Relation of evening intake to blood pressure, body mass index, and nutrient intake: The
INTERMAP Study. By G. Aljuraiban1,4, Q. Chan1,3, L.O. Griep1, J. Stamler2, L.Van Horn2,
M. L. Daviglus2, P. Elliott1,3 and G.Frost1,4 for the INTERMAP Research group, 1Department
of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2
1NY London, UK,
2
Department of Preventive Medicine, Feinberg School of Medicine,
Northwestern University, Chicago, Illinois, USA, 3 MRC-HPA Centre for Environment and
Health, Imperial College London, W2 1PG London, UK,
4
Nutrition and Dietetic Research
Group, Imperial College London, W12 0NN London, UK.
The relation of energy intake in the evening to blood pressure (BP) and body mass index
(BMI) has not been thoroughly investigated, and available studies show inconsistent findings
(1, 2). Some epidemiologic studies found a direct association between night-shift work and
the risk of developing cardiovascular diseases (3, 4), reflecting the consumption of a large
proportion of their energy during the night. The objective is to explore associations of
evening energy intake and BP/BMI and assess nutrient intake across quartiles of evening
intake.
Cross-sectional data
were analysed
from
the population-based
INTERnational
collaborative study of MAcronutrients, micronutrients and blood Pressure (INTERMAP)
Study, including 2,385 participants ages 40 to 59 from the United Kingdom (UK, n=444) and
the United States (US, n=1,941). Data were averaged from four 24-hour dietary recalls, two
24-hour urine collections, and eight BP readings. Time of intake was expressed as a ratio of
evening/morning energy intake. Morning intake was defined as the average energy intake
from 6:00 am to 11:55 am, while evening intake was defined as average energy intake from
6:00 pm to 11:55 pm:
𝑅𝑎𝑡𝑖𝑜 𝑜𝑓 𝑒𝑣𝑒𝑛𝑖𝑛𝑔 𝑡𝑜 𝑚𝑜𝑟𝑛𝑖𝑛𝑔 𝑒𝑛𝑒𝑟𝑔𝑦 𝑖𝑛𝑡𝑎𝑘𝑒
=
evening energy intake morning energy intake

24 − hr energy intake
24 − hr energy intake
These times were selected based on when the majority (98%) of the UK and US INTERMAP
participants consumed their morning and evening meals. Participants were classified into
quartiles of ratio of evening/morning energy intake (≤1, 1-1.5, 1.5-2, ≥2). Models were
adjusted for total energy intake, gender, age, and sample, with additional adjustment for BMI
in BP regression. Nutrient density was calculated per 100 kcal using the Nutrient Rich Food
(NRF9.3) index algorithm which has been previously validated against the Healthy Eating
Index (5). The NRF 9.3 index is a measure of nutrient quality of individual foods and can be
used as indicator of nutrient density of the overall diet (6). It reflects a composite of nutrients
to be encouraged (protein, fiber, vitamin A, C, E, calcium, iron, magnesium, and potassium)
and nutrients to be limited (total fat, total sugar, and sodium).
Ratio of evening/morning energy intake
<1.2
Variable
mean
N
Men (%)
BMI
(kg/m2)3
1.2-1.8
SE
mean
1.8-2.8
SE
mean
>2.8
SE
mean
594
595
595
595
47
51
49
59
SE
27.7
0.2
28.0
0.2
28.1
0.2
28.5
0.2
118.1
0.5
119.6
0.5
118.2
0.5
120.3
0.5
73.4
0.4
74.4
0.4
73.7
0.4
75.2
0.4
Total energy (kcal/24-hr)
2204.0
21.8
2322.4
21.7
2333.0
21.6
2432.4
21.7
Food weight (g/24-hr)*
1103.0
13.3
1124.0
13.2
1104.0
13.2
1067.0
13.3
Beverage weight4 (g/24-hr)
1575.3
30.0
1568.4
29.9
1649.2
29.8
1600.6
30.0
Dietary energy density*
1.7
0.02
1.7
0.02
1.7
0.02
1.8
0.02
NRF 9.3 index3,*
31.5
0.5
31.8
0.5
31.6
0.5
28.4
0.5
Whole fat dairy (g/1000 kcal)
28.3
1.6
24.6
1.6
23.8
1.6
27.4
1.6
Low/fat free dairy (g/1000 kcal)*
91.0
3.5
88.8
3.5
94.4
3.5
73.2
3.5
Red meat (g/1000 kcal)*
25.3
0.9
25.4
0.9
27.5
0.9
29.2
0.9
Raw vegetables (g/1000 kcal)*
26.4
1.2
28.0
1.2
30.1
1.2
27.6
1.2
Cooked vegetables (g/1000 kcal)*
48.6
1.6
51.7
1.6
48.3
1.6
48.4
1.6
Fruit (g/1000 kcal)*
54.4
2.5
54.1
2.5
51.2
2.5
44.7
2.5
(g/24-hr)3,*
7.1
0.6
7.9
0.6
8.8
0.6
11.1
0.6
Total Carbohydrate (%kcal)*
49.3
0.3
49.0
0.3
48.6
0.3
46.7
0.3
Total Fibre (g/1000kcal)*
9.7
0.1
9.7
0.1
9.5
0.1
8.8
0.1
Total Protein (kcal%)*
15.4
0.1
15.3
0.1
15.3
0.1
15.3
0.1
Total Fat (%kcal)*
33.1
0.3
33.0
0.3
32.8
0.3
34.1
0.3
Cholesterol(mg/1000kcal)*
123.6
2.2
124.4
2.2
130.4
2.2
135.2
2.2
Magnesium (mg/1000kcal)*
149.3
1.5
148.0
1.5
148.7
1.5
140.7
1.5
Potassium (mg/1000kcal)*
1400.6
13.8
1394.0
13.8
1408.0
13.7
1330.6
13.8
Calcium (mg/1000kcal)*
388.4
5.3
378.5
5.3
383.1
5.3
356.2
5.3
Systolic blood pressure (mm
Hg)3
Diastolic blood pressure (mm Hg)3,*
Alcohol
1 Presented
2Adjusted
as mean and SE
for gender, age, and sample, 3additionally adjusted for total energy, *P<0.05.
Participants in the highest quartiles of ratio of evening/morning energy intake (≥2) had
higher BMI (P=0.0700), SBP (P=0.0900), DBP (P=0.0040), dietary energy density from food
(P=0.0050). Assessment of intake showed individuals in the highest quartiles of ratio of
evening/morning energy intake (≥2) had lower nutrient density (P<0.0001) expressed by
NRF9.3 score, lower intakes of low/medium-fat dairy products (P<0.0001), fruits (P=0.012),
total fibre (P<0.0001), magnesium (P=0.0001), potassium (P=0.0002),
and calcium
(P<0.0001), and higher intakes of total fat (P=0.0043), and cholesterol (P<0.0001) compared
to those in the lowest quartile (<1.2).
Participants with lower ratio of evening/morning energy intake had lower BMI and BP
accompanied by a healthier nutritional profile compared to those in the higher ratio of
evening/morning energy intake. Having the larger portion of the diet in the evening is
probably in association with a lifestyle of eating-out and/or drinking, and is characterized by
energy dense foods with lower nutrient density.
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