Top Things to Know: Meal Timing and Frequency: Implications for CVD Prevention

1. Irregular eating patterns such as skipping meals and frequent snacking may have a contributory impact on cardiometabolic health markers such as body weight, insulin resistance, and blood pressure.ⁱ Currently, more than two-thirds of US adults are overweight or obese; 35.3% have prediabetes; and 32.6% have high blood pressure.ⁱⁱ
2. From 1971-1974 to 2009-2010, the percent of calories from meals has decreased while the percent of calories from snacks has increased for both women and men in the US. Where 73% of US men reported consuming all three standard meals in the 1970s, only 59% of US consumed three standard meals in the late 2000s. There was a narrower, yet equally striking decline for US women from 75% in the 1970s to 63% of women in the 2000s consuming all three meals.
3. This Scientific Statement aimed to review the cardiometabolic effects of eating patterns such as skipping breakfast and frequency and timing of eating occasions.
4. Daily breakfast consumption may decrease the risk of adverse effects related to glucose and insulin metabolism. In addition, comprehensive dietary counseling that supports daily breakfast consumption may be helpful in promoting healthy dietary habits throughout the day.
5. There is evidence that both alternate day fasting and periodic fasting may be effective for weight loss, though there are no data that indicate whether the weight loss can be sustained long-term. These eating patterns may be useful for triglyceride lowering, but have little or no effect on cholesterol levels. These fasting protocols may be beneficial for blood pressure lowering when combined with ≥6% weight loss. Intermittent fasting may decrease fasting insulin and insulin resistance, though fasting glucose remains largely unchanged in studies. Further studies will determine whether these effects are maintained longer-term.
6. The impact of changing meal frequency, without changing total calories consumed throughout the day, may not benefit weight loss or improve cardiometabolic risk factors.
7. Epidemiological studies suggest a potential detrimental effect of late meals on cardiometabolic health outcomes such as body weight and metabolic syndrome. Further clinical interventional trials will be important to elucidate this mechanism.
8. Further studies are needed to assess the impact of meal timing and frequency in racially/ethnically diverse populations, children, adolescents, and older adults.
9. Together, these data suggest that irregular patterns of total caloric intake appear to be less favorable for the maintenance of body weight and optimal cardiovascular health.
10. Clinicians may be able to use this information while discussing healthier lifestyles and improved risk factor management to encourage patients to consider a more intentional approach to eating by focusing on the frequency and timing throughout the day of meals and snacks.

ⁱ St-Onge M-P, Ard J, Baskin ML, Chiuve SE, Johnson HM, Kris-Etherton P, Varady K; on behalf of the American Heart Association Obesity Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association [published online ahead of print January 30, 2017]. Circulation. doi: 10.1161/CIR.0000000000000476.

ⁱⁱ Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després J-P, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER III, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:000-000.