Meal time and meal regularity: is it associated with pediatric obesity? A systematic review and meta-analysis

Childhood obesity is a global public health concern. Chrononutrition, in the form of meal timing and regularity, is emerging as a significant factor influencing obesity in children and adolescents.

This systematic review and meta-analysis synthesized recent evidence from studies published between 2014 and 2023, exploring the association between meal timing, meal regularity, and overweight/obesity (OW/OB) in children below 18 years old.

Searches were conducted until June 2023 in PubMed, Scopus, EMBASE, and Google Scholar, supplemented by manual searches, adhering to PRISMA guidelines. Studies were analyzed using narrative synthesis and meta-analysis, with odds ratios (OR) and confidence intervals (CI) calculated for pooled analyses using the Revman 5.4.1 tool. The Newcastle-Ottawa Scale was used to analyze the quality of studies.

A total of 30 observational studies, involving 102,335 children and adolescents from 22 countries were included in the analysis. The meta-analysis in 15 studies resulted in skipping main meals significantly increased the risk of pediatric OW/OB (skipping breakfast: OR 1.26, 95% CI: 1.11-1.43, p = 0.0003, lunch: OR 1.24, 95% CI: 1.00-1.53, p = 0.05, or dinner: OR 1.42, 95% CI: 1.18-1.71, p = 0.0002). Meal irregularity (OR 1.10, 95% CI 0.81-1.49, p = 0.55), late-night eating (OR 0.90, 95% CI: 0.64-1.26, p = 0.55), and meal before bedtime (OR 0.97, 95% CI: 0.68-1.38, p = 0.86) showed inconclusive associations on OW/OB, thus warrant further investigation.

Skipping any main meals significantly increases risk of OW/OB in children and adolescents. Although the associations were consistent, the evidence stems solely from observational studies and cannot establish causality. Understanding the role of dietary timing and regularity in pediatric obesity may inform future research and public health interventions aimed at preventing and managing pediatric obesity.