Academic journal article Central European Journal of Public Health

Higher Energy Intake Variability as Predisposition to Obesity: Novel Approach Using Interquartile Range

Academic journal article Central European Journal of Public Health

Higher Energy Intake Variability as Predisposition to Obesity: Novel Approach Using Interquartile Range

Article excerpt


An enormous increase in the number of obese patients, i. e. patients with body mass index (BMI) ≥ 30 kg/m2, has taken place during the past three decades. Along with the increasing prevalence of type 2 diabetes mellitus, this situation has contributed to the development of a new 21st century pandemic (1, 2). Obesity is caused by excessive fat accumulation caused in turn by increased energy intake, inappropriate eating patterns (e.g. irregular food intake), low energy expenditure, and genetic factors.

In the past several years, issues such as food composition, eating regularity, energy intake and changes in metabolism and body weight have become of significant research interest (3-5), especially as it has been shown that irregular food intake is linked to an increase in body weight (6).

The results of various studies indicate that eating less than 3 to 4 meals per day may lead to an increase in BMI (7), adiposity (8) and central obesity (9), and may negatively affect appetite control (10). Skipping one or more of the main daily meals (especially breakfast) is associated with obesity development and such a course cannot be recommended as a weight management technique (6). On the other hand, eating five or more meals per day is associated with a lower BMI and waist-hip ratio (WHR) and seems to be an important factor in weight loss maintenance (11). An additional theoretical model focusing on the relationship between eating frequency and appetite regulation (12) is based on studies associating eating frequency (ranging from 3 to 6 meals per day) with successful appetite regulation.

With respect to both the number of meals and to energy density (ED), a study by De Castro established that low ED intake in adults during any main daily meal may reduce overall food intake since the higher the ED of a particular ingested food, the more this food is eaten (13). Morning food intake is particularly satiating and may help reduce the total amount of food ingested during the day; on the other hand, eating late at night lacks the necessary satiating value and may result in greater overall daily intake (13). Taken together, the results of the above mentioned studies employing various methods in order to assess the regularity of food intake and its energy content are contradictory. Moreover, none of the studies focused on food intake regularity and energy content simultaneously. The aim of this study was therefore to establish the energy content of each daily meal and, with the help of 7-day food records, assess its variability during the course of one week. Interquartile range (IQR) was employed as it reflects the variability in food intake better than standard deviation, which can be easily skewed by one extreme value. IQR makes it possible to study food intake regularity, the number and size of portions and, to a certain degree, also the sequence of meals eaten throughout the day.



A total of 521 participants, 390 women and 131 men of Czech Caucasian origin (BMI 32.62 ± 7.86 kg/m2) aged 16-73 (45.41 ± 13.25 years) were included in the study. All study participants were recruited in a mass media campaign targeting the population of the South Moravia Region in the Czech Republic (14). The study was conducted according to guidelines set out in the Declaration of Helsinki and all procedures involving human subjects were approved by the Committee for Ethics of Medical Experiments on Human Subjects, Faculty of Medicine of Masaryk University (Brno, Czech Republic). Written informed consent was obtained from all subjects and subsequently archived.

Anthropometric Characteristics

All anthropometric measurements were carried out by three specialists and included weight, height, BMI, body fat percentage (%BF), body water percentage (%BW), waist circumference (cW), hip circumference (cH), and waist-hip ratio (WHR). For weight, height and BMI measurements, carried out using a precisely calibrated SECA 764 scale (Medical Measuring System, Hamburg, Germany), subjects were required to wear light indoor clothes and no shoes. …

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