Temporal Dietary Patterns Are Associated with Obesity in US Adults.

ABSTRACT

BACKGROUND: 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. OBJECTIVE: The association between TDPs and selected health status indicators and obesity, type 2 diabetes (T2D), and metabolic syndrome (MetS) was determined. METHODS: 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). RESULTS: A cluster representing a TDP with evenly spaced, energy balanced EOs reaching ≤1200 kcal between 0600 to 1000, 1200 to 1500, and 1800 to 2200, 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 1000-2400 kcal between 1500 and 1800 (OR 5.3; 95% CI 2.8, 10.1), 800-2400 kcal between 1100 and 1500 (OR 4.4; 95% CI 2.5, 7.9), and 1000-2600 kcal between 1800 and 2300 (OR 6.7; 95% CI 3.9, 11.6). CONCLUSIONS: 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.