Table 3.
Summary of the main results of studies that found an inverse association between eating frequency and body weight or body composition (n 14)
| Study | Quality score (%) | Outcomes | Exposure assessment | Exposure classification | Statistical analysis | Results | |
|---|---|---|---|---|---|---|---|
| Aljuraiban et al. (2015)( 24 ) | 94·7 | BMI: continuous variable | No. of meals: main meals and snacks Assessment: 4×24 h recall | <4 v. 4 v. 5 v. ≥6 meals and continuous variable | BMI: generalized linear model adjusted for sex, age, population sample, educational level, PA, smoking, diet, dietary supplement and EI BMI difference: multiple linear regression model adjusted for sex, age, population sample and EI Energy misreporting was defined based on EI:EER and <2092 kJ/24 h (<500 kcal/24 h) or >20 920 kJ/24 h (>5000 kcal/24 h) for women and >33 472 kJ/24 h (>8000 kcal/24 h) for men | Men and women BMI (kg/m2), mean (95 % CI): >4 meals: 29·0 (28·8, 29·5) 4 meals: 28·4 (28·0, 28·5) 5 meals: 28·1 (27·7, 28·4) ≥6 meals: 27·3 (26·8, 27·8) P<0·01 BMI difference (kg/m2): β=−1·1 (95 % CI −1·6, −0·7) P<0·0001 | |
| Oliveira et al. (2009)( 44 ) | 89·5 | Overweight: BMI ≥ 25·0 kg/m2 WC risk category: men>94 cm, women>80 cm | Total no. of meals: main meals and snacks Assessment: simple question | ≤3 v. ≥4 meals | Logistic regression model adjusted for sex, age, race, marital status, education, income, occupational status, self-rated health, PA, smoking, alcohol intake, parity, morbidities, dietary practices, frequency of fruits, vegetables, meats, sausages and derivatives intake | Men WC, OR (95 % CI): ≥4 v. ≤3 meals: 3·5 (1·3, 9·3) BMI: NS | Women WC and BMI: NS |
| Holmback et al. (2010)( 10 ) | 84·2 | Underweight: BMI<18·5 kg/m2 Normal weight: BMI=18·5–25·0 kg/m2 Overweight: BMI=25·0–29·9 kg/m2 Obesity: BMI≥30 kg/m2 WC increased risk: 80 cm (women), 94 cm (men) WC greatly increased risk: 88 cm (women), 102 cm (men) | No. of meals: main meals and snacks Assessment: meal pattern questionnaire | ≤3 v. ≥6 meals 4–5 v. ≥6 meals | Logistic regression model adjusted for age, education, SES, smoking, alcohol intake, PA activity and EI Energy misreporting was defined based on EI:BMR | Men Obese, OR (95 % CI): ≥6 v. ≤3 meals: 2·4 (1·02, 5·7) ≥6 v. 4–5 meals: 1·1 (0·6, 2·2) WC greatly increased risk, OR (95 % CI): ≥6 v. ≤3 meals: 2·1 (1·0, 4·3) ≥6 v. 4–5 meals: 1·6 (0·9, 2·8) | Women Obese: P=0·12 WC greatly increased risk: P=0·07 |
| Mohindra et al. (2009)( 25 ) | 84·2 | Overweight: BMI=≥25·0–29·0 kg/m2 Obesity: BMI≥30·0 kg/m2 | Total no. of meals: main meals and snacks Assessment: 1×24 h dietary recall | Continuous variable | Logistic regression model adjusted for sex, age, ethnicity and EI | Men and women Normal v. overweight, OR (95 % CI): 0·9 (0·8,1·1) Normal v. obese, OR (95 % CI): 0·8 (0·7,1·0) | |
| Titan et al. (2001)( 30 ) | 78·9 | BMI (kg/m2) and WHR: continuous variables | Total no. of meals: main meals, snacks, biscuits with coffee breaks Assessment: simple question | Continuous variable | Multiple linear regression adjusted for age, obesity, smoking, PA, intakes of alcohol, fat, protein and carbohydrate, and EI | Men BMI (kg/m2): β=−0·08 (se 0·03) P=0·02 WHR: β=−0·01 (se 0·01) P=0·42 | Women BMI (kg/m2): β=0·05 (se 0·04) P=0·27 WHR: β=−0·01 (se 0·01) P=0·02 |
| Ma et al. (2003)( 9 ) | 78·9 | Obesity: BMI≥30·0 kg/m2 | Total no. of meals: main meals and snacks Assessment: 10–15×24 h dietary recall | ≤3 v. ≥4 meals | Logistic regression model adjusted for sex, age, PA and EI | Men and women ≤3v. ≥4 meals, OR (95 % CI): 0·5 (0·3, 0·9) | |
| Smith et al. (2012)( 11 ) | 78·9 | BMI (kg/m2) and WC (cm): continuous variables | Total no. of meals: main meals and snacks Assessment: meal pattern questionnaire | Continuous variable | Multiple linear regression adjusted for age, education, PA, alcohol intake, diet quality and overall dietary quality | Men WC (cm): β=−0·7 (95 % CI −1·1, −0·3) BMI (kg/m2): β=−0·3 (95 % CI −0·4, −0·1) | Women WC (cm): β=−0·1 (95 % CI −0·5, 0·3) BMI (kg/m2): β=−0·1 (95 % CI −0·2, 0·9) |
| Drummond et al. (1998)( 8 ) | 73·7 | Body weight (kg), BMI (kg/m2) and body fat %: continuous variables | Total no. of meals: any occasion when food was taken Assessment: 7 d food record | Continuous variable | Pearson’s correlation without adjustments | Men Body weight: r=−0·34 P=0·03 BMI: P=0·09 Body fat %: P=0·17 | Women Body weight: P=0·41 BMI: P=0·35 Body fat %: P=0·43 |
| Marín-Guerrero et al. (2008)( 33 ) | 73·7 | Obesity: BMI ≥30·0 kg/m2 | 3–4 meals: 3 main meals and afternoon tea 2 meals: 2 main meals 1 meal: 1 main meal Snack: small amounts of food many times over the course of the day Assessment: meal pattern questionnaire | 1 v. ≥3–4 meals ≤2 v. ≥3–4 meals 3–4 v. ≥5 meals | Logistic regression model adjusted for age, education, size of town of residence, marital status, PA, smoking, alcohol intake and health status | Men 3–4 v. 2 meals, OR (95 % CI): 1·6 (CI 1·4, 1·9) 3–4 v. 1 meals, OR (95 % CI): 1·4 (0·9, 2·1) 3–4 v. ≥5 meals, OR (95 % CI): 1·4 (1·0, 2·0) | Women 3–4 v. 2 meals, OR (95 % CI): 1·3 (1·0, 1·6) 3–4 v. 1 meals, OR (95 % CI): 1·1 (0·7, 1·8) 3–4 v. ≥5 meals, OR (95 % CI): 1·5 (1·2, 1·9) |
| Peixoto et al. (2007)( 43 ) | 73·7 | BMI (kg/m2): continuous variables | No. of meals Assessment: simple question | ≤3 v. ≥4 meals | Multiple linear regression adjusted for age, income, smoking, alcohol intake, PA, frequency of meat and vegetable intake | Men <3 v. ≥4 meals: β=−0·8 (95 % CI −1·5, −2·1) | Women NS |
| Ruidavets et al. (2002)( 36 ) | 73·7 | BMI (kg/m2) and WHR: continuous variables | Total no. of meals: any food or drink intake providing energy Assessment: 3 d food record | 1–2 v. ≥5 meals 3 v. ≥5 meals 3 v. ≥5 meals | Multiple linear regression adjusted for age, education, PA, smoking, habits of dieting and EI Energy misreporting was defined based on EI:BMR | Men BMI (kg/m2): ≥5 meals: reference 4 meals: β=1·7 (se 0·7) 3 meals: β=1·7 (se 0·7) 1–2 meals: β=3·7 (se 1·1) P=0·05 WHR: ≥5 meals: reference 4 meals: β=0·01 (se 0·01) 3 meals: β=0·01 (se 0·01) 1–2 meals: β=0·04 (se 0·02) P<0·01 | |
| Bachman et al. (2011)( 26 ) | 68·4 | Overweight/obese (OW): BMI=27·0–45·0 kg/m2 Weight-loss maintainers (WLM): BMI>25·0 kg/m2 at some point in life, lost>10 % of maximum body weight and maintained that for at least 5 years, and were weight-stable within the previous 2 years Normal weight (NW): BMI=19·0–24·9 kg/m2 at entry into the trial, never overweight or obese and were weight-stable within the previous 2 years | Main meals: breakfast, lunch and dinner Snack: any food eaten outside habitual meal times Assessment: 3 ×24 h dietary recalls | Continuous variable | Covariance analyses adjusted for sex, age, PA and Pearson correlation without adjustment. | Men and women Snacks, mean (sd): WLM: 1·9 (1·1) NW: 2·3 (1·1) OW: 1·5 (1·3) P<0·05 Meals, mean (sd): WLM: 2·7 (0·4) NW: 2·7 (0·4) OW: 2·7 (0·5) P>0·05 All participants BMI v. snacks: r=−0·20 P<0·01 | |
| Metzner et al. (1977)( 6 ) | 68·4 | Adiposity index: continuous variable | Total no. of meals: main meals and snacks Assessment: 1 × 24 h dietary recall | 2 v. 6 meals | ANCOVA with energy (calories) per kilogram of ideal weight as the covariate | Men and women Mean adiposity index gets smaller as the number of meals increases from 2 to 6 (numerical results not shown) | |
| Reicks et al. (2014)( 28 ) | 63·2 | BMI (kg/m2): continuous variable Self-reported | No. of meals: main meals and snacks Assessment: self-administered meal pattern questionnaire and meal pattern history | 1–5 v. 6–10 v. ≥11 meals | Quantile regression of the median without adjustment | Men and women BMI (kg/m2), median: 1–5 meals: 27·0 6–10 meals: 26·5 ≥11 meals: 26·2 P=0·008 | |
WC, waist circumference; WHR, waist-to-hip ratio; PA, physical activity; EI, energy intake; EER, estimated energy requirement; SES, socio-economic status; β, linear regression coefficient; NS, not statistically significant and P value not available; r, correlation coefficient.