Development and Evaluation of Integrated Chrono-Nutrition Weight Reduction Program among Overweight/Obese with Morning and Evening Chronotypes
Abstract
:1. Introduction
2. Materials and Methods
- Phase 1: Development of Integrated Chrono-Nutrition Weight Reduction Program
2.1. Needs Assessments of Chrono-Nutrition Domains
2.2. Integration of Chrono-Nutrition and SLIMSHAPE™ Weight Reduction Module
- Phase 2 Feasibility of Integrated Chrono-Nutrition Weight Reduction Program
2.3. Measurement
2.3.1. Socio-Demographic Background
2.3.2. Attendance and Satisfaction
2.3.3. Chronotypes and Sleep Parameters
2.3.4. Dietary Information
- a.
- Energy intake (kcal) during early window = the sum of energy intake before mid-point of eating. Thus, %E intake during early window = ((energy intake (kcal) during early window ÷ total energy intake) × 100). The same calculation method was applied for intake in the late window.
- b.
- For example, carbohydrate intake early window = the sum of carbohydrate intake before the midpoint of eating. Thus, %E from carbohydrate intake during early window = (((carbohydrate intake (g) during early window × 4 kcal) ÷ total energy intake) × 100). The same calculation method was applied for the intake in the late window and suited the other macronutrient (protein and fat) intake.
2.3.5. Physical Activity
2.3.6. Adiposity, Biochemical and Clinical Parameters
2.4. Statistical Method
3. Results
3.1. Study Participants
3.2. Attendance and Satisfaction Rate
Parameters | Total (n = 91) | MT (n = 46) | ET (n = 45) | p-Value |
---|---|---|---|---|
Age a | 39.6 ± 6.3 | 40.8 ± 6.7 | 38.7 ± 5.8 | 0.257 |
Gender b | ||||
Women | 68 (74.7) | 37 (80.4) | 31 (68.9) | 0.205 |
Men | 23 (25.3) | 9 (19.6) | 14 (31.1) | |
Race b | ||||
Malay | 89 (97.8) | 45(97.8) | 44 (97.8) | 0.987 |
Chinese | 2 (2.2) | 1 (2.2) | 1 (2.2) | |
Marital status b | ||||
Married | 72 (79.1) | 41 (89.1) | 31 (68.9) | 0.018 |
Single/divorcee/widow | 19 (20.9) | 5 (10.9) | 14 (31.1) | |
Education level b | ||||
Tertiary | 81 (89.0) | 41 (89.1) | 40 (88.9) | 0.971 |
Secondary | 10 (11.0) | 5 (10.9) | 5 (11.1) | |
Monthly household income b | ||||
Low | 10 (11.0) | 5 (10.9) | 5 (11.1) | 0.136 |
Middle | 61 (67.0) | 27 (58.7) | 34 (75.6) | |
High | 20 (22.0) | 14 (30.4) | 6 (13.3) | |
Self-reported medical history | ||||
Hypertension, n (%) b | 11 (12.1) | 5 (10.9) | 6 (13.3) | 0.718 |
Diabetes mellitus, n (%) b | 6 (6.6) | 2 (4.3) | 4 (8.9) | 0.434 |
Dyslipidaemia, n (%) b | 11 (12.1) | 3 (6.5) | 8 (17.8) | 0.100 |
3.3. Changes in Dietary, Sleep and Physical Activity between Pre- and Post-Intervention
3.4. Changes in Temporal Pattern of Energy and Macronutrient Intake between Pre- and Post-Intervention
3.5. Changes in Adiposity and Biochemical Parameters between Pre- and Post-Intervention
3.6. Refinement of the Integrated Chrono-Nutrition Weight Reduction Intervention
4. Discussions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Components | Recommendation | Reference |
---|---|---|
Temporal pattern of energy intake | MT: BF—30%, MS—10%, LN—35%, AS—5% and DN—20% ET: BF—25%, MS—5%, LN—35%, AS—10% and DN—30%. | [26] |
Mealtime | To eat main meal before 15:00. To eat dinner at least 2 ½ h before sleep onset. To avoid night eating. | [35] |
Sleep | Sleep hours: ● Minimum: 6 h ● Optimum: 7–9 h | [36] |
SLIMSHAPE™ | SLIMSHAPE™ Chrono |
---|---|
Similarities | |
Dietary Calorie prescription: Men: 1600–1800 kcal/day Women: 1200–1500 kcal/day Macronutrient distribution: 50% CHO, 20% protein and 20% fat. Meal plan guide. Healthy eating guide through calorie counting, healthy cooking method and demonstration, understanding food labels, identify sugar-sweetened beverages and fats in cooked food. | |
Physical activity and exercise Weekly group exercise lead by exercise physiologist, including resistance tube exercise, aerobic exercise, high-intensity interval training and yoga. Encouragement to be physically active. | |
Behavioral therapy Group social support. Weekly weight monitoring. Session with psychologist on identifying barriers in weight reduction journey and motivational talk delivered by successful weight loss maintainers. | |
Differences | |
Duration 16 weeks/weekly session 2 h each session | Duration 12 weeks/weekly session 2-1/2 h each session |
Chronotype Not assessed. | Chronotype Assessed. |
Temporal pattern of energy intake No recommendation. | Temporal pattern of energy intake Prescription according to chronotype MT: Early window: 75% EI (BF: 30%, MS: 10%, LN: 35%) Late window: 25% EI (AS: 5% and DN: 20%) ET: Early window: 60% EI (BF: 20%, MS: 5%, LN: 35%) Late window: 40% EI (AS: 10% and DN: 30%) |
Mealtime No recommendation. | Mealtime Midpoint of eating before 15:00. Elapsed time between last meal and sleep onset ≥ 2-1/2 h. To avoid/reduce night eating. |
Sleep No recommendation. | Sleep Sleep hours: Minimum: 6 h Optimum: 7–9 h To maintain regular sleep–wake timing |
MT (n = 46) | ET (n = 45) | Mean Difference (95% CI) | |||||
---|---|---|---|---|---|---|---|
Pre | Post | Pre | Post | Time | CT | Time × CT | |
Total dietary intake | |||||||
EI (kcal/day) | 1660 ± 445 | 1228 ± 326 | 1878 ± 466 | 1373 ± 407 | −471 (−558, −384) *** | −180 (−330, −32) * | 68 (−106, 242) |
CHO (g/day) | 204.0 ± 64.5 | 152.1 ± 45.1 | 224.0 ± 65.3 | 167.1 ± 52.5 | −55.3 (−67.5, −43.0) *** | −17.4 (−3.1, 37.9) | 6.5 (−18.1, 31.1) |
% E CHO | 49.2 ± 5.8 | 49.5 ± 6.3 | 47.7 ± 5.7 | 48.7 ± 6.0 | 0.7 (−0.7, 2.1) | 1.1 (−1.0, 3.0) | −0.4 (−3.2, 2.5) |
Protein (g/day) | 66.0 ± 16.8 | 59.8 ± 11.3 | 72.8 ± 16.9 | 62.5 ± 16.9 | −8.6 (−12.0, −5.3) *** | −4.9 (−10.5, 0.7) | 3.94 (−2.8, 10.6) |
% E protein | 15.9 ± 3.3 | 19.5 ± 3.8 | 15.5 ± 2.0 | 18.2 ± 4.1 | 3.3 (2.3, 4.2) *** | 0.9 (−0.2, 1.9) | 0.9 (−1.0, 2.8) |
Fat (g/day) | 64.4 ± 19.4 | 42.3 ± 16.6 | 76.9 ± 22.5 | 50.5 ± 20.4 | −23.7 (−28.3, −19.1) *** | −10.3 (−17.2, −3.4) * | 3.29 (−5.9, 12.5) |
% E fat | 34.9 ± 4.9 | 31.0 ± 6.2 | 36.8 ± 5.0 | 33.1 ± 6.3 | −3.9 (−5.3, −2.4) *** | −2.1 (−3.9, −0.2) * | −0.3 (−3.2, 2.6) |
Meal timing | |||||||
First meal (hh:mm) | 08:12 ± 0:40 | 08:04 ± 0:46 | 08:24 ± 0:43 | 08:22 ± 0:43 | −0.1 (−0.2, 0.03) | −0.3 (−0.5, 0.03) | 0.1 (−0.3, 0.1) |
Last meal (hh:mm) | 19:52 ± 1:16 | 19:33 ± 1:08 | 20:29 ± 1:45 | 20:14 ± 1:37 | −0.3 (−0.6, 0.04) | −0.7 (−1.2, −0.1) * | −0.1 (−0.7, 0.6) |
Total eating window (h) | 11.7 ± 1.6 | 11.5 ± 1.4 | 12.1 ± 1.7 | 11.9 ± 1.6 | −0.2 (−0.6, 0.2) | −0.4 (−1.0, 0.2) | 0.0 (−0.7, 0.7) |
Midpoint eating (hh:mm) | 14:02 ± 0:38 | 13:49 ± 0:42 | 14:27 ± 1:01 | 14:18 ± 0:57 | −0.2 (−0.4, −0.02) * | −0.5 (−0.8, −0.1) ** | −0.1 (−0.4, 0.2) |
Elapse SOn-last meal (h) | 3.1 ± 1.5 | 3.5 ± 1.3 | 3.5 ± 1.8 | 3.2 ± 1.6 | 0.1 (−0.3, 0.4) | 0.0 (−0.5, 0.5) | 0.8 (0.1, 1.5) * |
NES score | 10.0 ± 5.1 | 8.9 ±4.3 | 10.7 ±5.4 | 8.9 ± 5.0 | −1.5 (−2.5, −0.5) ** | −0.4 (−2.2, 1.5) | 0.7 (−1.3, 2.7) |
Sleep | |||||||
Work SD (hour) | 6.6 ± 1.0 | 6.7 ± 0.9 | 6.1 ± 0.9 | 7.4 ± 1.2 | 0.7 (0.4, 1.0) *** | −0.1 (−0.4, 0.2) | −1.1 (−1.6, −0.6) *** |
Free SD (hour) | 7.3 ± 1.2 | 6.5 ± 0.9 | 6.8 ± 1.5 | 6.7 ± 0.8 | −0.5 (−0.8, −0.1) *** | 0.2 (−0.2, 0.5) | −0.7 (−1.3, −0.1) * |
Average SOn (hh:mm) | 22:57 ± 0:48 | 23:05 ± 0:50 | 23:56 ± 0:53 | 23:23 ± 0:57 | −0.2 (−0.4, −0.03) * | −0.6 (−1.0, −0.3) *** | 0.7 (0.3, 1.0) *** |
Average SOff (hh:mm) | 05:46 ± 0:31 | 05:38 ± 0:29 | 06:17 ± 0:41 | 06:18 ± 0:47 | −0.1 (−0.1, 0.2) | −0.6 (−0.8, −0.4) *** | −0.2 (−0.4, 0.1) |
Average SD (hour) | 6.8 ± 0.9 | 6.6 ± 0.8 | 6.3 ± 0.9 | 6.9 ± 0.7 | 0.2 (−0.0, 0.4) | 0.1 (−0.2, 0.4) | −0.8 (−1.2, −0.4) *** |
Social jetlag (min) | 18.2 ± 30.0 | 23.6 ± 23.6 | 53.1 ± 45.0 | 39.5 ± 42.6 | −4.1 (−12.7, 4.6) | −25.4 (−37.8, −13.0) *** | 19.0 (1.7, 36.3) * |
Physical activity (MET) | 1693.7 ± 303.8 | 3509.4 ± 387.0 | 1611.5 ± 303.8 | 3462.3 ± 387.0 | 1700.0 (1150.0, 2250.0) *** | −124.9 (−865.4, 615.5) | 48.1 (−1051.9, 1148.1) |
MT (n = 46) | ET (n = 45) | Mean Difference (95% CI) | ||||
---|---|---|---|---|---|---|
Pre | Post | Pre | Post | Time | Time × CT | |
Adiposity | ||||||
Weight (kg) | 79.8 ± 16.4 | 75.6 ± 15.6 | 81.5 ± 14.1 | 77.7 ± 13.2 | −4.0 (−4.9, −3.1) *** | −0.5 (−2.4, 1.3) |
BMI (kg/m2) | 31.3 ± 4.3 | 29.6 ± 4.5 | 31.2 ± 4.7 | 29.8 ± 4.7 | −1.5 (−1.9, −1.2) *** | −0.2 (−0.9, 0.5) |
Body fat (%) | 41.1 ± 7.4 | 39.0 ± 8.5 | 39.7 ± 8.1 | 37.8 ± 8.5 | −2.0 (−2.5, −1.4) *** | −0.3 (−1.4, 0.8) |
WC (cm) | 94.0 ± 11.8 | 90.3 ± 11.7 | 94.1 ± 10.1 | 90.0 ± 9.7 | −3.9 (−4.9, −2.9) *** | 0.4 (−1.6, 2.5) |
Biochemical | ||||||
FBG (mmol/L) | 5.0 ± 0.5 | 4.9 ± 0.6 | 5.0 ± 0.7 | 5.0 ± 0.7 | −0.1 (−0.2, 0.03) | −0.01 (−0.2, 0.2) |
Insulin (μIU/mL) | 13.9 ± 7.4 | 10.3 ± 6.7 | 12.7 ± 9.3 | 9.9 ± 5.8 | −3.2 (−4.5, −1.8) *** | −0.8 (−3.5, 1.9) |
HbA1c (%) | 5.8 ± 0.5 | 5.8 ± 0.7 | 5.8 ± 0.6 | 5.8 ± 0.5 | 0.01 (−0.1, 0.1) | 0.1 (−0.1, 0.2) |
HOMA-IR | 3.1 ± 1.8 | 2.3 ± 2.0 | 2.9 ± 2.4 | 2.3 ± 1.6 | −0.7 (−1.1, −0.4) *** | −0.1 (−0.8, 0.6) |
TC (mmol/L) | 5.2 ± 1.0 | 5.1 ± 1.1 | 5.1 ± 0.9 | 5.0 ± 0.8 | −0.1 (−0.2, 0.1) | 0.1 (−0.2, 0.4) |
TG (mmol/L) | 1.3 ± 0.8 | 1.2 ± 0.7 | 1.4 ± 0.8 | 1.3 ± 0.9 | −0.1 (−0.2, −0.01) * | −0.01 (−0.2, 0.2) |
LDL-C (mmol/L) | 3.3 ± 0.94 | 3.3 ± 1.0 | 3.1 ± 0.9 | 3.1 ± 0.8 | 0.04 (−0.1, 0.2) | 0.1 (−0.2, 0.3) |
HDL-C (mmol/L) | 1.3 ± 0.3 | 1.3 ± 0.3 | 1.4 ± 0.3 | 1.3 ± 0.3 | −0.04 (−0.1, −0.01) * | 0.03 (−0.1, 0.1) |
Uric acid (mmol/L) | 0.4 ± 0.1 | 0.3 ± 0.1 | 0.4 ± 0.1 | 0.4 ± 0.1 | −0.01 (−0.03, −0.00) * | 0.00 (−0.02, 0.02) |
Blood pressure | ||||||
Systolic (mmHg) | 128.5 ± 10.8 | 118.9 ± 12.2 | 135.6 ± 12.0 | 128.2 ± 14.2 | −8.5 (−10.7, −6.2) *** | −2.2 (−6.7, 2.3) |
Diastolic (mmHg) | 80.4 ± 9.6 | 75.3 ± 12.4 | 81.4 ± 9.0 | 77.7 ± 9.6 | −4.3 (−6.7, −2.0) *** | −1.4 (−6.0, 3.2) |
Components | Refinement in Interventions | Rationale |
---|---|---|
Temporal pattern of energy intake | Temporal energy prescription is the same for morning and evening chronotypes: Early window: 65–70% EI BF: 25–30% MS: 0–5% LN: 40% Late window: 30–35% EI AS: 0–5% DN: 25–30% Provide a complete set of menus, including the dishes for 12 weeks (intervention period). | There was no significant difference in % energy intake during early and late window between morning and evening chronotypes during pre- and post-intervention. Greater energy intake towards earlier part of the day and smaller intake towards later part of the day is beneficial for both chronotypes [48]. |
Meal timing | No changes in meal timing recommendations. | The participants adapt well to the recommendation. |
Sleep | No changes in sleep hours recommendation. Increase the sleep session to improve understanding on the importance of adequate sleep. | Morning chronotypes had reduced sleep duration on free days. |
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Mazri, F.H.; Manaf, Z.A.; Shahar, S.; Mat Ludin, A.F.; Abdul Basir, S.M. Development and Evaluation of Integrated Chrono-Nutrition Weight Reduction Program among Overweight/Obese with Morning and Evening Chronotypes. Int. J. Environ. Res. Public Health 2022, 19, 4469. https://doi.org/10.3390/ijerph19084469
Mazri FH, Manaf ZA, Shahar S, Mat Ludin AF, Abdul Basir SM. Development and Evaluation of Integrated Chrono-Nutrition Weight Reduction Program among Overweight/Obese with Morning and Evening Chronotypes. International Journal of Environmental Research and Public Health. 2022; 19(8):4469. https://doi.org/10.3390/ijerph19084469
Chicago/Turabian StyleMazri, Fatin Hanani, Zahara Abdul Manaf, Suzana Shahar, Arimi Fitri Mat Ludin, and Siti Munirah Abdul Basir. 2022. "Development and Evaluation of Integrated Chrono-Nutrition Weight Reduction Program among Overweight/Obese with Morning and Evening Chronotypes" International Journal of Environmental Research and Public Health 19, no. 8: 4469. https://doi.org/10.3390/ijerph19084469