CHRONONUTRITION AND

OBESITY
DONO INDARTO, dr., M.Biotech.St., Ph.D AIFM
Department of Physiology and Biomedical Laboratory, Faculty of
Medicine, Universitas Sebelas Maret

Presented in Nutrizone 2021 Seminar, Universitas Darusalam Gontor on 21st February 2021
INTRODUCTION
• Obesity prevalence has increased in pandemic dimensions
over the past 50 years (WHO, 2017).
• Obesity was designated as a disease by the American
Association of Clinical Endocrinologists in 2012 , by the
American Medical Association in 2013, and subsequently by
multiple medical professional and national associations
• However, the diagnosis of obesity is currently based only on
BMI, without an indication of the impact of excess adiposity
on health.
 Prevalence of obesity among adults ≥ 20 years old in the
USA

https://www.statista.com/statistics/244620/us-obesity-
prevalence-among-adults-aged-20-and-over/
OECD, 2017: Oganization for Economics Cooperation and Development
Blüher, Nat. Rev. Endocrinol. (2019)
CIRCADIAN RYTHM
• Circadian rhythms (CR) are endogenous autonomous oscillators of
physiological activities resulting 24-h day/night cycles, which allow
organisms to adapt to a fluctuating environment (Xie et al., 2019).
• The core pacemaker of CR lies in the suprachiasmatic nucleus (SCN).
• This system generally consists of the input pathway, the core circadian
clock, and the output pathway.
• The input pathway senses external timing signals, for example, light/dark,
and sends information to the core circadian clock.
• The core circadian clock forms endogenous CR according to external time
cues to allow for adaptation to the environment.
• The output pathway adjusts the physiological activities in various tissues
and organs through neurohumoral regulation.
CHRONO-NUTRITION
• Chrono-nutrition: mutual interactions between circadian clocks and
nutrition/food (Shibata et al., 2013).
• The regular feeding pattern can entrain the peripheral circadian clock that
controls the absorption distribution, metabolism and excretion of
nutrients.
• The relative new area of research studies not only focuses on the impact
of what we eat but also on when we eat.
• The timing of eating, generally three aspects of time are considered: (1)
irregularity (i.e. the inconsistency or inconsistent meal routine), (2)
frequency (the number of meals or eating occasions daily) and (3) clock
time (actual time of intake), for example, breakfast skipping and consuming
meals late at nigh
CHRONO-NUTRITION
• All these components could affect the circadian rhythms and thereby
have an effect on metabolic health.
• For example, one of the first epidemiological studies demonstrated
that people having a more irregular meal routine had a higher risk of
obesity and the metabolic syndrome, despite consuming less energy
than those who had a more regular meal routine (Pot et al., 2014).
• Another study shows a detrimental relation between skipping
breakfast and eating late in the day and children’s body weight (Vilela
et al., 2019).
THE IMPACT OF URBANISATION ON CHRONO-
NUTRITION
• Urbanisation becomes more prominent in many developed and developing
countries over the past century.
• This has had a huge impact on the way people live their lives, including their daily
routines, both work related as well as related to sleep.
• The urban environment comprises many dietary and lifestyle factors that affect
health, for example, shift work, sleep, stress, physical activity, age, income,
pollution, and social jetlag.
• The impact of urbanisation on dietary patterns, the main process by which this
occurs is nutrition transition.
• The changes of dietary patterns in developing countries from more traditional
diets, usually high in fibre and cereal, to a more Western dietary pattern,
characterised by more sugars, fat and animal-source food.
(Paoli et al., Nutrients, 2019)
(green: positive; red: negative; blue: neutral) of meal timing on
different CVD risks factors and diseases. CHD: coronary heart
disease; CVD: cardiovascular disease; TRF: time restricted feeding
(Paoli et al., Nutrients, 2019)
(Paoli et al., Nutrients, 2019)
THE ROLE OF CHRONO-NUTRITION ON BODY
WEIGHT MANAGEMENT
• Manipulation of the macronutrient composition of the diet, coupled
with reductions in energy intake, have been traditional tools to
improve metabolic health.
• A growing evidence suggests that periodic fasting and restricting the
daily duration over which food is consumed can delay and often
reverse the symptoms associated with metabolic disorders.
• Changes in the pattern of daily food consumption broadly encompass
three approaches (1) chronic energy restriction (CER), (2)
intermittent fasting (IF) and time restricted feeding (TRF).
THE ROLE OF CHRONO-NUTRITION ON BODY
WEIGHT MANAGEMENT
• In CER, daily energy intake is reduced by up to 40%, but meal
frequency and timing remain unchanged.
• In IF, one day or several days of fasting are interspersed with normal
ad libitum eating patterns, and meal frequency and timing remaining
unchanged on the days of food intake.
• The food is consumed ad libitum throughout a set time period of TRF
and the daily eating duration (i.e. the time between the first and last
energy intake) is typically reduced from a 12–14 h/day ‘eating
window’ to <10 h/day.
THE ROLE OF CHRONO-NUTRITION ON BODY
WEIGHT MANAGEMENT
• A feature common to these dietary interventions is the manipulation
of the feeding–fasting cycle.
• Gill and Panda (2015) reported that TRF in overweight humans
induced a modest weight loss after individuals decreased their eating
window from >14 to ~10 h/day for 16 weeks.
• Parr et al. (2020) determined the effects of TRF (8 h/day, meals
consumed at 10:00, 13:00 and 17:00 hours) vs extended feeding (15
h/ day, consuming meals at 07:00, 14:00 and 21:00 hours) on 24 h
and postprandial metabolism in men who were overweight or obese.
• TRF improved nocturnal and postprandial blood glucose control and
well accepted by the men.
 A = control
B = Fruit before
meal
C = Fruit + veg
after meal
D = Fruit + veg
before meal
E = Fruit + veg
after meal

Nagoro et al.,Bali Medical Journal (2019)

1. Changes in chrono-nutrition strongly correlate with metabolic