. 2015 Jun;28(1):1–21. doi: 10.1017/S0954422414000262

Table 4.

Characteristics of studies that have examined associations between meal patterns and overall diet quality

First author (year)	Country and study design	Sample	Aspect(s) of meal patterns examined	Measure(s) to assess diet and meal patterns	Meal or snack definition	Diet quality indicator(s)	Covariates	Selected key findings
Azadbakht (2013)⁽ ⁹⁴ ⁾	Iran C/S	411 women students, 18–28 years	Breakfast skipping	FFQ Meal patterns: not described	Time of-day^*	HEI, DDS	Not clear if covariates were adjusted for in the multivariate ANOVA	HEI and DDS scores and diversity scores for fruits, vegetables and whole grains were significantly lower among breakfast skippers than consumers (P< 0·001)
Deshmukh-Taskar (2010)⁽ ²³ ⁾	USA C/S	2615 men and women, 20–39 years	Breakfast skipping	1 × 24HR	Participant-identified^*	HEI	Ethnicity, sex, sex × ethnicity, age, poverty income ratio, smoking status, marital status and PA	Breakfast skippers had significantly lower (P< 0·0001) HEI scores than those who consumed ready-to-eat breakfast cereals or other breakfast foods
Dewolfe (2003)⁽ ⁹¹ ⁾	Canada C/S	84 men and 21 women, ≥ 65 years	Meal skipping and snacking	3 × 24HR Meal patterns: Q	Participant-identified	Diet score based on compliance with national dietary guidelines	Preparing own meals, how well food tastes, prescription medication use, sex	Eating lunch daily was positively associated (standardised β = 0·24, 95 % CI 0·05, 0·42) with the diet score reflecting adherence to Canadian dietary guidelines
Cahill (2013)⁽ ²⁸ ⁾	USA Prospective (16-year follow-up)	29 209 health professional men, 40–75 years	Breakfast eating and late-night eating	FFQ^† Meal patterns: Q	Time-of-day	AHEI-2010	–	Based on age-standardised baseline data, no significant differences in AHEI scores were reported between breakfast consumers and non-breakfast consumers or late-night eaters and non-late-night eaters
Kim (2011)⁽ ⁸⁸ ⁾	USA/Puerto Rico C/S	27 983 women, 35–74 years	Snack dominance and conventional eating pattern	Modified block FFQ^† Meal patterns: Q	Participant-identified^*	HEI	–	A higher conventional eating score (eating meals and snacks during conventional times) was associated with higher HEI scores (P< 0·01) whereas a higher snack-dominant eating score was associated with lower HEI scores (P< 0·01)
Mekary (2012)⁽ ⁸⁵ ⁾	USA Prospective (14-year follow-up)	34 968 men, 40–75 years	Eating frequency	FFQ^† Meal patterns: Q	Participant-identified	DASH score	–	Based on age-standardised baseline data, there was a positive association between eating frequency and the DASH score (r 0·14)
Mekary (2013)⁽ ⁸⁶ ⁾	USA Prospective (6-year follow-up)	46 289 women	Eating breakfast regularly and eating frequency	FFQ^† Meal patterns: Q (two items)	Participant-identified^*	AHEI-2010	–	Based on age-standardised baseline data, women who ate breakfast ≤ 6 times/week had lower scores for the AHEI-2010 than regular breakfast consumers. Diet quality by eating frequency was not assessed
Mesas (2012)⁽ ⁹³ ⁾	Spain C/S	10 791 men and women, ≥ 18 years	Skipping breakfast	Diet history Q^† Meal patterns: Q	Never eating anything at the breakfast occasion (meal definition could not be established)	MEDAS score; the OmniHeart diet score	Age, sex, education, social class, smoking, alcohol, binge drinking, PA at work, BMI and morbidity	No significant associations were found between skipping breakfast and either the MEDAS score or the OmniHeart diet score
Odegaard (2013)⁽ ⁸⁷ ⁾	USA Prospective (follow-up: 18 years)	3598 men and women, 18–30 years at baseline	Breakfast frequency	Diet history Q^† Meal patterns: Q	No definition provided	A priori diet quality score (no specific name given)	–	Based on C/S data at the 7-year follow-up, higher levels of breakfast intakes were associated with higher diet quality scores
Shatenstein (2013)⁽ ⁹² ⁾	Canada C/S	853 men and 940 women, 67–84 years	Meal frequency (snacks not included)	3 × 24HR Meal patterns: Q	No definition provided	Canadian HEI	Sex-specific models. Inclusion of the following covariates depended on model: education, diet, income, alcohol, wears dentures, perceived physical health, eats in restaurants, nutrition knowledge, hunger, BMI, chewing problems	Among males and females, number of meals/d was positively associated with Canadian HEI scores (β = 1·91, P< 0·02 and β = 3·61, P< 0·0001, respectively)
Smith (2010)⁽ ²² ⁾	Australia Prospective	1020 men and 1164 women, 9–15 years at baseline and 26–36 years at follow-up	Breakfast skipping	FFQ Meal patterns: Q (meal patterns chart)	Participant-identified and time-of-day	Compliance with dietary advice in the Australian Guide to Healthy Eating	–	Participants who skipped breakfast in both childhood and adulthood were less likely to meet recommendations for fruit, dairy products, lean meat and alternatives and takeout foods (P< 0·001) than those who did not skip breakfast at either time point
Smith (2012)⁽ ⁵⁶ ⁾	Australia C/S	1273 men and 1502 women, 26–36 years	Eating frequency	FFQ Meal patterns: Q (meal patterns chart)	Participant-identified	Diet score based on compliance with national dietary guidelines	Stratified by sex	There was a positive association (P< 0·001) between daily eating frequency and dietary scores, and meeting recommendations for fruit and dairy products among both men and women
Smith (2013)⁽ ⁹⁰ ⁾	Australia C/S	4123 women from low-SES areas, 18–45 years	Breakfast skipping	FFQ Meal patterns: Q (one item)	Participant-identified	DGI	–	Compared with women who ate breakfast < 1 d/week or 1–2 d/week, those who ate breakfast ≥ 3 d/week were more likely to be in the highest tertile for DGI scores
Zizza (2012)⁽ ⁸⁹ ⁾	USA C/S	11 209 adults ≥ 20 years	Snack frequency	1 × 24HR	Participant-identified^*	HEI-2005	Sex, race or ethnicity, education, smoking status, PA, eating ≥ 3 meals/d, chronic diseases, age, BMI, energy from meals	Frequency of snacking was positively associated with HEI-2005 scores and intakes of whole fruit, whole grains, milk, oils and Na (all P< 0·001) but inversely associated with total vegetables (P= 0·009), solid fat and added sugars (P= 0·007)

C/S, cross-sectional; HEI, Healthy Eating Index; DDS, dietary diversity score; 24HR, 24 h recall; PA, physical activity; Q, questionnaire; AHEI, Alternative Healthy Eating Index; DASH, Dietary Approaches to Stop Hypertension; MEDAS, Mediterranean Diet Adherence Score; OmniHeart, Optimal Macronutrient Intake Trial to Prevent Heart Disease; SES, socio-economic status; DGI, dietary guidelines index.

Beverages could explicitly qualify as a separate eating occasion.

^†

Excluded individuals with implausible energy intakes.