Intentional Eating: CV Health & Obesity

February 16, 2017
Veronica Hackethal, MD

The American Heart Association released a statement about the impact meal timing and frequency has on cardiometabolic health and obesity.

The American Heart Association (AHA) has released a new scientific statement about the impact of meal timing and frequency on cardiometabolic health and obesity.

The statement reviews evidence about how skipping breakfast, intermittent fasting, meal frequency, and meal timing affect cardiometabolic health. It was published online in Circulation.

Overall, it places an emphasis on intentional eating, with mindful planning of meal timing and frequency in order to improve weight management and cardiometabolic risk factors. 

“Ultimately, the clinician’s goal may be to help the patient spread energy intake over a defined portion of the day in a more balanced way rather than limited to 1 segment of the day or continuously over long periods of time (ie, grazing). This does not mean that total energy intake and macronutrient balance can be ignored but simply that the frequency and timing of intake are the basis for building the structure for intentional eating,” wrote first author Marie-Piere St-Onge PhD, FAHA, of Columbia University (New York, NY), and colleagues. Dr. St-Onge chaired the AHA committee that wrote the statement.

The emphasis on intentional eating is important, the report suggests, because eating patterns in the US have changed since the 1970s. The amount of total daily calories obtained from meals has decreased, while the amount of total daily calories from snacks has increased, according to NHANES data quoted in the article. 

That means more Americans are snacking instead of eating well-balanced meals. Snacking and eating on the go often includes foods obtained from vending machines or fast food outlets. Such foods are often high in calories but low in nutritional value, which can negatively impact cardiometabolic health and obesity.

To develop the statement, the authors did a comprehensive literature review of three databases, and consulted experts in the field. 

Overall, the evidence showed that irregular eating patterns may negatively impact cardiometabolic health.

Key Points:

• Breakfast:

♦ Skipping breakfast is linked to overweight/obesity, impaired glucose metabolism, increased HbA1c, T2DM

♦ Limited evidence suggests eating breakfast is important for preventing overweight/obesity and improving cardiometabolic risk

♦ Eating breakfast may contribute to an overall healthy eating pattern, and may slightly improve cardiometabolic risk

♦ Not enough evidence for definitive conclusions, more research is needed

• High meal frequency (eating several smaller meals per day) and intermittent fasting (alternate day or periodic fasting 1 or 2 days per week) may positively impact cardiometabolic health

• Meal timing: Eating late at night may increase the risk of overweight/obesity

Suggestions for clinicians on how they can help patients follow an intentional approach:

• Understand how a patient defines meals and snacks

• Recommend distributing calories over a pre-planned portion of the day

• Recommend eating a larger part of total daily calories earlier in the day

• Encourage consistent overnight fasting

• Link eating episodes to subsequent calorie intake (eg, eat snacks strategically before meals in which a patient often overeats)

• Provide intermittent fasting as an option for lowering weight

• Use additional eating episodes to diversify healthful foods in a patient’s diet, and displace unhealthy foods

• Plan meals and snacks throughout the day to manage hunger and control portion size

The statement also emphasizes cultural variations in dietary patterns, and stresses that additional research is needed on nutrition in ethnic/racial minorities, children and adolescents, and older adults.

Take-home Points

• The new AHA scientific statement on meal timing and frequency stresses intentional eating, with mindful planning of meal timing and frequency to improve weight management and cardiometabolic health.

• Eating breakfast may contribute to an overall healthier eating pattern, and may slightly improve cardiometabolic risk, though more research is needed.

• High meal frequency (eating several smaller meals per day) and intermittent fasting (alternate day or periodic fasting 1 or 2 days per week) may have a positive impact on cardiometabolic health.

• Eating late at night may be linked to overweight/obesity.

• The statement provides suggestions for how clinicians can help patients follow an intentional approach to eating.

One or more authors reports grants, speakers’ bureau membership and/or honoraria from one or more of the following: NIH, American Diabetes Association, University of Illinois at Chicago, North American Menopause Society, American Institute Cancer Research.

Reference: St-Onge MP, et al; 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. Circulation. 2017 Jan 30.