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Lancet (London, England) Oct 2022Studies have suggested that evening dosing with antihypertensive therapy might have better outcomes than morning dosing. The Treatment in Morning versus Evening (TIME)... (Randomized Controlled Trial)
Randomized Controlled Trial
Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial.
BACKGROUND
Studies have suggested that evening dosing with antihypertensive therapy might have better outcomes than morning dosing. The Treatment in Morning versus Evening (TIME) study aimed to investigate whether evening dosing of usual antihypertensive medication improves major cardiovascular outcomes compared with morning dosing in patients with hypertension.
METHODS
The TIME study is a prospective, pragmatic, decentralised, parallel-group study in the UK, that recruited adults (aged ≥18 years) with hypertension and taking at least one antihypertensive medication. Eligible participants were randomly assigned (1:1), without restriction, stratification, or minimisation, to take all of their usual antihypertensive medications in either the morning (0600-1000 h) or in the evening (2000-0000 h). Participants were followed up for the composite primary endpoint of vascular death or hospitalisation for non-fatal myocardial infarction or non-fatal stroke. Endpoints were identified by participant report or record linkage to National Health Service datasets and were adjudicated by a committee masked to treatment allocation. The primary endpoint was assessed as the time to first occurrence of an event in the intention-to-treat population (ie, all participants randomly assigned to a treatment group). Safety was assessed in all participants who submitted at least one follow-up questionnaire. The study is registered with EudraCT (2011-001968-21) and ISRCTN (18157641), and is now complete.
FINDINGS
Between Dec 17, 2011, and June 5, 2018, 24 610 individuals were screened and 21 104 were randomly assigned to evening (n=10 503) or morning (n=10 601) dosing groups. Mean age at study entry was 65·1 years (SD 9·3); 12 136 (57·5%) participants were men; 8968 (42·5%) were women; 19 101 (90·5%) were White; 98 (0·5%) were Black, African, Caribbean, or Black British (ethnicity was not reported by 1637 [7·8%] participants); and 2725 (13·0%) had a previous cardiovascular disease. By the end of study follow-up (March 31, 2021), median follow-up was 5·2 years (IQR 4·9-5·7), and 529 (5·0%) of 10 503 participants assigned to evening treatment and 318 (3·0%) of 10 601 assigned to morning treatment had withdrawn from all follow-up. A primary endpoint event occurred in 362 (3·4%) participants assigned to evening treatment (0·69 events [95% CI 0·62-0·76] per 100 patient-years) and 390 (3·7%) assigned to morning treatment (0·72 events [95% CI 0·65-0·79] per 100 patient-years; unadjusted hazard ratio 0·95 [95% CI 0·83-1·10]; p=0·53). No safety concerns were identified.
INTERPRETATION
Evening dosing of usual antihypertensive medication was not different from morning dosing in terms of major cardiovascular outcomes. Patients can be advised that they can take their regular antihypertensive medications at a convenient time that minimises any undesirable effects.
FUNDING
British Heart Foundation.
Topics: Adult; Male; Humans; Female; Adolescent; Aged; Antihypertensive Agents; Prospective Studies; State Medicine; Time and Motion Studies; Treatment Outcome; Hypertension; Myocardial Infarction; United Kingdom
PubMed: 36240838
DOI: 10.1016/S0140-6736(22)01786-X -
Molecular Aspects of Medicine Oct 2020Iron deficiency and iron deficiency anemia (IDA) are major public health problems worldwide, especially in young women. Oral iron supplementation can be an effective... (Review)
Review
Iron deficiency and iron deficiency anemia (IDA) are major public health problems worldwide, especially in young women. Oral iron supplementation can be an effective strategy to treat and prevent IDA, but guidelines vary. Some experts recommend doses of 150-200 mg elemental iron per day, with the dose split through the day. However, recent studies suggest this may not be an optimal regimen. The fraction of iron absorbed from high doses of oral iron is low, and unabsorbed iron can cause gut irritation, inflammation and dysbiosis, and these reduce compliance. In recent studies using serum hepcidin profiles and stable iron isotopes to quantify iron absorption in young women, we have shown that: (a) oral iron doses ≥60 mg in iron-deficient women, and doses ≥100 mg in women with IDA, stimulate an acute increase in hepcidin that persists 24 h after the dose, but subsides by 48 h; (b) therefore, to maximize fractional iron absorption, oral doses ≥60 mg should be given on alternate days; (c) the circadian increase in plasma hepcidin is augmented by a morning iron dose; therefore, iron doses should not be given in the afternoon or evening after a morning dose. If rate of Hb response is important, a pooled analysis of our data done for this review indicates that total iron absorption is also higher if twice the target daily iron dose is given on alternate days. In summary, these studies suggest changing from daily to alternate-day schedules and from divided to morning single doses increases iron absorption and may reduce side effects. Thus, providing morning doses of 60-120 mg iron as a ferrous salt given with ascorbic acid on alternate days may be an optimal oral dosing regimen for women with iron-deficiency and mild IDA.
Topics: Anemia, Iron-Deficiency; Dietary Supplements; Female; Humans; Inflammation; Iron
PubMed: 32650997
DOI: 10.1016/j.mam.2020.100865 -
Cell Metabolism Oct 2022Morning loaded calorie intake in humans has been advocated as a dietary strategy to improve weight loss. This is also supported by animal studies suggesting time of... (Randomized Controlled Trial)
Randomized Controlled Trial
Morning loaded calorie intake in humans has been advocated as a dietary strategy to improve weight loss. This is also supported by animal studies suggesting time of eating can prevent weight gain. However, the underlying mechanisms through which timing of eating could promote weight loss in humans are unclear. In a randomized crossover trial (NCT03305237), 30 subjects with obesity/overweight underwent two 4-week calorie-restricted but isoenergetic weight loss diets, with morning loaded or evening loaded calories (45%:35%:20% versus 20%:35%:45% calories at breakfast, lunch, and dinner, respectively). We demonstrate no differences in total daily energy expenditure or resting metabolic rate related to the timing of calorie distribution, and no difference in weight loss. Participants consuming the morning loaded diet reported significantly lower hunger. Thus, morning loaded intake (big breakfast) may assist with compliance to weight loss regime through a greater suppression of appetite.
Topics: Animals; Appetite; Diet, Reducing; Energy Intake; Energy Metabolism; Healthy Volunteers; Humans; Hunger; Obesity; Weight Loss
PubMed: 36087576
DOI: 10.1016/j.cmet.2022.08.001 -
Scandinavian Journal of Work,... Jul 2019Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated...
Objectives Unhealthy dietary profiles contribute to the elevated risk of chronic diseases for shift workers. There has been limited investigation into factors associated both with shift work and diet, such as sleep and mood, that may further influence food intake among shift workers. The aim of this study was to explore the relationship between shift work, sleep, mood, and diet. Methods Shift working nurses [N=52; 46 female; age: mean 39.8 (SD 12.4) years] participated in a 14-day, repeated measures, within- and between-subjects design study. Analyses included data from 40 nurses over 181 shifts. Food diaries were completed for a minimum of three days per shift type (morning, afternoon, night). Foodworks nutrition software was used to determine energy intake in kilojoules and macronutrient intake (as a percentage of total energy intake). Mood (happiness, anxiety, depressive mood, stress, and tiredness) was measured using visual analog scales. Sleep was estimated using actigraphy. Demographic and work-related variables (covariates) were measured using a modified version of the Standard Shiftwork Index. A path analysis was conducted using generalized structural equation modelling with a random effect of participant ID. Predictors were selected using purposive selection of covariates (an alternative to stepwise modelling) and final models included important predictors only. Results Compared to night and morning shifts, results showed that working an afternoon shift was associated with a lower energy intake (β= -1659.4, P<0.01) and lower levels of stress (β= -5.6, P<0.01). Higher levels of stress were associated with a higher energy intake (β=35.3, P<0.01) and a higher percentage of fat (ß=0.1, P=0.05) and saturated fat (β=0.1, P<0.01). Compared to the other shift types, morning shift was associated with lower carbohydrates (β= -4.3, P<0.01) and night shift was associated with lower protein (β= -2.7, P=0.03). Lower sleep efficiency was associated with a higher carbohydrate intake (β= -0.4, P<0.01) and a lower protein intake (β=0.25, P<0.01) Conclusions Results suggest that compared to nights and mornings, afternoon shifts were associated with reduced energy consumption. Negative mood (stress, depression, and anxiety) mediated the association between shift type and energy intake. Negative mood was also associated with higher fat intake. Dietary interventions for shift workers should consider the role of mood as well as shift type.
Topics: Adult; Affect; Circadian Rhythm; Diet; Energy Intake; Fatigue; Female; Humans; Male; Middle Aged; Occupational Health; Occupational Stress; Shift Work Schedule; Sleep; Socioeconomic Factors
PubMed: 30806474
DOI: 10.5271/sjweh.3803 -
CMAJ : Canadian Medical Association... May 2024
PubMed: 38719216
DOI: 10.1503/cmaj.230784 -
The American Journal of Clinical... Nov 2020Poor dietary choices may underlie known associations between having an evening diurnal preference and cardiometabolic diseases. Assessing causal links between diurnal...
BACKGROUND
Poor dietary choices may underlie known associations between having an evening diurnal preference and cardiometabolic diseases. Assessing causal links between diurnal preference and food intake is now possible in Mendelian randomization (MR) analyses.
OBJECTIVES
We aimed to use a 2-sample MR to determine potential causal effects of genetic liability to a morning preference on food intake. We also examined potential causal effects of a morning preference on objectively captured response performances to email-administered 24-h diet recalls.
METHODS
We used genetic variants associated with a morning preference from a published genome-wide association meta-analysis. Our outcomes included 61 food items with estimates from a food-frequency questionnaire in the UK Biobank (n = 361,194). For significant findings, we repeated the analysis using intake estimates from modified 24-h diet recalls in a subset of overlapping participants (n = 146,086). In addition, we examined 7 response performance outcomes, including the time and duration of responses to 24-h diet recalls (n = 123,035). MR effects were estimated using an inverse-variance weighted analysis.
RESULTS
Genetic liability to a morning preference was associated with increased intake of 6 food items (fresh fruit, alcohol with meals, bran cereal, cereals, dried fruit, and water), decreased intake of 4 food items (beer plus cider, processed meat, other cereals [e.g., corn or frosted flakes], and full cream milk), increased temperature of hot drinks, and decreased variation in diet (PFalse Discovery Rate < 0.05). There was no evidence for an effect on coffee or tea intake. Findings for fresh fruit, beer plus cider, bran cereal, and cereal were consistent when intakes were estimated by 24-h diet recalls (P < 0.05). We also identified potential causal links between a morning preference with earlier timing and a shorter duration for completing email-administered 24-h diet recalls.
CONCLUSIONS
Our findings provide evidence for a potentially causal effect of a morning preference with the increased intake of foods known to constitute a healthy diet, suggesting possible health benefits of adopting a more morning diurnal preference.
Topics: Adult; Circadian Rhythm; Diet; Diet Records; Eating; Feeding Behavior; Female; Genome-Wide Association Study; Humans; Male; Mendelian Randomization Analysis
PubMed: 32860398
DOI: 10.1093/ajcn/nqaa219 -
Frontiers in Endocrinology 2021Biochemically monitoring 21-hydroxylase deficiency (21-OHD) is challenging. Serum/blood 17-hydroxyprogesterone (17OHP) measurements are normally used for this purpose....
BACKGROUND
Biochemically monitoring 21-hydroxylase deficiency (21-OHD) is challenging. Serum/blood 17-hydroxyprogesterone (17OHP) measurements are normally used for this purpose. Urinary pregnanetriol (PT), a urinary metabolite of 17OHP, may also be used. Based on auxological data, we previously reported that the optimal first morning PT value fell in the range of 2.2-3.3 mg/gCr (95% confidence interval of the mean) and 0.59-6.0 mg/gCr (10 - 90 percentile) for monitoring 21-OHD treatment. No report thus far has directly compared the first morning urinary PT value with the 17OHP value at various times during the day.
OBJECTIVE
To explore the correlation between the first morning urinary PT value before glucocorticoid administration and the serum/blood 17OHP value at three time points, namely, before and two and four hours after glucocorticoid administration.
DESIGN
This was a prospective study done at two children's hospitals.
METHODS
In total, 25 patients with 21-OHD aged 3-25 years were recruited. Their urinary PT levels and 17OHP levels were measured for three days within a total period of one week. The first morning PT value was collected on all three days. Dried blood spots and serum were used to measure 17OHP.
RESULTS
The range for the first morning PT value for all the samples (n=69) was 0.10-56.1 mg/gCr. A significant, positive correlation was found between the first morning PT and 17OHP values before medication (r=0.87, p<0.01), and weaker correlation was observed between the first morning PT and 17OHP values after medication.
CONCLUSIONS
The first morning PT correlated more significantly with 17OHP before the morning medication. Measuring the first morning PT value may be more practical and useful for monitoring 21-OHD biochemically.
Topics: 17-alpha-Hydroxyprogesterone; Adolescent; Adrenal Hyperplasia, Congenital; Adult; Child; Child, Preschool; Humans; Pregnanetriol; Prospective Studies; Young Adult
PubMed: 35140686
DOI: 10.3389/fendo.2021.808254