part of the management of chronic non-communicable diseases

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Thank you

• Dr Suzana Almoosawi

• Dr Luigi Palla (LSHTM, London)

• All participants of presented studies

• Colleagues Louis Bolk Institute & Colleagues King’s College London