Associations between Meal Frequency and Cardiometabolic Risk Factors (<i>Diabetes Metab J</i> 2025;49:311-20)

Ja Young Jeon

doi:10.4093/dmj.2025.0260

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Letter Associations between Meal Frequency and Cardiometabolic Risk Factors (Diabetes Metab J 2025;49:311-20): Ja Young Jeon; Diabetes & Metabolism Journal 2025;49(4):908-909.
DOI: https://doi.org/10.4093/dmj.2025.0260
Published online: July 1, 2025

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Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea

Corresponding author: Ja Young Jeon

Department of Endocrinology and Metabolism, Ajou University Hospital, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea E-mail: twinstwins@hanmail.net

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the reply "Impact of Meal Frequency on Insulin Resistance in Middle-Aged and Older Adults: A Prospective Cohort Study (Diabetes Metab J 2025;49:311-20)" in Volume 49 on page 912.

See the article "Impact of Meal Frequency on Insulin Resistance in Middle-Aged and Older Adults: A Prospective Cohort Study" on page 311.

Dietary patterns strongly influence health and have been significantly associated with chronic diseases such as obesity, cardiovascular disease, cancer, and type 2 diabetes mellitus [1]. Numerous studies have reported associations between specific eating patterns, including meal timing and frequency, and cardiovascular risk factors [2]. Eating styles and meal patterns vary considerably across ethnicities, races, and cultures, and these have evolved over time [3,4].

In Korea, food consumption trends have shifted notably over the past two decades. According to data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 1998 and 2016–2018, the proportion of energy intake derived from breakfast decreased by approximately 7%, while energy from snacks and convenience foods increased by approximately 10% [5]. These changes indicate a growing tendency to skip breakfast and a shift toward increased consumption of dinner and snacks, potentially impacting overall health and chronic disease risk.

Regarding eating habits, accumulating evidence indicates that regular breakfast consumption may reduce cardiometabolic risk factors, whereas skipping breakfast may increase cardiovascular disease risk. Prospective observational studies have demonstrated that daily or frequent breakfast intake is associated with a reduced risk of obesity, metabolic syndrome, and hypertension [6]. Additionally, men who skipped breakfast had higher incidence of coronary heart disease compared to those who regularly consumed breakfast [7]. However, no clear association was observed between meal frequency and coronary heart disease risk when meal frequency was categorized as 1–2, 3, 4–5, or ≥6 meals per day [7]. Thus, evidence supporting the impact of meal frequency alone on chronic disease remains limited.

Recent studies based on KNHANES data, including the current study, have increasingly reported associations between meal frequency and cardiometabolic risk factors [8,9]. One study found that men consuming two meals per day had a higher prevalence of metabolic syndrome compared to those eating three meals per day (27.5% vs. 17.8%, P<0.001) [8]. Another study indicated that men who consumed two meals per day and skipped breakfast had a higher risk of metabolic syndrome (odds ratio, 1.22; 95% confidence interval, 1.04 to 1.43) compared to men who consumed three meals daily [9]. Interestingly, these two studies demonstrated gender-specific associations, with the meal frequency and metabolic syndrome relationship significant only among men. However, reasonable explanations or mechanistic evidence for these gender-specific differences remain unclear.

These findings align with the recent prospective cohort study by Ryu et al. [10] titled, ‘Impact of meal frequency on insulin resistance in middle-aged and older adults: a prospective cohort study.’ This study focused on insulin resistance, a central factor underlying metabolic syndrome, and identified distinct temporal changes in metabolic syndrome components between groups consuming ≥3 meals versus <3 meals per day through group-by-time interactions. Importantly, this 20-year prospective observational study suggested a potential causal link between meal frequency and insulin resistance, contrasting the cross-sectional nature of previous studies. Despite both groups having mixed favorable and unfavorable metabolic characteristics at baseline, the significant association between meal frequency and insulin resistance persisted after adjusting for relevant confounding variables. Incorporating baseline dietary factors such as fat intake content or proportions into multivariate analysis could further clarify these associations.

Additionally, while the authors categorized participants into two groups (≥3 meals vs. <3 meals per day), I suggest further subdivision into three distinct groups—more than three meals, exactly three meals, and fewer than three meals per day—to provide clearer insights, particularly in populations where consuming three meals per day is the cultural norm, such as in Korea. This refined categorization would better capture potential linear trends, clarify whether increased meal frequency truly correlates with reduced insulin resistance, and enhance interpretability, facilitating more precise public health recommendations.

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CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Wang P, Song M, Eliassen AH, Wang M, Fung TT, Clinton SK, et al. Optimal dietary patterns for prevention of chronic disease. Nat Med 2023;29:719-28.Article PubMed PMC PDF
2. St-Onge MP, Ard J, Baskin ML, Chiuve SE, Johnson HM, KrisEtherton P, et al. Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation 2017;135:e96-121.Article PubMed PMC
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6. Odegaard AO, Jacobs DR Jr, Steffen LM, Van Horn L, Ludwig DS, Pereira MA. Breakfast frequency and development of metabolic risk. Diabetes Care 2013;36:3100-6.Article PubMed PMC PDF
7. Cahill LE, Chiuve SE, Mekary RA, Jensen MK, Flint AJ, Hu FB, et al. Prospective study of breakfast eating and incident coronary heart disease in a cohort of male US health professionals. Circulation 2013;128:337-43.Article PubMed PMC
8. Jung CH, Lee JS, Ahn HJ, Choi JS, Noh MY, Lee JJ, et al. Association of meal frequency with metabolic syndrome in Korean adults: from the Korea National Health and Nutrition Examination Survey (KNHANES). Diabetol Metab Syndr 2017;9:77.Article PubMed PMC PDF
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10. Ryu HE, Lee JH, Park B, Heo SJ, Kwon YJ. Impact of meal frequency on insulin resistance in middle-aged and older adults: a prospective cohort study. Diabetes Metab J 2025;49:311-20.Article PubMed PDF

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Associations between Meal Frequency and Cardiometabolic Risk Factors (Diabetes Metab J 2025;49:311-20)

Diabetes Metab J. 2025;49(4):908-909. Published online July 1, 2025

DOI: https://doi.org/10.4093/dmj.2025.0260

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Associations between Meal Frequency and Cardiometabolic Risk Factors (Diabetes Metab J 2025;49:311-20)

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Jeon JY. Associations between Meal Frequency and Cardiometabolic Risk Factors (Diabetes Metab J 2025;49:311-20). Diabetes Metab J. 2025;49(4):908-909.

DOI: https://doi.org/10.4093/dmj.2025.0260.

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