The study of relationship between nutritional behaviors and metabolic indices: A systematic review
Sarah Nouriyengejeh1, Bahare Seyedhoseini2, Parastou Kordestani-Moghadam3, Ata Pourabbasi2
1 Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
2 Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
3 Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
|Date of Submission||14-Jan-2020|
|Date of Acceptance||20-Jun-2020|
|Date of Web Publication||30-Oct-2020|
Dr. Ata Pourabbasi
Ground Floor, EMRI Central Building, Al-E-Ahmad Hyw., Tehran
Source of Support: None, Conflict of Interest: None
Metabolic indices are the wide range of characteristic factors, which can be changed during several medical conditions such as metabolic syndrome. Nutrition and related behaviors are one of the main aspects of human lifestyle which recent investigations have recognized their roles in the development of metabolic disorders. According to the spread of risky nutritional habits/behaviors due to the changes in lifestyle, and its importance in the prevalence of metabolic disorders, the authors attempted to summarize these evidences in a systematic review. The present study is a systematic review that encompasses those studies investigating the association between metabolic indices and nutritional/dietary behaviors published in two international databases in recent 11 years. Twenty-nine related articles were considered and their data were extracted. The relation between food choices and metabolic indices is more frequent in studies. While, inhibition and abstinent and eating together were two behavioral sets with the smallest share of research. Anthropometric indices have the highest rate in the evaluations. Finding the links between nutritional behavior and metabolic indices will be the key point in selecting the different types of interventions. These results will guide therapists to the accurate recognition of metabolic effects in targeting behavior for their intervention.
Keywords: Behavior, feeding behavior, metabolism, nutrition assessment
|How to cite this article:|
Nouriyengejeh S, Seyedhoseini B, Kordestani-Moghadam P, Pourabbasi A. The study of relationship between nutritional behaviors and metabolic indices: A systematic review. Adv Biomed Res 2020;9:66
|How to cite this URL:|
Nouriyengejeh S, Seyedhoseini B, Kordestani-Moghadam P, Pourabbasi A. The study of relationship between nutritional behaviors and metabolic indices: A systematic review. Adv Biomed Res [serial online] 2020 [cited 2021 Mar 1];9:66. Available from: https://www.advbiores.net/text.asp?2020/9/1/66/299501
| Introduction|| |
Metabolic indices are the wide range of characteristic factors, which can be changed during several medical conditions. Metabolic syndrome (MetS) as the main metabolic disorder with impaired metabolic indices is a set of signs and symptoms, including abdominal obesity, glucose intolerance, high blood pressure, and dyslipidemia, in which the insulin resistance is the most common pathophysiologic characteristic. In addition, MetS is one of the most important diseases with metabolic changes and the high proportion of research work on it. More than 1 per 3 American adults involve in MetS. The prevalence of MetS among Middle East countries is reported up to 63%, according to some national surveys.,, Regarding these studies, MetS is also correlated with the risk of other diseases, such as type II diabetes and cardiovascular diseases.,,
Recent investigations have recognized the role of lifestyle in the development of chronic diseases such as diabetes and MetS. Nutrition and related behaviors are one of the main aspects of human lifestyle whose effects on metabolic indices have been shown in studies.,,,, For instance, some researches have demonstrated that a healthy diet is associated with a decline in the prevalence of MetS.,,,, Furthermore, the effect of emotional eating disorders on the weight control and its significant role in the development of MetS has been proven.,,, In fact, the “eating until feeling full” and “fast eating” are two abnormal habits, which are in relation with high blood pressure, impaired lipid profiles, and fatty liver. As well as, evidences on behaviors such as the type of food and the number of daily meals, especially breakfast, demonstrate their association with metabolic indices.,
A closer look on the studies conducted so far reveals that nutritional issues and their metabolic correlates include the wide range of topics, such as nutritional habits, eating patterns, and food content; among them, the nutritional habits – metabolic axis – is the point of interest in recent years.,,,
According to the spread of risky nutritional habits/behaviors due to the changes in lifestyle, and its importance in changing metabolic indices and consequently the prevalence of metabolic disorders, the authors attempted to summarize these evidences by designing and running a systematic review to provide a general overview in this regard. Regarding the fact that the authors could not find the comprehensive research in this field, it seems that the current study could gather the results of existing research and show a future horizon for the next studies.
| Materials and Methods|| |
The present study is a systematic review that encompasses those studies investigating the association between metabolic indices and nutritional/dietary behaviors as the following.
Two valid databases, PubMed and Scopus, were searched using key words including Dietary, Eating, Nutrition, Habit, Behavior, and a combination of them to identify studies conducted until September 2019. The articles were limited to those human studies published in English since 2008. It should be noted that only original studies were included in the current research.
After reading the titles, the articles were categorized as relevant and nonrelevant by two researchers, according to study objectives. The relevant ones were read in their full text in order to data extraction.
Followed by determining the relevant studies in terms of titles and abstracts, the researchers used the STROBE checklist (i.e., strengthening the reporting of observational studies in epidemiology) which is a standard checklist to evaluate the selected papers. Articles given at least score 40 points according to the checklist questions were entered into the research.
All articles were further evaluated in terms of the behaviors and metabolic indices. All data including title, year of publication, samples, measurements, measurement tools, and main findings of the selected papers were extracted and categorized in the form of a table.
| Results|| |
Totally, the 11,174 articles were found in initial search. Nearly 4511 articles were duplicates, and 6627 articles served as irrelevant after the evaluation. Finally, 34 related articles were considered and their data were extracted. A summary of the data of these papers is summarized in [Figure 1]. The five full texts were not available, so E-mails were sent to their authors to request the full text. Four authors did not respond after 2 weeks, but because of the lack of papers in this area, we tried to extract data from the abstracts in their full capacity.
|Figure 1: The flowchart shows the process of searching and selecting articles for the review|
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In the end, in all of these 34 remaining studies, 47 behavioral codes and 83 metabolic indices were measured in participants. The data extracted from these articles are shown in [Table 1].
|Table 1: Data extracted from selected articles, including: authors, year of publication, title, study participants, measurements, tools, and main findings|
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Behavioral codes extracting from the studies were classified and identified into eight categories by an expert panel including food choice, drinking habits, set meals, calorie intake, mindful eating, inhibition and abstinence, eating together, and food safety [Table 2]. Furthermore, the metabolic indices were classified into eight groups including protein and amino acid, glycemic profile, lipid profile, vital signs, anthropometric indices, hormones, diseases, and others by the same experts. These categorizations, mentioned in [Table 2], could help a better understanding of research trends on behavior-metabolic relations.
|Table 2: Subcategorized nutritional behaviors based on expert panel discussion|
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As shown in [Table 3], the relation between food choices and metabolic indices is more frequent in studies. While, inhibition and abstinent and eating together were two behavioral sets with the smallest share of research. Anthropometric indices have the highest rate in the evaluations, namely 11%–100% of studies assessed at least one anthropometric index. Food choice as one of the behavioral categories, with the highest relative frequency, gets 26% of anthropometric indices.
|Table 3: The absolute and relative frequency of metabolic indices measured in dietary/nutritional behavior categories|
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| Discussion|| |
In this study, the authors investigated all the 10-year relevant original articles in the field of nutrition/dietary behavior-metabolic axis. The literature overview shows that the majority of the researchers have focused on the nutritional contents and its other aspects such as nutritional/dietary behaviors, which can affect metabolic status, have been less considered.
Nutritional behaviors more relevant to the type of food choice behaviors such as eating fast food, cooking with available ingredients, meat-only diet, the consumption of crustaceans, and the family of Lobsters and crabs were placed in this category.
Several studies have focused on these behaviors and their metabolic effects. In some studies, healthy food choice was associated with a reduction in the risk of developing metabolic diseases and normal body mass index (BMI).,,, In a study by Ahn et al., the consumption of rice among 26,006 Korean volunteers was examined, and the results showed that rice consumption with green vegetables, especially in postmenopausal women, has a role in reducing the risk of developing MetS. However, there are some controversies in these relations. In a study done by Bloomer et al. on the Daniel's diet (rich in whole vegetables and fruits), no statistically significant reduction was shown on the oxidative stress.
The behaviors included in drinking category are nonalcoholic and alcoholic beverage intake, milk consumption, etc., These behaviors have been studied in five researches; withal mostly, their impact on lipid and glycemic profile was assessed.
For instance, Korean researchers conduct an investigation on adult women and found that the high levels of soft drink consumption can be important for the risk of Met. In another study conducted by Al-Haifi et al., the association of sweet and nonalcoholic beverages with BMI was examined, and the findings shows that controlling this behavioral pattern has a more effective role on BMI than physical activity.
The set of nutritional behaviors included the hours during a day spent on eating, the number of meals, eating breakfast or not, and so on, which have been considered as set meals. These behaviors and their impact on 34 metabolic indices related to protein and amino acid have been studied so far. Most of these researches show the positive effect of recommended proper set meals (e. g., eating all three daily meals, especially breakfast) on metabolic indices. Eating breakfast is one of the most effective behaviors, and there are several works in this issue.,,,, This behavior has a significant effect on the reduction of BMI and the risk of developing MetS. Furthermore, avoidance of eating breakfast, which increases insulin resistance, can also increase hunger and reduce the feeling of satiety., Thomas et al. detected that a short-term change in set meal habits would have a negative effect on metabolic indices. Beside, Alexandrove et al. led an investigation on 10–17 youths, and their work showed that eating breakfast (as a primer meal) could prevent obesity. In another study, it is found that eating habits (such as skipping or eating breakfast) have a greater impact on changes in body mass in contrast with physical activity.
The majority of the investigations focus on calorie intake. This behavior category consists of the total sugar, carbohydrate and fat consumption, and related topics. Studies in this area have found that controlling the input calorie can help to reduce harmful metabolic parameters.,, In these studies, the change in nutritional behaviors for the control of calorie intake would help to improve overall health. It also plays an important role in the regulation of intestinal microbes, which is theoretically related to the probability of developing future chronic diseases.
Mindful eating behavior is only addressed by three studies. This category involves fast eating, eating consciously (avoid doing something else while eating and being fully focused on eating) and eating emotionally. These studies have suggested that eating consciously as a behavior helps to reduce abdominal fat and metabolic risk factors as well as a great influence on the individual weight gain.,,
Food safety is another set of nutritional behaviors which only one research runs with this concept. This set of behaviors includes avoiding the hot food and the school cafeteria. The results showed a significant effect of these behaviors on the reduction of metabolic risk factors.
Inhibition and abstinent behaviors include habits that help the individual control their appetite and behaviors that somehow play a role in inhibitory functions. Hunger, dietary restraint, eating until feeling full, and external based (responding to exogenous stimuli), such as the smell and appearance of food, are among those behaviors that fall into this set. In studies that examined these behaviors, it has been observed that adopting a proper pattern of inhibition and abstinent has a significant effect on the reduction of the risk of metabolic diseases and their risk factors.,,
Eating together consists of several behaviors such as eating with friends, eating with family, sharing food, and eating in parties. Nevertheless, there are few evidences in this set of behaviors. In a study conducted by Choi et al., 29 participants with more than one metabolic risk factor were dining with others, and the participants were found to have a significant reduction in weight, wrist size, and BMI during 16 weeks. However, other interventions have been designed in addition to eating together in their study.,
It could be concluded that most of the studies have focused on investigating the association between food choices and anthropometric indices, and the least studies have been done on the relationship between the concentration of nutritional hormones and behaviors such as drinking and eating habits. Although it was expected that the association of calorie intake with all metabolic indices has been checked out, only half of the studies examined this nutritional behavior. The authors could not find more related literatures considering the associations of metabolic diseases and “making safe food choices” as well as “eating together” behaviors, and the association of inhibition and abstinent eating behaviors has been investigated in few studies. Furthermore, there is a dearth in research on glycemic, lipid, and amino acid profiles, and behaviors such as eating together and eating safe food (for example, refusing to consume hot foods) are among the areas that have been less explored by researchers.
| Conclusion|| |
Assessing the relation between nutritional behavior/eating habits and metabolic indices leads to new search fields in behavioral interventions. The essential goal in these interventions is to promote metabolic status and decrease metabolic disorder incidences. Accordingly, finding the links between nutritional behavior and metabolic indices will be the key point in selecting the different types of interventions. The results of these studies will guide therapists to the accurate recognition of metabolic effects in targeting behavior for their intervention. In addition, these results will be a proper field for boosting metabolic health.
Furthermore, detecting the relations between nutritional behaviors and metabolic indices will be a vital point for policymaking and designing social interventions. Finding these relations could prioritize the selected behaviors for interventions in population level. As may be expected, the selected behaviors for population-wide interventions should have the maximum effect on metabolic indices. In addition, the result will help to find the effective behaviors in this regard.
The authors acknowledge Mrs. Ghobadi and other staff of Endocrinology and Metabolism Research Institute for their nice cooperation in this project.
Financial support and sponsorship
The study was supported by Endocrinology and Metabolism Research Institute (grant no. 1396-02-98-2186), Tehran University of Medical Science.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]