>>WELCOME, I'M DEIDRE
O'NEIL, WORKSHOP COORDINATOR FOR
CHRONONUTRITION.
OUR WORKSHOP HOUSEKEEPING SIDE
IS AS FOLLOWS.
THIS WORKSHOP IS BEING RECORDED.
LOCATED ON THE TOOL BAR,
STAY OFF MUTE AND OFF CAMERA.
TYPE YOUR QUESTIONS IN THE Q&A,
MODERATORS WILL ANSWER.
THANK YOU AND WE'RE HAPPY TO
HAVE YOU TODAY.
NEXT SLIDE.
WE'RE GOING TO OPEN WITH OUR
WELCOME REMARKS, VALUE OF
NUTRITIONAL RESEARCH BY DR.
DAVID GOFF, NHLBI.
WELCOME, DR. GOFF.
>>THANK YOU.
IT'S A PLEASURE TO BE HERE.
I WANT TO START BY THANKING ALL
OF YOU FOR SPENDING TIME WITH US
DURING THIS WORKSHOP.
WE KNOW THAT THERE ARE MANY WAYS
THAT YOU CAN BE SPENDING THIS
TIME.
EVERYONE IS BUSY THESE DAYS.
WE'RE GRATEFUL ARE YOU CHOSE TO
SPEND SOME TIME WITH US AND WITH
EACH OTHER, TO HAVE THESE
DISCUSSIONS AND TO PROVIDE SOME
INPUT INTO HOW WE CAN MOVE THIS
FIELD FORWARD.
NEXT SLIDE PLEASE.
I WAS ASKED TO GIVE A FEW
THOUGHTS ABOUT THE -- HOW WE'RE
IMPLEMENTING THE STRATEGIC
VISION OF THE NATIONAL HEART,
LUNG AND BLOOD INSTITUTE IN THE
DIVISION OF CARDIOVASCULAR
SCIENCES, HOW TOPICS YOU'RE
DISCUSSING FEED INTO THAT
PROCESS.
SO I'LL START BY SAYING FIRST
THAT THIS MATERIAL REPRESENTS MY
OWN PERSONAL VIEWS ON THESE
ISSUES, AND DOES NOT NECESSARILY
REPRESENT THE OFFICIAL VIEWS OF
NHLBI AND NIH, HHS, AND U.S.
FEDERAL GOVERNMENT.
WITH THAT OUT OF THE WAY, WE CAN
MOVE TO THE NEXT SLIDE.
NEXT SLIDE PLEASE.
THANK YOU.
SO, IN 2016 NHLBI SHARED ITS
CURRENT STRATEGIC VISION WITH
THE BIOMEDICAL RESEARCH
COMMUNITY.
THIS WAS CREATED IN A PROCESS
THAT WAS HIGHLY ENGAGING WITH
THE BIOMEDICAL RESEARCH
COMMUNITY.
MANY OF YOU MAY HAVE
PARTICIPATED.
THOUSANDS OF SCIENTISTS AROUND
THE COUNTRY AND AROUND THE WORLD
CONTRIBUTED TO THE CROWDSOURCING
PLATFORM THAT RESULTED IN
DEVELOPMENT OF THIS VISION
DOCUMENT THAT HAS FOUR
OVERARCHING GOALS.
, TO UNDERSTAND HUMAN BIOLOGY,
REDUCE HUMAN DISEASE, ADVANCE
TRANSLATIONAL RESEARCH, AND
DEVELOP WORKFORCE AND RESOURCES.
AS YOU'LL SEE ON THE NEXT SLIDE
UNDER THESE FOUR GOALS WERE
EIGHT STRATEGIC OBJECTIVES.
AND I WON'T LIST THEM ALL FOR
YOU BUT I WILL POINT OUT SEVERAL
THAT ARE PARTICULARLY PERTINENT
TO TOPICS BEING DISCUSSED HERE.
THAT WOULD BE OBJECTIVE 4 ABOUT
ADVANCING PRECISION MEDICINE FOR
HEART LUNG BLOOD AND SLEEP
CONDITIONS.
NUMBER 6 WHICH HAS TO DO WITH
CLINICAL AND IMPLEMENTATION
SCIENCE.
AND CERTAINLY WE NEED MORE OF
THAT IN THE AREA OF NUTRITION
AND NUTRITION RESEARCH.
AS WELL AS POTENTIALLY SOMEWHAT
IN OTHER AREAS LIKE OBJECTIVE 5
WITH NOVEL THERAPEUTICS.
PRECISION NUTRITION IS ALSO
RELATED TO THE CONCEPT OF
POPULATION DIFFERENCES, WHICH IS
RELATED TO OBJECTIVE 3.
NOW, THE OTHER THING YOU'LL
NOTICE ON THIS SLIDE PERHAPS IS
THAT THESE STRATEGIC OBJECTIVES
ARE SOMEWHAT DISEASE AGNOSTIC,
WHICH IS PERHAPS NOT SURPRISING
FOR AN INSTITUTE THAT COVERS A
FAIRLY BROAD RANGE OF
RESPONSIBILITY ACROSS HEART,
LUNG, BLOOD, SLEEP DISORDERS.
AND SO WHEN I GOT TO THE
INSTITUTE IN 2016, DR. GIBBONS
ASKED ME TO HELP LEAD OUR
DIVISION THROUGH A PROCESS OF
DEVELOPING A STRATEGIC VISION
IMPLEMENTATION PLAN, BECAUSE AS
THEY SAY A VISION WITHOUT A PLAN
IS JUST A DREAM.
OF COURSE A PLAN WITHOUT VISION
IS A NIGHTMARE.
WE HAD OUR VISION STATEMENT.
AND EVEN UNDER THESE EIGHT
OBJECTIVES THERE WERE WELL OVER
100 CRITICAL QUESTIONS AND
CHALLENGES THAT HAD BEEN
IDENTIFIED.
SO IF YOU WOULD LIKE SOME
READING MATERIAL, YOU CAN GO
ONLINE, DOWNLOAD THE STRATEGIC
VISION DOCUMENT AND TAKE A LOOK
AT COMPELLING QUESTIONS AND
CRITICAL CHALLENGES.
NEXT SLIDE PLEASE.
SO WITHIN THE -- WE MIGHT HAVE
SKIPPED A SLIDE.
SOMETHING MUST HAVE GOTTEN
HIDDEN.
I'LL JUST MENTION WHEN WE
STARTED THE PROCESS OF
DEVELOPING STRATEGIC VISION
IMPLEMENTATION PLAN, THE FIRST
THING WE DID WAS A LANDSCAPE AS
A COUNTRY, AND THIS SLIDE
DEPICTS THAT AT THE TIME WE WERE
DEVELOPING OUR IMPLEMENTATION
PLAN BACK IN 2017.
SO THE LEFT-HAND PANEL SHOWS
AFTER DECADES OF DECLINE IN
DEATH RATES FROM CORONARY
DISEASE IN THE U.S., WE HAD
ENTERED A PERIOD OF STAGNATION,
BEGINNING IN ABOUT 2010.
THIS IS HOW THE DATA LOOKED WHEN
WE LOOKED IN 2017.
AND EVEN IF YOU LOOK MORE
RECENTLY, THIS STAGNATION
CONTINUES.
WE'RE NO LONGER SEEING PROGRESS
OR SUBSTANTIAL REDUCTIONS IN
DEATH RATES FROM CORONARY
DISEASE AND HEART DISEASE IN
GENERAL.
IN ADDITION TO STAGNATION WE SAW
PERSISTENT DISPARITIES.
IN THE MIDDLE PANEL, IT SHOWS
DISPARITIES BY RACE AND
ETHNICITY FOR ISCHEMIC HEART
DISEASE AND HEART FAILURE.
THE RIGHT-HAND PANEL SHOWS
DISPARITIES BY GEOGRAPHY IN THE
U.S.
AND I REAL WANT TO CALL YOUR
ATTENTION TO THE LEGEND FOR THAT
FIGURE.
BECAUSE IT'S IMPORTANT TO HAVE
AN IDEA OF HOW BIG THESE
DIFFERENCES ARE.
THE COUNTIES COLORED RED HAVE
THE HIGHEST RATES OF
AGE-ADJUSTED CARDIOVASCULAR
MORTALITY.
THE COUNTIES COLORED BLUE HAVE
LOWEST RATES.
AND OF COURSE, ONE CAN ALWAYS
RANK COUNTIES SO THE QUESTION
HERE IS ARE THESE DIFFERENCES
MEANINGFUL.
IF YOU ARE ABLE TO SEE THE
LEGEND, DOWN AT THE BLUE END OF
THE SPECTRUM, THE ANNUAL
MORTALITY RATES ARE SOMEWHERE
AROUND 100, 100,000 PEOPLE.
THAT'S 100 PER 100,000 PEOPLE.
AT THE HIGH END, THE COUNTIES
THAT ARE COLORED DARK RED DEATH
RATE IS AROUND 500 PER 100,000
PEOPLE.
THAT'S A RELATIVE RANGE OF
FIVE-FOLD DIFFERENCE IN
AGE-ADJUSTED CARDIOVASCULAR
DISEASE MORTALITY ACROSS
COUNTIES IN THE UNITED STATES.
WE'RE NOT COMPARING LOW INCOME
AND HIGH-INCOME COUNTRIES WHERE
YOU MIGHT EXPECT TO SEE THIS
KIND OF RANGE OF DIFFERENCE.
BUT WE'RE SEEING THAT HERE IN
THE U.S. ACROSS COUNTIES WITH
STARKLY DIFFERENT MORTALITY
RATES FOR CARDIOVASCULAR
DISEASE.
AND IF YOU LOOK AT OTHER
PATTERNS, CHRONIC OBSTRUCTIVE
PULMONARY DISEASE IS SIMILAR,
POVERTY IS HIGHLY CORRELATED.
WE SEE AROUND 20 AFTER DECADES
OF PROGRESS HAD STAGNATION AND
DISPARITIES.
CLICK PLEASE.
WHAT WE ADOPTED WAS A RENEWED
COMMITMENT TO THE MISSION OF
TURNING DISCOVERY INTO
CARDIOVASCULAR HEALTH, WITH THE
GOALS OF REIGNITING DECLINE IN
CARDIOVASCULAR DISEASE MORTALITY
FOR WHICH WE HAD STAGNATION.
AND CLOSING THE EQUITY GAP IN
CARDIOVASCULAR DISEASE AND
CARDIOVASCULAR HEALTH.
THAT WOULD DRIVE OUR STRATEGIC
VISION IMPLEMENTATION PLAN.
NEXT SLIDE PLEASE.
THROUGH A PROCESS THAT ENGAGED
EXTERNAL STAKEHOLDERS AND A LOT
OF DISCUSSION INTERNALLY AS WELL
WE IDENTIFIED SIX PILLARS OF OUR
STRATEGIC VISION IMPLEMENTATION
PLAN PUBLISHED IN CIRCULATION
RESEARCH BACK IN 2019.
IT'S THE FIRST SIX BULLETS IN
THE LEFT-HAND COLUMN THAT ARE
THE PILLARS OF THE DCDS
STRATEGIC VISION IMPLEMENTATION
PLAN, THE FIRST ADDRESSING
SOCIAL DETERMINANTS OF
CARDIOVASCULAR HEALTH AND HEALTH
INEQUITIES, THE ROOT CAUSES OF
CARDIOVASCULAR DISEASE AND OTHER
CONDITIONS.
IT'S ADDRESSING, NOT OBSERVING
OR UNDERSTANDING.
WE'VE BEEN DOING THAT A LONG
TIME.
IT'S TIME TO GET ON WITH THE
WORK, TESTING APPROACHES TO
IMPROVE SOCIAL DETERMINANTS OR
MITIGATE THE IMPACT OF SOCIAL
DETERMINANTS ON CARDIOVASCULAR
HEALTH AND OTHER CONDITIONS.
ENHANCING AND UNDERSTANDING
RESILIENCE SO WE CAN LEVERAGE
KNOWLEDGE TO HELP PEOPLE DO
BETTER DESPITE ADVERSE
ENVIRONMENTS WE LIVE IN.
PROMOTING CARDIOVASCULAR HEALTH
ACROSS THE LIFESPAN, AS THEY SAY
FROM THE TWINKLE TO THE WRINKLE.
ELIMINATING HYPERTENSION-RELATED
CARDIOVASCULAR DISEASE.
HYPERTENSION IS THE LEADING
CAUSE OF DEATH AND DISABILITY ON
OUR PLANET, ACCORDING TO THE
GLOBAL BURDEN OF DISEASE
CONSORTIUM.
REDUCING BURDEN OF HEART
FAILURE, WHICH IS A CHALLENGE,
ESPECIALLY HEART FAILURE WITH
PRESERVED EJECTION FRACTION WITH
FEW EFFECTIVE THERAPIES AND
PREVENTING VASCULAR DEMENTIA,
WE'RE WOEFULLY NOT PREPARED TO
CONFRONT IN THE COMING DECADES.
I WOULD PROPOSE NUTRITION AND
DIET, HEALTHY DIET, IS CRITICAL
IN EVERY ONE OF THESE PILLARS
THAT WE HAVE AS MAJOR AREAS OF
FOCUS WITHIN OUR STRATEGIC
VISION IMPLEMENTATION.
IF I HAD MORE TIME COULD GO INTO
DETAIL.
WE'VE PUBLISHED AN UPDATE WITH
IMPLEMENTATION PLAN, THAT WAS
PUBLISHED IN CIRCULATION
RESEARCH JUST THIS PAST YEAR.
BOTH THOSE CITATIONS ARE ON THE
SLIDES THAT ARE MADE AVAILABLE
TO YOU.
OF COURSE IN ADDITION TO WHAT
WE'RE DOING IN THE DIVISION
WE'RE HIGHLY ENGAGED IN THE
STRATEGIC PRIORITIES OF THE
INSTITUTE OVERALL.
WHICH INCLUDE WORKFORCE
DEVELOPMENT, PRECISION MEDICINE,
DATA SCIENCE, HIV RESEARCH,
CLIMATE AND HEALTH RESEARCH, AND
COVID RESEARCH.
NEXT SLIDE PLEASE.
I MENTIONED NUTRITION PLAYS A
CRITICAL ROLE IN MANY AREAS,
WE'VE BEEN ACTIVE IN SUPPORTING
EFFORTS IN THIS AREA.
THIS SHOWS A COUPLE RECENT
PUBLICATIONS THAT FOCUS ON
RESEARCH OPPORTUNITIES IN THE
AREAS OF NUTRITION RESEARCH
RELEVANT FOR HEART, LUNG, BLOOD
AND SLEEP CONDITIONS.
IN PARTICULAR RELATED TO CONCEPT
OF PRECISION NUTRITION RESEARCH.
THE IDEA THAT INDIVIDUALS MAY
DIFFER IN THEIR NUTRITIONAL
NEEDS AND RESPONSES TO
NUTRITIONAL INTERVENTIONS.
NEXT SLIDE.
I HOPE I'VE IMPRESSED UPON YOU
CRITICAL NATURE OF THE WORK THAT
YOU'RE DOING IN THE AREA YOU'RE
DISCUSSING TO THESE STRATEGIC
VISION OF THE INSTITUTE AND
DIVISION AND TO OUR PLANS FOR
MOVING FORWARD TO IMPLEMENT THAT
VISION.
YESTERDAY IN YOUR DISCUSSIONS
YOU DISCUSSED THE CONCEPTS POOR
SLEEP AND CIRCADIAN
MISALIGNMENT, ASSOCIATED WITH
RISK AND BECOMING OVERWEIGHT AND
OBESE, THAT SLEEP LOSS
INFLUENCES HUNGER AND APPETITE,
AND PROMOTES FOOD INTAKE AND
PROBABLY UNHEALTHY FOOD INTAKE.
LATER EATING TIME AND GREATER
CALORIC INTAKE IN THE EVENING
CAN INCREASE RISK OF
CARDIOMETABOLIC CONDITIONS.
THIS REMINDS ME OF SOMETHING
ATTRIBUTED TO I THINK ADELE
DAVIS THAT ONE SHOULD EAT
BREAKFAST LIKE A KING, LUNCH
LIKE A PRINCE, DINNER LIKE A
PAUPER.
YOU'VE ALL HEARD THAT.
IN THE U.S. WE HAVE OUR LARGEST
MEAL AT THE END OF THE DAY AND
SOME PEOPLE SKIP BREAKFAST ON
THEIR WAY OUT THE DOOR AND DRINK
A CUP OF COFFEE OR SOMETHING.
SO REBALANCING OUR APPROACH TO
FOOD OVER THE COURSE OF THE MAY
BE HELPFUL SO CIRCADIAN TIMING
CAN POTENTIALLY BE QUITE HELPFUL
IN THAT RESPECT.
AND YOU ALSO IDENTIFIED
CHALLENGES AND OPPORTUNITIES TO
MOVE THE WHOLE FIELD OF
CHRONONUTRITION FURTHER INTO
CLINICAL PRACTICE THROUGH
TRANSLATION RESEARCH AND
IMPLEMENTATION SCIENCE.
I'M EXCITED ABOUT WHAT YOU'VE
DONE, LOOKING FORWARD TO THE
DISCUSSIONS THAT WE'LL BE HAVING
TODAY, LOOK FORWARD TO YOUR
INPUT.
WE'LL TAKE IT VERY SERIOUSLY.
IT REALLY WILL HELP DIED OUR
STRATEGIC INITIATIVES GOING
FORWARD.
AND I'LL PASS THE BATON BACK TO
THE WORKSHOP ORGANIZERS.
THANK YOU.
>>THANK YOU SO MUCH, DR. GOFF.
MY NAME IS KAREN GAMBLE.
IF YOU MISSED THE DAY 12 FROM
YESTERDAY, I'M ONE OF THE
CO-CHAIRS OF THE WORKSHOP ALONG
WITH DR. MARIE-PIERRE ST-ONGE.
I WANTED TO DO A QUICK
FIVE-MINUTE RECAP OF WHAT WE
LEARNED YESTERDAY.
SO I WILL SHARE MY SLIDES VERY
QUICKLY.
OKAY.
GETTING INTO OUR DAY 1 RECAP,
THE FIRST THING WE DID
YESTERDAY, WE HEARD A GREAT
KEYNOTE ON STATE OF
CHRONONUTRITION SCIENCE AND
OPPORTUNITIES TO ADVANCE THE
FIELD.
AND ONE OF THE HIGHLIGHTS THAT
WE HEARD ABOUT IS THE IMPORTANCE
OF FOOD TIMING ASSESSMENT ACROSS
ALL COHORT STUDIES EVEN ON
CIRCADIAN STUDIES.
I'M NOT GOING TO DELVE INTO
THESE BULLET POINTS BECAUSE WE
WILL SHOW THESE POINTS AGAIN
LATER IN THE DAY WHEN WE
SYNTHESIZE ALL THE INFORMATION
FROM YESTERDAY AND TODAY.
SO BEAR WITH ME.
THERE MAY BE A LOT OF
INFORMATION ON THIS SLIDE BUT
YOU'LL HAVE ACCESS TO IT LATER.
SECONDLY, WE LEARNED ABOUT THE
IMPORTANCE AND OPPORTUNITIES FOR
HAVING THIS MULTI-DIMENSIONAL
CIRCADIAN SCORE, LOOKING AT
ENDPOINTS AND BIOMARKERS.
AND ALONG WITH THAT, IT'S
IMPORTANT TO CONSIDER GENETICS.
THERE ARE A LOT OF
CIRCADIAN-RELATED GENES AND
POLYMORPHISMS THAT NEED TO BE
TAKEN INTO CONSIDERATION WITH
RESPECT TO FOOD TIMING.
NEXT WE STARTED OUR FIRST
SESSION ON THE BASIC
TRANSLATIONAL RESEARCH.
WE DISCUSSED IMPORTANT POINTS
SUCH AS DIFFERENCE BETWEEN
EFFECTS ON PERIPHERAL CLOCKS
VERSUS LACK OF EFFECT OR LACK OF
LARGER EFFECT ON CENTRAL CLOCK.
AND WE ALSO DISCUSSED CERTAIN
RISK FACTORS FOR OBESITY AND
DIABETES, INCLUDING SLEEP AND
CIRCADIAN DISRUPTION.
WE TALKED ABOUT HOW INSUFFICIENT
SLEEP OR SLEEP RESTRICTION CAN
AFFECT A LOT OF METABOLIC
PATHWAYS AFFECTED BY MEAL
TIMING.
FINALLY WE TALKED ABOUT
OPPORTUNITIES FOR
COUNTER-MEASURES TO SORT OF
REAMELIORATE CIRCADIAN
MISALIGNMENT BY IMPROPERLY
RESTRICTED TIME RESTRICTED
EATING AND IMPORTANT ECOLOGICAL
STUDIES IN THE FUTURE IN ORDER
TO ADDRESS THIS INCREASE IN
PREVALENCE OF OBESITY THAT YOU
JUST HEARD DR. GOFF TALK ABOUT.
AND THEN WE NEED MORE STUDIES
LOOKING AT UNDERLYING MECHANISMS
FOR HOW SLEEP RESTRICTION IS
LINKED TO CALORIC INTAKE.
FINALLY, IN SESSION 1 WE TALKED
ABOUT IMPORTANCE OF EXERCISE,
SINCE THE MUSCLE IS AN IMPORTANT
METABOLIC REGULATOR IN OUR
BODIES, AND EXERCISE AND THE
MUSCLES ARE ALSO VERY ATTUNED TO
THE TIMING OF FOOD INTAKE AND
NUTRITION.
ON SESSION 2, MEAL TIMING,
EATING PATTERNS AND HUMAN HEALTH
OUTCOMES, WE TALKED ABOUT HOW
THIS IDEA A CALORIE IS A CALORIE
IS PROBABLY NOT CORRECT AND
MACRONUTRIENTS AND TIMING ARE
REALLY IMPORTANT.
WE TALKED ABOUT HOW IN THE FIELD
THERE'S BEEN AN INCREASE IN
INTEREST IN THIS TOPIC AREA.
AS MORE PEOPLE ARE JUMPING IN TO
FIGURE OUT DIRECTIONS AND
UNDERLYING IMPLICATIONS, WE'VE
GOTTEN SORT OF A LOT OF VARIETY
OF DIFFERENT DEFINITIONS AND
TERMINOLOGY AND NEED TO DEFINE
THINGS BETTER.
THERE'S SORT OF A WHOLE LIST OF
THINGS THAT WE CAN DO BETTER IN
THIS AREA.
FINALLY IT'S IMPORTANT TO
CONSIDER INTERACTIONS BECAUSE AT
THE END OF THE DAY THIS IS A
MULTI-DISCIPLINARY FIELD.
THERE'S A LOT OF CROSS-TALK
BETWEEN ORGAN SYSTEMS AND THAT
IS DUE TO FACTORS INTRINSIC AND
BIOLOGICAL, TO THINGS OUTSIDE
THAT ARE EITHER ENVIRONMENTAL OR
BEHAVIORAL, AND THERE ARE ALSO
INTERACTIONS WITH THINGS LIKE
OTHER DRUGS AND
PHARMACODYNAMICS.
FINALLY WE SHOULD CONTINUE THAT
MAYBE THE VARIABILITY THAT WE
SEE IN MEAL TIMING MAY BE
IMPORTANT TO CONSIDER AND MEAL
TIMING REGULARITY IS REALLY
IMPORTANT.
SO, THAT WRAPS UP FROM SESSION 1
AND 2, KEYNOTE FROM DAY 1.
WE LEARNED A LOT.
WE'RE REALLY EXCITED TO MOVE ON
TO DAY 2.
SO I'M GOING TO TURN IT OVER TO
MY CO-CHAIR TO INTRODUCE OUR
NEXT SPEAKER.
>>THANK YOU, KAREN, FOR THE
GREAT OVERVIEW OF YESTERDAY'S
SESSION.
IT'S MY PLEASURE TO INTRODUCE
OUR NEXT FEW SPEAKERS, TALKING
ON RESEARCH RESEARCH PRIORITIEM
FEDERAL PARTNERS.
DR. CHRISTOPHER LYNCH COMPLETED
HIS PhD at northwestern,
during his tenure at Penn State
he co-chaired the nutrition task
force for curriculum.
HE SERVED AS EXECUTIVE SECRETARY
OF THE RESEARCH TASK FORCE,
WHICH DEVELOPED THE FIRST EVER
STRATEGIC PLAN FOR NIH NUTRITION
RESEARCH AND SET UP 7 WORK
GROUPS TO GUIDE IMPLEMENTATION.
HE LED EFFORTS TO DEVELOP A
COMMON FUND PROJECT IN 2020,
NUTRITION FOR PRECISION HEALTH,
POWERED BY THE "ALL OF US"
PROGRAM, THE FIRST ANCILLARY
STUDY NESTED IN "ALL OF US."
IN 2021, DR. LYNCH WAS APPOINTED
BY FRANCIS COLLINS AS THE ACTING
DIRECTOR OF NIH OFFICE OF
NUTRITION RESEARCH, AND WE'RE
VERY HAPPY TO HAVE HIM SPEAK
TODAY ABOUT THE OFFICE OF
NUTRITION RESEARCH STRATEGIC FOR
NUTRITION RESEARCH.
>>THANKS VERY MUCH.
DO YOU HAVE MY SLIDES?
DO YOU WANT ME TO SHARE THEM?
VERY GOOD.
YEAH, I'M GOING TO TALK ABOUT
THE NIH OFFICE OF NUTRITION
RESEARCH AND STRATEGIC PLAN FOR
NIH NUTRITION RESEARCH AND I
APPRECIATE THE ORGANIZERS FOR
INVITING ME.
NEXT SLIDE.
SO AS MARIE MENTIONED, OUR
OFFICE WAS A NEW OFFICE,
NUTRITION RESEARCH, TO PROMOTE
HEALTH, AND TO REDUCE BURDEN OF
DIET-RELATED DISEASES AND
NUTRITION HEALTH DISPARITIES.
NEXT SLIDE.
AS SHE MENTIONED, WE
COLLABORATIVELY DEVELOPED A
TRANS-NIH STRATEGIC PLAN FOR NIH
NUTRITION RESEARCH, WHICH HAS A
UNIFYING VISION OF PRECISION
NUTRITION.
ONE CLICK AND IT WILL SHIFT THAT
BOOK COVER OVER.
THANK YOU.
AND SO IT HAS FOUR STRATEGIC
OBJECTIVES.
FIRST IS DISCOVERY AND INVASION
THROUGH RESEARCH, WHAT DO WE EAT
AND HOW DOES IT AFFECT US?
THE SECOND ONE THAT HAS THE
FOCUS IN THE CHRONONUTRITION
AREA, THAT'S TO INVESTIGATE THE
ROLE OF DIETARY PATTERNS AND
BEHAVIORS FOR OPTIMAL HEALTH,
WHAT AND WHEN SHOULD WE EAT?
SO THIS PART OF THE PLAN, YOU
KNOW, LOOKS AT NOT ONLY
FOOD-BASED DIETARY PATTERNS BUT
ALSO OTHER KINDS OF DIETARY
PATTERNS SUCH AS WHEN WE EAT AND
WHO WE EAT WITH, AND THOSE KINDS
OF BEHAVIORS.
WE HAVE ANOTHER ONE ON DEFINING
ROLE OF NUTRITION ACROSS THE
LIFESPAN.
AND THEN A FOURTH ONE ON
REDUCING THE BURDEN OF DISEASE
IN CLINICAL SETTINGS, HOW CAN WE
IMPROVE THE USE OF FOOD AS
MEDICINE, WHICH IS A VERY
POPULAR TOPIC RECENTLY.
AND CAN I HAVE THE NEXT SLIDE.
WE HAVE A NUMBER OF
CROSS-CUTTING RESEARCH AREAS,
MINORITY HEALTH AND HEALTH
DISPARITIES, HEALTH OF WOMEN,
RIGOR AND REPRODUCIBILITY, DATA
SCIENCE, SYSTEM SCIENCE, AND
ARTIFICIAL INTELLIGENCE.
AND THEN TRAINING THE SCIENTIFIC
WORKFORCE.
NEXT SLIDE PLEASE.
TO CARRY OUT THIS STRATEGIC PLAN
WE ORIGINALLY STOOD UP SEVEN
IMPLEMENTATION WORKING GROUPS
THAT FOCUSED ON DIFFERENT TOPIC
AREAS.
CAN YOU JUST DO ONE CLICK FOR ME
PLEASE.
AND WE RECENTLY STOOD UP ANOTHER
ONE ON INCREASING DIVERSITY,
EQUITY, INCLUSION, AND
ACCESSIBILITY IN THE NUTRITION
WORKFORCE, BOTH NUTRITION
SCIENCE WORKFORCE, ALSO IN THE
AREA OF, YOU KNOW, THE OTHER
PARTS OF THE NUTRITION
PROFESSIONALS.
NEXT SLIDE.
AND SO I'M GOING TO TALK IN THE
NEXT FEW SLIDES ABOUT SOME OF
THE THINGS THAT WE ARE -- OUR
OFFICE IS WORKING ON.
OUR OFFICE WORKS WITH THE OTHER
INSTITUTES AND OFFICES TO
DEVELOP RESEARCH PROGRAMS, AND
THE FIRST ONE I THINK DOES HAVE
AN OPPORTUNITY FOR
CHRONONUTRITION.
THE GOAL IS NUTRITION FOR
PRECISION HEALTH POWERED BY THE
"ALL OF US" RESEARCH PROGRAM.
AND SO THE GOAL OF THIS IS TO
DEVELOP ALGORITHMS TO PREDICT
INDIVIDUAL RESPONSES TO FOODS
AND DIETARY PATTERNS USING
COMPREHENSIVE SET OF MICROBIOME,
GENOMIC, PHYSIOLOGIC, METABOLIC,
BEHAVIORAL, COGNITIVE,
CONTEXTUAL EHR SURVEY,
ENVIRONMENTAL DATA, LARGE AND
DIVERSE POPULATION OF
PARTICIPANTS.
CURRENTLY THIS PROGRAM RECENTLY
LAUNCHED, AND WE'RE AIMING TO
RECRUIT 10,000 PARTICIPANTS INTO
IT.
BUT ONE OF THE AREAS OF FOCUS
FOR THIS WILL BE SLEEP.
SLEEP AND NUTRITION.
WE'LL BE DOING A CAREFUL DIETARY
ASSESSMENT, WHEN PEOPLE EAT,
ALSO HAVING A LOT OF RECORDINGS
OF PEOPLE'S SLEEP PATTERNS.
NOW, THE -- REALLY THE NICE
THING ABOUT THIS STUDY, ABOUT
THE "ALL OF US" RESEARCH
PROGRAM, IS THEY NOT ONLY
DEVELOP PLANS TO RELEASE THEIR
DATA TO THEIR PARTICIPANTS, BUT
THE DATA IS OPEN ACCESS TO
ALMOST ANYBODY.
YOU JUST HAVE TO APPLY, FILL OUT
A FORM TO USE THE DATA.
BUT, YOU KNOW, YOU CAN GO THERE
NOW, THEY JUST RELEASED I THINK
ABOUT AT LEAST, YOU KNOW, MANY
THOUSANDS OF GENETIC RECORDS,
AND JUST GO THROUGH AND LOOK FOR
YOUR FAVORITE GENE OR SNP THAT'S
IN THERE AND YOU CAN SEE HOW
FREQUENT IT IS IN THE
POPULATION.
SO THE GREAT THING FOR US IN
GETTING INVOLVED WITH "ALL OF
US" IS THEY WERE ALREADY DOING
COMPLETE GENOMIC SEQUENCING ON
ALL PARTICIPANTS, A GREAT THING
FOR US.
THEY ARE -- WE ALREADY HAD
ACCESS TO A LOT OF OTHER SURVEY
DATA THAT THEY HAD ALREADY
PERFORMED, AND THEY HAVE A
LIVE -- MORE OR LESS LIVE
ELECTRONIC HEALTH RECORDS
UPDATED THREE TIMES A YEAR.
IT DOESN'T MATTER WHAT EHR
SYSTEM YOU'RE IN.
THEY ARE WORKING WITH SOME --
WITH ANOTHER TRANSACTIONAL
AUTHORITY WITH A GROUP THAT'S
SORT OF HARMONIZING THE
ELECTRONIC MEDICAL RECORDS
BETWEEN DIFFERENT PLATFORMS SO
THAT THEY CAN BE A.I.-ABLE, SO
WE CAN EASILY ANALYZE THEM.
THIS NPH STUDY IS MODULAR STUDY,
THE FIRST PART WILL EXAMINE
BASELINE DIET AND PHYSIOLOGIC
RESPONSE TO MEAL CHALLENGES.
WE'LL BE RECORDING SLEEP AND
TIME OF DAY FOOD IS CONSUMED,
INCLUDED.
ALL THE PEOPLE WILL GET A MIXED
MEAL TOLERANCE TEST AT THE END
WITH REPEATED BLOOD SAMPLES
BEING COLLECTED.
BUT WE'LL HAVE A LOT OF THIS
OTHER DATA.
THESE PEOPLE ARE ALREADY
ENROLLED IN "ALL OF US" SO WE'LL
HAVE ELECTRONIC HEALTH RECORD
DATA ON ALL OF THEM.
THEN THE PEOPLE CAN EITHER LEAVE
THE STUDY AT THAT POINT OR ENTER
MODULE 2 OR MODULE 3, IN BOTH OF
THOSE MODULES WE'LL BE EXAMINING
RESPONSES TO THREE SHORT-TERM,
THE LENGTH TIMED TO ALLOW
CHANGES IN THE BETA DIVERSITY OF
MICROBIOME WITH WASHOUT PERIODS,
PRESENTED WITH ANOTHER CHALLENGE
DIET AND ANOTHER CHALLENGE DIET.
AND EACH TIME THEY WILL BE
GETTING A MIXED MEAL TOLERANCE
TEST AT THE END.
SOME OF THIS WILL BE DONE IN
FREE LIVING CONTROL EATING
STUDIES WHERE THEY WILL COME IN
AND MAYBE HAVE BREAKFAST AND
LUNCH ON SITE.
AND THEN PACK THEM OUT THEIR
DINNER OR MEALS FOR THE WEEKEND.
AND THEN THE OTHER PART WILL BE
DONE IN A DOMICILED FEEDING
CENTERS, WHERE WE'LL BE ABLE TO
DO HIGHER LEVEL OF INTERVENTION
SUCH AS 24-HOUR URINE AND THINGS
LIKE THAT.
WE HAVE TWO GROUPS USING MACHINE
LEARNING AND ARTIFICIAL
INTELLIGENCE TO DEVELOP
PREDICTIVE ALGORITHMS AND
ADDRESS OTHER QUESTIONS THAT THE
CONSORTIUM COMES UP WITH.
AGAIN, THIS DATA IS GOING TO BE
FAIRLY AVAILABLE IF NOT OWNED BY
THE CONSORTIUM, IN THE
RESEARCHER'S WORKBENCH AT "ALL
OF US" FOR PEOPLE TO STUDY BUT
DOES REQUIRE, THEY HAVE A
PLATFORM THAT MAKES SOME DATA
VERY EASY TO USE BUT IF YOU WANT
TO ENTER SPECIFIC QUESTIONS YOU
TO HAVE BE ABLE TO USE R OR
JUPYTER NOTEBOOKS OR SOMETHING
LIKE THAT TO ACCESS THE DATA.
AND FOR THAT REASON, WE STARTED
LAST YEAR A TRAINING PROGRAM TO
TRY AND GET MORE WORKERS WHO CAN
USE THE KIND OF DATA THAT NHLBI
HAS, AND THAT DATA THAT'S IN
"ALL OF US" TO ANSWER QUESTIONS
THAT MIGHT BE ON THE REALM OF
HUMAN INTUITION.
WE RELEASED A TRAINING PROGRAM
ON ARTIFICIAL INTELLIGENCE FOR
PRECISION NUTRITION, TO START
TRAINING THE NEXT GENERATION OF
NUTRITION SCIENTISTS TO BE ABLE
TO USE BIG DATA SETS SUCH AS
TOPMed AND OTHER DATASETS THAT
THE COMMON FUND AND THIS NPH
STUDY AND ALL OF US HAS.
NEXT SLIDE.
ANOTHER AREA THAT WE'VE BEEN
WORKING IN, WE RELEASED A NOSI
WITH 16 INSTITUTES AND CENTERS
TO STIMULATE RESEARCH TO
UNDERSTAND AND ADDRESS HUNGER,
FOOD, AND NUTRITION SECURITY.
AND THIS IS TO SUPPORT NOVEL AND
INNOVATIVE STRATEGIES TO ADDRESS
NUTRITION INSECURITY AND ITS
EFFECTS ON HEALTH OUTCOMES.
AND THIS IS AN ONGOING -- THIS
NOSI IS STILL OPEN TO FUND
INVESTIGATOR-INITIATED IDEAS.
NEXT SLIDE.
ANOTHER AREA THAT WE'RE WORKING
ON, THAT YOU MAY BE SEEING ABOUT
IN THE NEWS AND THINGS IS FOOD
AS MEDICINE.
FOOD IS MEDICINE REFERS TO TO
THE PROVISION OF FOOD, BUT IT'S
AN ACTIVITY WHICH IS USUALLY
DONE IN THE CONTEXT OR WITH THE
NEXUS TO THE HEALTHCARE SYSTEM.
AND SO THE TYPE OF SERVICES THAT
THIS IS DESCRIBING ARE THINGS
LIKE MEDICALLY TAILORED MEALS,
MEDICALLY TAILORED GROCERIES.
WE HAVE A RISING RATE OF
DIET-RELATED DISEASES IN THIS
COUNTRY, AND AS WE LOOKED ACROSS
NIH, WHAT KIND OF EFFORTS NIH
HAS ACCOMPLISHED TO ADDRESS
DIET -- LIKE OTHER DISEASES, WE
LOOKED AT THE COMPREHENSIVE
CANCER CENTERS, WHICH THERE'S
CURRENTLY 71 OF ACROSS THE
COUNTRIES.
THOSE COMPREHENSIVE CANCER
CENTERS PERFORM RESEARCH.
THEY DO EDUCATION AND TRAINING.
THEY PROVIDE PATIENT SERVICES.
AND THEY DO A CRITICAL PART OF
THEIR APPLICATION DO COMMUNITY
OUTREACH AND ENGAGEMENT.
AND SO WE'RE EXPLORING AS A
CONCEPT, YOU KNOW, DEVELOPING
THINGS THAT WOULD BE AT THE
SCALE OF NCI COMPREHENSIVE
CANCER CENTER.
WE DON'T HAVE ANY FOR DIET
RELATED DISEASES THAT DO PATIENT
CARE, COMMUNITY OUTREACH
ENGAGEMENT, EDUCATION TRAINING,
AND RESEARCH.
WE WOULD LIKE TO DO IT AS AN
EXPERIMENT TO SEE IF THESE WOULD
HELP REDUCE DIET-RELATED
DISEASES AND CLINICAL
MALNUTRITION, AND IN -- YOU
KNOW, IN CERTAIN CATCHMENT
AREAS, EXPANDING THEM TO EXPAND
FOOD INSECURITY AND NUTRITIONAL
STATUS ASSESSMENT SUCH AS
PHYSICAL EXAMS AND TOUCH POINTS
AND WHERE INDICATED PROVIDE
THESE FOOD IS MEDICINE SERVICES.
WE'VE RECENTLY RELEASED A
REQUEST FOR INFORMATION ON FOOD
IS MEDICINE RESEARCH
OPPORTUNITIES.
THERE'S A GREAT INTEREST IN THIS
ACROSS THE FEDERAL GOVERNMENT,
AND WITH THE AMERICAN HEART
ASSOCIATION.
THE AMERICAN HEART ASSOCIATION
TOGETHER WITH ROCKEFELLER
FOUNDATION HAS ANNOUNCED A $250
MILLION COMMITMENT TO FOOD IS
MEDICINE RESEARCH.
VERY LITTLE FOOD IS MEDICINE
RESEARCH IS CURRENTLY BEING
CONDUCTED AT NIH.
WE RELEASED THIS RFI WITH 12
FEDERAL AGENCIES INCLUDING
CENTERS FOR MEDICAID SERVICES
INTERESTED BECAUSE THEY ARE
STARTING TO PAY FOR FOOD IS
MEDICINE SERVICES, WANT TO KNOW
WHERE THEY SHOULD BE DEPLOYING
AND WHAT KIND OF SERVICE SHOULD
BE USED WHERE AND FOR HOW LONG.
FIFTEEN INSTITUTE CENTERS AND
OFFICES ARE PARTICIPATING IN
THIS AS WELL.
ANOTHER AREA, SLEEP WILL BE AN
OPPORTUNITY, WE HAVE RELEASED
ANOTHER CONCEPT, INITIATIVE
CONCEPT THAT HAS BEEN CLEARED AT
THE COUNCIL.
FOR THE LAST TWO THINGS, WE'RE
HOPING FOR FUNDING IN THE NEXT
FISCAL YEAR, BUT WE'RE IN THE
NEXT FEW DAYS ANNOUNCING WE'RE
HAVING A WORKSHOP ON NUTRITION
AND DEVELOPMENTAL ORIGINS OF
HEALTH AND DISEASE.
AND SO WE HAVE PROPOSED A
DISCOVERY SCIENCE PROJECT THAT
WE'RE CURRENTLY SHOPPING AROUND
LOOKING FOR COHORT STUDIES TO
NEST THIS IN LIKE WE DID WITH
"ALL OF US."
THAT WOULD EXAMINE ROLE OF DIET,
FOOD, ENVIRONMENT, THINGS LIKE
SLEEP AND RELATED ENVIRONMENTAL
EXPOSURES ON THE DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE.
WE WOULD BE LOOKING AT THINGS,
HOPEFULLY AS MUCH AS POSSIBLE,
IN PARENTS, PRE-CONCEPTUALLY,
AND THEN, YOU KNOW, INTENSIVELY
STUDYING THE MOTHER DURING
PREGNANCY THROUGHOUT THE THREE
TRIMESTERS, AND LOOKING ALSO AT
THE MICROBIOME, CHILD'S
MICROBIOME AND CHILDHOOD
EXPOSURES.
ONE DEEP DIVE WOULD LOOK AT
HUMAN MILK COMPOSITION, THE
FEDERAL GOVERNMENT KNOWS MORE
ABOUT WHAT'S IN A STRAWBERRY OR
BANANA THAN HUMAN MILK.
WE HAVE A LOT OF RESEARCH GOING
ON, A LOT OF VARIABILITY IN
HUMAN MILK COMPOSITION, AND WE
NEED TO BETTER UNDERSTAND HOW
THAT VARIABILITY IS LINKED TO
THINGS LIKE NUTRITION, AND
GENETICS, EPIGENETIC PHENOMENON,
AFFECTING DEVELOPMENTAL OUTCOMES
OF THE INFANT, ANOTHER STUDY WE
HAVE GOING ON.
NEXT SLIDE.
THERE'S OTHER OPPORTUNITIES ONR
IS CLOCKING.
ONE OF THE THINGS IS THAT A FEW
YEARS AGO, NATIONAL INSTITUTES
OF AGING STARTED PILOTING A
STUDY TO COMPARE TIME-RESTRICTED
EATING WITH CALORIC RESTRICTION.
THEY RELEASED AN RFI THAT WOULD
OFFER PEOPLE TO LOOK AT
DIFFERENT DIETARY PATTERNS IN
COMPARISON TO CALORIC
RESTRICTION.
THE ONE THE INVESTIGATORS
SETTLED ON WAS TIME-RESTRICTED
EATING.
THIS AREA OF -- THIS
CHRONONUTRITION IS VERY MUCH
PART OF THE ONR STRATEGIC PLAN,
WHICH IN STRATEGIC OBJECTIVE 2
HAS THIS PRIORITY TO DETERMINE
HEALTH BENEFITS AND MECHANISMS
OF MEAL TIMING, DIETARY
PATTERNS, SOMETHING FRANCIS
COLLINS WAS VERY INTERESTED IN
AND SO TEXT IN OUR PLAN SAID
THERE IS BROAD TRANS-NIH
INTEREST IN IMPROVING HOW
UNDERSTANDING OF HOW OUR DIETARY
PATTERNS FOCUSED ON CIRCADIAN
MEAL TIME OR INTERMITTENT
FASTING, TO IMPROVE OUTCOMES AND
UNDERSTAND VARIABILITY.
WE'LL CONSIDER OPPORTUNITIES TO
EXPAND OUR MECHANISTIC KNOWLEDGE
IN THIS AREA.
SO A NUMBER OF INSTITUTES HAVE
AN INTEREST IN THIS.
NEXT SLIDE.
AND THEN NATIONAL INSTITUTE OF
AGING STARTED A STUDY AND HAD
THIS CALORIE TWO STUDY, GREATEST
ENERGY RESTRICTION ACCOMPLISHED
BY ITS PARTICIPANTS OVER A
TWO-YEAR PERIOD THAN ANY OTHER
NIH STUDY THEY ACHIEVED, AROUND
A 12% INCREASE IN ENERGY
RESTRICTION, LOOKING AT OTHER
OPPORTUNITIES AFTER THE CALORIE
STUDY.
SO THEY DEVELOPED THIS IDEA OF
HAVING A FIVE-YEAR STUDY, BUT
THEY -- THAT WOULD COMPARE
CALORIC RESTRICTION TO SOME
OTHER DIETARY PATTERN OF
INTEREST.
IT DID CENTER ON TIME-RESTRICTED
EATING.
AND SO THEY INVITED APPLICATIONS
FOR PLANNING PROJECTS TO DEVELOP
TWO FIVE-YEAR TRIALS ON EFFECTS
OF NUTRITION INTERVENTION IN
YOUNGER AND OLDER ADULTS ON RISK
FACTORS FOR AGING-RELATED
CONDITIONS AND MECHANISMS THAT
MAY INFLUENCE HEALTH SPAN AND
LONGEVITY.
TWO INVESTIGATORS GOT ONE ON THE
YOUNGER ADULTS DIETARY
APPROACHES FOR LONGEVITY AND
HEALTH.
AND THEN COLLINGS AT WAKE FOREST
GOT THE OTHER PILOT STUDY,
HEALTH AGING AND LIFE OUTCOMES.
PART OF THE PLANNING PROJECT WAS
FOR THEM TO GET TOGETHER TO
DEVELOP A PLAN FOR THE STUDY TO
COME TO SOME AGREEMENT ON THAT.
AND THEN TO START PILOTING THE
STUDY FOR FEASIBILITY.
AND SO THEY HAVE BEEN GIVEN
THREE YEARS TO DO THIS.
WE'RE GOING TO HEAR ABOUT THE
OUTCOMES OF THESE PILOT STUDIES
SOON.
BUT OUTCOMES OF THE PILOT
STUDIES ARE POSITIVE.
THEN I BELIEVE NATIONAL
INSTITUTES OF AGING WILL, YOU
KNOW, TRY AND FUND THIS
FIVE-YEAR STUDY THEY PLAN.
AND YOU CAN IMAGINE -- NEXT
SLIDE TO SEE IF THERE'S -- YOU
CAN -- YEAH, SO THIS IS WHAT'S
HAPPENED SO FAR IN THIS STUDY.
THEY HAVE THIS DSMB, TRIAL
LAUNCHED IN JUNE OF 2022.
AND THEN THEY SAID HERE THE
DECISION ABOUT ACCEPTANCE OF
APPLICATIONS FOR THE MAIN TRIALS
WILL BE AROUND THIS SUMMER 2024.
WE INITIALLY SPOKE TO THEM, THEY
WERE PLANNING A LARGE STUDY,
LOOKING AT OLDER ADULTS AND
MIDDLE AGED YOUNGER PEOPLE, AND
IF YOU DID A FIVE-YEAR STUDY YOU
CAN IMAGINE IF YOU HAD, YOU
KNOW, A LARGE ENOUGH STUDY AND
COULD, FOR EXAMPLE, GET 300
CASES OF CARDIOVASCULAR DISEASE
IN ONE OF THE ARMS SUCH AS
PLACEBO ARM, YOU COULD DETERMINE
WHETHER CALORIC RESTRICTION OR
TIME-RESTRICTED FEEDING WOULD
HAVE A BENEFIT FOR THAT DISEASE.
AND THIS STUDY I THINK WILL BE
ABLE TO ANSWER A NUMBER OF
SCIENTIFIC QUESTIONS WE HAVE.
FOR EXAMPLE, DOES
TIME-RESTRICTED EATING HAVE
ADDITIONAL BENEFITS ABOVE AND
BEYOND CALORIC RESTRICTION
ALONE?
THEY HAD A VERY GOOD EXPERIENCE
WITH THEIR CALORIE TWO STUDY AND
THIS IS A VERY GOOD GROUP.
I THINK THE IDEA HERE MIGHT BE
TO EXPAND THIS STUDY AND TO TRY
AND BRING OTHER I.C.s IN TO
CO-FUND THIS, TO LOOK AT
ENDPOINTS OF INTEREST TO EACH
NCI AND NHLBI AND NIDDK.
I THINK THERE'S A BIG
OPPORTUNITY THERE TO LOOK AT
THIS, TO ADDRESS A NUMBER OF
NUTRITION QUESTIONS INCLUDING,
YOU KNOW, IN THE AREA OF
CHRONONUTRITION.
SO THAT'S MY LAST SLIDE.
THANK YOU.
>>WE'LL HOLD OFF FOR QUESTIONS
UNTIL THE END OF THIS SESSION,
WHERE WE'LL HAVE DISCUSSION AND
Q&A.
NOW WE'LL MOVE TO DR.
TUSAREBECCA PANNUCCI, A MASTER'S
IN PUBLIC HEALTH HARVARD SCHOOL
OF PUBLIC HEALTH, POSTDOC WORK
AT NATIONAL CANCER INSTITUTE,
DIETARY TOOLS TO ANALYSIS OF
DIETARY PATTERNS.
DR. PANNUCCI JOINED THE CENTER
FOR POLICY PROMOTION IN 2015,
BRANCH CHIEF, LEADS A TEAM
CONDUCTING ANALYSES FOR USDA
FOOD PLANS, HEALTH EATING INDEX
AND USDA FOOD PATTERNS.
THE FLOOR IS YOURS.
>>THANK YOU VERY MUCH.
IT'S A PLEASURE TO BE HERE AND
TO BE A PART OF THE BROADER
CONVERSATION AROUND
CHRONONUTRITION.
ONE OF MY ROLES AT THE CENTER
FOR NUTRITION POLICY AND
PROMOTION IS RELATED TO OUR
COLLABORATIVE WORK WITH OFFICE
OF DISEASE PREVENTION AND HEALTH
PROMOTION AT HHS.
AND SUPPORTING THE DEVELOPMENT
OF THE DIETARY GUIDELINES FOR
AMERICANS.
SO TODAY I'LL BE GIVING AN
OVERVIEW OF THAT PROCESS, SOME
OF THE WORK RELATED TO TOPICS
THAT MIGHT BE OF INTEREST TO
YOU.
NEXT SLIDE PLEASE.
LET'S GO OVER A LITTLE BIT ABOUT
THE DIETARY GUIDELINES.
THIS PRESENTATION IS A FAST
TRACK OR ADVANCED TRACK IN THE
DIETARY GUIDELINES DEVELOPMENT.
WE WANT TO SPEND A MINUTE TO
LEVEL SET TO MAKE SURE WE'RE ALL
ON THE SAME PAGE ABOUT THE
PURPOSE OF THE DIETARY
GUIDELINES.
THE DIETARY GUIDELINES PROVIDE
SIGH INSURE-BASED ADVICE ON WHAT
TO EAT AND DRINK TO PROMOTE
HEALTH, REDUCE RISK OF CHRONIC
DISEASE, MEET NUTRIENT NEEDS,
INTENDED FOR POLICYMAKERS AND
HEALTH PROFESSIONALS TO HELP THE
GENERAL PUBLIC CONSUME A HEALTHY
AND ADEQUATE DIET, THE
CORNERSTONE FOR FEDERAL
NUTRITION PROGRAMS AND POLICIES.
WE WORK ON A FIVE-YEAR PSYCH
TOLL REFLECT PREPONDERANCE OF
EVIDENCE, PUBLISHED JOINTLY AS
MENTIONED EARLIER BY USDA AND
HHS.
AND THIS IS ALL MANDATED IN THE
1990 NATIONAL NUTRITION
MONITORING AND RELATED RESEARCH
ACT.
NEXT SLIDE.
NATIONAL DIETARY GUIDANCE IS NOT
KNEW, WE'VE PROVIDED GUIDANCE
FOR MORE THAN 100 YEARS.
ADVICE HAS TENDED TO FOCUS ON
WHAT TO EAT AND DRINK FOR BETTER
HEALTH BUT SPECIFIC MESSAGING OF
COURSE HAS CHANGED THROUGHOUT
THE YEARS TO REFLECT ADVANCES IN
NUTRITION SCIENCE, MUCH OF WHAT
WE'RE GOING TO COVER TODAY.
EARLY GUIDANCE REFLECTED IN THE
TOP LEFT-HAND CORNER FOCUSED ON
THE FOOD GROUPS AND HEALTHY
DEET.
WITH ADDITIONAL GUIDANCE AROUND
FOOD SAFETY AND FOOD STORAGE,
ENSURING PEOPLE GOT ENOUGH
VITAMINS AND MINERALS TO PREVENT
DISEASES CAUSED BY NUTRIENT
DEFICIENCY, BUT OF COURSE AS
NUTRITION SCIENCE HAS EVOLVED
THERE WAS GREATER RECOGNITION OF
THE ROLE DIET PLAYED IN DISEASE
PRE-INVESTIGATORS AND HEALTH
PROMOTION.
THIS IS REFLECTED IN THE FIRST
FORMAL ADDITION OF THE DIETARY
GUIDELINES THAT WAS RELEASED IN
1980s.
IN 1985 THE EDITION FOLLOWED,
THE FIRST EDITION FOR WHICH USDA
AND HHS CONVENED A FEDERAL
ADVISORY COMMITTEE TO PROVIDE
THAT OUTSIDE SCIENTIFIC
EXPERTISE THAT WOULD INFORM
DIETARY GUIDELINES.
THAT PRACTICE CONTINUES TODAY.
NEXT SLIDE.
WITH THAT BACKGROUND IN MIND,
THE LAST IMPORTANT POINT IS TO
NOTE THAT THE DIETARY GUIDELINE
IS ONE PIECE OF THE LARGER
NUTRITION LANDSCAPE, AND
SOMETIMES IT'S NICE TO BE
REMINDED OF THE DIFFERENT ROLES
THAT ARE PLAYED BY DIFFERENT
AGENCIES.
WHILE THE DIETARY GUIDELINES
PROVIDE THE WHAT AND HOW MUCH OF
FOODS AND BEVERAGES TO CONSUME,
TO ACHIEVE GOOD HEALTH, REDUCE
RISK OF CHRONIC RELATED
DIET-RELATED CHRONIC DISEASE AND
MEET NUTRIENT NEEDS, THEY ARE
JUST ONE PIECE.
NUTRITION REQUIREMENTS ARE
LIMITS, UPDATED BY NATIONAL
ACADEMIES OF SCIENCE,
ENGINEERING AND MEDICINE, WE'RE
NOT SETTING NUTRIENT
RECOMMENDATIONS.
CLINICAL GUIDANCE IS NOT COVERED
IN THE GUIDELINES.
THE GUIDELINES SERVE AS
REFERENCE IN DEVELOPMENT OF
CLINICAL NUTRITION GUIDANCE,
TAILORED FOR PEOPLE LIVING WITH
SPECIFIC MEDICAL CONDITIONS.
BUT THE DIETARY GUIDELINE FOR
AMERICANS ARE NOT INTENDED FOR
CLINICAL GUIDANCE.
LET'S KEEP THAT CONTEXT IN MIND
AND WE'LL LEARN MORE ABOUT THE
CURRENT SCIENCE THAT IS THE
BASIS OF THE DIETARY GUIDELINES.
NEXT SLIDE.
SO TO THE RIGHT YOU SEE THERE
ARE FOUR KEY MESSAGES, FOUR KEY
GUIDELINES THAT WERE PUBLISHED
AS PART OF THE 2020-2025 ISSUE
OF THE DIETARY GUIDELINES FOR
AMERICANS.
FIRST IS TO FOLLOW HEALTHY
PATTERN AT EVERY LIFE STAGE.
FOR THE FIRST TIME WE INCLUDED
HEALTHY DIETARY PATTERNS FOR
1-YEAR-OLDS AND MORE -- BROADER
SET SPECIFIC TO INFANTS AND
TODDLERS UNDER 2.
AS WELL AS WOMEN PREGNANT OR
LACTATING.
THE SECOND GUIDELINE IS
CUSTOMIZE AND ENJOY NUTRIENT
DENSE FOODS AND BEVERAGES TO
REFLECT PERSONAL PREFERENCES,
CULTURAL TRADITIONS, BUDGETARY
CONSIDERATIONS.
WE RECOGNIZE GUIDELINES PROVIDE
A FRAMEWORK THAT CAN BE
CUSTOMIZED.
THREE FOCUS ON MEETING FOOD
GROUP NEEDS WITH FOODS AND
BEVERAGES, STAYING WITHIN
CALORIE LIMITS, EMPHASIZES
CHOOSING FOODS AND BEVERAGES
THAT HAVE -- PROVIDE NUTRIENTS,
WHILE LIMITING CONTRIBUTION TO
SATURATED FAT, ADDED SUGARS,
SODIUM.
WHICH TRANSITIONS AND SEGUES
INTO NUMBER FOUR, TO LIMIT THOSE
FRUITS AND BEVERAGESES HIGHER IN
SUGARS AND SATURATED FATS AND
ALCOHOLIC BEVERAGE.
THERE'S NOTHING ABOUT TIMING IN
THE KEY GUIDELINES.
2020 DIETARY GUIDELINES ADVISORY
COMMITTEE DID CONDUCT REVIEWS
RELATED TO TIMING AND FREQUENCY
OF EATING AND HEALTH OUTCOMES,
BUT THOSE DIDN'T YIELD ANSWERS
ABOUT THAT RELATIONSHIP.
IN PART, HOW IT WAS DEFINED IN
THE QUESTION AND INCLUSION AND
EXCLUSION CRITERIA.
THE COMMITTEE REVIEWED DATA
ANALYSIS THAT DESCRIBED CURRENT
EATING FREQUENCY OF AMERICANS IN
RELATION TO DIET QUALITY, AND
RECOGNIZED FOR GROUPS OF
INDIVIDUALS WHERE THEY REPORTED
NOT CONSUMING AS MANY MEALS OR
SNACKS, THERE MAY HAVE BEEN A
MISSED OPPORTUNITY TO ACHIEVE
FOOD GROUP RECOMMENDATIONS, SO
DIET QUALITY SCORES USING
HEALTHY EATING INDEX WERE LOWER
FOR THOSE GROUPS, FEWER EATING
EVENTS.
HEALTHY DIETARY PATTERNS AND
EATING FREQUENCIES CAN BE
CONSTRUCTED IN A VARIETY OF
WAYS, TO SUIT DIFFERING LIFE
STAGES OR CULTURAL PRACTICES.
WE RECOGNIZE THAT CUSTOMIZING
ENJOYING A HEALTHY DIETARY
PATTERN MIGHT FIT SOME DIFFERENT
WAYS THAT FREQUENCY MIGHT BE
ACHIEVED.
REDUCING SNACKING AND
EMPHASIZING MEALS BOTH PRIMARILY
COMPRISE FOODS AND BEVERAGE THAT
CONTRIBUTE TO RECOMMENDATIONS
CAN HELP ALIGN EATING PATTERNS
WITH DIETARY GUIDELINES FOR
RECOMMENDATIONS.
NEXT SLIDE.
SO RIGHT NOW IS AN EXCITING TIME
FOR ALL OF AT CNPP AND ODP,
RIGHT AT THE BEGINNING OF THE
PROCESS TO DEVELOP THE NEXT
EDITION OF THE DIETARY
GUIDELINES.
THIS STARTED IN 2022, WHERE THE
PROPOSED SCIENTIFIC QUESTIONS
WERE POSTED FOR PUBLIC COMMENT.
THERE WAS A CALL FOR NOMINATIONS
FOR ADVISORY COMMITTEE MEMBERS,
AND THOSE ADVISORY COMMITTEE
MEMBERS WERE APPOINTED THIS YEAR
AND I SHOULD HAVE MOVED THAT
STAR.
WE'RE ACTUALLY PREPARING FOR THE
SECOND PUBLIC MEETING AND THAT
WILL OCCUR NEXT WEEK.
I'LL PROVIDE INFORMATION AT THE
END OF THE PRESENTATION FOR
THOSE WHO MIGHT WANT TO TUNE IN.
THERE WILL BE SIX PUBLIC
MEETINGS WHERE THE ADVISORY
COMMITTEE IS GOING TO DISCUSS
THEIR EVALUATION OF THE EVIDENCE
AND FINALLY PROVIDE A REPORT TO
THE DEPARTMENT, THERE WILL BE AN
OPPORTUNITY FOR PUBLIC COMMENT
ON THAT REPORT.
THERE'S AN OPPORTUNITY FOR
PUBLIC COMMENT THROUGHOUT THEIR
DELIBERATION, AND SPECIFICALLY
PUBLIC COMMENTS ARE OPEN FOR THE
PROTOCOLS THAT THEY WILL BE
POSTING ONLINE FOR HOW THEY ARE
GOING TO APPROACH THE SCIENTIFIC
QUESTIONS.
NEXT SLIDE..
THE BEGINNING IS IDENTIFY
SCIENTIFIC QUESTIONS BASED ON
RELEVANCE, IMPORTANCE, POTENTIAL
FEDERAL IMPACT, AVOIDING
DUPLICATION WITH OTHER FEDERAL
AGENCIES.
THESE WERE POSTED FOR PUBLIC
COMMENT FOR 30 DAYS.
WE CONSIDER PUBLIC COMMENT AND
RESEARCH AVAILABILITY AS THE
COMMITTEE WILL PRIORITIZE THE
QUESTIONS THEY WILL REVIEW.
NEXT SLIDE.
THOSE QUESTIONS THEN HELP US IN
THE APPOINTMENT OF THE ADVISORY
COMMITTEE TO UNDERSTAND
EXPERTISE THAT'S NEEDED.
WE REQUEST COMMITTEE NOMINATIONS
FROM THE PUBLIC FOR 30 DAYS,
SELECT A BALANCED COMMITTEE
BASED ON EDUCATION, EXPERIENCE,
DEMONSTRATED EXPERTISE AND
DESIRE FOR DIVERSE MEMBERSHIP.
AND THEN THE SECRETARIES OF HHS
AND USDA JOINTLY APPOINT
COMMITTEE MEMBERS.
NEXT SLIDE.
NEXT SLIDE PLEASE.
GREAT.
SO WE'RE IN THIS PROCESS, THIS
STEP OF THE PROCESS NOW WHERE
ADVISORY COMMITTEE IS BEGINNING
TO REVIEW SCIENTIFIC EVIDENCE.
THEY ARE GOING TO REVIEW
SCIENTIFIC EVIDENCE ON NUTRITION
AND HEALTH ACROSS THE LIFESPAN,
THEY ARE GOING TO DISCUSS
REVIEW, AS A FULL COMMITTEE, IN
PUBLIC MEETING, CONSIDER PUBLIC
COMMENT THROUGHOUT THE PROCESS,
AND AGAIN AS I MENTIONED THEY
WILL SUBMIT SCIENTIFIC REPORT TO
THE SECRETARIES OF HHS AND USDA.
I WANT TO DISTINGUISH THEIR
REPORT IS THEIR SUMMARY SPECIFIC
AND CONCLUSIONS DRAWN THAT THEY
PRESENT MAKING RECOMMENDATIONS
TO THE DEPARTMENTS, BUT THEIR
REPORT IS NOT THE DIETARY
GUIDELINES FOR AMERICANS IN AND
OF ITSELF.
NEXT SLIDE PLEASE.
SO THE COMMITTEE WILL USE THREE
SCIENTIFIC APPROACHES AS THEY
REVIEW EVIDENCE, COMPLEMENTARY
IN NATURE, AND EACH HAS A UNIQUE
PERSPECTIVE TO ADD TO THE
CONVERSATION.
SO, OUR NESR REVIEW BRANCH, WE
HAVE AN ENTIRE TEAM THAT
CONDUCTS THESE SYSTEMATIC
REVIEWS USING GOLD STANDARD
EVIDENCE SYNTHESIS TO ANSWER
QUESTIONS ABOUT NUTRITION AND
PUBLIC HEALTH IMPORTANCE.
ALL OF THE PROTOCOLS FOR THESE
SYSTEMATIC REVIEWS WILL BE
POSTED ONLINE.
THEY WILL ALSO REVIEW THE DATA.
WE USE COLLECTION OF DATA
ANALYSIS FROM NATIONAL --
FEDERAL NATIONALLY REPRESENTED
DATASETS TO DESCRIBE CURRENT
HEALTH AND DIETARY INTAKE OF
AMERICANS.
THE DATA REALLY HELP MAKE THE
DIETARY GUIDELINES PRACTICAL,
RELEVANT, ACHIEVABLE, TO GIVE AN
UNDERSTANDING OF WHERE WE ARE AS
A COUNTRY RELATIVE TO THESE
TOPICS.
FINALLY, FOOD PATTERN MODELING,
CLOSE TO MY HEART BECAUSE PART
OF THE WORK I LEAD.
IT'S ANALYSIS THAT ILLUSTRATES
HOW CHANGES TO THE AMOUNTS AND
TYPES OF FOODS AND BEVERAGES AND
DIETARY PATTERN MIGHT AFFECT
MEETING NUTRIENT NEEDS ACROSS
THE POPULATION.
I HOPE YOU'LL BE INTERESTED IN
SOME OF THE WORK AND QUESTIONS
THE COMMITTEE IS ASKING, USING
THOSE FOOD PATTERN MODELING THIS
GO ROUND.
NEXT SLIDE.
THEN AFTER THE COMMITTEE SUBMITS
THEIR REPORT, THEN WE USE THAT
REPORT TO INFORM THE DEVELOPMENT
OF THE DIETARY GUIDELINES FOR
AMERICANS WHICH WILL BE THE
2025-2030 EDITION.
WE FORM A FEDERAL WRITING TEAM
TO UPDATE THE DIETARY
GUIDELINES.
WE DEVELOP THOSE GUIDELINES
AGAIN USING THE COMMITTEE
SCIENTIFIC REPORT, ALSO FEDERAL
RESOURCES AND INPUT FROM
AGENCIES AND THE PUBLIC.
WE CONSIDER PEER REVIEW BY
FEDERAL AND NON-FEDERAL
SCIENTISTS, ONCE THE DRAFT OF
THE GUIDELINES IS COMPLETE.
AND THEN WE FACILITATE THE
APPROVAL PROCESS THROUGH BOTH
DEPARTMENTS, USDA AND HHS.
THE SECRETARIES JOINTLY RELEASE
THE NEW EDITION OF DIETARY
GUIDELINES FOR AMERICANS.
NEXT SLIDE.
SO THEN WE GET TO THE
IMPLEMENTATION WHICH IS ALWAYS
FUN.
DIETARY GUIDELINES INFORM
FEDERAL PROGRAMS SUCH AS FOOD
ASSISTANCE, MEAL PROGRAMS,
RESEARCH, PRIORITIES, NUTRITION
EDUCATION EFFORTS, AND NATIONAL
HEALTH OBJECTIVES.
GUIDELINES PROVIDE A STRUCTURE
FOR STATE AND LOCAL PUBLIC
HEALTH INITIATIVES.
IT OFFERS NUTRITION GUIDANCE FOR
POLICYMAKERS, HEALTH CARE
PROVIDERS, NUTRITION EDUCATORS,
IMPLEMENTED THROUGH MY PLATE,
FEDERAL NUTRITION SYMBOL TO HELP
AMERICANS PUT GUIDELINES INTO
ACTION AND HOST OF RESOURCES
ONLINE THROUGH MY PLATE.
NEXT SLIDE PLEASE.
OH NO.
CAN SOMEBODY ALERT ME IF YOU CAN
LARRY ME?
I THINK MY INTERNET JUST KICKED.
>>IT SEEMS LIKE SHE WAS SAYING
HER INTERNET KICKED HER OUT.
THERE SHE IS.
>>I'M SORRY FOR THAT SNAFU.
THANKS.
BACK UP ONE SLIDE TO MAKE SURE
I'M ON TRACK.
PERFECT.
NEXT SLIDE.
GREAT.
SO, THINKING ABOUT THE
COMMITTEE'S EVIDENCE REVIEW,
SOME OF THE SCIENTIFIC TOPICS TO
BE ADDRESSED ARE DIETARY
PATTERNS, ULTRA PROCESSED FOOD,
ADDED SUGAR, SATURATED FAT,
BEHAVIOR STRATEGIES, WEIGHT
MANAGEMENT.
HEALTH MANAGEMENT INCLUDES
OVERWEIGHT AND OBESITY,
CARDIOVASCULAR DISEASE, TYPE 2
DIABETES, CANCER, NEUROCOGNITIVE
HEALTH, SARCOPENIA, ALL-CAUSE
MORTALITY, BONE HEALTH,
PREGNANCY AND ALL CAUSE
MORTALITY, THREE SOURCES OF
EVIDENCE USE AND SYNTHESIZED IN
THE REPORT.
FINALLY, WE HAVE ASKED THE
COMMITTEE TO TAKE -- TO
INCORPORATE HEALTH EQUITY
PRINCIPLES USING LIFE STAGE
APPROACH ACROSS ITS REVIEW.
I SHOULD ON THAT NOTE APOLOGIZE
THAT THERE ARE SOME TERMS THAT
ARE BEING VERY CAREFULLY
CONSIDERED BY THE COMMITTEE.
OVERWEIGHT AND OBESITY, OR THE
TERM DIET-RELATED CHRONIC
DISEASE, RECOGNIZING IT'S NOT
NECESSARILY JUST DIET AND THERE
ARE MANY THINGS THAT CREATE A
COMPLEX ENVIRONMENT THAT CAN
CONTRIBUTE TO HEALTH OUTCOMES.
I WANT TO ACKNOWLEDGE THAT MAYBE
SOME OF MY TERMINOLOGY COULD USE
IMPROVING, AND WE'RE ALL WORKING
QUITE HARD TO LEARN AND THINK
WITH A HEALTH EQUITY LENS AS WE
PRESENT THESE TOPICS.
I'M STILL LEARNING TO REMEMBER
TO BE COGNIZANT OF THESE TERMS
AS I GO ALONG.
NEXT SLIDE PLEASE.
THERE ARE PROPOSED SCIENTIFIC
QUESTIONS RELATED TO TIMING OF
EATING.
ONE IS WHAT IS THE RELATIONSHIP
BETWEEN TIMING OF EATING
OCCASIONS, EATING BREAKFAST,
LIMITING EATING LATE IN THE DAY,
SNACKING, INTERMITTENT FASTING,
TIME-RESTRICTED EATING, AND SOME
OF THE OUTCOMES THAT I MENTIONED
ON A PREVIOUS SLIDE.
RELATIONSHIP BETWEEN TIMING OF
EATING AND OUTCOMES SUCH AS
GROWTH, BODY COMPOSITION,
OVERWEIGHT, OBESITY, WEIGHT
LOSS, WEIGHT GAIN.
WITH CONSUMING DIETARY PATTERNS
MORE ALIGNED WITH DIETARY
GUIDELINES FOR AMERICANS.
WE'LL USE DATA ANALYSIS TO
DESCRIBE CURRENT INTAKE,
PREVALENCE OF NUTRITION RELATED
CHRONIC HEALTH CONDITIONS, AND
DIETARY COMPONENTS OF PUBLIC
HEALTH CONCERN WILL BE CONDUCTED
TO INFORM THE WORK.
WE'LL LOOK AT DATA RELATED TO
FREQUENCY OF EATING AND HOW
THOSE EATING EVENTS ARE LABELED.
NOW, THERE ARE TWO TOPICS THAT
WEREN'T ON THE LIST OF QUESTIONS
TO BE EXAMINED BY THE 2025
COMMITTEE THAT I DO WANT TO
RECOGNIZE.
YOU CAN GO TO THE NEXT SLIDE I
THINK.
OH, NO, WE'LL GO BACK.
I DO WANT TO RECOGNIZE THAT
THERE'S SOME TOPICS THAT WILL BE
ADDRESSED IN A SEPARATE PROCESS
OUTSIDE THE ADVISORY COMMITTEE.
ONE IS ALCOHOLIC BEVERAGES.
THIS REMAINS HIGH PRIORITY TOPIC
BUT BECAUSE IT REQUIRES
SIGNIFICANT AND SPECIFIC
EXPERTISE AND HAS UNIQUE
CONSIDERATIONS IT'S GOING TO BE
EXAMINE IN A SEPARATE EFFORT LED
BY HHS AGENCIES TO SUPPORT WORK
ON THE TOPIC.
OTHER TOPICS THAT I WANTED TO BE
TRANSPARENT ABOUT IS
SUSTAINABILITY AND COMPLEX
RELATIONSHIP BETWEEN NUTRITION
AND CLIMATE CHANGE WHICH WE FEEL
IS A VERY IMPORTANT
CROSS-CUTTING AND HIGH-PRIORITY
TOPIC, THAT ALSO REQUIRES
SPECIFIC EXPERTISE.
HHS AND USDA WILL ADDRESS THIS
TOPIC SEPARATE FROM THE
COMMITTEE'S PROCESS, TO ENOUGH
WORK ACROSS THE DEPARTMENT.
I HOPE THAT GIVES YOU A SENSE OF
PROCESS, WHERE WE ARE NOW, AND
SCIENCE THAT WILL BE EXPLORED BY
THE CURRENT COMMITTEE.
YOU CAN GO TO THE FINAL SLIDE
WITH MY CONTACT INFORMATION.
ALSO INFORMATION TO STAY
CONNECTED AND JOIN IN ON THIS
PROCESS.
SO DIETARYGUIDELINES.GOV, YOU
CAN FIND A VARIETY OF RESOURCES
THAT MIGHT BE USEFUL IN YOUR
RESEARCH, INCLUDING SLIDE DECKS,
THAT HAVE DATA TABLES AND
FIGURES, TALKING POINTS ABOUT
THE DIETARY GUIDELINES, SPECIFIC
TO EACH LIFE STAGE, ALSO THE
CURRENT PLACE WE ARE NOW.
YOU CAN SIGN UP TO GET UPDATES
WITH THINGS LIKE REGISTRATION
FOR PUBLIC MEETINGS LIKE THE ONE
THAT WILL OCCUR NEXT WEEK, ALSO
AT THE LINK WITH THE OPPORTUNITY
TO PROVIDE PUBLIC COMMENT.
SO PARTICULARLY AS PROTOCOLS GET
DEVELOPED YOU MIGHT BE
INTERESTED TO REVIEW PROTOCOLS,
AND PROVIDE COMMENTS TO THE
COMMITTEE IN SUPPORT OR OFFERING
SUGGESTIONS HOW THEY MIGHT LOOK
AT THE RESEARCH DIFFERENTLY.
I ENCOURAGE YOU TO STAY UPDATED
AND WELCOME YOUR PARTICIPATION
THROUGH PUBLIC COMMENT AND BY
ATTENDING THE MEETINGS.
AND AM HAPPY TO ENTERTAIN ANY
QUESTIONS.
>>THANK YOU, DR. PANNUCCI.
IT IS OPEN FOR DISCUSSION AND
Q&A.
I WANT TO SUMMARIZE THE
DISCUSSION, THANKING DR. LYNCH
FOR GUIDING US THROUGH THE NIH'S
NUTRITION RESEARCH PRIORITIES.
ANSWERING QUESTIONS AS TO WHAT
AND WHEN WE SHOULD EAT,
DISCUSSION ABOUT THE "ALL OF US"
RESEARCH PROGRAM.
AND THEN THE NIA RESEARCH
EFFORTS RELATED TO
TIME-RESTRICTED EATING, ALSO THE
"ALL OF US" RESEARCH PROGRAM.
DR. PA PANNUCCI FOR GUIDING US
THROUGH HISTORY AND DEVELOPMENT,
INTERROGATORY HEAR ABOUT THE
PROCESS BY WHICH A COMMITTEE IS
APPOINTED AND WHAT ROLES ARE AND
HOW THAT CULMINATES INTO THE
PUBLICATION OF GUIDELINES FOR
AMERICANS.
WE HAVE SOME QUESTIONS FOR YOU
IN THE Q&A.
DR. LYNCH, A QUESTION ABOUT THE
SHORT-TERM DIETARY INTERVENTIONS
USED IN THE NUTRITION FOR
PREVENTION "ALL OF US" RESEARCH
PROGRAM.
YOU TALKED ABOUT THE THREE
MODULES, WHAT DIETS ARE BEING
EVALUATED?
>> RIGHT, SO -- AND, YOU KNOW,
WHEN WE MADE THE FRAMEWORK FOR
THIS STUDY, BUT WE ALLOWED THE
CONSORTIUM, YOU KNOW, WHICH IS A
BIG CONSORTIUM, TO, YOU KNOW,
MAKE THOSE DECISIONS ABOUT THE
DIETS.
SO THE DIETS, AND THERE'S MANY
PEOPLE WELL KNOWN NUTRITION
EXPERTS, SO THREE DIETS THEY
DECIDED TO CHALLENGE
PARTICIPANTS WITH, AND THEY WILL
BE ROTATED, RANDOMIZED.
BUT THE FIRST ONE IS WHAT WE
CALL STANDARD AMERICAN DIET,
SAD.
THE OTHER ONE IS SOMETHING ALONG
THE LINES OF KETOGENIC DEET
CETERA, LOW CARB, HIGH FAT.
AND THE LAST DIET IS WHAT THEY
ARE TERMING MEDITERRANEAN/DASH
DIET, WHICH ARE TWO OF THE MOST
POPULAR DIETS MEDITERRANEAN AND
DASH, OF COURSE FROM INVENTION
OF THE NHLBI.
>>THANK YOU.
ALSO, ANOTHER QUESTION RELATED
TO HOW THE ACADEMIC COMMUNITY
CAN BE MORE INVOLVED WITH THE
DEVELOPMENT OF POLICY
GUIDELINES.
MAYBE THAT'S SOMETHING BOTH OF
YOU COULD ADDRESS.
>>WELL, I'LL LET THE DIETARY
GUIDELINES FOLKS ANSWER THAT
FIRST.
WHAT KIND OF POLICIES DO YOU
THINK THEY ARE ASKING ABOUT?
>>I BELIEVE NUTRITION
GUIDANCE.
>>DIETARY GUIDELINES, OKAY.
>>I WAS LOOKING AT A QUESTION
IN THE CHAT, IF YOU COULD REPEAT
THE QUESTION THAT WOULD BE
HELPFUL.
>>HOW CAN THE ACADEMIC
COMMUNITY SUPPORT OR GET MORE
INVOLVED WITH THE DEVELOPMENT OF
POLICY GUIDELINES.
>>SURE.
I THINK ONE WAY IS PARTICIPATE
IN THE PUBLIC COMMENTS.
IF THERE'S A QUESTION RELATED TO
YOUR AREA OF RESEARCH, TO TAKE
THE TIME TO REVIEW THE PROTOCOLS
FOR HOW THE COMMITTEE PLANS TO
ADDRESS THE RESEARCH QUESTION
AND MAYBE PROVIDE YOUR THOUGHTS,
EITHER TO SUPPORT OR IMPROVE
THAT APPROACH.
I THINK FOLLOWING ALONG AND
ENCOURAGING YOUR STUDENTS TO
FOLLOW ALONG TOO, TO UNDERSTAND
THE RIGORS BEHIND THE REVIEW OF
THE EVIDENCE, AND TO FOLLOW
ALONG THE DISCUSSIONS THE
COMMITTEE MEMBERS ARE HAVING IS
ALSO QUITE HELPFUL.
AND TO DO GOOD RESEARCH,
CONTINUE DOING GOOD RESEARCH.
BECAUSE OF THE GOOD RESEARCH
YOU'RE DOING, RESEARCH IS BEING
REVIEWED BY THE COMMITTEE.
THERE ARE MULTIPLE WAYS TO GET
INVOLVED.
ALSO MANY COMMITTEE MEMBERS OF
COURSE ARE IN ACADEMIA.
SO BEING WILLING TO BE PART OF
THE PROCESS AND CONTRIBUTE YOUR
EXPERTISE THAT WAY, MAYBE ON
FUTURE COMMITTEES.
>>OPPORTUNITIES TO BE INVOLVED
IN PROPOSING SCIENTIFIC
QUESTIONS THAT SHOULD BE
ADDRESSED BY THE ADVISORY
COMMITTEE.
>>THAT TOO, AND PUBLIC COMMENT
PROCESS WHEN TOPICS AND
QUESTIONS ARE PROPOSED, THERE'S
AN OPPORTUNITY FOR CONTRIBUTING
YOUR THOUGHTS IN THE PUBLIC
COMMENT PROCESS FOR THAT AS
WELL.
>>DR. LYNCH, YOU MENTIONED --
>> I WANTED TO MENTION, WE HAVE
SOMETHING SIMILAR BUT WE DON'T
CALL THEM PUBLIC COMMENTS.
WE PUT OUT REQUESTS FOR
INFORMATION.
AND NIH IS PUTTING THOSE OUT ALL
THE TIME TO REQUEST INPUT ON
WHAT IT IS THAT WE DO.
THE OFFICE OF NUTRITION RESEARCH
HAS LISTENING SESSIONS,
NUTRITIONALS, SOME OF THEM ARE
EFFORTS TO HELP PEOPLE THROUGH
THE GRANT PROCESS OR SOMETHING,
BUT OTHER TIMES WE HAVE LARGER
GROUPS SAYING, A, WE THINK THAT,
YOU KNOW, YOU SHOULD BE DOING
MORE RESEARCH ON X OR Y.
AND SO WE GET AD HOC INPUT THAT
WAY, IN ADDITION TO HAVING THESE
REQUESTS FOR INFORMATION FROM
TIME TO TIME.
>>THANK YOU.
DR. LYNCH, YOU TALKED ABOUT
CLOCKING IN, CHRONONUTRITION,
AND THE NIA INITIATIVES IN THIS
AREA THAT ALIGN WITH STRATEGIC
GOALS TWO, INITIATED PLANNING
PROJECTS, YOUNGER ADULTS BY
PENNINGTON AND KOJESKI, THE NIA
WILL FOUND FIVE YEAR PROJECTS.
>>AT THE ENDS OF THE PLANNING
PROJECTS, THE NIA WILL -- AS DR.
GOFF MENTIONED, I'M SPEAKING ON
MY PERSONAL BEHALF, NOT WORKING
FOR NIA, BUT I BELIEVE WHAT THEY
WILL DO IS EVALUATE THE OUTCOMES
OF THE PILOT STUDIES.
WAS WHAT THEY WERE DOING IN
THOSE STUDIES FEASIBLE?
AND, YOU KNOW, COULD THEY
RECRUIT SUFFICIENT PARTICIPANTS
TO TAKE PART IN THAT KIND OF
THING?
AND BECAUSE SOME PEOPLE, THE
EVENTUAL STUDY THEY WERE
REFLECTING ABOUT WOULD HAVE, YOU
KNOW, A CONTROL ARM, PLACEBO
ARM, AND TWO INTERVENTION DIETS
FOR FIVE YEARS.
YOU KNOW, THAT'S VERY RISKY.
AND IT INVOLVES A LARGE
INVESTMENT PER YEAR.
SO, THEY ARE GOING TO LOOK AT
THAT AND SEE, AND MAKE THE
DECISION ABOUT WHETHER THEY
SHOULD PROCEED, YOU KNOW, WITH
WHETHER IT'S VIABLE TO PROCEED
AHEAD OR NOT.
SO IT'S THAT POINT.
BUT I THINK, YOU KNOW, WE --
BECAUSE MANY INSTITUTES, YOU
KNOW, PLAN AHEAD, WE NEED TO --
IN CASE THE OUTCOME IS WE'RE
GOING TO DO THIS, I THINK WE
NEED TO NOW, YOU KNOW, GET THE
BAND -- BECAUSE WE GOT TOGETHER
WITH THEM AT THE BEGINNING, TO
GET THE BAND BACK TOGETHER TO,
YOU KNOW, SEE WHAT KIND OF, YOU
KNOW, WHAT KIND OF THINGS THE
INSTITUTES WOULD BE INTERESTED
IN, ARE THEY INTERESTED IN A
PARTICULAR POPULATION, ARE THEY
INTERESTED IN DISEASE OUTCOMES
TO BE MEASURED IN ADDITION TO
WHATEVER NIA IS GOING TO DO,
WOULD THAT BE FEASIBLE OR
RELATIVE EASY.
I THINK THERE'S BIG
OPPORTUNITIES THERE TO LOOK AT
DISEASES OF INTEREST, MULTIPLE,
YOU KNOW, INSTITUTES AND
CENTERS.
YOU KNOW, OBESITY, YOU KNOW,
CARDIOVASCULAR OUTCOMES, CANCER
OUTCOMES, AND, YOU KNOW, OTHER
OUTCOMES IN PREGNANCY AND SO ON
FOR THE OTHER INSTITUTES THAT
MIGHT BE INTERESTED IN.
>>AGING-RELATED OUTCOMES, THE
REASON I'M PROBING, A QUESTION
IN THE Q&A RELATED TO POTENTIAL
RFAs OR PROGRAM ANNOUNCEMENTS
THAT WOULD COME OUT, WHETHER
THESE WOULD BE PROJECTS THAT
WOULD COME OUT OF THE CURRENTLY
FUNDED LABS FOR THE PROJECTS.
>> WELL, YEAH, I DON'T KNOW HOW
THAT WOULD LOOK.
NIA REPORT -- THEY DO A LOT OF
NUTRITION RESEARCH FRANKLY.
AND THEY HAVE THIS BALTIMORE
LONGITUDINAL STUDY THAT THEY
HAVE GOING ON INTRAMURALLY.
THEIR INTRAMURAL SCIENTISTS DO A
LOT OF RESEARCH ON CALORIC
RESTRICTION AND OTHER, YOU KNOW,
DIETARY PATTERNS IN PRE-CLINICAL
MODELS.
AND THEY SUPPORT A LOT OF
NUTRITION RESEARCH FROM THE
BASIC SCIENCE LEVEL TO INCLUDING
INVESTIGATOR -- A LOT OF
INVESTIGATOR-INITIATED RESEARCH
THAT YOU DON'T HAVE TO WAIT FOR
AN RFA FOR.
THIS IS THE NIH'S STRENGTH IS
YOU COMING UP WITH THE IDEA, AND
SO THERE'S -- WE'VE RECOGNIZED
THERE'S OPPORTUNITIES IN THIS
SPACE AND THERE'S A LOT OF
INSTITUTES THAT ARE INTERESTED
IN THIS SPACE.
>>AND WE HAVE A QUESTION FROM
ONE OF OUR PANELISTS ABOUT THE
DIETARY GUIDELINES.
WE KNOW MANY AMERICANS AREN'T
MEETING EVEN THE BASIC DIETARY
RECOMMENDATIONS, THE EXERCISE
RECOMMENDATIONS THAT GO WITH
THOSE.
WHAT ARE THE WAYS IN WHICH WE
CAN IMPROVE ADHERENCE TO
EXISTING GUIDELINES AND WOULD
PRECISION MEDICINE HELP THEM?
YOU MEANINGSED A LITTLE BIT OF
THIS IN YOUR CLOSING STATEMENT,
HOW WE SHOULD EVALUATE WHETHER
TIMING OF EATING CAN HELP
SOMEONE ADHERE TO DIETARY
GUIDELINES.
IS THAT SOMETHING WE SHOULD BE
PUSHING FORWARD IN TERMS OF THE
RESEARCH AGENDA IN THIS AREA?
WELL, ON AVERAGE THE POPULATION
IS NOT -- DOES NOT HAVE DIETS
THAT ALIGN WITH DIETARY
GUIDELINES, CERTAINLY FALLS
SHORT OF MANY OF THE FOOD GROUPS
THAT WE HAVE ADEQUACY GOALS FOR.
FRUITS, VEGETABLES, WHOLE GRAINS
IN PARTICULAR.
AND EXCEEDS LIMITS ON SATURATED
FAT, ADDED SUGAR, SODIUM.
WHAT THE COMMITTEE NOTED LAST
TIME WAS THAT FOR THOSE WITH FEW
EATING EVENTS MAY BE A MISSED
OPPORTUNITY TO ACHIEVE THOSE
GOALS.
I THINK THERE ARE MANY BARRIERS
TO HEALTHY EATING THAT ARE
COMPLEX AND NEED TO BE UNPACKED.
BUT CERTAINLY WHEN WE THINK
ABOUT THE HEALTH EQUITY
APPROACH, WE NEED TO THINK ABOUT
WHAT THOSE BARRIERS ARE, AND HOW
WE CAN WORK TOGETHER TO
DISMANTLE THOSE BARRIERS.
THAT'S SOMETHING THAT IS BEING
DISCUSSED.
BUT I THINK TIMING OF EATING
COULD BE SOMETHING THAT MIGHT
HAVE A ROLE.
OR MIGHT -- WHERE RESEARCH MIGHT
HAVE A ROLE ELUCIDATING
BARRIERS, BUT IT'S A CHALLENGE
BETWEEN CHOICES AND ACCESS, AND
AFFORDABILITY, EDUCATION, SO
MANY COMPLEX FACTORS THAT MIGHT
CREATE BARRIERS.
IT LOOKS LIKE YOU WERE GOING TO
ADD TO THAT, CHRIS.
>>I'M THINKING, AT THE END OF
EACH ONE OF THESE GUIDELINES,
THE SCIENTIFIC COMMITTEE
PRODUCES A SET OF GAPS AND RE--
RESEARCH GAPS AND OPPORTUNITIES,
THAT, YOU KNOW, IT MIGHT NOT BE
THE PART THAT WE GET TO WHEN
WE'RE READING THE DIETARY
GUIDELINES, BUT MAYBE THEY NEED
TO COME UP WITH -- WE'VE ASKED
THIS LAST TIME.
IT WOULD BE HELPFUL IF
ORGANIZERS WROTE TO THE GRANT
INSTITUTIONS, THE PEOPLE GIVING
OUT GRANTS, AND LET THEM KNOW,
LIKE NOT THE WHOLE LAUNDRY LIST
BUT WHAT THE SCIENTIFIC
COMMITTEE THOUGHT WERE GOOD
OPPORTUNITIES AND GAPS AND
OPPORTUNITIES AND COULD YOU HELP
US WITH THESE.
>>SO GLAD YOU BROUGHT THAT UP.
THAT'S RIGHT, AT THE END OF EACH
CHAPTER, THERE'S A LIST OF
RESEARCH RECOMMENDATIONS.
AND THAT'S AN INTERESTING IDEA
TO HAVE THOSE COMMUNICATED THAT
WAY.
>>GREAT.
THANK YOU BOTH SO MUCH.
WE'RE ENDING RIGHT ON TIME WITH
THIS DISCUSSION PERIOD.
NOW IT'S TIME FOR A TEN-MINUTE
STRETCH BREAK, BACK AT 1:30 FOR
THE NEXT SESSION.
SEE YOU SOON.
>>WELCOME BACK.
IT'S MY PLEASURE TO INTRODUCE
THE SESSION CHAIR, DR. KEN
WRIGHT, DIRECTOR OF THE SLEEP
LABORATORY, UNIVERSITY OF
COLORADO BOULDER, 25 YEARS OF
EXPERIENCE IN THE SLEEP AND
CIRCADIAN FIELD, TO UNDERSTAND
DISRUPTION, SUCH AS
CARDIOMETABOLIC RECOGNITION TO
IMPROVE PUBLIC HEALTH AND SAVED.
DIRECTS NIH T32 GRANT IN SLEEP
AND CIRCADIAN RESEARCH, NINDS
GRANT, TO PROMOTE DIVERSITY AND
EXCELLENCE IN SLEEP AND
CIRCADIAN RESEARCH CAREERS,
SERVED IN LEADERSHIP AND
ADVISORY ROLES FOR GOVERNMENT
PROFESSIONAL, COMMUNITY AND
COMMERCIAL STAKEHOLDERS SUCH AS
SLEEP DISORDERS RESEARCH
ADVISORY BOARD OF THE NIH,
NHLBI, AND BOARD OF DIRECTORS OF
THIS SLEEP RESEARCH SOCIETY.
IT'S MY PLEASURE TO HAVE HIM
GIVE THE INTRODUCTORY ADDRESS
FOR TODAY'S AFTERNOON SESSION.
>>THANK YOU FOR THE KIND
INTRODUCTION.
I'D LIKE TO THANK THE ORGANIZERS
AND ACKNOWLEDGE MY FACILITATOR
A POSTDOCTORAL FELLOW AND
ASSISTANT ASSOCIATE WE SEARCH
SCIENTIST, DEPARTMENT OF
MEDICINE, COLUMBIA UNIVERSITY
WORKING WITH DR. ST-ONGE ON
TOPICS WE'RE TALKING ABOUT
TODAY.
NEXT SLIDE PLEASE.
NEXT SLIDE.
QUICK DISCLOSURES, I DO HAVE
RESEARCH SUPPORT, DONATED
MATERIALS FROM A NUMBER OF
COMPANIES FOR OUR MICROBIOME AND
SLEEP AND CIRCADIAN RESEARCH,
AND CONSULTING FOR A NUMBER OF
COMPANIES THAT ARE DESIGNING
CIRCADIAN INTERVENTIONS BUT NONE
ARE GOING TO BE DISCUSSED TODAY.
NEXT SLIDE PLEASE.
ONE THING I CAN DO IS HIGHLIGHT
SOMETHING ELSE FROM ANOTHER
STRATEGIC PLANS FROM THE NIH.
THIS COMES FROM THE SLEEP
RESEARCH PLAN.
TO HIGHLIGHT THAT GOAL 2 OF THE
PLAN, LISTED AS HIGH-PRIORITY
AREA, ELUDICATE REMEMBER WHEN
CIRCADIAN BIOLOGY, SLEEP HEALTH
AND TIMING OF FOOD INTAKE.
FOR THOSE LOOKING FOR STRATEGIES
TO CONSIDER IN TERMS OF APPLYING
FOR GRANTS AND EMPHASIS THE NIH
IS HIGH LIGHTING HERE, IT'S
RELEVANT TO THE TOPIC TODAY.
WHAT I WOULD LIKE TO GO IS GO
OVER BACKGROUND OF CLINICAL
TRIALS, BUT PURPOSELY AM NOT
INCLUDING ANY TRIALS THAT THE
SUBSEQUENT SPEAKERS WILL BE
TALKING ABOUT.
I'M GOING TO GIVE A BROAD
OVERVIEW SURVEY AND KEY AREAS OF
OTHER OPPORTUNITIES THAT ARE NOT
SCHEDULED TO BE TALKED ABOUT
HERE.
FIRST, THIS IS RESULTS A
SYSTEMATIC REVIEW AND
META-ANALYSIS LOOKING AT
TIME-RESTRICTED EATING ON BODY
WEIGHT AND METABOLISM AND
HUMANS, WITH A NUMBER OF KEY
OUTCOMES STUDIES LOOKED AT.
ONE IS WEIGHT LOSS.
YOU CAN SEE IF YOU LOOK AT THE
BOTTOM, THE OVERALL REDUCTION IN
WEIGHT LOSS HERE IS ABOUT 1
KILOGRAM ON AVERAGE ACROSS THE
STUDIES.
MAJORITY OF STUDIES SHOW
BENEFITS IN TERMS OF WEIGHT LOSS
DID YOU SOME HAVE SMALLER SAMPLE
SIZES THAN OTHERS, AND AGAIN
SOME ARE OBSERVATIONAL VERSUS
RANDOMIZED CONTROLLED TRIALS.
BUT IT IS BENEFICIAL FOR WEIGHT
LOSS AND WE'LL HEAR MORE ABOUT
THAT LATER TODAY.
NEXT SLIDE.
IN PARTICULAR ONE OF THE THINGS
WE SHOULD BE CONSIDERING WHEN WE
LOOK AT THESE STUDIES IS NOT
JUST WEIGHT LOSS BUT WHAT TYPE
OF WEIGHT IS BEING LOST,
ESPECIALLY IN SPECIAL
POPULATIONS WHEN WE CONSIDER THE
LOSS OF FAT-FREE MASS MAY BE
SOMETHING WE WANT TO TRY TO
AVOID.
IN ANY CALORIC RESTRICTION TYPE
STUDY WE SHOULD HAVE THE LOSS OF
BOTH.
AND YOU CAN SEE HERE IN THESE
PARTICULAR TRIALS AND SO FORTH
WE CAN SEE THERE IS A LOSS OF
BOTH FAT MASS AND FAT FREE MASS,
AND LOSS OF FAT FREE MASS IS
SIGNIFICANT -- I'M SORRY, ALSO
NOT SIGNIFICANT.
THERE ARE INDIVIDUAL TRIALS THAT
DO HAVE SIGNIFICANT CHANGES.
THIS IS AN AREA BEING WATCHED
ESPECIALLY CONSIDERING OLDER
ADULTS, THE OTHER THING I'D LIKE
TO HIGHLIGHT HERE IS A STUDY
DONE A NUMBER OF YEARS AGO,
RANDOMIZED CLINICAL TRIAL WITH
CALORIC RESTRICTIONS UNDER
CONDITIONS OF SUFFICIENT SLEEP
AND INSUFFICIENT SLEEP.
THE SAME INDIVIDUALS, RANDOMIZED
CONTROL.
WEIGHT LOSS WAS THE SAME BUT
WHAT WAS LOST WAS DIFFERENT.
PEOPLE LOST MORE FAT FREE MASS
WITH CALORIC RESTRICTION UNDER
INSUFFICIENT THAN FAT MASS.
THAT'S A KEY THING WHEN LOOKING
AT TRIALS IN THE FUTURE WHERE
SLEEP COULD BE INSUFFICIENT IN A
NUMBER OF PATIENTS IN THE
POPULATION AND TO CONSIDER HOW
THAT MAY BE IMPACTING THE TYPE
OF MASS THAT IS BEING LOST, BODY
MASS BEING LOST.
NEXT SLIDE.
WHEN WE LOOK AT FASTING GLUCOSE
AND FASTING INSULIN WE HAVE
SIGNIFICANT DECREASE IN FASTING
GLUCOSE, NON-SIGNIFICANT EFFECT
ON FASTING INSULIN.
SO SOME POTENTIAL IMPROVEMENTS
IN FASTING GLUCOSE, TRIALS HAVE
BEEN DONE.
IF WE LOOK AT CARDIOVASCULAR
OUTCOMES, SYSTOLIC AND DIE
TOLL -- DIASTOLIC BLOOD
PRESSURE, CHANGES IN STUDIES
OVERALL ARE NON-SIGNIFICANT.
AGAIN, WE'LL HAVE SOME STUDIES
THAT WILL SHOW SIGNIFICANCE, AND
OTHERS WON'T.
NEXT SLIDE.
NEXT I WANT TO SWITCH TO THIS
STUDY, ILLUSTRATING ANOTHER
CONCEPT THAT WE CAN BE
CONSIDERING IN THE TIMES OF
TRIALS, USING ENHANCED GLUCOSE
MONITORING IN EIGHT MALES,
RANDOMIZED CROSSOVER STUDY,
EARLY OR LATE MEAL TIMING.
YOU CAN SEE THE TIME ON THE
UPPER RIGHT-HAND CORNER.
FOR THREE DAYS AND TWO NIGHTS
EACH.
IF WE LOOK AT CONTINUOUS GLUCOSE
MONITORING, INTERSTITIAL LEVELS
ON THE Y-AXIS, CLOCK TIME ON THE
X-AXIS.
PINK FOR LATE-EATING GROUP,
LEVELS OF GLUCOSE THROUGHOUT THE
SLEEP OPPORTUNITY ARE MUCH MEYER
THAN WHAT IS SEEN IN THOSE WITH
THE EARLIER TIMING PATTERN.
I THINK IT BEHOOVES US AS
SCIENTISTS AND TRYING TO LOOK AT
THESE QUESTIONS NOT JUST TO LOOK
AT RESPONSES TO MEALS WHEN WE'RE
EATING BUT ALSO TO LOOK TO SEE
WHAT'S HAPPENING OVERNIGHT TO
GLUCOSE AND, FOR EXAMPLE, TO
LIPID METABOLISM AND HOW THAT
COULD CONTRIBUTE TO OUTCOMES
WE'RE EXAMINING.
NEXT SLIDE.
WE HAVEN'T HEARD AS MUCH ABOUT
SHIFT WORK BUT THIS IS ANOTHER
KEY AREA WHEN WE THINK ABOUT
TIME-RESTRICTED.
NEXT SLIDE.
ONE OF THE THINGS THAT WE CAN
CONSIDER BEYOND LOOKING AT
METABOLIC OUTCOMES IS OTHER
OUTCOMES IN THESE TYPES OF
TRIALS.
THIS IS TO ILLUSTRATE IN
ADDITION TO WORK WE'VE HEARD
ALREADY PRESENTED YESTERDAY,
THIS IS AN EXAMPLE OF A STUDY IN
AUSTRALIA WHERE THEY WENT AHEAD
AND COMPARED EATING A SMALL
SNACK OR NOT EATING AT ALL AT
NIGHT COMPARED TO EATING A
TYPICAL MEAL, 30% OF TOTAL DAILY
ENERGY EXPENDITURE.
SMALL SNACK, 10% OF TOTAL DAILY
EXPENDITURE, AND NOT EATING,
IMPROVED PERFORMANCE IN THE
LEFT-HAND AND MIDDLE GRAPH,
LAPSES IN ATTENTION, ON THE
SECOND TASK, AND THE SOLID BAR
IS REPRESENTING THE MEAL, AND
THE ONE WITH THE OPEN SYMBOL IS
THE SNACK AND THEN NOT EATING IS
THE DASHED LINE, REDUCED IN
SMALL SNACK OR NOT EATING AT
ALL, CONSISTING SHOWING FASTING
OVERNIGHT WHEN PEOPLE ARE AWARE
SHOWS IMPROVEMENTS IN
PERFORMANCE.
SO THERE COULD BE AGAIN OTHER
RELEVANT OUTCOMES TO CONSIDER.
THE FAR RIGHT HERE IT REDUCED
SLEEPINESS IN TERMS OF JUST
HAVING A SNACK ON THE NIGHT
SHIFT.
NEXT SLIDE.
WE TALKED ABOUT ASSESSING
CIRCADIAN PHASE RELATED TO
TIMING OF EATING.
THAT'S IMPORTANT IN OUR DAYTIME
STUDIES.
ONE OF THE THINGS THINKING ABOUT
TRYING TO IMPLEMENT IN SHIFT
WORKERS, THE SHIFT IS MUCH MORE
WIDELY DID I PERCENTED, SHOWN
HERE IN THIS GRAPH BY CHANG, A
RADIAL PLOT, AND BARS FROM THE
CENTRE
-- STERILE STRAIGHT TIMING
IN SHIFT WORKERS, FARTHER OUT IS
MORE SUBJECTS, RANGES GO IN THE
AFTERNOON HOURS UNTIL THE
MORNING HOURS.
IF WE'RE TRYING TO TIME FOOD
INTAKE RELATIVE TO CIRCADIAN
TIMING IN SHIFT WORKERS WE NEED
A BIOMARKER TO DETERMINE THAT
BECAUSE OF THE DISTRIBUTION.
NEXT SLIDE.
AND I'M GOING TO END WITH
OPPORTUNITIES IN FUTURE
DIRECTIONS.
AND WE'VE HEARD ABOUT MOTHER'S
MILK, TRYING TO UNDERSTAND THAT
AND COMPONENTS OF THAT.
AND I WANT TO HIGHLIGHT HERE
THAT THE TIME OF DAY IMPACTS THE
COMPONENTS OF BREAST MILK.
WHEN WE THINK ABOUT WHEN AN
INFANT IS FEEDING, IF THEY ARE
BREASTFEEDING, THEY ARE GETTING
APPROPRIATE TIME CUES
THEORETICALLY DURING THE DAY AND
HAS DIFFERENT COMPOSITION IN
TERMS OF MOLECULES COMPARED TO
NIGHTTIME.
IF MOTHERS ARE PUMPING MILK, AND
THAT'S PROVIDED TO A CHILD AT
THE DIFFERENT TIME FROM WHAT THE
MILK WAS PUMPED IN TERMS OF
BIOLOGICAL PUMPING THAT COULD
HAVE IMPLICATIONS FOR HEALTH OF
THE INFANT, AN OPEN AREA TO
EXPLORE CHRONONUTRITION.
NEXT SLIDE.
I WANT TO HIGHLIGHT ONE OTHER
AREA OF HEALTH HERE IN TERMS OF
PREGNANCY, AN INTERVENTION
LOOKING AT WOMEN WITH
GESTATIONAL DIABETES, CONTROL.
THEY DID A CHRONONUTRITION STUDY
WHERE THEY HAD A GROUP, THE
INTERVENTION OF NF 33 VERSUS
CONTROL OF NF 70, REDUCED
CARBOHYDRATE INTAKE IN THE
EVENING HOURS, THEY INCREASED
CARBOHYDRATE INTAKE IN MORNING
HOURS, THEY HAD THEM EAT
BREAKFAST 30 MINUTES FROM WAKING
UP AND EAT DINNER WITHIN 12
HOURS FROM WAKING UP, AVOID
EATING CLOSE TO SLEEP.
THAT SIMPLE INTERVENTION SHOWED
IT REDUCED MATERNAL RELATIVE
RISK OF DEVELOPING SUBOPTIMAL
GLYCEMIC CONTROL, SIGNIFICANTLY,
.28, ANOTHER OPPORTUNITY HERE.
NEXT SLIDE.
THE WANT TO HIGHLIGHT KEY
THINGS, WE'VE HEARD ALREADY,
LOOKING AT THE REGULARITY OF THE
TIMING OF EATING, NOT JUST WHEN,
THE AMOUNT, MACRONUTRIENTS,
QUALITY OF FOOD, AS WELL AS
ADHERENCE.
AND TO ILLUSTRATE MORE ABOUT
THAT CHRONONUTRITION BASED ON
BIOLOGICAL TIMING, IF WE DON'T
HAVE ACCURATE MARKER OF
CIRCADIAN PHASE RELATIVE TO WAKE
TIME AND BEDTIME IS THE FIRST
PROXY, BUT NOT AS EFFECTIVE.
IF WE'RE GOING TO MEASURE
CIRCADIAN TIMING, WE CAN DO IT
IN PATIENT'S HOMES, BUT IT'S
MORE OF AN ISSUE OF FEASIBILITY
SOMETIMES.
THIS LEADS TO ANOTHER GOAL FOR
THE STRATEGIC PLAN FROM THE NIH,
TO DEVELOP CIRCADIAN BIOMARKERS
USED IN LARGE SCALE CLINICAL
TRIALS SO THAT WAY WE CAN TAKE
CIRCADIAN PHASE INTO ACCOUNT IN
OUR INTERVENTIONS.
OFTEN THE TRIALS HAVE BEEN SMALL
SAMPLE SIZES, CLINICAL TRIALS IN
THIS AREA REQUIRE LARGER SAMPLE
SIZES AND REPRESENTATION NEEDED.
AND WHEN WE THINK ABOUT
TIME-RESTRICTED EATING, TESTED
IN POPULATION WAS OVERWEIGHT AND
OBESITY, EFFORTS TO SCREEN AND
STRATIFY OUTCOMES FOR THOSE WITH
AND WITHOUT SLEEP APNEA GIVEN
50% OF PATIENTS WITH OBESITY ARE
GOING TO HAVE SLEEP APNEA,
THAT'S GOING TO BE AN IMPACT ON
METABOLIC OUTCOMES, UNCLEAR
WHETHER OR NOT TIME-RESTRICTED
EATING IS GOING TO BE AS
EFFECTIVE IN THAT POPULATION.
AND WHETHER OR NOT THE
COMBINATION OF TREATMENT AND
EATING HAS BETTER METABOLIC
HEALTH BENEFITS IN THAT
POPULATION.
NEXT SLIDE.
LASTLY HERE I WANT TO HIGHLIGHT
NEED FOR CONTINUOUS AND FREQUENT
SAMPLING OF OUTCOMES ACROSS THE
24-HOUR DAY, INCLUDING CGM,
CONTINUOUS BLOOD PRESSURE
MONITORING, HORMONES, NOT JUST
MEAL RESPONSE BUT ACROSS THE
TIME OF DAY BECAUSE NIGHTTIME
AFFECTS -- ASSESSMENTS ARE
IMPORTANT.
ENERGY EXPENDITURE AND OTHER
MEASURES OF ENERGY METABOLISM,
AN OPPORTUNITY TO USE OMICS,
DEVELOPING BIOMARKERS, PROTEOME
TO UNDERSTAND MECHANISMS IT
TARGETS.
I THINK OPPORTUNITIES TO LOOK AT
INFLAMMATORY PROTEINS, OXIDATIVE
STRESS, AUTOPHAGY CHANGES
UNDERLYING MECHANISMS THAT
CONTRIBUTE TO CARDIOMETABOLIC
DISEASE AND HOW TIME RESTRICTED
EATING CAN IMPROVE THESE
OUTCOMES AS WELL AS MEASURING
SLEEP AND PERFORMANCE, A NEED TO
USE GOLD STANDARD ASSESSMENTS,
USING CLAMPS, TOLERANCE TESTS TO
GET BETTER ASSESSMENT OF
METABOLIC STATUS.
THERE NEEDS TO COMBINE
CHRONONUTRITION, LOOKING AT
HEALTHY DIET, MACRONUTRIENT
TIMING, CALORIC RESTRICTION.
LASTLY, TIMING AND AMOUNT OF
PHYSICAL ACTIVITY NEEDED TO
PROMOTE CARDIOVASCULAR HEALTH,
CARDIOMETABOLIC HEALTH IN DAY
WORKERS, ESPECIALLY SHIFT
WORKERS, IS A CRITICAL NEED,
UNDERSTANDING OR RECOMMENDATIONS
FOR PHYSICAL ACTIVITY FOR DAY
WORKERS MAY NEED TO BE DIFFERENT
FOR SHIFT WORKERS BECAUSE THEY
HAVE A HIGHER CARDIOMETABOLIC
BURDEN THAN DAY WORKERS.
LASTLY NEEDS TO COMBINE
CHRONONUTRITION WITH PHYSICAL
ACTIVITY AND SLEEP AND CIRCADIAN
PARAMETERS.
NEXT SLIDE.
THE LAST THING I WILL SAY IS
THAT WE NEED TO LOOK AT HEALTH
ACROSS THE LIFESPAN, DEVELOPING
INFANTS, TO OLDER ADULTS.
AS WELL AS AGAIN A NUMBER OF THE
CONDITIONS THAT WE'VE ALREADY
TALKED ABOUT, LASTLY I'LL ADD
PATIENTS IN MEDICAL CARE
FACILITIES, ENTEROFEEDING, AS
WELL AS DISORDER WITH NIGHTTIME
EATING, WE NEED TRIALS.
WITH THAT I WILL THANK YOU AND
WE'LL MOVE TO THE FIRST OF OUR
TALKS.
WE'LL GO TO THE NEXT SLIDE.
DR. COURTNEY PETERSON, ASSOCIATE
PROFESSOR IN NUTRITION,
UNIVERSITY OF ALABAMA
BIRMINGHAM, CO-DIRECTOR OF THE
SLEEP AND CIRCADIAN RESEARCH
CORE, FOCUSING ON DAILY
INTERMITTENT FASTING AND
TIME-RESTRICTED EATING, A P.I.
FOR SEVERAL CLINICAL TRIALS IN
THIS AREA INCLUDING THE LARGE
CLINICAL TRIAL IN PATIENTS WITH
TYPE 2 DIABETES.
WE LOOK FORWARD TO HEARING YOUR
PRESENTATION.
THANK YOU.
THAT WAS EXCELLENT.
THANK YOU FOR SUCH AN
OUTSTANDING OVERVIEW.
I COULDN'T AGREE MORE ON
OPPORTUNITIES AND CHALLENGES.
I'M GOING TO TALK ABOUT CLINICAL
TRIALS OF MEAL TIMING AND FOCUS
ON RANDOMIZED CONTROLLED TRIALS.
NEXT.
THE FIELD OF MEAL TIMING IS
BROAD.
I'M GOING TO FOCUS ON TWO MAJOR
TOPICS WITHIN THAT FIELD,
INTERMITTENT FASTING, AND
TIME-RESTRICTED EATING.
AND ALSO TALK ABOUT APPROACHES
THAT CHANGE THE TIME OF DAY OF
FOOD INTAKE WITHOUT CHANGING
THAT FEEDING FASTING DURATION,
PRIMARILY EATING BREAKFAST LIKE
A KING BUT OTHER APPROACHES TOO.
I'LL END BY TALKING ABOUT
OPPORTUNITIES AND CHALLENGES FOR
THE FIELD.
NEXT.
INTERMITTENT FASTING IS ANY MEAL
TIMING INTERVENTION OR APPROACH
THAT ALTERNATES PERIODS OF
EATING AND EXTENDED FASTING.
THERE WAS NO SINGLE DEFINITION
THAT EVERYONE AGREED ON.
BUT WE'RE CONVERGING TOWARDS A
14-HOUR DEFINITION IN HUMANS,
AND I'M A FAN OF
SPECIES-SPECIFIC DEFINITIONS.
MYSELF AND OTHER SPEAKERS SIT ON
AN INTERNATIONAL CONSENSUS
COMMITTEE THAT'S TRYING TO
HARMONIZE THESE DEFINITIONS OF
INTERMITTENT FASTING.
I LIKE THE 14 HOUR DEFINITION.
IF YOU LOOK AT SUBSTRATE
OXIDATION WE DON'T SEE A BIG
UPREGULATION IN FATTY ACID
OXIDATION OR GLUCONEOGENESIS
UNTIL 14 TO 20 HOURS.
IF YOU LOOK AT DATA FROM NHANES,
THE AVERAGE FASTING DURATION IS
ABOUT 12 HOURS A NIGHT SO I'M
RELUCTANT TO CALL THAT
INTERMITTENT FASTING.
I'LL TALK ABOUT THE AVERAGE
DEFINITION.
I PREFER THE AVERAGE FASTING
DEFINITION FOR TWO REASONS.
THE FIRST ONE IS THE 95%
CONFIDENCE INTERVAL DEFINITION
LUMPS TOGETHER BOTH VARIABILITY
OF EATING AS WELL AS FASTING
DURATION SO DOESN'T ALLOW US TO
PARSE OUT THE TWO SEPARATE
EFFECTS.
AND SECOND, YOU CAN COME UNWITH
SCENARIOS WHERE SOMEONE IS DOING
TIME-RESTRICTED EATING, SIX DAYS
A WEEK, 6 6 HOUR WINDOW, ONE DA
14-HOUR WINDOW, ASSIGNED 13% SO
THEY WOULD LOOK LIKE THEY ARE
NOT DOING TIME-RESTRICTED AND
WOULD LOOK INDISTINGUISHABLE, SO
THERE ARE LIMITATIONS TO BE
AWARE OF.
SEVERAL TIMES OF INTERMITTENT
FASTING ARE HETEROGENEOUS IN
TERMS OF ADHERENCE, BIOLOGICAL
EFFECTS, IN SOME CASES
MECHANISMS.
TO MAKE SENSE OF THESE DIFFERENT
APPROACHES I LIKE TO GROUP THEM
INTO THREE BROAD CATEGORIES.
FIRST IS PERIODIC FASTING WHERE
YOU HAVE A COMPLETE 24-HOUR
WATER ONLY FAST, SUCH AS
RELIGIOUS TRADITIONS OR 24-HOUR
WATER ONLY FAST.
SECOND APPROACHES ARE CALLED
INTERMITTENT ENERGY RESTRICTION,
APPROACH WHERE IS INSTEAD OF
HAVING A 24-HOUR WATER ONLY
FAST, YOU HAVE A LOW CALORIE
DIET, LIKE A MODIFIED FASTING
APPROACH.
IN THESE APPROACHES YOU HAVE
MODIFIED OR LOW-CALORIE DAYS,
ALTERNATE DAYS MODIFIED WHERE
YOU EAT ONE MEAL A DAY, OR THREE
TO FIVE DAYS IN A ROW, REPEAT
THIS CYCLE A FEW TIMES A YEAR.
NEXT SLIDE.
I DON'T HAVE TIME TO GO INTO THE
BROAD CATEGORIES, I'LL REFER YOU
ALL TO AN NIH WEBCAST THAT I DID
AS PART OF THE OPNA WEBINAR A
COUPLE WEEKS AGO.
PLEASE WATCH THAT IF YOU'RE
INTERESTED.
NEXT SLIDE.
THE THIRD TYPE ARE DAILY
INTERMITTENT FASTING APPROACHES,
KNOWN AS TIME-RESTRICTED EATING
IN HUMANS OR ANIMALS.
THESE ARE QUITE DIFFERENT FROM
THE OTHER FORMS OF INTERMITTENT
FASTING, NOT A SPECIFIC CALORIE
TARGET, WHETHER WATER ONLY
FASTING OR LOW CALORIE.
YOU'RE CONDENSING YOUR FOOD
INTAKE INTO SHORTER PERIOD EACH
DAY.
I'M GOING TO DEFINE
TIME-RESTRICTED EATING AS WITHIN
A CONSISTENT 10-HOUR WINDOW,
APPROXIMATELY SAME TIME EACH
DAY.
OR LESS.
AND THE MOST POPULAR FORM OF
TIME RESTRICTED EATING STUDIED
IS WHAT HAS BEEN CALLED 16:8
DIET, 8 HOUR WINDOWS, THE MOST
COMMONLY STUDIED.
WHAT'S UNIQUE RELATIVE TO OTHER
FORMS OF INTERMITTENT FASTING
WITH OR WITHOUT CUTTING
CALORIES, HAS MORE POTENTIAL FOR
US TO EVENTUALLY FIND SOMETHING
THAT CAN BE TRANSLATED INTO A
PUBLIC HEALTH GUIDELINE, MORE
CUSTOMIZABILITY THERE.
A LOT OF RESEARCH HAS BEEN QUITE
INTERESTING BECAUSE OF
UNIQUENESS, MOST GIVE PEOPLE
TIMING RULES, WHEN TO EAT, NO
INSTRUCTIONS ON HOW MUCH OR WHAT
TO EAT.
TIME-RESTRICTED CAN BE PRACTICED
BY EATING EARLY IN THE DAY,
MIDDLE SUCH AS SKIPPING
BREAKFAST, OR LATE SUCH AS
SKIPPING BREAKFAST AND LUNCH.
I'LL COME BACK TO THAT LATER.
NEXT SLIDE.
ONE OF THE FIRST STUDIES WAS
THIS STUDY IN 2018, THEY TOOK 23
ADULTS WITH OBESITY, AND HAD
THEM PRACTICE 8-HOUR
TIME-RESTRICTED EATING, STARTING
AT 10 A.M. AND ENDING AT 6 P.M.
AND THEY COMPARED THIS AGAINST
HISTORICAL CONTROLS.
WHAT THEY FOUND OVER A 12-WEEK
PERIOD THAT PARTICIPANTS WHO
PRACTICED TIME-RESTRICTED EATING
LOST 2 1/2% OF THEIR BODY WEIGHT
DESPITE NO INSTRUCTIONS TO
REDUCE ENERGY INTAKE OR COUNT
CALORIES.
THIS WAS SOME OF THE FIRST
EVIDENCE THAT TIME-RESTRICTED
EATING SPONTANEOUSLY REDUCES
ENERGY INTAKE.
THEY REPORTED GOOD ADHERENCE,
PARTICIPANTS ADHERED ABOUT 5 TO
6 DAYS A WEEK, AND THIS IS
REPLICATED BY A DOZEN OTHER
STUDIES, MOST REPORTED ADHERENCE
LEVELS AROUND FIVE TO SIX DAYS A
WEEK.
NEXT.
SINCE THEN WE'VE HAD NOW MORE
THAN 55, ALMOST 60 CLINICAL
TRIALS ON TIME-RESTRICTED EATING
IN HUMANS, THESE ARE
INTERVENTIONAL TRIALS.
WHEN YOU LOOK AT THE FIELD AS A
WHOLE, UNFORTUNATELY MOST OF
THESE STUDIES ARE SMALL SINGLE
ARM OR HAVE A WEAK CONTROL
GROUP.
PART WAS JUST BECAUSE YOU ALWAYS
HAVE TO DO A PILOT STUDY BEFORE
YOU DO A LARGE SCALE STUDY, BUT
UNFORTUNATELY THE FIELD IS
FLOODED WITH THESE LOWER QUALITY
STUDIES.
MANY OF THESE HAVE REPORTED
BENEFITS.
AND THESE INCLUDE REDUCTIONS IN
ENERGY INTAKE, IMPROVEMENT IN
GLYCEMIC CONTROL, IN BLOOD
PRESSURE, OXIDATIVE STRESS, AND
QUALITY OF LIFE.
HOWEVER I WILL SAY PROTOCOLS AE
HETEROGENEOUS.
A LOT OF THE MIXED RESULTS MAY
BE DUE TO DIFFERENCE IN STUDY
DESIGN AND INTERVENTION ITSELF.
NEXT.
AND WHEN YOU LOOK AT THE OUTCOME
OF WEIGHT LOSS, IF YOU DO A
SURVEY AND BODY WEIGHT, THEY ARE
EVENLY MIXED.
ABOUT HALF REPORTED WEIGHT LOSS
BENEFIT RELATIVE TO BASELINE OR
EATING SCHEDULE CONTROL, AND IF
YOU LOOK AT THOSE STUDIES THE
MEAN REPORTED WEIGHT LOSS IS 3%.
THE STUDY DURATION HAS BEEN VERY
VARIABLE.
RANGING FROM 6 TO 16 WEEKS.
INITIALLY, META-ANALYSES
REPORTED NO IMPROVEMENT IN BODY
WEIGHT.
HOWEVER, THE LAST THREE
META-ANALYSES I'VE SEEN
PUBLISHED AND I LOOKED ABOUT A
MONTH AGO ALL FOUND
STATISTICALLY SIGNIFICANT
IMPROVEMENTS IN BODY WEIGHT.
SO HERE'S AN EXAMPLE, FROM ONE,
IT REPORTED A WEIGHTED MEAN
DIFFERENCE OF ABOUT 2%, RELATIVE
TO A CONTROL EATING SCHEDULE.
MANY OF THESE META-ANALYSES
REPORTED IMPROVEMENTS IN FASTING
GLUCOSE BUT THOSE RESULTS HAVE
NOT NECESSARILY BEEN CONSISTENT.
I WOULD CHARACTERIZE THIS AS A
MODEST TO MODERATE EFFECT ON
BODY WEIGHT.
NEXT.
MY LAB TOOK A LOOK AT SOME OF
THE STUDIES ON WEIGHT LOSS, AND
REALIZED THREE LARGEST STUDIES
HAD SOME ISSUES, STUDY DESIGN OR
STUDY QUALITY, THAT THE
INTERVENTION WAS NOT
APPROPRIATELY MATCHED ACROSS
GROUP, OR THERE WERE
CONFOUNDERS.
WE DID A WEIGHT LOSS STUDY IN 90
ADULTS WITH OBESITY.
WE WANTED TO SEE IF YOU
PERFECTLY MATCH VARIABLES,
WHAT'S THE EFFECT OF
TIME-RESTRICTED EATING ON WEIGHT
LOSS AND WHAT'S A MORE ACCURATE
ESTIMATE OF THE CALORIE DEFICIT
INDUCED?
ARE THERE BENEFITS FOR WEIGHT
LOSS?
WE RANDOMIZED PATIENTS TO EITHER
PRACTICE EARLY TIME RESTRICTED
EATING BY EATING IN AN 8 HOUR
WINDOW EARLY IN THE DAY OR OVER
A SELF-SELECTED 12 HOUR OR
LONGER PERIOD AND BOTH THE 12
AND 14 WEEK MARK WE DID FIND
IMPROVEMENTS IN BODY WEIGHT
RELATIVE TO A CONTROLLED EATING
SCHEDULE.
WE DID SOME WEIGHT LOSS
MODELING, WERE ABLE TO ESTIMATE
SIZE OF THE CALORIC ESTIMATE, IN
THE INTENTION-TO-TREAT ANALYSIS
INDUCED CALORIC DEFICIT OF 214
CALORIES A DAY, LOOKED AT
ADHERED PARTICIPANTS, AT LEAST
FIVE DAYS A WEEK EVERY WEEK,
EFFECT WAS EVEN LARGER AT 350
CALORIES A DAY.
THIS PROVIDES SOME FIRST BEST
ESTIMATE FROM THE MAGNITUDE OF
THE CALORIC DEFICIT.
THAT'S IN GOOD ALIGNMENT WITH
THE LAST THREE META-ANALYSES I
MENTIONED.
MY LAB DID A DIFFERENT STUDY
PUBLISHED FOUR YEARS AGO,
INTERESTED IN MECHANISMS BY
WHICH TIME-RESTRICTED AND OTHER
FORMS OF INTERMITTENT FASTING
MAY INDUCE WEIGHT LOSS AND WERE
INTERESTED IN SEEING WHETHER IT
WAS DUE TO INCREASES IN ENERGY
EXPENDITURE OR REDUCTION IN
APPETITE.
WE PUT PEOPLE IN A RESPIRATORY
CHAMBER, TIME RESTRICTED EATING
DID NOT HAVE EFFECTS, NOT LARGER
THAN 80 CALORIES A DAY.
IF THEY ARE, THEY ARE NOT LARGE.
WE THINK THE PREDOMINANT
MECHANISM IS REDUCED APPETITE.
WE DID FIND ALTERATIONS IN
SUBJECTIVE APPETITE THROUGHOUT
THE DAY, ALSO CHANGES IN
APPETITE HORMONES, LOWER GHRELIN
LEVELS IN THE MORE THAN.
ONE SURPRISING STUDY WE MEASURED
SLEEP DURATION BY SELF-REPORT
AND FOUND EARLY TIME-RESTRICTED
EATING REDUCED SLEEP DURATION BY
30 MINUTES, WHICH WE WERE NOT
EXPECTING.
WE THOUGHT THIS MUST BE A
NEGATIVE EFFECT.
MAYBE PEOPLE ARE HUNGRY AT NIGHT
SO THEY ARE NOT SLEEPING WELL.
OR MAYBE NEED MORE TIME TO PREP
FOOD FOR THE NEXT DAY.
WE FOUND NO CORRELATION WITH
HUNGER, FOUND NO EVIDENCE IN OUR
EXIT INTERVIEWS PEOPLE NEEDED
MORE FOOD PREP TIME.
WE DID FIND PEOPLE REPORTED
HAVING HIGHER ENERGY LEVEL, LESS
FATIGUE, IDENTICAL SLEEP
QUALITY, HYPOTHESIZING EARLY
TIME-RESTRICTED EATING REDUCES
NEED FOR SLEEP BECAUSE WE SEE
POSITIVE EFFECTS ON ENERGY LEVEL
AND FATIGUE, PERHAPS ON A
SIMPLISTIC LEVEL THAT'S DUE TO A
LONGER FASTING PERIOD BEFORE
SLEEP ONSET WHICH MIGHT ALLOW
MORE TIME FOR REST AND REPAIR.
VERY INTERESTING INTRIGUING
HYPOTHESIS.
THERE'S EVIDENCE TIME-RESTRICTED
EATING MAY AFFECT OTHER
ENDPOINTS, ASIDE FROM WEIGHT
LOSS, SO HERE IS DATA FROM THE
LARGEST STUDY OF TIME-RESTRICTED
EATING IN ADULTS WITH TYPE 2
DIABETESA 12-WEEK TRIAL, 120
ADULTS OUT OF CHINA, EATING IN A
10 HOUR PERIOD 8 A.M. TO 6 P.M.
OR GIVEN NO RESTRICTIONS.
THEY REPORTED TIME-RESTRICTED
EATING IMPROVED HEMOGLOBIN
A1c, FASTING LOWER WEIGHT, AND
MANY OTHER CONDITIONS INCLUDING
METABOLIC SYNDROME, PCOS, MS, I
DO WANT TO HAVE A NICE CALL OUT
TO THOSE WHO DID THIS IMPORTANT
SEMINAL WORK IN THE FIELD.
NEXT.
MY LAB WAS INTERESTED IN THE
BIGGER PICTURE QUESTION, ABOUT
BENEFITS, CAN IT IMPROVE
CARDIOMETABOLIC HEALTH?
WE DID A FIVE-WEEK CONTROLLED
FEEDING CROSSOVER STUDY, MEN
WITH PREDIABETES, AND THE
PARTICIPANTS TRIED TWO
SCHEDULES, SIX HOUR FROM 8 A.M.
TO 2 P.M. OR A CONTROL PERIOD,
WE PICKED 12 HOURS TO MIMIC
AVERAGE AMERICAN EATING HABITS.
WE FOUND THAT EARLY TIME
RESTRICTED EATING IMPROVED
INSULIN RESISTANCE DRAMATICALLY,
IMPROVEMENTS IN BETA CELL
RESPONSIVENESS, EFFECTS ON BLOOD
PRESSURE, HALF PARTICIPANTS WERE
ON BORDERLINE OF PREDIABETES AND
DIABETES.
WE DIDN'T FIND FAVORABLE EFFECTS
ON LIPIDS OR INFLAMMATORY
MARKERS.
THERE HAVE BEEN NINE OTHER
RANDOMIZED CONTROLLED TRIALS
THAT TRIED TO ANSWER THE SAME
QUESTION WHETHER THERE ARE
BENEFITS INDEPENDENT OF CALORIE
RESTRICTION.
EIGHT OF NINE REPORTED BENEFIT.
WE FEEL THIS HAS BEEN DECENTLY
WELL REPLICATED.
THERE'S A GOOD CONSENSUS AMONG
STUDIES WITH A HIGH DEGREE OF
CONTROL.
NEXT.
THERE'S PROMISING STUDIES.
HOW DO WE MAKE SENSE?
THIS IS AN EXAMPLE OF ONE,
PROBABLY MANY OF YOU KNOW THIS.
PUBLISHED IN JAMA IN 2020,
12-WEEK TRIAL ON 116 ADULTS.
RANDOMIZED TO 8 HOUR TRE
SCHEDULE, 12 P.M. TO 8 P.M.,
MIDDAY SCHEDULE, WITH BREAKFAST
SKIPPING.
THIS IS COMPARED TO A THREE MEAL
A DAY CONTROL WHERE THE CONTROL
GROUP WAS REQUIRED TO EAT
BREAKFAST.
IN THIS STUDY TIME-RESTRICTED
WITH BREAKFAST SKIPPING WAS NOT
BETTER THAN THREE MEALS A DAY.
NEXT.
THERE'S A COUPLE STUDIES SHOWING
THAT LATER IN THE DAY MAY WORK
IN CARDIOMETABOLIC HEALTH, I'LL
DEFINE LATE TIME-RESTRICTED
EATING, SKIPPING BREAKFAST AND
LUNCH.
HERE IS DATA FROM MARK
MATHESON'S LAB, 8-WEEK CROSSOVER
STUDY, 4-HOUR TIME-RESTRICTED
EATING SCHEDULE, ABOUT ONE MEAL
A DAY AT DINNER TIME, BETWEEN 5
AND 9 P.M., VERSUS THREE MEALS A
DAY, FOR REQUIRED TO EAT THE
FIRST MEAL AT BREAKFAST.
WHAT THEY FOUND IS THAT LATE
TIME RESTRICTED EATING INCREASED
POSTPRANDIAL AND GLUCOSE LEVELS.
AND MOST OF THE STUDIES FINDING
CHANGES IN GLYCEMIC CONTROL FIND
THEM AT THE POSTPRANDIAL LEVEL,
NOT FASTING LEVEL, AS A FIELD
WE'RE DOING A DISSERVICE WITH
STUDIES THAT ONLY MEASURE
FASTING MARKERS.
EFFECTS ARE LARGER AT
POSTPRANDIAL LEVEL.
NEXT.
WHAT MIGHT EXPLAIN SOME RESULTS
DIFFERENCES IN FASTING DURATION
BUT ALSO POTENTIALLY TIME OF DAY
OF EATING.
AS WE'VE SEEN, WE ALL KNOW THE
BODY HAS AN INTERNAL BIOLOGICAL
CLOCK, CIRCADIAN SYSTEM,
PRODUCES 24 HOUR RHYTHMS, MOST
IMPORTANT IS RHYTHM OF GLYCEMIC
CONTROL.
IF YOU TOOK A TEST AT 9 A.M.,
AFTERNOON OR EVENING, LEVELS
SPIKED HIGHER IN THE AFTERNOON
AND EVENING.
THIS IS NOT A SMALL EFFECT.
THIS IS ABOUT A 40-POINT
DIFFERENCE IN INDIVIDUALS WITH
NORMAL GLYCEMIC CONTROL.
SO THIS IS EQUIVALENT TO SAYING
WE'RE ALMOST METABOLICALLY
PRE-DIABETIC WHEN WE EAT LATER
IN THE DAY.
NEXT.
AND THERE ARE OTHER RHYTHMS TO
CONSIDER, THREE STUDIES IN
RESPIRATORY CHAMBERS FOUND
EATING EARLIER IN THE DAY
INCREASES FAT OXIDATION RELATIVE
TO LATER IN THE DAY.
POTENTIALLY DIURNAL RHYTHMS, AND
ALSO THERE'S DATA ON DIURNAL
RHYTHMS AND BLOOD PRESSURE, SO
RHYTHMS ON LIPIDS ARE
HETEROGENEOUS AND VARIABLE.
NEXT.
PERFECT, THANK YOU.
AND CLINICAL INTERVENTIONS, ONE
OF THE -- BUILDING ON OTHER
DATA, DANIELLEA AND ORIN FROM
ISRAEL HAVE DONE GREAT WORK IN
THIS AREA TESTING THE ADAGE OF
EATING BREAKFAST LIKE A KING,
AND ONE STUDY WAS THIS 12-WEEK
RANDOMIZED CONTROLLED TRIAL, 93
OVERWEIGHT WOMEN, IN REVERSE
ORDER ARE LARGE DINNER.
LARGE BREAKFAST LOST MORE
WEIGHT, LESS HUNGRY.
AND FRANK SCHERER'S LAB SHOWED
EATING EARLY IN THE DAY WAS
BETTER FOR IMPROVING ENERGY
EXPENDITURE, REDUCING APPETITE,
ALSO FAVORABLY AFFECTED BALANCE
OF LIPOGENICS VERSUS LIPO LYTIC
GENE EXPRESSION.
THEY FOLLOWED UP THIS STUDY WITH
A COUPLE STUDIES FROM THE LAB
WHERE THEY TESTED THE SAME ADAGE
EATING BREAKFAST LIKE A KING,
ENERGY BALANCE, NOT LOSING
WEIGHT OR MATCHING CALORIE
INTAKE.
HERE IS DATA FROM A ONE-WEEK
CROSSOVER STUDY IN 18 ADULTS
WITH TYPE 2 DIABETES, AFTER ONE
WEEK OF EATING A LARGE BREAKFAST
THIS LOWERED GLUCOSE LEVELS
ACROSS THE DAY, AS YOU CAN SEE,
INCREASED INSULIN SECRETION
ACROSS THE DAY.
THIS IS ABOUT 15 TO 20%, SO A
LARGE IMPROVEMENT AFTER ONLY ONE
WEEK, NO DIFFERENCE IN ENERGY
INTAKE.
NEXT.
AND I THINK WE'RE UP TO ABOUT A
DOZEN STUDIES TESTING EATING
BREAKFAST LIKE A KING, OR
PRINCIPLE OF EATING EARLIER IN
THE DAY, AND THIS NICE
META-ANALYSIS SHOWED EATER DOES
APPEAR TO FACILITATE WEIGHT
LOSS, REDUCE BODY WEIGHT,
REDUCES FASTING GLUCOSE AND LDL
CHOLESTEROL.
AND THERE ARE ALL KINDS OF
VARIANTS ON THE TIMING OF FOOD
INTAKE.
WE KNOW BASED ON SOME BASIC
SCIENCE RESEARCH WHICH HAS BEEN
TERRIFIC THAT DIFFERENT
MACRONUTRIENTS VERY IN
EFFECTIVENESS FOR PERIPHERAL
CLOCKS.
CARBS, PROTEINS, FATS ARE NOT
EQUALLY EFFECTIVE.
THERE HAVE BEEN STUDIES IN
RODENTS AND HUMANS INDICATING
INDICATING FATS EARLIER IN THE
MORNING, CARBS IN THE EVENING,
REDUCES WEIGHT GAIN AND BODY FAT
IN RODENTS, IMPROVES SATIETY IN
HUMANS.
HOW DO WE PUT INTERMITTENT
FASTING AND SORT OF TIME OF DAY
OF INTAKE DATA TOGETHER AND
RESOLVE BREAKFAST SKIPPING, WHY
IS IT KROAFERL?
YOU CAN SKIP BREAKFAST AND DO
TIME RESTRICTING EATING, ONE
HYPOTHESIS IS BREAKFAST SKIPPING
MAY NOT INCREASE RISK OF
CARDIOMETABOLIC DISEASE UNLESS
ACCOMPANIED BY LATE NIGHT
EATING.
THIS IS ANOTHER IMPORTANT
QUESTION FOR THE FIELD.
NICE WORK OUT OF JAPAN SHOWS
THERE ARE TWO DISTINCT BREAKFAST
SKIPPING PHENOTYPES.
HALF SKIP BREAKFAST AND EAT
DINNER AT REGULAR TIME, OTHER
HALF EAT LATE.
THERE ARE BEHAVIORAL PHENOTYPES,
YOU HAVE TO ASK ABOUT THE WHOLE
DAY.
INTERESTINGLY, THOSE WHO SKIP
BREAKFAST AND ATE LATER HAD
HIGHER ODDS OF METABOLIC
SYNDROME, SIMILAR ODDS RATIO FOR
OBESITY WAS MUCH HIGHER THAN
THOSE WHO ONLY SKIPPED
BREAKFAST.
NEXT.
AND THE LARGEST TRIAL ON
BREAKFAST SKIPPING INDICATES IT
DOES NOT AFFECT BODY WEIGHT,
BUT, AGAIN, THESE BEHAVIORAL
PHENOTYPES WEREN'T TAKEN INTO
ACCOUNT SO TAKE THAT WITH A
GRAIN OF SALT.
THIS WAS DONE AS A PUBLIC HEALTH
RECOMMENDATION TO SKIP OR NOT
SKIP BREAKFAST.
THE DEVIL IS IN THE DETAILS.
THERE'S A PRETTY GOOD CONSENSUS
IN SKIPPING BREAKFAST ON 24 HOUR
GLUCOSE LEVELS, A HANDFUL
LOOKING AT THE EFFECT OF
SKIPPING BREAKFAST VERSUS EATING
3 MEALS A DAY, INCREASES IN
DAYTIME OR 24-HOUR GLUCOSE
LEVELS.
THE ONE CAVEAT IS ALL THESE
STUDIES HAVE BEEN A WEEK OR
LESS.
SO THAT MAY NOT BE ENOUGH TIME.
WE NEED LONGER STUDIES TO ANSWER
DEFINITIVELY.
NEXT.
AND COMING BACK TO SOME OF THE
MIXED RESULTS ON TIME RESTRICTED
EATING, IN ADDITION TO
CONSIDERING THE LENGTH OF THAT
WINDOW WE NEED TO THINK ABOUT
WHETHER THAT'S EARLY VERSUS
LATE.
WE'RE UP TO HALF A DOZEN
STUDIES, MOST UNDERPOWERED.
THE THREE LARGEST COMPARING
EARLY TIME RESTRICTED EATING TO
MIDDAY, SO BY SKIPPING
BREAKFAST, ALL THREE REPORT MORE
CARDIOMETABOLIC BENEFIT.
I DON'T THINK WE'RE CLOSE TO
DEFINITIVE ANSWER ON WHETHER
EARLY VERSUS MIDDAY
TIME-RESTRICTED IS MORE EFFECT
THE FOR WEIGHT LOSS BUT INDICATE
BENEFITS SUCH AS IMPROVEMENTS IN
SYSTOLIC BLOOD PRESSURE, MEAN
GLUCOSE LEVELS, INSULIN AND SO
FORTH.
MY PERSPECTIVE ON OPPORTUNITIES
AND CHALLENGES, THE MOST
PROMISING EFFECT TO PURSUE,
WEIGHT LOSS, GLYCEMIC CONTROL,
BLOOD PRESSURE AND MOOD, LESS IS
KNOWN ABOUT EFFECTS IN
PRE-HYPERTENSIVE OR
HYPERLIPIDEMIC POPULATIONS.
IT'S IMPORTANT FOR NHLBI TO
KNOW.
THERE'S LACK OF TRANSLATION
THERE.
IMPORTANT TO FIGURE OUT TO WHAT
DEGREE RESULTS DEPEND ON CRIT
AM, AND IMPORTANT TO BE HUMBLE,
EVEN IF WE SEE ALIGNED RHYTHM
MAY NOT INDICATE BEST TIME OF
DAY TO EAT.
INDIVIDUALS WITH TYPE 2 DIABETES
TEND TO HAVE BEST SENSITIVITY
LATER IN THE DAY, YOU MIGHT
THINK MAYBE THEY SHOULD EAT MORE
LATER BUT INTERVENTION FOUND THE
OPPOSITE.
RHYTHMS MAY BE MALLEABLE.
INPATIENT WITH NEAR PERFECT
ADHERENCE.
WE HAVE GOOD CONSENSUS IN TERMS
OF WHETHER THERE ARE BENEFITS.
WE DON'T HAVE ENOUGH STUDIES.
THESE ARE IMPORTANT TO DETERMINE
EFFICACY.
IF I WERE TO TAKE MY TOP FOUR
FAVORITE LAYERS OF THE ONION TO
TARGET IN RANDOMIZED CONTROLLED
TRIALS I WOULD TARGET TRYING TO
TEASE EFFECT ENERGY RESTRICTION,
FASTING DURATION, TIME OF DAY
AND CONSISTENCY OF THE WINDOW,
MY TOP FOUR LAYERS FOR US TO
TACKLE, THOSE WHO DO RCTs.
THE RESULTS WERE MIXED FOR
LARGER FREE-LIVING STUDIES BUT
IT'S IMPORTANT TO DO LARGER AND
LONG TERM.
WE NEED TO KNOW ABOUT
EFFECTIVENESS, WHAT ADHERENCE IS
IN THE LONG TERM, HOW
FEASIBILITY DEPENDS ON THE
LENGTH AND TIME.
WE'RE FLOODED BY LOWER QUALITY
STUDIES, SAMPLE SIZES ARE LOWER,
ISSUES WITH STUDY DESIGN.
UNFORTUNATELY ONE TREND I SEE IS
MANY ARE DESIGNED BY PEOPLE THAT
DON'T HAVE -- THERE'S A LOT OF
ENTHUSIASM BUT ARE DESIGNED BY
PEOPLE WITHOUT EXPERIENCE IN
NUTRITION STUDIES OR
CHRONOBIOLOGY, THERE'S ISSUES
THAT UNDERMINE THE QUALITY.
WE NEED A VIRTUAL EDUCATION PATH
FOR INVESTIGATORS AND MUCH
LARGER SAMPLE SIZES, A LOT OF
STUDIES ARE UNDERPOWERED.
I'D LIKE TO CLOSE AND THANK
SPONSORS AND COLLABORATORS.
>>THANK YOU.
OKAY.
NEXT SLIDE.
INTRODUCING PROFESSOR CRISPIM,
PROFESSOR OF NUTRITION AT THE
FEDERAL UNIVERSITY IN BRAZIL,
VISITING RESEARCHER IN THE U.K.,
FOCUSING ON CHRONONUTRITION
BROADLY WITH EMPHASIS ON SHIFT
WORKERS AND PREGNANCY AS WELL AS
FOOD INTAKE AND SLEEP.
WE LOOK FORWARD TO YOUR
PRESENTATION.
>>THANK YOU.
I'D LIKE TO THANK THE
ORGANIZERS.
IT'S A PLEASURE TO BE HERE AND
TO BE PART OF THIS AMAZING TEAM.
MY TOPIC IS CIRCADIAN
MISALIGNMENT AND MEAL TOMORROW
ON PUBLIC HEALTH, SPECIFIC FOCUS
ON SHIFT-WORK POPULATION.
NEXT PLEASE.
SHIFT WORK IS PREVALENT IN OUR
SOCIETY, AROUND 20% OF THE WHOLE
WORKFORCE, THE SHIFT WORK HAS
BEEN CONSIDERED THE MODEL OF
CIRCADIAN MISALIGNMENT, MORE
LIKELY TO DEVELOP MANY DISEASES,
ESPECIALLY NUTRITIONAL AND
METABOLIC, SUCH AS OBESITY,
LIPID DISORDERS, TYPE 2
DIABETES, AND OTHERS.
BASED ON THIS, I DIVIDED MY
PRESENTATION INTO PARTS.
FIRST EPIDEMIOLOGICAL POINTS,
CLINICAL APPROACH ON THE SAME
SUBJECT, GAPS IN KNOWLEDGE, AND
CONCLUSIONS.
NEXT.
DIETARY INTAKE OF SHIFT WORKERS
HAS BEEN ADDRESSED BY STUDIES,
ESPECIALLY IN THE LAST 15 YEARS.
WE HAVE MORE SYSTEMATIC REVIEWS,
SOME WITH META-ANALYSIS,
COMPARING THE FOOD INTAKE AND
DIETARY INTAKE OF SHIFT WORKERS,
AND COMPARED WITH DAY WORKERS.
NEXT PLEASE.
AND IN GENERAL, THE STUDIES THAT
WERE INCLUDED IN ALL THIS
REVEALS ENERGY INTAKE OF SHIFT
WORKERS, AS FAR AS QUANTITY AND
QUALITY OF DIET, SNACKING
BEHAVIOR, EATING FREQUENCY, AND
IN GENERAL THESE ARTICLES HAVE
ADDRESSED THE TIME OF MEAL OF
SHIFT WORKERS, AND WE HAVE
EVIDENCE THAT THEY EAT AROUND
THE CLOCK.
NEXT PLEASE.
HERE WE COMPARED 6:00 AT NIGHT.
UP TO 11 P.M. BOTH DAY AND NIGHT
SHIFT WORKERS TEND TO PRESENT A
SIMILAR ENERGY INTAKE, AND ALSO
SIMILAR DISTRIBUTION OF THE
ENERGY INTAKE THROUGHOUT THE
DAY.
HOWEVER, NEXT PLEASE.
AFTER 11 P.M. SHIFT WORKERS,
NIGHT WORKERS, THEY TENDED TO
INTAKE 600 MORE CALORIES THAN
DAY WORKERS.
NEXT.
WHICH REPRESENTED AROUND 20% OF
THEIR DAILY CALORIC INTAKE.
NEXT.
AND HERE IS ANOTHER STUDY WITH
DIFFERENT SHIFT.
WE EVALUATED ROTATING SHIFT
WORKERS.
THEY WERE MINE WORKERS.
WE EVALUATED FOOD INTAKE
THROUGHOUT TEN DAYS, WE HAVE
HERE DATA FROM 240 CONSECUTIVE
HOURS OF FOOD RECALL, AND WE CAN
SEE IN RED SQUARES THAT DURING
THE NIGHT SHIFT, THE NIGHT SHIFT
WORKERS, THEY TEND TO PRESENT --
TO HAVE MANY EATING OCCASIONS,
WITH DIFFERENT AMOUNTS OF
ENERGY.
NEXT.
AND THIS REPRESENTED AROUND A
THOUSAND CALORIES FROM 8 TO 6
A.M., AROUND 30% OF THE DAILY
CALORIE INTAKE.
THIS IS REALLY IMPORTANT WHEN
YOU THINK ABOUT OBESITY, THOSE
ARE MORE LIKELY TO PRESENT.
NEXT.
THIS IS AN INTERESTING REVIEW
ARTICLE FROM THE UNIVERSITY OF
SOUTH AUSTRALIA.
THE AUTHORS EVALUATED, DISCUSSED
FACTORS INFLUENCING EATING
BEHAVIOR OF SHIFT WORKERS,
WHERE, WHAT, WHEN AND WHY.
SOMETHING THAT'S INTERESTING TO
NOTE IS THAT THE MOST FREQUENT
FACTORS INFLUENCING EATING
BEHAVIOR OF SHIFT WORKERS
ESPECIALLY WITH THIS QUESTION,
WHEN THEY EAT, WERE IRREGULAR
WORKING HOURS, BREAK
AVAILABILITY.
NEXT.
BUT WHAT I'D LIKE TO HIGHLIGHT
IN THIS REVIEW, NEXT PLEASE,
SOMETHING THAT ARE IS IMPORTANT
IN THIS REVIEW IS THAT
CROSS-SECTIONAL, 90%, WE KNOW
THERE ARE MANY IMPORTANT
LIMITATIONS ON CROSS-SECTIONAL
STUDIES, WE CANNOT EVALUATE
CAUSE AND EFFECT RELATIONSHIP,
WE CANNOT CAPTURE CHANGES OVER
TIME, AND ONLY THREE OF THESE 30
WERE EVALUATED TIME OF MEAL, AND
NO COHORT STUDIES WERE INCLUDED.
SO I CONSIDER IT AS A VERY
IMPORTANT LIMITATION FOR THE
FIELD AND I'M GOING TO ADDRESS
IT LATER IN MY PRESENTATION.
NEXT.
NOW CLINICAL APPROACH ON
CHRONONUTRITION FOR SHIFT
WORKERS.
NEXT.
I'M GOING TO SHOW YOU SOME
RANDOMIZED CROSSOVERS THAT WE'VE
DONE AT OUR UNIVERSITY IN
BRAZIL, DIFFERENT MEALS DURING
THE NIGHT SHIFT, SPECIFICALLY
FOCUSED ON MEASURED INFLUENCE OF
DIFFERENT MEAL STRETCHES AND
COMPOSITION ON EATING BEHAVIOR
THE NEXT DAY.
NEXT.
AND THESE TWO ARTICLES, WE
TESTED THE SAME NUTRITIONAL
PROTOCOL DURING THE NIGHT SHIFT,
SO IT WAS HIGH PROTEIN MODERATE
CARB MEAL VERSUS LOW PROTEIN
HIGH CARBOHYDRATE, RELATED TO
FOOD INTAKE THE FOLLOWING DAY,
SECOND ARTICLE WE MEASURED
POSTPRANDIAL RESPONSE FOLLOWING
BREAKFAST, INSULIN AND GLUCOSE
LEVELS.
WE FOUND IN BOTH STUDIES THE
COMPOSITION OF MEALS DURING THE
NIGHT SHIFT DID NOT INFLUENCE
POSTPRANDIAL METABOLIC RESPONSE
THE FOLLOWING DAY.
NEXT.
THIS IS ANOTHER STUDY OF OURS,
AND HERE WE RANDOMIZED CROSSOVER
STUDIES, WITH THREE ARMS.
FIRST WAS NIGHT SHIFT FASTING,
HERE THE WORKERS, THE WHOLE
NIGHT WORKING WITHOUT EATING.
THEY RECEIVED 100% OF THE ENERGY
REQUIREMENT UP TO 10 P.M., AND
SECOND WAS NIGHT SHIFT EATING.
SO THEY RECEIVED 7% OF THE
ENERGY INTAKE UP TO 10 P.M.
AND 30% AT 2 A.M., DURING THE
NIGHT SHIFT.
IT WAS A BALANCED DIET.
BALANCED MEALS, SORRY.
THE CONDITION WAS REGULAR NIGHT
SLEEP.
NEXT PLEASE.
SURPRISINGLY WE FOUND THAT THE
FASTING DURING THE NIGHT SHIFT
LED TO HIGHER INTAKE OF ENERGY
AND MICRONUTRIENTS THE NEXT DAY,
IN GENERAL WE CAN SEE IN THIS
TABLE THAT THE NIGHT SHIFT
FASTING CONDITION, IN THIS
CONDITION THEY ATE AROUND A
THOUSAND CALORIES MORE THAN THE
OTHER TWO CONDITIONS.
OF COURSE, WE DON'T KNOW IF
REPLICATED IN LONG TERM FOR
EXAMPLE BUT PROBLEMATIC BECAUSE
WE KNOW THESE WORKERS ARE MORE
LIKELY TO HAVE OBESITY, FOR
EXAMPLE.
NEXT.
MAYBE THE POINT, THE QUESTION
HERE, DID WE USE THESE FINDINGS,
SO FAR IN LITERATURE, TO DIVIDE
SHIFT WORKERS AND UNFORTUNATELY
WE CANNOT BECAUSE, AGAIN, THIS
IS STUDIES CAN SHORT TERM, THESE
THREE WE TESTED ONLY TWO DAYS OF
INTERVENTIONS.
NEXT.
AND WE REALLY NEED LONG-TERM
INTERVENTION.
HERE, WE HAVE FOUR REVIEWS OF
THE LITERATURE ON THE TOPIC
ADDRESSING INTERVENTIONS,
HEALTHY NUTRITION FOR SHIFT
WORKERS.
AND NEXT.
IN GENERAL WE CAN SEE THAT MOST
OF THESE STUDIES INCLUDED A FEW
NUMBERS OF LONG-TERM
INTERVENTION.
SO TO ONE, TWO, FIVE, FOUR, AND
NEXT.
AND RESULTING PART HIGHLIGHTED
VAST MAJORITY OF THESE STUDIES
FOCUS ON PROMOTING EATING --
HEALTHY EATING HABITS IN
PATIENTS, SOMETHING THAT'S
REALLY IMPORTANT BUT VAST
MAJORITY OF THE DISEASE DOES NOT
ADDRESS MEAL TIME AS IMPORTANT
PART OF THE INTERVENTION.
SO, AGAIN, WE NEED MORE FOCUS ON
THIS SUBJECT.
NEXT.
FIRST I HAVE ALSO GOOD NEWS,
SUCH AMAZING RESEARCH BEING DONE
ON DIFFERENT PARTS OF THE WORLD,
FIRST ONE IS FROM A PROFESSOR
HERE WITH US, TESTING THE
TIME-RESTRICTED EATING IN SHIFT
WORKERS AND ALSO TWO OTHERS.
NEXT.
IN GENERAL WE OBSERVE MEAL TIME
FOR SHIFT WORKERS, FEASIBLE,
SOMETHING THAT'S REALLY
IMPORTANT.
POSITIVE METABOLIC OUTCOMES.
MAYBE IMPROVEMENT HAS BEEN LIKE
STILL LIMITED BECAUSE THE
DURATION OF THE INTERVENTIONS IS
LIKE FROM 80 TO 12 A WEEK -- 8
TO 12 WEEKS, MAYBE NEED TO FOCUS
ON LONGER INTERVENTIONS.
NEXT.
SOME GAPS IN KNOWLEDGE.
NEXT.
I BELIEVE NUTRITION GUIDELINE
FOR SHIFT WORKERS, HIGH DEGREE
OF RECOMMENDATION AND STRENGTH
OF EVIDENCE MAIN GOAL ADVISE
THESE WORKERS, BUT I THINK WE'RE
TOO FAR FROM THIS OBJECTIVE.
NEXT.
BECAUSE WHEN YOU -- WE SEE
HIERARCHY OF EVIDENCE FOR
CLINICAL DECISION MAKING WE CAN
KNOW TO HAVE SYSTEMATIC REVIEW,
GUIDELINES, WE NEED TO HAVE A
GOOD NUMBER OF RANDOMIZED
CONTROLLED TRIALS AND COHORTS.
AND SO FAR THIS IS VERY LIMITED
FOR SHIFT WORKERS AND
CHRONONUTRITION.
NEXT.
LONG-TERM RANDOMIZED CLINICAL
TRIALS I THINK SOMETHING THAT'S
REALLY IMPORTANT TO TEST THE
MINIMUM OR MAXIMUM ONE, INTAKE
REQUIRED DURING NIGHT SHIFT,
CONSIDERING FOR EXAMPLE HEDONIC
SENSATIONS, SOCIAL INTERACTIONS,
SAFETY, VARIABLES CLOSELY
RELATED TO FOOD INTAKE DURING
THE NIGHT SHIFT.
NEXT.
WE HAVE SOME DATA THAT SHOWS 10%
OF DAILY ENERGY CAN ALLEVIATE
HUNGER IN THE NIGHT SHIFT, BUT
THIS IS FROM STUDIES, WE NEED
LONG-TERM EVIDENCE ITSELF.
NEXT.
I BELIEVE THAT A CHRONONUTRITION
INTERVENTION FOR SHIFT WORKERS
SHOULD INVOLVE DIFFERENT
STAKEHOLDERS, SO SHIFT WORKERS
BUT ALSO THE COMPANY, THE FAMILY
ACADEMICS, SPECIALIZED HEALTH
CARE TEAM.
NEXT.
MAYBE WE CAN CALL IT A
CHRONOTEAM, BECAUSE
CHRONOBIOLOGY APPROACH MUST BE
IMPORTANT ON SLEEP HYGIENE AND
EXERCISE TIME.
NEXT.
AND THIS TOPIC, CIRCADIAN
HYGIENE INTERVENTION, HAS
EMERGED IN LITERATURE, IN RECENT
YEARS.
AND I THINK IT SOUNDS QUITE
EXCITING AND INTERESTING FOR
SHIFT WORKERS AS WELL.
BETWEEN DIFFERENT SECTORS AND
BEHAVIORS IN THESE INTERVENTIONS
WE HAVE TIME OF LIGHT, EATING
TIME, TIME OF PHYSICAL ACTIVITY,
SOCIAL TIME.
NEXT.
HERE IS SOME POTENTIAL QUESTIONS
FOR COHORT STUDIES TO EVALUATE
CHRONIC EFFECT OF SHIFT WORK ON
EATING HABITS AND TIME OF
EATING.
ALSO SHIFT SCHEDULE ASSOCIATED
WITH WORSENING EATING HABITS
OVER TIME.
ASSOCIATION BETWEEN CHANGING
MEAL TIMES AND WEIGHT GAIN OVER
TIME.
WE KNOW THAT SHIFT WORKERS
USUALLY GAIN WEIGHT AFTER
WORKING SHIFT.
BUT WE DON'T KNOW THE DYNAMICS
OF THIS PROCESS, SUCH AS WHAT IS
THE EFFECT OF MEALTIME, FOR
EXAMPLE.
ALSO FINALLY EFFECT ALSO OF
ADDITIONAL VARIABLES RELATED TO
OUTCOMES, CHRONOTYPE AND
CIRCADIAN MISALIGNMENT.
NEXT.
THANK YOU.
FUTURE DIRECTIONS, I THINK
POPULATION-BASED STUDIES SHOULD
INCLUDE MORE INFORMATION ON
SHIFT WORKERS' MEAL TIMES OR
HAVE SOME EXAMPLES OF SOME
SURVEYS THAT INCLUDE THIS
INFORMATION SUCH AS NHANES, BUT
I REALLY NEEDED SOMETHING TO
PROVIDE VERY IMPORTANT
INFORMATION ON THIS SUBJECT.
WE ALSO NEED LARGER AND
LONG-TERM RANDOMIZED CLINICAL
TRIALS.
AND WE ALSO HAVE MANY CHALLENGES
AND BARRIERS TO ACHIEVE, AND
MONEY IS ONE IMPORTANT ONE
BECAUSE FOR EXAMPLE I CAME FROM
A DEVELOPING COUNTRY, IT'S BEEN
CHALLENGING FOR US TO DO
RESEARCH IN RECENT YEARS.
AND ENGAGING AND HOLDING
COMPANIES ACCOUNTABLE, I THINK
COMPANIES MUST BE RESPONSIBLE
FOR THE WORKERS AND ALSO THEIR
HEALTH.
NEXT.
I'D LIKE TO THANK MY TEAM FROM
FEDERAL UNIVERSITY.
AND THE PARTNERSHIP IN RESEARCH,
WORKING ON NOWADAYS.
THANK YOU.
>>THANK YOU.
NEXT SLIDE PLEASE.
LET ME INTRODUCE DR. SETH
CREASEY, UNIVERSITY OF COLORADO,
ANSCHUTZ MEDICAL SCHOOL, NIH,
NHLBI CAREER DEVELOPMENT
AWARDEE, RESEARCH FOCUSES ON
UNDERSTANDING HOW PATTERNS OF
PHYSICAL ACTIVITY, SLEEP, AND
FOOD INTAKE ARE RELATED TO
WEIGHT LOSS AND METABOLISM
BROADLY.
DR. CREASY, THANK YOU.
>>THANK YOU FOR THE KIND
INTRODUCTION.
I WOULD LIKE TO THANK ORGANIZERS
OF THIS WORKSHOP.
I'M HONORED TO BE ABLE TO
PRESENT HERE TODAY.
I'M GOING TO SPEND 15 OR 20
MINUTES CONVINCING YOU WHY
EXERCISE TIMING IS IMPORTANT AND
WHY IT NEEDS TO BE PART OF THE
CONVERSATION WITH THIS
CHRONONUTRITION WORKSHOP.
FIRST I WANT TO TAKE A QUICK
DISCLAIMER, EXERCISE AT ANY TIME
OF THE DAY IS GOOD.
I DON'T WANT YOU TO TAKE AWAY
FROM THE TALK IF YOU CAN'T
EXERCISE AT A PARTICULAR TIME,
THAT YOU SHOULDN'T EXERCISE.
EXERCISE WHENEVER YOU CAN.
WHAT I'M GOING TO FOCUS ON IS
ARE THERE SPECIFIC TIMES OF THE
DAY THAT WE CAN PRESCRIBE
EXERCISE TO ELICIT A CERTAIN
RESPONSE, WHATEVER THAT
METABOLIC OR PHYSIOLOGIC
RESPONSE IS WE WANT, TO TARGET
DISEASE TREATMENT OR PREVENTION.
NEXT SLIDE.
FIRST I WANT TO HIGHLIGHT
IMPORTANCE OF EXERCISE AND
PHYSICAL ACTIVITY, A NICE FIGURE
FROM THE 2018 GUIDELINES.
TWO THINGS.
NUMBER ONE, THIS IS ON THE
Y-AXIS IS RISK OF MORTALITY,
CARDIOVASCULAR DISEASE, TYPE 2
DIABETES.
ON THE X-AXIS IS PHYSICAL
ACTIVITY, VOLUME OF PHYSICAL
ACTIVITY.
NUMBER ONE, THE MORE YOU DO, THE
GREATER RISK REDUCTION YOU'RE
GETTING IN ALL THESE AREAS.
SO THAT'S NUMBER ONE.
THE OTHER THING I WANT TO POINT
OUT, STRIKING IN THIS FIGURE, ON
THE FAR LEFT SIDE YOU SEE THE
BIGGEST BANG FOR YOUR BUCK OR
RISK REDUCTION IS GOING FROM
NOTHING, DOING NO ACTIVITY, TO
DOING SOMETHING.
THIS IS A REALLY IMPORTANT
MESSAGE FOR PEOPLE WORKING WITH
PATIENT-FACING POPULATIONS,
TRYING TO GET PEOPLE TO BE MORE
ACTIVE.
THE FIRST STEP IS OFTEN THE MOST
IMPORTANT STEP.
AND THE MOST EFFECTIVE STEP.
I WANT TO POINT THAT OUT.
NEXT SLIDE.
NOW I'M GOING TO TALK ABOUT WHY
THE PATTERNS OF EXERCISE AND
PHYSICAL ACTIVITY MAY MATTER.
AND THIS IS A BUSY SLIDE.
THESE ARE THE PHYSICAL ACTIVITY
PATTERNS FROM A WEARABLE
THIGH-WORN ACCELEROMETER FROM
THREE SUBJECTS.
AND WHAT EACH REPRESENTS, LIKE A
CLOCK, AT THE TOP IS MIDNIGHT,
FAR RIGHT IS 6 A.M., BOTTOM IS
NOON, FAR LEFT IS 6 P.M.
AND EACH OF THESE RINGS
REPRESENTS ONE DAY OF WEAR TIME.
BLUE INDICATES SLEEP BEHAVIOR.
YELLOW IS SITTING BEHAVIOR.
GREEN IS STANDING.
RED IS WALKING BEHAVIOR.
IF YOU LOOK AT ALL THREE,
PARTICIPANTS FROM OUR RESEARCH
STUDIES, IF YOU JUST LOOK AT
SIMPLE VOLUME OF PHYSICAL
ACTIVITY, WHICH IS TRADITIONALLY
WHAT WE LOOK AT, ALL THREE ARE
DOING GREAT, 10,000 STEPS PER
DAY.
HOWEVER, THE PATTERNS, LOOK AT
THE DETAILS, PATTERNS IS
STRIKINGLY DIFFERENT.
IF YOU LOOK AT THE FIRST PERSON,
CLICK NEXT.
THEY HAVE REALLY NO PATTERN OF
PHYSICAL ACTIVITY.
SO THEY HAVE INTERMITTENT
STANDING THROUGHOUT THE DAY,
WALKING AT VARIOUS TIMES
THROUGHOUT THE DAY.
DIFFERENT WALKING BOUTS AT
RANDOM, DIFFERENT TIMES.
THEY HAVE ABOUT 20 WALKING BOUTS
OVER THE 14-DAY WEAR PERIOD WE
CAN SEE HERE.
THE NEXT PERSON IN THE MIDDLE
HAS A STRIKING MORNING EXERCISE
PATTERN.
YOU CAN SEE THIS PERSON
EXERCISES REGULARLY AROUND 9
P.M., FOR ABOUT AN HOUR EACH
TIME.
ACROSS THE 14-DAY OBSERVATION,
THEY EXERCISE THE EIGHT DAYS.
THEY ALSO HAVE QUITE A BIT OF
STANDING BEHAVIOR THROUGHOUT THE
DAY.
WHICH IS DIFFERENT THAN MOST
PEOPLE.
CLICK NEXT.
THE LAST PERSON HAS STRONG
EVENING EXERCISE PATTERN.
THIS PERSON ACTUALLY GETS VERY
LITTLE ACTIVITY DURING THE DAY,
SITTING MOST OF THE DAY,
SOMETHING WE ALL PROBABLY DO.
AND THIS PERSON EXERCISES AT THE
END OF THE DAY, ACTUALLY THE
EVENING CLOSER TO 4 TO 5 P.M.,
EXERCISING ABOUT FOUR DAYS PER
WEEK, AND FOR ABOUT AN HOUR.
THE MANNER IN WHICH THE THREE
PEOPLE ARE GETTING EXERCISE OR
PHYSICAL ACTIVITY IS VERY
DIFFERENT.
THAT MAY HAVE PHYSIOLOGICAL
IMPLICATIONS.
NEXT.
THESE TALKS HAVE HIGHLIGHTED THE
IMPORTANCE OF THE CIRCADIAN
SYSTEM.
THIS IS JUST THE FIGURE TO SHOW
DIFFERENT PEAKS IN HUER HORMOND
PHYSIOLOGIC PROCESS ACROSS THE
DAY.
I WANT YOU TO THINK IF YOU
IMPOSE EXERCISE AT THESE TIMES
OF THE DAY, NOT ONLY EXERCISE
AFFECTS EVERY SYSTEM IN THE
BODY, YOU'LL AFFECT THOSE
HORMONES AND PROCESSES AT THE
TIME OF EXERCISE, THERE WAS AN
AFTER EFFECT, OR NEXT DAY EFFECT
AS THE SYSTEM IS PREPARING, IT
MAY BE DIFFERENT IF SOMEBODY
EXERCISES ESPECIALLY SAT SAME
TIME OF DAY.
ONE OF MY JOBS WAS TO TALK ABOUT
THE CLINICAL DATA IN THIS
EXERCISE SPACE, EXERCISE TIMING
SPACE.
WE ARE I WOULD SAY WAY BEHIND
THE NUTRITION, CHRONONUTRITION
SIDE OF THINGS.
HOWEVER, I WILL GIVE PROPS TO
THE FIELD BECAUSE I THINK WE'RE
STARTING TO INVESTIGATE THIS
MORE BECAUSE OF ALL OF THE FOCUS
ON CHRONONUTRITION RECENTLY.
AND SO THIS IS ONE STUDY THAT
I'M GOING TO HIGHLIGHT, I'LL
HIGHLIGHT A FEW TO GIVE YOU A
FLAVOR WHERE THINGS ARE IN THE
EXERCISE TIMING SPACE.
THIS WAS JUST PUBLISHED THIS
YEAR.
THIS WAS U.K. BIOBANK DATA.
AND THEY HAD OVER 90,000 --
ALMOST 90,000 PARTICIPANTS.
THEY LOOK AT DIFFERENT PHYSICAL
ACTIVITY PATTERNS IN THESE FOLKS
AND HAD 6 TO 8 YEARS OF
FOLLOW-UP DATA.
THE GROUP A MORNING EXERCISE
GROUP OR MORNING PHYSICALLY
ACTIVE GROUP, THEY HAVE 16%
REDUCTION IN CORONARY ARTERY
DISEASE SUGGESTING MAYBE MORNING
EXERCISE IS IMPORTANT.
THE NEXT WAS PUBLISHED IN 2016,
FROM THE WOMEN'S HEALTH STUDY.
AGAIN LOOKED AT PHYSICAL
ACTIVITY PATTERNS AND TIMING,
HOW IT WAS RELATED TO OBESITY
RISK.
WOMEN LESS ACTIVE IN THE
MORNING, NOT ACTIVE IN THE
MORNING, HAD HIGHER RISK FOR
OBESITY RISK.
AND SO, AGAIN, THIS SUGGESTED
MAYBE MORNING ACTIVITY IS
BENEFICIAL FOR WEIGHT
MANAGEMENT.
CLICK NEXT.
THOSE WERE TWO OBSERVATIONAL
STUDIES, LARGER SCALE STUDIES.
WHERE IS THE CLINICAL DATA
INTERVENTIONAL STUDY?
NUMBER ONE, THERE'S A HUGE LACK
OF CLINICAL DATA.
THAT'S MY FIRST CALL.
WE NEED MORE STUDIES IN THIS
SPACE, RANDOMIZED TRIALS IN
PARTICULAR.
MOST ARE UNDERPOWERED OR SMALL.
THIS WAS A QUASI-EXPERIMENTAL
STUDY, SELF-COLLECTING GROUPS OF
MORNING AND EVENING EXERCISERS.
I WANTED TO HIGHLIGHT THIS.
IT WAS ONE OF THE FIRST TO LOOK
AT EXERCISE TIME OF DAY ON
WEIGHT LOSS.
IT WAS POST MENOPAUSAL WOMEN,
MEAN AGE 53, EXERCISED IN
MORNING OR EVENING FOR 12 WEEKS,
200 MINUTES PER WEEK.
CLICK NEXT.
THEY SAW THESE WOMEN REDUCED
THEIR FAT MASS IF THEY EXERCISED
IN THE EVENING MORE SO THAN
MORNING.
CLICK NEXT.
THEY ALSO INCREASED FITNESS
LEVELS, EVENING EXERCISERS, MORE
SO THAN THE MORNING EXERCISERS.
CLICK NEXT.
THE OTHER REASON I WANTED TO
POINT OUT THIS STUDY, THEY FOUND
THAT THESE EVENING EXERCISEERS
STARTED TO SHIFT TIMING OF MEALS
EVEN THOUGH THEY WEREN'T
PRESCRIBING CHANGES TO MEALS,
THESE EVENING EXERCISERS STARTED
TO EAT LESS IN THE EVENING AND
EAT MORE IN THE MORNING, AND
THAT MIGHT HAVE BEEN ONE OF THE
REASONS WHY WE SEE THIS
REDUCTION IN FAT MASS FOR THE
EVENING EXERCISEERS.
CLICK NEXT.
THE NEXT WAS A STUDY I WAS PART
OF SO THIS WAS A SECONDARY
ANALYSIS OF THE MIDWEST EXERCISE
TRIAL.
THIS IS OUT OF UNIVERSITY OF
KANSAS.
HIGHLY CONTROLLED EXERCISE STUDY
IN YOUNG ADULTS LOOKING AT
EFFECTS OF HIGH DOSES OF
EXERCISE ON WEIGHT LOSS, LOOKING
IN BOTH MALES AND FEMALES.
THE PRIMARY OBJECTIVE WAS TO
LOOK AT SEX DIFFERENCES IN
WEIGHT LOSS WITH HIGH AMOUNT OF
EXERCISE.
THERE WAS HIGH AMOUNT OF
EXERCISE, NO PRESCRIPTION ON
DIET.
THEY ASKED PEOPLE TO NOT CHANGE
THE DIET ACROSS THE COURSE OF
THE STUDY.
AND ANOTHER THING I WANT TO
POINT OUT THESE PEOPLE HAD TO
REMAIN ADHERENT TO THE EXERCISE
PROTOCOL, KICKED OUT OF THE
STUDY IF THEY DROPPED BELOW 90%
ADHERENCE.
I'M ONLY SHOWING PEOPLE WHO DID
THE EXERCISE.
DID THE TIME OF DAY MATTER?
WE DID THE SECONDARY ANALYSIS
LOOKING AT TIME OF DAY THAT
PEOPLE DID MAJORITY OF EXERCISE.
CLICK NEXT.
WE FOUND MORNING EXERCISERS,
THIS GROUP OF PEOPLE THAT DID
THE MAJORITY OF EXERCISE BEFORE
NOON, HOW WE CLASSIFIED FOR THIS
STUDY, LOST 7% OF BODY WEIGHT
OVER 10 MONTHS, A HUGE AMOUNT
WITH JUST EXERCISE ALONE,
SIMILAR MAGNITUDE TO DIET,
STANDARD BEHAVIORAL WEIGHT LOSS
INTERVENTION WITH CALORIC
RESTRICTION AND EXERCISE.
EVENING EXERCISERS LOST 2% EVER
BODY WEIGHT.
THIS IS DESPITE DOING THE SAME
AMOUNT OF EXERCISE, ALL
ADHERENT, SO THE QUESTION IS WHY
ARE WE SEEING STRIKING
DIFFERENCES IN MORNING VERSUS
EVENING EXERCISERS IN THIS
STUDY?
NEXT.
WE HAD INFORMATION ON THIS.
THIS IS AGAIN DATA FROM THE SAME
SECONDARY ANALYSIS.
WE HAD ENERGY EXPENDITURE WITH
WATER, YOU CAN SEE PERHAPS SOME
EVIDENCE THAT THE MORNING
EXERCISERS WERE BURNING MORE
CALORIES ACROSS 24 HOURS
COMPARED TO EVENING EXERCISERS.
ONE THING THAT'S IMPORTANT,
EXERCISE ENERGY EXPENDITURE WAS
CONTROLLED.
THIS POTENTIAL DIFFERENCE WOULD
BE SUGGESTIVE IT WAS
NON-EXERCISE BEHAVIOR, COULD BE
SLEEP, SEDENTARY BEHAVIOR,
NON-EXERCISE PHYSICAL ACTIVITY
THAT WAS DIFFERENT BETWEEN
MORNING AND EVENING GROUPS.
WE LOOKED AT ENERGY INTAKE, A
SNAPSHOT AT THE END OF THE
INTERVENTION.
IT LOOKED LIKE THE MORNING
EXERCISERS WERE REPORTING EATING
LESS AND EVENING EXERCISERS WERE
REPORTING EATING MORE.
AGAIN, SHOWING MAYBE THIS TIME
OF EXERCISE IS HAVING AN
INTERACTION EFFECT ON ENERGY
INTAKE.
CLICK NEXT PLEASE.
I WOULD BE REMISS TO NOT
HIGHLIGHT SOME OF THE TIMING OF
EXERCISE DATA ON GLYCEMIC
CONTROL.
THERE'S OTHER STUDIES IN THIS
SPACE, I'M GOING TO POINT OUT
JUST THIS ONE.
THIS WAS CROSSOVER STUDY IN 11
MALES I BELIEVE WITH TYPE 2
DIABETES.
WHAT THEY DID, A CROSSOVER
STUDY, THE GRAY -- GLUCOSE OVER
24 HOURS.
GRAY BAR IS BASELINE PRIOR TO
EXERCISE.
AND YOU CAN SEE, YOU KNOW, WHAT
IT LOOKS LIKE OVER 24 HOURS.
THEN THEY HAVE THESE MALES DO A
WEEK OF HIGH INTENSITY EXERCISE
TRAINING IN THE MORNING, YOU CAN
SEE THAT THE MORNING HAD ILL
EFFECTS ON GLUCOSE, IT WAS
HIGHER COMPARED TO BASELINE WHEN
EXERCISING IN THE MORNING.
THE EVENING EXERCISE ACTUALLY
RESULTED IN A DROP IN GLUCOSE.
THEY LOOK AT THESE RESULTS AFTER
ONE WEEK OF TRAINING AND TWO
WEEKS OF TRAINING.
THEY SAW THE SAME THING.
ESSENTIALLY MORNING EXERCISE
INCREASED GLUCOSE ABSOLUTELY,
EVENING EXERCISE DROPPED
GLUCOSE, WHAT YOU WANT HERE.
I'M PRESENTING DIFFERENT DATA
HERE.
PERHAPS THE TIME OF DAY OF
EXERCISE, WHAT WE SHOULD
RECOMMEND DEPENDS ON THE DISEASE
TARGET THAT WE'RE TRYING TO
PREVENT OR TREAT.
CLICK NEXT.
WHAT ARE SOME LIMITATIONS OF
PRIOR RESEARCH IN THIS SPACE?
NUMBER ONE, I WANT TO HIGHLIGHT,
I PRESENTED A COUPLE STUDIES,
AGAIN THERE ARE OTHERS THAT I
DID NOT HIGHLIGHT.
FOR THE MOST PART, SO FAR WE'VE
BEEN COMPARING APPLES TO ORANGES
IF WE TRY TO COMPARE ACROSS
STUDIES.
WE'VE HAD REALLY UNDERPOWERED
TRIALS OR NON-RANDOMIZED, THAT'S
MY FIRST CALL, WE NEED
ADEQUATELY POWERED TRIALS,
RANDOMIZED IN THIS SPACE.
NEXT.
THE STUDIES HAVE BEEN IN VARIOUS
STUDY POPULATIONS, ANOTHER
REASON WHY WE'VE SEEN DIFFERENT
RESULTS DEPENDING ON WHICH STUDY
WE'RE LOOKING AT.
SOME IN YOUNGER ADULTS, SOME IN
OLDER ADULTS, SOME MALES ONLY,
SOME FEMALES ONLY.
SO THERE'S A REAL NEED TO BE
RECRUITING THESE DIVERSE
POPULATIONS AND STUDYING
DIFFERENT POPULATIONS.
NEXT.
STUDIES HAVE USED DIFFERENT
EXERCISE STIMULI, AND TIMING.
SO IT'S REALLY HARD OR DIFFICULT
TO COMPARE ACROSS STUDIES
BECAUSE SOME ARE HIGH INTENSITY
EXERCISE TRAINING, SOME THREE
DAYS A WEEK, SOME FIVE, SOME
AEROBIC ONLY, SOME AEROBIC AND
RESISTANCE.
THE TIMING IS VARIABLE.
SOME SAY MORE THAN IS PRIOR TO
NOON, SOME SAY 6 TO 10 P.M., ET
CETERA.
THESE HAVE ALL BEEN LIMITED WITH
OUTCOME MEASURES, HARD TO
UNDERSTAND WHAT IS THE MECHANISM
BECAUSE WE HAVEN'T HAD ALL OF
THE MEASURES IN THESE STUDIES
PUBLISHED TO DATE.
NEXT.
THERE'S ALSO BEEN A LACK OF
CONTROL FOR CONFOUNDING SO I
THINK MANY HAVE BEEN THESE RCT
STUDIES BUT WE HAVEN'T -- AS FAR
AS EXERCISE TIMING IS CONCERNED
WE HAVEN'T HAD CONTROLS STUDIES
WHERE WE CAN HONE ON IN ON
EFFECT OF TIME OF DAY OF
EXERCISE.
THE LAST THING I'LL HIGHLIGHT IS
THESE STUDIES SUFFER FROM
INDIVIDUAL VARIABILITY IN
RESPONSE TO EXERCISE AT
DIFFERENT TIMES OF THE DAY.
SO AGAIN IN THESE CONTROLLED
STUDIES THERE'S A NEED FOR
CROSSOVER TRIALS WHERE WE'RE
RANDOMIZING SOMEBODY TO MORNING
EXERCISE, AND HAVE A WASHOUT
PERIOD AND LOOK AT THEIR
RESPONSE TO EVENING EXERCISE AS
WELL.
OPPORTUNITIES AND FUTURE
DIRECTIONS FOR THIS RESEARCH,
CLICK NEXT.
NUMBER ONE, HOPEFULLY I'VE
CONVINCED YOU THAT ACTIVITY
BELONGS IN THE CHRONOTRINITY
I'LL CALL IT OF RESEARCH
THERAPY.
WE NEED TO LOOK AT ALL OF THESE
THREE PILLARS, AND WHY THE
TIMING OF ALL OF THEM ARE
IMPORTANT.
IN PARTICULAR FOR EXERCISE
TIMING RESEARCH, WE HAVE NOT
LOOKED AT FASTED VERSUS FED
EXERCISE, IS IT A TIME-DEPENDENT
RESPONSE OR JUST NUTRIENT DEPEND
RESPONSE?
NUMBER TWO, HARMONIZING
MEASUREMENT AND METRICS.
AGAIN, WE NOW HAVE TECHNOLOGY TO
BE LOOKING AT SLEEP TIME, MEAL
TIME, EXERCISE OR PHYSICAL
ACTIVITY TIME, HARMONIZE TO
MEASURE WHAT IS IT THE MOST
POTENT VARIABLE THAT'S CHANGING
OUR OUTCOMES.
NEXT.
THE OTHER THING IS, IS
CONSISTENCY IMPORTANT?
THIS IS AN INTERESTING QUESTION
FROM AN EXERCISE TIMING
STANDPOINT AND MEAL TIMING.
FOR EXERCISE IN PARTICULAR MOST
PEOPLE DON'T EXERCISE SEVEN DAYS
A WEEK.
PARTICULARLY THEY DON'TS
EXERCISE AT THE SAME TIME OF
DAY.
MAYBE THEY HAVE A
MONDAY-WEDNESDAY-FRIDAY PATTERN,
OR TUESDAY AND THURSDAY EVENING
BECAUSE THAT'S WHEN THE CLASS
IS, OR WEEKEND WARRIORS.
WE NEED TO FIGURE OUT IS
CONSISTENCY AN IMPORTANT
VARIABLE.
NEXT.
ANOTHER THING TO POINT OUT, WE
NEED BOTH ACUTE AND CHRONIC
STUDIES.
WE NEED HIGHLY CONTROLLED
STUDIES, WHAT IS ACUTE RESPONSE
AT CERTAIN TIMES OF DAY TO
EXERCISE.
MUCH OF THE PRE-CLINICAL DATA
HAS BEEN MORE OF ACUTE RESPONSE.
AND THEN WHAT IS THE TRAINING
RESPONSE, IF WE CONSISTENTLY
EXERCISE AT CERTAIN TIME OF DAY
WHAT IS RESPONSE, IS THAT ACUTE
AFTER TRAINING DIFFERENT?
NEXT.
ONE MORE.
THERE'S A NEED FOR MECHANISTIC
STUDIES, WE'RE TRYING TO
UNDERSTAND WHY OR WHAT IS
AFFECTED BY EXERCISE TIME OF
DAY.
NEXT.
THERE'S ALSO A NEED FOR BOTH
EFFICACY AND EFFECTIVENESS
TRIALS, WE DON'T NECESSARILY
NEED TO LOOK UNDER THE HOOD.
WE JUST NEED TO KNOW DOES IT
WORK.
IF IT DOES WORK HOW DO WE
TRANSLATE THAT TO THE LARGER
POPULATION.
AND ONE MORE.
THE LAST OPPORTUNITY OR FUTURE
DIRECTION IS WE NEED TO BE
STUDYING HEALTHY POPULATIONS AND
DISEASE POPULATIONS.
I'LL MAKE A CALL IF WE'RE TRYING
TO UNDERSTAND HOW THESE
CHRONOTHERAPIES WORK, WE NEED TO
STUDY THE POPULATIONS WHO ARE
GOING TO BE IMPACTED BY THESE,
SO WE NEED TO STUDY POPULATION
WAS OVERWEIGHT AND OBESITY TO
SEE WHAT IS THEIR RESPONSE AND
WHAT IS OPTIMAL RESPONSE.
NEXT.
I THINK WHERE IS THIS MOVING?
HOPEFULLY WE'RE ALL MOVING
TOWARDS PRECISION LIFESTYLE
MEDICINE, IN PARTICULAR FOR
EXERCISE TIMING, I THINK THAT
TARGET MIGHT MOVE DEPENDING
WHETHER WE'RE TRYING TO TREAT
OVERWEIGHT OBESITY, OR DIABETES
OR CARDIOVASCULAR DISEASE, THE
TIMING MIGHT BE DIFFERENT BUT
WE'RE TRYING TO HONE IN ON WHAT
IS THE TARGET FIRST.
ONE MORE.
WITH THAT I'D LIKE TO THANK MY
MENTORS, STUDY TEAM, COLLEAGUES,
AND FUNDING.
>>THANK YOU VERY MUCH, DR.
CREASY.
IF WE CAN GO AHEAD AND MOVE THE
SLIDES AND LET'S PUT UP THE
DISCUSSION.
WE'RE GOING TO EXTEND TO 3:05.
I'M GOING TO START.
FANTASTIC QUESTIONS IN THE Q&A.
STARTING WITH COMBINING A COUPLE
HERE FOR OUR SPEAKERS,
INDIVIDUAL DIFFERENCES IN THE
RESPONSE TO INTERVENTIONS WE
TALKED ABOUT.
IN PARTICULAR IF THERE'S ANY
DATA LOOKING AT THINGS SUCH AS
CHRONOTYPE, SEX DIFFERENCES OR
AGE DIFFERENCES IN OUTCOMES.
DR. PETERSON, DO YOU WANT TO
START OFF?
>>SURE.
THERE'S NOT A LOT OF RESEARCH ON
SEX-SPECIFIC DIFFERENCES, NOT IN
HUMAN INTERVENTIONS.
THERE'S A LITTLE BIT OF WORK IN
ANIMAL MODELS, AND THERE'S SOME
EVIDENCE SUGGESTING THERE MAY BE
OPTIMAL FASTING DURATIONS FOR
MALES VERSUS FEMALES.
IF WE THINK ABOUT ANOTHER ANGLE,
METABOLIC FLEXIBILITY, SOMEONE
WITH OBESITY MAY BE MORE -- OR
LESS METABOLICALLY FLEXIBLE,
MAYBE LEAD LONGER FASTING
DURATION, I DON'T KNOW.
THAT'S A REALLY IMPORTANT
QUESTION.
PERSONALLY IN OUR CLINICAL
TRIALS WE HAVEN'T SEEN AFFECT OF
AGE.
ONE SUPER INTERESTING FIND WE
DID HAVE ONE PERSON IN OUR STUDY
WHO TECHNICALLY WASN'T A CURRENT
SHIFT WORKER BUT HAD A 20-YEAR
HISTORY OF NIGHT SHIFT WORK AND
THE ONLY PERSON THAT GOT
DRAMATICALLY WORSE ON THE TIME
RESTRICTED SCHEDULE, QUITE
STARK, DEFINITELY
PERSONALIZATION AND
CUSTOMIZATION THERE.
WE'RE VERY UNDERDEVELOPED AS A
FIELD FOR ANSWERING THESE
QUESTIONS.
VERY LITTLE EVIDENCE.
>>DR. CRISPIN, ANYTHING TO
ADD?
>>I THINK REALLY INTERESTING
QUESTION, IMPORTANT PROBLEM IN
THE SHIFT WORK FIELD, ESPECIALLY
WHEN YOU THINK ABOUT CROSSOVER
INTO CLINICAL TRIALS THAT WE
HAVE SO FAR.
WE HAVE A LARGER NUMBER OF
STUDIES WITH MEALS, WHEN YOU
THINK ABOUT EATING FOCUSED ON
HEALTH EATING HABITS FOR EXAMPLE
WE HAVE GOOD EVIDENCE OF
(INDISCERNIBLE) A VERY IMPORTANT
PART OF LIMITATION, THE
INFORMATION I SHOWED FOR EXAMPLE
IN MY PRESENTATION, MOST OF THEM
ARE FROM STUDIES WITH MALES.
>>DR. CREASY?
>>YEAH, I COMMENTED BUT WE'RE
EVEN MORE UNDERDEVELOPED ON THE
NUTRITION SIDE OF THINGS.
WE HAVE ONE STUDY IN A CERTAIN
POPULATION, AND WE HAVEN'T HAD,
YOU KNOW, LIKE I SAID THIS
STIMULUS THAT BE DIFFERENT
ACROSS THE POPULATIONS SO IT'S
HARD TO COMPARE ACROSS STUDIES.
THERE'S BEEN A LITTLE BIT OF
WORK ON IMPORTANCE OF CHRONOTYPE
WITH EXERCISE TIMING, AND HOW
CHRONOTYPE MIGHT AFFECT HOW
EXERCISE TIME OF DAY SHIFTS
CIRCADIAN CLOCK, AND ALSO A
FELLOW IN OUR GROUP IS VERY
INTERESTED, DO WE LOOK AT
EXERCISE IN CHRONOTYPE, IF
YOU'RE A MORNING TYPE DOING
MORNING EXERCISE VERSUS EVENING
TYPE DOING EVEN EXERCISE, OR
VICE VERSA.
THERE ARE EFFECTS POTENTIALLY
CHRONOTYPE SPECIFIC ALIGN WITH
YOUR CHRONOTYPE MAY BE
BENEFICIAL BUT EARLY PILOT WORK
IN THAT SPACE.
>>ONE MORE QUICK COMMENT.
LOOKING AT EFFECT OF CHRONOTYPE
AT ADHERENCE, WE FOUND NO
RELATIONSHIP BETWEEN CHRONOTYPE
AND ADHERENCE TO EARLY
TIME-RESTRICTED RESTRICTED,
OTHER FACTORS DICTATE MORE THAN
CHRONOTYPE AT LEAST IN OUR HANDS
IN THESE STUDIES.
>>SOUNDS LIKE ADDITIONAL
OPPORTUNITY TO EXPLORE SOME OF
THESE DIFFERENCES AND RESPONSE
TO INTERVENTIONS AND POTENTIALLY
ADHERENCE AS WE FOCUS ON THIS AS
A COMPONENT OF PRECISION
MEDICINE.
SO NEXT I'LL OPEN UP TO WHOEVER
WOULD LIKE TO ANSWER, THINKING
ABOUT MACRONUTRIENT COMPONENT OF
MEALS AND HOW THAT MAY IMPACT
THE RECOMMENDATIONS, NOT ONLY
TIMING OF MEAL INTAKE BUT ALSO,
YOU KNOW, THE MACRONUTRIENT
COMPONENT OR EVEN FASTING PRIOR
TO EXERCISE.
DR. CREASY?
>>I'LL COMMENT ON THIS FASTING
VERSUS EXERCISE QUESTION.
AGAIN, I THINK WE'RE VERY
UNDERDEVELOPED IN THE SPACE
RIGHT NOW.
I DO THINK THAT'S WHERE WE NEED
TO GO.
THAT'S WHY I THINK I WANTED TO
TALK ABOUT EXERCISE TIMING
TODAY.
AS WE MOVE THE TIMING FIELD
FORWARD WE NEED TO LOOK IN TERMS
OF NUTRITION AND SAY IS IT --
ARE THEY TIME DEPENDENT OR
NUTRIENT DEPENDENT EFFECTS.
ON TOP OF THAT IS THERE EATING A
SPECIFIC TYPE OF FOOD PRIOR TO
EXERCISE, HOW DOES THAT ELICIT A
CERTAIN RESPONSE.
WE'VE NOT MOVED INTO THAT SPACE
YET BUT IT'S AN OPPORTUNITY IN
THE VERY NEAR FUTURE.
>>HOW ABOUT SHIFT WORKERS?
WHEN YOU THINK ABOUT MEALS, ANY
RECOMMENDATIONS OR DATA SHOWING
THAT THE MACRONUTRIENT
COMPOSITION OF MEALS PRIOR TO
NIGHT SHIFT OR IF PEOPLE ARE
GOING TO EAT ON NIGHT SHIFT THAT
PLAYS A ROLE IN OUTCOMES?
>> A QUITE EXCITING TOPIC.
I'M AFRAID WE DON'T HAVE --
ACTUALLY WE HAVE NOT STUDIED
SPECIFICALLY ON THIS SUBJECT.
WE HAVE SOME DATA SHOWING THAT
HIGH INTAKE OF CARBOHYDRATE
BEFORE SHIFT, FOR EXAMPLE, CAN
IMPROVE SLEEPINESS BUT SOMETHING
NEEDED, IT'S AN OPPORTUNITY FOR
THE FUTURE AS WELL.
>>THANK YOU.
FOR PEOPLE WHO HAVE BREAKFAST
WHAT SHOULD THEY BE HAVING FOR
BREAKFAST?
>>GREAT QUESTION.
WE HAVE SO LITTLE EVIDENCE.
WE'VE BEEN COMBINING APPROACHES
WITH GLYCEMIC AND FOUND GOOD
EFFECTS, BREAKFAST THEY HAVE
BEEN TESTING ARE LOW PROTEIN,
CAN'T THINK OF GOOD ROBUST
EVIDENCE OTHER THAN COUPLE
STUDIES IN MY TALK SHOWING
FRONT-LOADING FAT TO EARLY IN
THE DAY MAY IMPROVE SATIETY AS
OPPOSED TO LATER IN THE DAY,
THAT'S WORTH FOLLOWING, BUT
THERE ARE ONLY A COUPLE STUDIES
IN THE SPACE.
ONE THING THAT IS QUITE
INTERESTING, NOT MACRONUTRIENT
BUT DIETARY COMPOSITION, WE TALK
ABOUT GLYCEMIC INDEX, LOAD AND
NUTRITION, WHICH IS ONE MEASURE
OF DIET QUALITY.
INTERESTINGLY, THOSE DIFFERENCES
IN GLYCEMIC LOAD APPEAR TO BE
FAR MORE IMPORTANT LATER IN THE
DAY.
SAID ANOTHER WAY, THERE'S BEEN A
COUPLE ELEGANT STUDIES SHOWING
THAT THE GLYCEMIC EXCURSION IN
THE MORE THAN BETWEEN GOOD AND
BAD FOODS FROM G.I. PERSPECTIVE
IS SMALL, IT'S HUGE LATER IN THE
DAY.
THERE'S LIKE A TIME BY GLYCEMIC
INDEX EFFECT GOING ON WHICH IS
FASCINATING.
>>SO WE'VE HEARD THROUGHOUT
THE WORKSHOP ABOUT EATING TOO
LATE IN THE DAY IS NOT GOOD.
THERE'S CLEAR EVIDENCE THERE.
ONE THING WE HAVEN'T
HIGHLIGHTED, I WANT TO ADD HERE,
UNDER CONDITIONS OF INSUFFICIENT
SLEEP PEOPLE SEND TO EAT MORE
LATER AT NIGHT.
THERE'S A SIGNIFICANT SHIFT, EAT
MORE AFTER DINNER FOR EXAMPLE
THAN AT ANY MEAL ACROSS THE DAY.
I THINK THAT'S A PRETTY CLEAR
THING IN TERMS OF NOT EATING
LATER AT NIGHT.
WHEN WE GET TO EXERCISE, HOW
LATE IS TOO LATE?
DR. CREASY, THERE'S SOME
RECOMMENDATIONS OUT THERE IN THE
CLINICAL WORLD SAYING DON'T
EXERCISE TOO CLOSE TO BEDTIME.
IT MAY DISTURB SLEEP.
FROM YOUR PERSPECTIVE HOW GOOD
IS STRENGTH OF THAT EVIDENCE AND
WHAT ARE OPPORTUNITIES WHETHER
WHEN IT COMES TO SLEEP AS
OUTCOME?
>>REQUEST OF GOOD DID -- GOOD
QUESTION. .
IT'S VIGOROUS EXERCISE CLOSE TO
BEDTIME THAT MIGHT BE
DETRIMENTAL, EXERCISE HELPS
PROMOTE BETTER SLEEP.
THERE'S OPPORTUNITY LOOKING AT
CROSSOVER STUDIES IN THE
MORNING, EVENING, HOW DOES THAT
AFFECT SLEEP, ACTUALLY AFFECT
NOCTURNAL METABOLISM IS AN
INTERESTING AREA FOR RESEARCH AS
WELL.
I DON'T THINK THERE'S ENOUGH
EVIDENCE IN THIS SPACE, AND AT
LEAST RIGHT NOW I WOULD STILL
RECOMMEND EXERCISING.
I WOULDN'T SAY DON'T EXERCISE.
THAT PROBABLY OVERPOWERS THE
EFFECT IF IT DISRUPTS SLEEP
POTENTIALLY.
>>WE HAVE A QUESTION FROM THE
AUDIENCE ABOUT CULTURAL
DIFFERENCES IN EATING PATTERNS.
SPAIN WAS AN EXAMPLE OF LATE
EATERS.
SPAIN IS ON A TIME ZONE ONE HOUR
EAST, IF THEY WERE ON
APPROPRIATE WOULD BE AN HOUR
WEST WHICH WOULD REDUCE LATE
DIFFERENCES TO HIGHLIGHT THAT.
PERHAPS DR. CRISPIM CAN COMMENT
IN BRAZIL OR OTHER CULTURES.
>>THIS IS QUITING TOPIC AS
WELL.
IN BRAZIL I HAVE EVALUATED NOW
THE -- SURVEYED A REPRESENTATIVE
SURVEY FROM COUNTRY, AND WE HAVE
SEEN THAT BRAZILIANS USUALLY EAT
EARLY, TIME OF BREAKFAST FOR
EXAMPLE IS LIKE 7 TO 8 A.M.,
FROM MIDDAY TO 1 P.M. THEY
USUALLY HAVE THE LUNCH, AND
AROUND 7 P.M. THE LUNCH.
THIS IS NOT VERY LATE.
AND WE HAVE A VERY IMPORTANT
PROBLEM WITH OVERWEIGHT AND
OBESITY IN THE COUNTRY, AND WE
HAVE MORE THAN 60% OF THE
POPULATION WITH SOME DEGREE OF
OVERWEIGHT OR OBESITY.
OF COURSE, MAYBE IMPORTANT
OPPORTUNITY AND CHALLENGE FOR
THE FUTURE TO UNDERSTAND HOW
THIS CULTURAL ASPECT CAN RELATE
TO THE DISEASE AND TO MANY OTHER
EXPOSURES YOU HAVE, BECAUSE ON
THE OTHER HANDS WE HAVE A VERY
PROBLEMATIC PATTERN OF QUALITY
OF DIET IN THE COUNTRY.
TO CONTROL ALL THESE
INTERACTIONS IT'S SOMETHING VERY
WE NEED TO FOCUS, SPECIFICALLY
EPIDEMIOLOGIC RESEARCH ON THIS
SUBJECT, I THINK.
>>LAST WORD HERE FOR US?
>>SURE, DIFFERENCES BY COUNTRY
AND CULTURE, AND SOMEBODY ELSE
CAN COMMENT ON SPAIN.
THERE WAS A NICE STUDY SHOWING
MEDIAN TIME FOR LUNCH IS 2:45
P.M., QUITE LATE.
LET ME POINT OUT ONE OTHER
DIFFERENCE THAT MIGHT NOT BE
CONSIDERED CULTURAL BUT
GENERATIONAL.
THERE'S DATA SUGGESTING YOUNGER
AMERICANS EAT OVER A MUCH LONGER
EATING WINDOW AND HAVE MORE
ERRATIC EATING PATTERNS, AND ONE
INTERESTING IN FREE LIVING
STUDIES, A NUMBER OF PEOPLE HAVE
NO INTEREST IN DOING
TIME-RESTRICTED EATING.
WE'RE PREACHING TO THE CHOIR
BECAUSE WE'RE EXCITED ABOUT
CHRONONUTRITION BUT WE NEED TO
TEST A VARIETY OF
CHRONONUTRITION APPROACHES
BECAUSE SOME PEOPLE JUST CAN'T
CHANGE THE TIMES OF THEIR MEALS.
CAN WE ADOPT SOME OTHER
APPROACHES SHIFTING
MACRONUTRIENTS, DISTRIBUTION OF
CALORIES TO MEET PEOPLE WHERE
THEY ARE.
WE NEED TO BROADLY TEST
FEASIBILITY ACROSS A RANGE OF
APPROACHES AND FIND OUT HOW TO
PRESCRIBE INTERVENTIONS BASED ON
CULTURAL AND OTHER BEHAVIORAL
CONTEXTS.
IT MATTERS WHETHER YOU HAVE
YOUNG KIDS AT HOME AND WE SEE
THAT IN EXIT INTERVIEWS.
>>HELP ME THANK THE SPEAKERS
FOR EXCELLENT PRESENTATIONS AND
DISCUSSION HERE.
AND WE'LL TURN IT BACK OVER TO
OUR CO-CHAIRS AND I THINK WE
HAVE A SHORT BREAK NOW.
>>WE'LL TAKE A FIVE-MINUTE
BREAK, COME BACK AT 3:12.
>>WELCOME BACK.
WE'LL TAKE AN HOUR, MOVING
CHRONONUTRITION TO CLINICAL
PRACTICE, IF I COULD SHARE MY
SLIDES.
I WANT TO GIVE A BRIEF, BRIEF
OVERVIEW OF THE HIGH PRIORITY
RESEARCH AREAS THAT WERE
HIGHLIGHTED BY THE PREVIOUS
SPEAKERS, NEEDING INFORMATION
FROM VARIOUS INTERVENTION
STUDIES, USING VARIOUS METHODS
LIKE CGM, DR. WRIGHT HIGHLIGHTED
IMPORTANCE OF EXAMINING
SUBSTRATE METABOLISM, OVERNIGHT,
NOT JUST TAKING DAYTIME
ASSESSMENTS, A RECURRING THEME,
SUBSTRATES AND OUTCOMES ACROSS
MULTIPLE TIME POINTS OVER A DAY.
KEY AREA HIGHLIGHTED SHIFT
WORKERS, CONDUCTING ASSESSMENTS
TO COGNITIVE PERFORMANCE RELATED
TO EATING IN THE NIGHT,
DISTRIBUTING CIRCADIAN SPACE,
WIDELY DISPERSED AMONG SHIFT
WORKERS AND TIMING OF FOOD
INTAKE CANNOT BE UNIVERSALLY
DETERMINED WERE CONCLUSIONS.
VARIOUS FUTURE DIRECTIONS
HIGHLIGHTED BY DR. WRIGHT, TIME
OF DAY, IMPACTING BREAST MILK
COMPOSITION, SOMETHING THAT CAME
UP FROM DR. LYNCH AS WELL, WE
KNOW NUTRIENT COMPOSITION OF
STRAWBERRIES BUT NOT SO MUCH
BREAST MILK, AND FUTURE
DIRECTIONS THAT CAME OUT OF THIS
PRESENTATION.
DR. PETERSON'S TALK WE HEARD
ABOUT CHRONONUTRITION, TIME
RESTRICTED EATING, INTERMITTENT
FASTING, PROVIDING DEFINITIONS
FOR THIS, PROVIDING INFORMATION
RELATED TO LIMITATIONS OF
CURRENT STUDIES SMALL SINGLE ARM
WITH WEAK CONTROL GROUPS,
HETEROGENEOUS PROTOCOLS, NEED TO
TAKE POSTPRANDIAL MEASURES, NOT
JUST FASTING ASSESSMENTS, LONGER
TERM STUDIES.
DR. CRISPIM TALKED ABOUT SHIFT
WORK, EATING AT NIGHT,
UNDERSTANDS WHAT, WHEN, WHERE
AND WHY, SHIFTING AND
POTENTIALLY PROVIDING MEALS IN
THE MIDDLE OF THE NIGHT CAN
INFLUENCE OUTCOMES AND INFLUENCE
INTAKE THE FOLLOWING DAY.
AND FINALLY DR. CREASY TALKED
ABOUT PATTERNS OF PHYSICAL SHIFT
THAT NEED TO BE PART OF THE
CONVERSATION RELATED TO
CHRONONUTRITION AND PATTERNS OF
PHYSICAL ACTIVITY ARE IMPORTANT
AND MAY INFLUENCE FOOD INTAKE
THE NEXT DAY HIGHLIGHTING
MULTIPLE LIMITATIONS OF STUDIES,
BEING UNDERPOWERED,
NON-RANDOMIZED, HETEROGENEOUS
POPULATION IN TIMING, LIMITED
OUTCOME MEASURES,
INTERINDIVIDUAL VARIABILITY.
HE BROUGHT UP THIS CHRONOTRINITY
TERM OF EVALUATING
CHRONOTHERAPY
RELATED TO PHYSICAL ACTIVITY AND
SLEEP.
I WANT TO START THE DISCUSSION
FOR THE PANEL TODAY TO ADDRESS
THESE HIGH-LEVEL QUESTIONS THAT
WE'VE HIGHLIGHTED FOR THIS
WORKSHOP.
TO ADDRESS PRIORITIES AND
BALANCING, CLINICAL INTERVENTION
RESEARCH, MOST URGENT BASIC
SCIENCE NEEDED TO INFORM
APPLICATION OF TIME-RESTRICTED
IN CLINICAL RESEARCH, WOULD LIKE
TO HEAR YOUR THOUGHTS ON
DEFINING SHORT VERSUS LONG-TERM
OPPORTUNITIES, MOST IMMEDIATE
OPPORTUNITIES TO APPLY
CHRONONUTRITION, WHAT CAN BE
DONE NOW, KNOWING WHAT WE KNOW,
ALSO WHAT DO WE NEED TO LEARN TO
PROMOTE FUTURE RESEARCH AND
LONG-TERM ASSESSMENTS.
WHAT ASPECTS OF CHRONONUTRITION
REQUIRE MORE LONG-TERM RESEARCH
INVESTMENT AND WHAT IS THE
SINGLE MOST IMPORTANT GOAL OR
MILESTONE FOR RESEARCH AND IF
THERE IS A DEFINITIVE EAVED
--
EVIDENCE-BASED THAT CAN BE DONE,
WHAT RESEARCH IS NEEDED AND WHAT
NEEDS TO BE DEFINED BEFORE THIS
TRIAL CAN BE DONE.
I'LL STOP SHARING AND BRING UP
THE PANELISTS.
>>WE'D LIKE TO OPEN FOR
COMMENTS FROM ALL OF YOU, ALL OF
US HERE, PANELISTS FROM
YESTERDAY'S SESSIONS AS WELL AS
TODAY'S SESSIONS, ABOUT
ADDRESSING THESE VARIOUS
QUESTIONS.
WHAT DO WE NEED FIRST OF ALL IN
TERMS OF MECHANISMS, BALANCING
BASIC SCIENCE, CLINICAL SCIENCE,
TO MOVE THE FIELD FORWARD.
>>I'D LIKE TO START WITH A
QUESTION FOR PEOPLE ON THE
CLINICAL SIDE DOING THESE
PRELIMINARY RANDOMIZED CLINICAL
TRIALS.
WE HEARD A LOT ABOUT DIFFERENT
KINDS OF OUTCOMES AND WHICH
OUTCOMES ARE STRONGEST, ET
CETERA.
I DIDN'T HEAR A LOT ABOUT THE
LONG-TERM EFFECTIVENESS.
SO, AFTER THE TRIALS CONCLUDED,
HOW LONG THOSE RESULTS ARE
MAINTAINED.
WE KNOW A LOT OF WEIGHT LOSS
TRIALS ARE VERY EFFECTIVE, AND
YET SIX MONTHS LATER OR A YEAR
LATER THEIR EFFECTIVE INs I
S -- EFFECTIVENESS IS GONE.
HOW WELL AS A BEHAVIOR CHANGE,
TO CHANGE TIMING OF EATING, IS
MAINTAINED.
>>VERY IMPORTANT QUESTION.
DO WE EVEN TRYING AFTER THE
STUDY IS DONE?
WE DO TIME-RESTRICTED EATING
INTERVENTION AND STOP
ASSESSMENTS, THAT'S THE END.
DO WE KNOW IF INDIVIDUALS
CONTINUE ON TO THESE BEHAVIORS
AND ADOPT BEHAVIORS LONG-TERM?
I DON'T THINK WE HAVE THAT
INFORMATION.
>>EVEN ONE OR TWO YEARS ARE
ENCOURAGED BUT DIDN'T GO BEYOND
4 OR 8 WEEKS, 12 WEEKS WERE THE
LONGEST FOR A LONG DURATION OF
TIME.
WE'LL SEE ANSWERS IN THE NEXT
FEW YEARS.
>>SPECIFICALLY I THINK WE HAVE
THREE ONE-YEAR-LONG STUDIES ON
TIME-RESTRICTED EATING.
RESULTS ARE MIXED ON WHETHER
WEIGHT LOSS IS CONCERNED BUT ONE
OF THOSE I HAVE CONCERNS ABOUT
STUDY QUALITY.
THERE'S NO ALMOST NO DATA ON
LONG-TERM FOLLOW-UP.
>>SPEAKING WITH MY COLLEAGUES
WHO DO CLINICAL TRIALS, THIS IS
AN OPPORTUNITY FOR THIS AREA
WHETHER REGARDLESS OF HOW THE
WEIGHT LOSS OCCURS, CAN WE USE
TIME-RESTRICTED FEEDING AS A
METHOD OF MAINTAINING, THAT
WOULD BE A CRITICAL TRIAL WHERE
WE COULD SEE WHAT IS
EFFECTIVENESS TO MAINTAIN THIS
AS A BEHAVIOR.
THAT MAY BE EASIER THAN
RETAINING CALORIC
RESTRICTION/PHYSICAL ACTIVITY
PARADIGM.
THAT'S A USEFUL TRIAL TO
CONSIDER.
>>ONE PROBLEM, YOU CANNOT
CHANGE YOUR EATING TIMING
WITHOUT IMPACTING YOUR
ENVIRONMENT.
THE FAMILY, THE FRIENDS, SOCIAL
LIFE.
SO I THINK THIS IS ALSO AN
IMPORTANT QUESTION BECAUSE THE
IDEA IS NOT TO INSULATE YOURSELF
BECAUSE YOU ARE THE ONE WHO
WANTS TO CHANGE YOUR HABITS.
YOU NEED TO BE IN THE COMMUNITY.
SO I THINK IT'S ALSO AN
IMPORTANT QUESTION IN BEHAVIORAL
CHANGES IN THE LONG TERM.
>>THIS IS SOMETHING THAT BEV
BROUGHT UP AS WELL,
INCORPORATING STAKEHOLDERS FOR
SHIFT WORKERS.
THE FAMILY, SOCIAL ENVIRONMENT,
THE WORK ENVIRONMENT, BEING VERY
IMPORTANT TO HEALTH CARE TEAM
THAT CARES FOR THESE INDIVIDUALS
ALSO HAVING SOMETHING TO SAY.
FRANK, A COMMENT?
>>YEAH, I WAS THINKING ABOUT
THIS, ABOUT THE -- I THINK IT
RELATES TO WHAT KEN BROUGHT UP
AND RESPONDED TO, WHICH IS THE
DISTINCTION BETWEEN FOLLOWING A
DIET VERSUS CHANGING YOUR
HABITUAL LIFESTYLE.
A DIET IS SOMETHING PEOPLE CAN'T
SUSTAIN.
GENERALLY SPEAKING SHORTER
INTERVENTION.
WHEREAS, MARTA CAN SPEAK TO THIS
BET ISSUE THAN -- BETTER, BUT U
CAN CHANGE PEOPLE'S HABITS AND
ADDRESS ADDRESS THE INDIVIDUAL
ROAD BLOCKS THAT THEY PERSONALLY
MAY HAVE, TO MAKE IT WORK FOR
THEM, AND I THINK IT BRINGS IT
BACK TO QUESTION ONE, BECAUSE IN
ORDER TO KNOW -- MAYBE EMILY
SAID IT.
IN ORDER TO KNOW HOW YOU CAN
ADOPT IT, IT WAS MENTIONED
NUTRIENTS COMPOSITION, ET
CETERA, MAYBE FOR SOME PEOPLE
CHANGING WHEN THEY EAT IS
IMPOSSIBLE BECAUSE THEY ARE AT
WORK, THEY ONLY HAVE THAT SLOT,
AND THEY WANT TO EAT WITH THEIR
FAMILY WHEN THEY ARRIVE HOME AND
THERE IS ONLY ONE TIME THAT
EVERYBODY CAN DO THAT, AND SO I
THINK THAT BRINGS US BACK TO
QUESTION 1, REALLY WHAT
MECHANISMS ARE MOST IMPORTANT,
AND IT'S NOT ONE.
AND WHICH COMBINATION OF FACTORS
ARE WE CHANGING?
SO IN OTHER WORDS ADVOCATING FOR
REALLY BETTER UNDERSTANDING
FUNDAMENTAL MECHANISTIC
UNDERPINNINGS OF ONION SLICES
OR -- HOW DO YOU CALL THEM,
LEAVES?
SUCH THAT YOU CAN MAKE THE
APPROACH INDIVIDUALLY EFFECTIVE
AND INTEGRATE IT, AS MARTA SAID,
IN THEIR EVERYDAY LIFE.
I WANTED TO MAKE A QUICK COMMENT
THAT I THINK THE SPEAKER VIEW
ONLY SHOWS SPEAKERS OF JUST NOW.
I'M FINE WITH THAT BUT NOT ALL
THE PANELISTS ARE VISIBLE TO THE
ATTENDEES.
>>I AGREE, I LIKE THE IDEA OF
PEELING THE ONION APART.
ADDITIONAL PERSPECTIVE, THAT'S
ONE PATH WE NEED TO TAKE.
ANOTHER IS THINKING ABOUT
COMBINED INTERVENTIONS.
I'M SHARING A CLINICAL TRIAL
GUIDELINE FOR CIRCADIAN RHYTHM
DISORDERS.
WHEN WE LOOK AT MOST EFFECTIVE
TREATMENT FOR STRATEGIES, JET
LOG, COMBINED COUNTERMEASURES,
LOOKING AT COMBINATION OF TIMED
FOOD AND PHYSICAL ACTIVITY, IN
THIS CASE NOT THE TRIALS, I'D
LIKE TO ENCOURAGE US TO CONSIDER
TRIALS THAT DON'T TRY TO GET AT
SPECIFIC MECHANISMS BUT TAKE
WHAT WE KNOW FROM A VARIETY OF
STRATEGIES WHEN WE'RE READY FOR
THAT AND COMBINE THESE
INTERVENTION STRATEGIES TO GET
LARGER IMPACTS ON OUR OUTCOMES
THAN JUST FOCUSING ON ONE ASPECT
OF IT.
>>YEAH, ONE MORE QUICK THING
TO ADD.
I AGREE WITH EVERYTHING THAT WAS
SAID, BUT I THINK THERE'S TWO
PIECES, TIME-RESTRICTED MIGHT
NOT WORK FOR EVERYONE.
IT MIGHT BE ONE OF MANY, LIKE
SOME MIGHT HAVE TO BE DIFFERENT
SHIFTS OR THERE'S MANY WAYS TO
LIVE A HEALTHY LIFE.
FIGURING OUT IF IT IS ANOTHER
SUSTAINABLE OPTION THAT MAYBE
YOU CANNOT DO CALORIC, NOT IN
ADDITION JUST ANOTHER HEALTHY
TASK, THAT GETS BACK TO OTHER
QUESTIONS BEING ABLE TO IDENTIFY
WHO IS RESPONSIVE, SOME MIGHT BE
UNDERSTANDING WHAT SCHEDULE
LIMITATIONS ARE AND USING THAT
AS A GUIDE THEN CHOOSING WHICH
COMBINATIONS OF TREATMENTS TO
USE.
>>THAT'S VERY IMPORTANT,
TARGETING INTERVENTIONS TO THE
PROPER GROUPS.
AND THAT'S SOMETHING THAT I
THINK WE NEED TO CONSIDER ALSO
IS THAT WHAT ARE OUR
PARTICIPANTS ALREADY DOING AND
WHETHER WE'RE INDUCING OR NOT
INDUCING A CHANGE, SO
TIME-RESTRICTED EATING MAY BE
BENEFICIAL IF PEOPLE HAVE A LONG
EATING WINDOW BUT IF YOU ALREADY
HAVE A SHORT WINDOW THAT'S NOT
HELPFUL.
AT THAT POINT TIMING OF EATING
WINDOW RATHER THAN DURATION OF
THE EATING WINDOW, AND SOME WORK
THAT WAS PRESENTED, COURTNEY,
RELATED TO EARLY VERSUS LATE
TIME-RESTRICTED EATING OR LATE
EATING WINDOW OR EARLY WINDOW
WITH GREATER BANG FOR YOUR BUCK,
BASE EQUALLY, IF THE FEEDING
WINDOW IS EARLIER.
SOMETHING TO CONSIDER AS WELL.
>>MAYBE TO KIND OF FOLLOW UP
ON KEN'S POINT, WHICH I THINK IS
IMPORTANT, WHICH IS REALLY TO
CONSIDER NOT JUST IN ISOLATION
TIMING OF DIET, AND I THINK,
SETH, YOUR POINT WAS VERY WELL
TAKEN, WHICH IS THAT IF YOU HAVE
EXERCISE GOING AT A DIFFERENT
TIME YOUR MEAL TIMING MAY
SYSTEMATICICALLY CHANGE, AND SO
YOU DON'T KNOW WHAT IT'S CAUSED
BY.
WE CAN ONLY DO ONE OF THE THREE
MAIN THINGS, EAT, SLEEP OR
EXERCISE.
MOST PEOPLE CAN'T DO ALL THREE
AT ONCE.
SO, OBVIOUSLY IF YOU CHANGE ONE,
THE OTHER IS GOING TO CHANGE.
WE NEED TO BE COGNIZANT OF THAT
AND LEVERAGE THAT.
>>WE'VE BEEN TALKING ABOUT
CARDIOMETABOLIC RISK FACTORS BUT
SOMETHING THAT COMES UP THEN IS
WHAT'S THE IMPACT ON SLEEP.
WHAT'S THE IMPACT ON SLEEP OF
SHIFTING EATING WINDOW, SHIFTING
TIMING OF NUTRIENT INTAKE,
SHIFTING TIMING OF EXERCISE.
AND SHOULD WE TALK ABOUT
DIFFERENT TYPES OF EXERCISE?
SOMETHING THAT SETH AND I TALKED
ABOUT.
DOING EFFECTIVE ACTIVITIES OR
PREFERRED DIFFERENT ACTIVITIES
AT DIFFERENT TIMES OF DAY, ALSO
PREFERRING DIFFERENT NUTRIENT AT
DIFFERENT TIMES TO IMPROVE
SLEEP, TO LEVERAGE THAT TO HELP
PEOPLE ADHERE BETTER TO DIETARY
GUIDELINES TO EXERCISE
GUIDELINES AND OTHER HELPFUL
BEHAVIORS.
I WANT TO BRING UP THE SECOND
QUESTION ABOUT SHORT VERSUS
LONG-TERM OPPORTUNITIES, RIGHT
NOW AND HOW CAN WE LEVERAGE WHAT
WE KNOW RIGHT NOW TO THINK ABOUT
VARIOUS OPPORTUNITIES TO STUDY
AND APPLY CHRONONUTRITION.
ARE WE READY TO MAKE
RECOMMENDATIONS OR NOT THERE
YET?
IF WE'RE NOT THERE TO MAKE
RECOMMENDATIONS WHAT DO WE NEED
TO GET THERE?
>> I COULD START ONE THING.
I MENTIONED IN THE DISCUSSION IN
THE LAST SECTION THAT EATING
LATER IN THE EVENING HOURS FOR
DAY WORKERS IS SOMETHING THAT WE
CAN CLEARLY RECOMMEND RIGHT NOW.
I DON'T THINK THERE'S ANY
EVIDENCE OUT THERE TO SAY EATING
LATE IS GOOD FOR OUR HEALTH.
I THINK THAT IS A RECOMMENDATION
THAT WE CAN ACTUALLY START TO
EDUCATE IN THE GENERAL PUBLIC,
AND ALSO TRY TO INCORPORATE THAT
INTO, YOU KNOW, RECOMMENDATIONS
IN SOCIETIES THAT ALL OF US ARE
PART OF.
I THINK LOW-HANGING FRUIT, I
THINK WE'VE HEARD TRYING TO
BETTER ARTICULATE HOW WE'RE
DEFINING THINGS AS LOW-HANGING
FRUIT, IT'S BETTER TO GO AHEAD
AND DO THINGS RELATED TO
BIOLOGICAL TIME WHETHER WE START
JUST BY OUR TIME-RESTRICTED
EATING STUDIES AND PHYSICAL
ACTIVITY STUDIES RELATIVE TO
BEDTIME, RATHER THAN CLOCK ON
THE WALL, A LOW-HANGING FRUIT TO
INCORPORATE MORE NOW, AS WE GET
MORE SOPHISTICATED DOING THINGS
RELATED TO CIRCADIAN TIME.
SO WE CAN TAKE VARIOUS STEPS
RIGHT NOW, SOME IMMEDIATE
LONG-TERM THINGS.
THE OTHER LOW-HANGING FRUIT TO
MENTION WE NEED TO THINK ABOUT
WHEN WE THINK OF CIRCADIAN TIME
WE FOCUS ON DOMO, THE MOST
COMMONLY USED STANDARD BUT
THERE'S MORE EVIDENCE NOW FROM
VARIETY OF LABORATORIES SHOWING
TIMING BIOLOGY ENDS AT NIGHT IS
IMPORTANT, ESPECIALLY TALKING
WHEN DO WE START EATING OR
BECOMING PHYSICALLY ACTIVE.
IN OUR HANDS, MELATONIN ONSET
TURNS OFF AFTER WAIT TIME MORE
THAN AN HOUR IN 25%, MORE IN THE
HOUR AFTER WE WAKE UP.
WE WANT TO THINK ABOUT THOSE
THINGS TOO IN TERMS OF HOW WE
TIME OUR STUDIES.
>>I'D LIKE TO FOLLOW UP.
HOW LATE IS LATE?
THIS WAS BROUGHT UP YESTERDAY.
WE'RE LOOKING AT FASTING.
DO WE WANT TO TALK ABOUT NUMBER
OF CALORIES BEING CONSUMED AFTER
5 P.M., 8 P.M., WITHIN AN HOUR
BEFORE GOING TO BED, TWO OR
THREE HOURS BEFORE GOING TO BED?
WHAT ARE OUR PARAMETERS THERE IN
TERMS OF RECOMMENDATIONS?
>>I'LL JUST ADD SOMETHING AS
WELL.
MORE RELATED TO OBSERVATIONAL
RESEARCH, THINKING OF IMPORTANT
OPPORTUNITIES FOR STUDIES, DIET
AND ONGOING, A LOT OF
CARDIOVASCULAR DISEASE FOCUS
COHORT STUDIES ARE OVERDUE FOR
DIET ASSESSMENT, AND I THINK
IT'S GOING TO BE IMPORTANT TO
MAKE SURE THAT IN ANCILLARY
STUDIES THERE IS SOME MEASURE OF
WHEN WE EAT AND NOT JUST WHAT WE
EAT.
ANOTHER IMPORTANT OPPORTUNITY IS
PROBABLY MORE INNOVATION AND
DIETARY ASSESSMENT METHODS.
THE DREAM WOK TO HAVE A TOOL
THAT IS JUST LIKE ASA 24
PUBLICLY AVAILABLE, WIDELY
AVAILABLE, FREE.
AND VALIDATE IT BUT ALSO WORKS
LIKE COMMERCIAL APPS WHERE
PEOPLE CAN TAKE PICTURES OR SCAN
AND THERE'S NOT AS MUCH
PARTICIPANT BURDEN.
I THINK THAT WILL MAKE DIETARY
ASSESSMENT MUCH EASIER, ALSO
MAKES SELF-MONITORING EASIER
WHICH CAN IMPROVE LONG-TERM
OUTCOMES FOR CLINICAL TRIALS.
>>THANK YOU.
>>I'LL ADD ANOTHER LOW-HANGING
FRUIT, TO ELABORATE SOMETHING ON
DR. WRIGHT MENTIONED,
APPLICATION OF CHRONONUTRITION
IN A CLINICAL SITTING, A LOT OF
PATIENTS WHO RECEIVE ENTERAL
TUBE FEEDS OR PARENTERAL ARE FED
OVERNIGHT OR ACROSS 24 HOURS,
AND THERE'S REALLY NO REASON FOR
THAT TO HAPPEN AROUND
CONVENIENCE.
THAT'S A HUGE OPPORTUNITY TO
START INTERVENING IN A CLINICAL
SETTING, APPLYING
CHRONONUTRITION IN A MEDICAL
SETTING, TO SEE WHAT EFFECTS
OPTIMIZE TIMING OF THOSE FEEDS
ON NOT ONLY SLEEP AND OUTCOMES
BUT ALSO ENDPOINTS THAT ARE
IMPORTANT FOR A HOSPITAL.
THERE ARE ONGOING TRIALS ON THIS
BUT THE GENERAL APPLICATION OF
CHRONONUTRITION INTO MEDICAL
SETTINGS.
>> I TEND TO TAKE MORE OF A
CONSERVATIVE VIEW ON WHEN WE
TRANSLATE THINGS INTO CLINICAL
GUIDELINES.
I THINK ONE OF THE QUESTIONS NOW
IS ADHERENCE.
WE'VE SEEN IN GREAT SHORT-TERM
ADHERENCE EVAPORATES AT ONE
YEAR.
WE'LL BE READY IN MAYBE TWO TO
FIVE YEARS BUT THERE'S LAYERS OF
THE ONION TO TEASE APART AND
UNDERSTAND WHAT WORTH TESTING IN
A MULTI-CENTER TRIAL, AND
ENDPOINT WEIGHT LOSS PERHAPS THE
MOST STUDIED ENDPOINT OR PICK
PREVENTING REGRESSION FROM
PREDIABETES TO TYPE 2 DIABETES
OR SAME THING WITH BLOOD
PRESSURE AND PRE-HYPERTENSION TO
HYPERTENSION, SOMETHING ALONG
THOSE LINES.
I DON'T KNOW YET WHAT WOULD BE
THE RIGHT PRIMARY ENDPOINT FOR A
LARGE MULTI-CENTER TRIAL.
I THINK WE SHOULD BE READY FOR
THE ONE-YEAR-LONG STUDIES.
I ALMOST WANT TO SEE, BACK TO
FRANK AND OTHER PANELIST POINTS,
CAN WE BETTER TEASE APART WHICH
LAYERS ARE MOST IMPORTANT.
IS IT THE CONSISTENCY OF MEAL
TIMES, FASTING TIME, MEAL
DURATION, IF WE PROCEED TO A
MULTI-CENTER STUDY WE ALREADY
KNOW WE -- IT'S LIKE A PHARMA
TRIAL, THE RIGHT DOSE, IN THIS
CASE THE RIGHT DESIGN OF MEAL
TIMING INTERVENTION.
DO WE KNOW WHAT THE RIGHT NUMBER
OF HOURS OF DIFFERENCE WE WANT
BETWEEN THE CONTROL GROUP AND
TRE GROUP, 8 VERSUS 12 HOURS, WE
HAVE A LOT OF OPEN QUESTIONS WE
NEED TO DO TO FIGURE OUT MORE
ANSWERS BEFORE WE PROCEED TO
NUMBER 3, DEFINITIVE
EVIDENCE-BASED CLINICAL TRIAL.
WE'RE CERTAINLY READY TO PROCEED
TO A ONE-YEAR-LONG TRIAL THAT
MIGHT BE A SINGLE SITE OR
TWO-CITED STUDY.
>>I AGREE WITH YOU, COURTNEY.
ONE RISK THE COMMUNITY FACES IS
THAT IF THIS IS PRESENTED AS
BEING THE DEFINITIVE TRIAL AND
WE HAVEN'T WORKED OUT THE KINKS
AND IT LAUNCHES, EITHER DUE TO
CHALLENGES WITH ADHERENCE OR DUE
TO CONFOUNDERS, THE TRIAL ENDS
UP BEING NEGATIVE OR NEGATIVE,
YOU KNOW, ADVERSE, THEN WE'RE
BACK, YOU KNOW, DECADES.
I THINK THERE IS A REAL RISK OF
MOVING TOO FAST, AND SO IT FEELS
LIKE THINGS MAY BE MOVING SLOW
FOR CERTAIN PEOPLE.
BUT I THINK THERE'S A GOOD
REASON FOR THAT.
IT'S BECAUSE IT'S COMPLEX.
IT'S NOT JUST -- MANY ASPECT OF
NUTRITION ITSELF, ALL ITS
FACETS, BUT AS WE DISCUSSED
THERE ARE MANY OTHER BEHAVIORS
THAT ARE TIED IN TO ANY
MANIPULATION AND SO ANY OTHER
ASPECT, PERSONALIZED ASPECT,
IT'S GENETICS, WORK AND SCHOOL
SCHEDULE, ENVIRONMENT, AGE AND
DISEASE.
YEAH, I SHARE YOUR CAUTIOUS
NATURE THAT WE CERTAINLY -- A
YEAR, YES, BUT DEFINITIVE NOT
FROM MY PERSPECTIVE.
>>A GREAT EXAMPLE IS
BREAKFASTER CONSUMPTION,
RELUCTANT TO ISSUE A SIMPLE
GUIDELINES ON EAT BREAKFAST OR
NOT, NOT KNOWING OTHER
CONFOUNDERS.
>>GREAT POINTS.
WE CAN MAYBE LEVERAGE SOME OF
THE REALLY TIGHTLY CONTROLLED
TRIALS THAT I WAS SORT OF
ALLUDING TO TO TEASE APART, BUT
ALSO BEFORE THE LARGE SCALE
TRIAL WE NEED EVIDENCE FOR
MULTIPLE LINES, SO NOT ONLY LIKE
THE ONE-YEAR TYPES OF TRIALS BUT
SHORTER-TERM ONE TO TWO WEEK
TRIALS, MAYBE EPIDEMIOLOGIC
EVIDENCE, CONVERGING ON THE SAME
IDEA, WHAT IS THE ACTUAL PRIMARY
ENDPOINT WE WANT TO LOOK AT.
I AGREE IT MIGHT BE FRUSTRATING
TO GO SLOW BUT WISE TO GO SLOW
BEFORE WE TRIP OURSELVES UP
GETTING TOO FAR AHEAD OF
OURSELVES.
>>I COULD MAKE ONE COMMENT ON
THAT.
I THINK WE HAVE TO HAVE LONG
TERM GOALS AND NEEDS TO MAKE
STRONG RECOMMENDATIONS IN THE
FUTURE, BUT I ALSO THINK WE HAVE
OPPORTUNITIES NOW WITH THE
INTEREST NOT ONLY BY THE NIH BUT
ALSO BY THE PUBLIC, CONCEPT OF
TIMING OF THINGS THESE DAYS
WHERE WE CAN MAKE GENERAL
RECOMMENDATIONS.
IT DOESN'T MEAN WE'LL BE 100%
CAN BEING -- ACCURATE.
SMOKING IS BAD BASED ON EVIDENCE
OVER THE YEARS, WE CAN START NOW
AND EVIDENCE MAY CHANGE.
I'LL USE BLOOD PRESSURE AS AN
EXAMPLE.
IT USED TO BE OVER 200 TO BE
SYSTOLIC, THAT'S NOT THE CASE
ANYMORE.
AGAIN, BACK TO THERE ARE MAYBE
LOW-HANGING FRUIT THAT WE CAN
MAKE SOME TRANSLATION SO WORK
ELEGANTLY SHOWED IF YOU JUST
HAVE EARLIER TIMED FOOD INTAKE
IN WEIGHT LOSS PROGRAMS THAT'S A
RECOMMENDATION THAT WE CAN START
WITH NOW TO GO AHEAD AND
TRANSLATE TO THE PUBLIC,
MESSAGES THAT EARLIER TIMING IS
A HEALTHIER PATTERN HERE.
AND THEN LET THE SCIENCE BUILD
FROM THERE.
>> I AGREE.
VERY LOW-HANGING FRUIT.
THE OTHER THING NOT ALWAYS
UNDERSTOOD IN THE PUBLIC OR
OUTSIDE BIOLOGY IS CONCEPT WE
BROUGHT UP, IT'S NOT JUST THE
WALL, RELATIVE EARLIER EATING
FOR YOU, SOMETIMES PEOPLE PUSH
TOO EARLY OR TOO LATE.
THEY THINK IT HAS TO BE 6 A.M.
IF THEY WAKE UP AT 7 OR 8 THAT
MAKES NO SENSE.
PUSHING OUT GOOD CONTEXTUAL
INFORMATION ABOUT WHAT WE MEAN
BY EARLIER IS AN IMPORTANT THING
TO DO AS WELL.
>>BRINGING IN BASIC SCIENCE,
TALKING ABOUT CLINICAL RESEARCH,
HOW CAN WE LEVERAGE ANIMAL
RESEARCH TO HELP US GET CLOSER
TO OUR GOALS FOR MAKING
RECOMMENDATIONS AND ADDRESSING
MECHANISMS?
FRANK?
>>YEAH, I THINK ONE -- TWO BIG
BENEFITS OF ANIMAL EXPERIMENTAL
WORK IS, ONE, DEPTH OF
MECHANISTIC QUESTIONS, HOW WE
CAN ADDRESS THOSE IS EASIER IN
ANIMAL EXPERIMENTAL WORK
COMPARED TO HUMANS.
THE OTHER IS THIS AMOUNT OF
TIME, EFFORT, AND MONEY IT TAKES
TO -- ESPECIALLY IF ONE MOVES
NOT JUST TO RODENT STUDIES BUT
LET'S SAY DROSOPHILA MODELS OR
OTHER ANIMAL MODELS THAT ARE --
HAVE A SHORTER LIFESPAN, REQUIRE
MUCH LESS HOUSING THAN A HUMAN
IN CONTROLLED STUDIES OR IN
FIELD-BASED STUDIES.
SO I THINK THOSE TWO -- CIRCLING
BACK TO CHRIS' POINT, YES, I
THINK THAT'S EXACTLY WHAT I
THINK AS WELL.
IF WE HAVE EVIDENCE FROM
MULTIPLE ANGLES, THINKING ABOUT
ANIMAL EXPERIMENTAL WORK,
CONTROLLED HUMAN TRIALS, EPI
WORK, IDEALLY LONGITUDINAL EPI,
THEN WE STRENGTHEN OUR OWN
CONVICTION THIS IS A SOLID
INTERVENTION.
AND SO, YOU KNOW, JOE'S WORK
WHERE HE CLEANLY LAID OUT THE
SEPARATE CONTRIBUTIONS OF
CALORIE RESTRICTION, DURATION
AND TIMING, IS ONE EXAMPLE OF
HOW AS A FIELD WORKING TOGETHER
WE CAN MAKE GREAT ADVANCES.
AND SO, YEAH, I CERTAINLY THINK
THERE'S IMPORTANT ROLE FOR
ANIMAL EXPERIMENTAL WORK
RECOGNIZING US A -- AS ALWAYS,
WITH ANY APPROACH, THERE ARE
LIMITATIONS.
>>ANYTHING ELSE?
MATT?
>>I ALLUDED TO THIS BRIEFLY
YESTERDAY ABOUT THE ISSUE OF
BODY SIZE AND HOW THAT AFFECTS
OUR METABOLISM.
AND WHEN WE THINK ABOUT THIS
FAST WE IMPOSE ON ANIMALS, WE DO
NEED TO BE CAREFUL WE'RE NOT
USING -- I THINK TYPICAL ANIMAL
EXPERIMENTS ARE OFTEN 12-HOUR
FAST, 12-HOUR FEEDING, IN THIS
DOMAIN AT LEAST.
AND THOSE 12-HOUR FASTS ARE LONG
FOR THE MICE.
THERE HAVE BEEN RECOMMENDATIONS
FROM THE NUTRITION
ENDOCRINOLOGIST THAT WE
SHOULDN'T BE DOING OVERNIGHT
FASTS FOR MICE, IF WE WANT TO
LOOK AT FASTING GLUCOSE OR
GLUCOSE OR INSULIN TOLERANCE
TESTS, THAT'S TOO LONG, WE'RE
GETTING TO STARVATION PROTECTION
MECHANISM MODE.
SOME WORK WITH ANIMALS WHERE WE
TRY AND REDUCE FASTING INTERVALS
TO GET ESSENTIALLY METABOLIC
CUES TO LOOK A LITTLE BIT MORE
LIKE WHAT HUMANS ARE
EXPERIENCING OVER A 12 OR
14-HOUR FAST WOULD HAVE GOOD
REPERCUSSIONS.
OF COURSE I BRING THIS UP, WE
USE PELLET FEEDERS TO MIMIC,
THEY ARE EATING 2/3 OR 3/4 IN
THE LAB AT NIGHT, A THIRD DURING
THE DAY.
THOSE NATURAL INTAKE PATTERNS
TURN OUT TO BE FAIRLY WEAK, AND
THE UNDERLYING METABOLIC CUES
MIGHT BE A GOOD MODEL FOR THE
METABOLIC CUES LEADING TO
HUMANS.
THINKING ABOUT WHAT THE
EFFECTIVE FOOD PRESENTATION
SCHEDULE THAT WOULD BEST INFORM
US ABOUT THE HUMAN EXPERIENCE, I
THINK WOULD BE A GOOD LINE OF
RESEARCH.
>>ARE THERE WAYS TO
LEVERAGE -- WE'VE BEEN TALKING
ABOUT LEVERAGING MULTIPLE
BEHAVIORS, CHRONONUTRITION,
EXERCISE, SLEEP.
ARE THERE MODELS WE COULD DO, DO
THIS, ANIMAL MODELS BASICALLY, I
DON'T DO ANIMAL RESEARCH.
IS THIS A GOOD FIRST STEP TO USE
ANIMAL MODELS FOR THIS?
>>I THINK THERE ARE EXCELLENT
OPPORTUNITIES I FORGET WHO
SHOWED THE SLIDE TODAY OF WORK
FROM MOLLY BRAY, JUST TESTING
FAT DURING THE DAY AND CHOW
DURING THE NIGHT, WAYS OF
MODELING CHANGES IN DIETARY
INTAKE, NUTRITION INTAKE HUMANS
MAY EXPERIENCE WITH TRE LOOKING
AT ANIMAL MODELS FROM LOADING
FAT, TRYING TO UNDERSTAND GOING
BACK TO YESTERDAY, THE
HOMEOSTATIC VERSUS HEDONIC FOOD,
HOW THAT'S BEING AFFECTED.
THOSE ARE THINGS THAT CAN BE
DONE IN SHORT TERM ANIMAL MODELS
TO AT LEAST GIVE A GOOD SENSE
FOR TESTABLE HYPOTHESES IN
HUMANS.
>>YESTERDAY WE TALKED ABOUT
THIS CIRCADIAN OVERALL HEALTH
SCORE, FOR PEOPLE, THAT THAT'S
ANOTHER THING THAT COULD BE DONE
IN ANIMALS.
WE CAN IN SOME WAYS IN A TIGHTLY
CONTROLLED ENVIRONMENT MEASURE A
LOT OF THINGS.
THE BLOOD SAMPLING IS DIFFICULT
IN A MOUSE BUT THAT COULD BE
DONE IN RATS.
I THINK RATS ARE UNDERVALUED AS
A RESEARCH MODEL.
THEY ACTUALLY SOLVE SOME OF THE
PROBLEMS THAT MATT BROUGHT UP
ACTUALLY WITH THE METABOLIC
RATE.
THE OTHER THING THAT'S ALARMING
TO ME, MATT, WITH FASTING TIMES
WITH THE MOUSE STUDIES, A LOT OF
THEM AREN'T 12-HOUR FASTS, THEY
ARE EVEN GREATER THAN THAT.
YEAH, AND WHEN YOU LOOKED AT
OSCILLATOR, ANTICIPATORY
ACTIVITIES DONE, CONTINUE TO BE
DONE, THOSE ARE EXTREMELY SHORT
4-HOUR FOOD ACCESS INTERVALS
DURING THE INACTIVE PERIOD.
SO THOSE ARE GREAT POINTS.
I WOULD ADD ONE ADVANTAGE OF
MECHANISM THAT FRANK HINTED AT
IS ABILITY TO LOOK AT SPECIFIC
ORGANS AND THEIR MOLECULAR AND
PHYSIOLOGICAL RESPONSES ARE
OBVIOUSLY VERY DIFFICULT,
IMPOSSIBLE, UNETHICAL TO DO IN
PEOPLE.
>>MAYBE JUST TO ADD ONE OTHER
CONSIDERATION, WHEN MAKING
TRANSLATION AS MATT SAID BETWEEN
ANIMAL AND HUMAN PHYSIOLOGY IS
THE ACTUAL EXPERIMENTAL
CONDITIONS, IN THE SENSE THAT
RODENT STUDIES ARE GENERALLY
DONE AT ROOM TEMPERATURE, WHICH
IS FAR AWAY FROM THE MORE
NEUTRALITY.
SO THERE'S A BIG METABOLIC
CHALLENGE THAT THE RODENTS ARE
UNDER THROUGHOUT THOSE STUDIES.
THAT'S UNLIKE HUMANS WHERE MOST
OF US ARE IN A NEUTRAL -- AT A
THERMONEUTRAL TEMPERATURE.
>>WE REDUCED TEMPERATURE NOT
ALL THE WAY TO NEUTRALITY, BUT
THE HUMAN METABOLIC COST IS
HORRIBLE WORKING IN THAT ROOM.
>>RIGHT.
>>MATT, DO YOU HAVE -- MARTA,
A COMMENT?
>>MELATONIN AND EATING, THAT
IS A BIG THING.
THERE IS PLENTY OF STUDIES THAT
SHOW EFFECT OF MELATONIN, AND
THIS IS TOTALLY DIFFERENT IN
HUMANS, SO THIS IS VERY
IMPORTANT TO HIGHLIGHT BECAUSE I
FEEL MANY PAPERS COMING ON ABOUT
THE PROPERTIES OF MELATONIN AND
IT'S TOTALLY DIFFERENT IN
HUMANS.
WE CAN GET TO TOTALLY OPPOSITE
RESULTS.
>>EXCELLENT POINT, FOR TWO
REASONS.
MANY MOUSE MODELS DON'T EVEN
MAKE MELATONIN.
OF COURSE, IN HUMANS, MELATONIN
IS HIGH WHEN WE FAST, IN RATS
AND HUMANS IT'S HIGH WHEN THEY
EAT.
THANKS FOR BRINGING THAT UP,
MARTA.
>>I THINK ONE OF THE THINGS IN
ROADENED STUDIES, DURATIONAL
FASTING, IF YOU DO LESS THAN
8-HOUR INTERVAL THEY WON'T EAT
THE SAME AMOUNT OF CALORIES.
THAT'S CRUCIAL AS WELL.
SEEMS LIKE EXACT DURATION WOULD
BE DIFFERENT FOR OBVIOUSLY A
MOUSE THAN HUMAN.
STILL DEEP INSIGHT INTO
MECHANISMS THAT ARE RELATED TO
FASTING DURATION.
>>SO AT THE RISK OF MOVING
INTO A DIFFERENT AREA, I WANT TO
FOLLOW UP ON WHAT KAREN
MENTIONED ABOUT ABILITY TO
MONITOR CLOCK CHANGE PHASE IN
ANIMALS.
AND ASK ABOUT, YOU KNOW, WHAT'S
THE RELEVANCE OF THAT IF WE CAN
NEVER ACTUALLY MEASURE PHASE IN
ANY OF THE HUMAN TISSUES?
YOU KNOW, THERE HAVE BEEN A
COUPLE VERY NICE STUDIES LOOKING
AT CHANGES IN FOOD TIMING IN
TERMS OF BLOOD CHANGES,
METABOLITES AND PROTEOMIC
STUDIES AGAIN IN BLOOD SHOWING
SOME THINGS ARE VERY SENSITIVE
TO FOOD SCHEDULES OR WORK
SCHEDULES, SOME THINGS
COMPLETELY INSENSITIVE.
WHAT ARE THE BARRIERS TO
ACTUALLY BEING ABLE TO MEASURE
PERIPHERAL TISSUE PHASE?
ARE THERE EXOSOMES WE ATTRIBUTE
TO PARTICULAR TISSUES?
ARE THERE PARTICULAR BLOOD
METABOLITES THAT ARE GOING TO
BE -- THAT WE CAN RELIABLY
ATTRIBUTE TO TAKE ORGAN
SECRETING IT IN THERE HAVE BEEN
WORKSHOPS ON CIRCADIAN
BIOMARKERS BUT IT'S AN AREA TO
PUSH FORWARD TO SEE HOW
CIRCADIAN DISRUPTION IS
OCCURRING AT THE LEVEL OF THE
HUMAN.
>>I'M HAPPY TO JUMP IN HERE,
MATT, BECAUSE WE WRESTLED WITH
THIS A FEW YEARS AGO AND
SUBMITTED A GRANT TO THE DoD
BEFORE IT WAS FUNDED.
TRYING TO LOOK AT PERIPHERAL
CLOCKS, WANTED TO DO BIOPSIES,
IT WAS OUT OF THE QUESTION.
AND SO WE KIND OF DEBATED
BETWEEN DO YOU GO WITH MOLECULAR
MARKER OR A NET PHYSIOLOGIC OR
METABOLIC CLOCK, EXAMPLE COULD
BE -- WHAT WE DID FOR THIS
STUDY, A CONSTANT GLUCOSE INFUSE
PROCEDURE TO DEFINE A NET
GLYCEMIC CLOCK.
YOU COULD DO SOMETHING SIMILAR
WITH BLOOD PRESSURE, LIPID
RHYTHMS, THINGS LIKE THAT.
MY PERSONAL BIAS, I TENDED TO
NOW MOVE TOWARDS THE OUTCOME
ITSELF, IN UNDERSTANDING THAT
RHYTHM.
BUT IT'S IMPERFECT EITHER WAY.
THAT'S THE DIRECTION I'VE HEADED
IN BECAUSE IT'S JUST REALLY HARD
TO CORRELATE THOSE RHYTHMS WITH
SOMETHING THAT'S SCALABLE AT THE
LEVEL WE WOULD NEED TO ANSWER
SOME OF THESE PRECISION
NUTRITION QUESTIONS.
>>ONE OF THE THINGS WOULD BE,
YOU COULD COMPARE TO SLEEP/WAKE,
SOMETHING ANYONE CAN DO WITHOUT
PAYING FOR AN EXPENSIVE TOOL OR
HAVE AC STOWS A CLINIC, EVEN
GETTING TO THE POINT ONE DAY OF
HOPEFULLY BEING ABLE TO PUT THIS
ON A PUBLIC RECOMMENDATION.
WE NEED SOME KIND OF WAY TO GIVE
A RECOMMENDATION THAT DOESN'T
REQUIRE SUPER HIGH TECH INFO.
THAT BEING SAID OBVIOUSLY TOOLS
ON THE SMALLER SCALE WOULD BE
EXTREMELY INFORMATIVE.
>>FRANK?
>>YEAH, I THINK THE QUESTION,
IT'S SO CHALLENGING IN HUMANS TO
DO.
THE OTHER AS YOU SAY WHAT IS THE
RELEVANCE?
PART IS RELEVANCE TO TRANSLATE
TO HUMANS BUT THE SECOND, WE
DON'T EVEN UNDERSTAND TO WHAT
DEGREE INTERNAL CIRCADIAN
MISALIGNMENT IS CONTRIBUTING TO
ADVERSE EFFECTS.
IT'S NOT JUST WE CAN'T MEASURE
IT.
WE DON'T EVEN UNDERSTAND WELL
HOW IT WORKS.
THE EVIDENCE IS INDIRECT,
INTERNAL CIRCADIAN MISALIGNMENT
PLAYS A ROLE.
WE DO KNOW BEHAVIORAL
MISALIGNMENT, WHAT I MEAN IS
MISALIGNMENT OF LET'S SAY
EATING-FASTING CYCLE RELEVANT TO
CENTRAL CLOCK IS OF IMPORTANCE
BUT DON'T KNOW -- WE KNOW THE
LIVER CAN BE UNCOUPLED FROM THE
CENTRAL CLOCK BUT DON'T KNOW IF
THAT IS A CAUSAL -- TO WHAT
DEGREE IT PLAYS A CAUSAL ROLE IN
ADVERSE EFFECTS.
IT'S VERY MUCH A WORKING
HYPOTHESIS IN THE FIELD AS OF
NOW.
>>YEAH, MAYBE JUST ADD TO THE
CONCEPT, THINKING ABOUT THE
TIMING OF SLEEP, FIRST ACTIVITY,
AND NUTRITION, TRYING TO FIGURE
OUT WHICH OF THOSE IN
COMBINATION MIGHT BE MOST
IMPINGING ON SOME PERIPHERAL
CLOCKS.
IF THAT MATTERS AND IN
COMBINATION HOW THOSE MIGHT
INFLUENCE CARDIOMETABOLIC HEALTH
OUTCOMES.
THAT'S PROBABLY ANYBODY'S -- WE
CAN MAKE AN EDUCATED GUESS NOW
BUT THAT'S PROBABLY THE BEST WE
CAN DO.
>>WE'RE GETTING SLEEP
MISTIMING AND EATING MISTIMING.
BRIEFLY SHOWED A SLIDE ON THAT.
THAT WAS THE EXACT QUESTION.
>>RIGHT.
>>SO THE DATA THERE SUGGEST
THAT EATING TIME OR EATING
MISTIMING IS MORE IMPORTANT
DRIVER, FOR THE MEASURES WE
LOOKED AT.
OF COURSE WE JUST LOOKED AT
GLYCEMIC CONTROL, WE LOOKED AT
DEPRESSIVE ANXIETY-LIKE MOOD, WE
LOOKED AT INTERNAL MISALIGNMENT
IN HUMANS, AND UNPUBLISHED WE
ALSO ARE LOOKING AT
CARDIOVASCULAR-RELATED MEASURES.
ALL OF THESE SUGGEST THE MEAL
TIMING IS MORE IMPORTANT THAN
THE MISTIMING OF THE SLEEP-WAKE
CYCLE.
THE BEHAVIORAL ASPECT WE CAN
UNCOUPLE.
INTERNAL MISALIGNMENT BETWEEN
CLOCKS THROUGHOUT THE BODY IS A
TOUGHER NUT TO CRACK AT LEAST IN
HUMANS.
>>AS WE THINK ABOUT TIMING,
MISTIMING OF EATING BEING MORE
IMPORTANT THAN MISTIMING OF
SLEEP.
COURTNEY, HAD YOU A COMMENT?
>>YEAH, ONE THING A WE
COLLECTIVELY AS A COMMUNITY
TACKLE QUESTIONS ABOUT INTERNAL
MISALIGNMENT OF PERIPHERAL
ORGANS IT TAKES LONGER TO TRAIN
THAN IT DOES TO DELIVER.
IF I REMEMBER, FOUR WEEKS IN ONE
RODENT STUDY.
HOW LONG DOES IT TAKE IN HUMANS,
IF WE NEED TO DO STUDIES UNDER
SUCH GREAT INPATIENT OR IN-LAB
CONTROL WE HAVE TO MAKE SURE WE
HAVE SUFFICIENT DURATION OF
THOSE INTERVENTIONS SUCH THE
ORGANS CAN ADAPT OR ENTRAIN TO
THE SCHEDULES.
THAT'S GOING TO BE CHALLENGING
TO FIGURE OUT.
>>I WANT TO REITERATE, IT'S
IMPORTANT, YESTERDAY WE TALKED
ABOUT FOOD IS A GREAT
IN-TRAINING STIMULUS FOR CERTAIN
OSCILLATORS, BUT IT'S WEAK FOR
OTHERS.
KEEPING IN MIND THAT IN
ADDITION, THERE ARE CENTRAL
OSCILLATORS OUTSIDE OF SBN, I
THINK MATT SHOWED THIS IN HIS
INTRO, THAT ENTRAIN TO FOOD VERY
SLIGHTLY AND STRONGLY, STRONGLY
COUPLED TO TIMING OF FOOD, NOT
SCN OSCILLATORS, STILL IN THE
BRAIN AND CONTROL THINGS
IMPORTANT TO THIS TOPIC.
THAT NUMBER ONE IS IMPORTANT
REASON TO DO ANIMAL RESEARCH BUT
NUMBER TWO, WHEN WE THINK ABOUT
ENTRAINING STIMULI AND THE POINT
COURTNEY MADE WE HAVE TO TAKE
INTO ACCOUNT COUPLING STRENGTH
FOR THE DIFFERENT RHYTHMS THAT
WE'RE WISHING TO MEASURE OR
OBSERVE.
>>WE HAVE TEN MINUTES LEFT
HERE.
I'D LIKE TO KNOW, GIVEN WHAT
WE'VE SEEN OVER THE LAST TWO
DAYS WHERE DO WE NEED TO GO FROM
HERE TO MOVE CHRONONUTRITION
INTO CLINICAL PRACTICE?
WHAT INFORMATION DO WE NEED TO
GATHER?
>>RELATED TO YOUR QUESTION,
HIGHLIGHTING ONE OF THE
QUESTIONS IN THE CHAT, WHICH IS
ONE OF THE THINGS WE NEED
PROBABLY TO COLLABORATE WITH
IMPLEMENTATION SCIENCE EXPERTS
TO APPLY IMPLEMENTATION SCIENCE
FRAME WORKS AND COLLECT
INFORMATION TO DESIGN
INTERVENTIONS THAT WORK IN REAL
SETTINGS FOR A LONG TIME.
>>EVERYONE ON THIS CALL KNOWS
TIMING IS IMPORTANT.
RIGHT?
BUT THIS IS A MESSAGE THAT NEEDS
TO GET TO EVERY OTHER ASPECT OF
THE NIH.
WHEN THINGS ARE MEASURED, WE
NEED TO GET THE METADATA TO KNOW
WHEN IT WAS DONE, NEED TO KNOW
WHEN IT WAS DONE RELATIVE TO
WHEN THE PERSON SLEPT, WHEN IT
WAS DONE RELATIVE TO WHEN THE
PERSON ATE.
AND IF WE CAN HAVE A CHANGE IN
PERSPECTIVE HERE AND ADDING THAT
TIMING INFORMATION INTO ALL
TRIALS DONE, THAT WILL HELP MOVE
THIS FIELD FORWARD.
AS WE FOCUS ON THIS AREA OF
CHRONONUTRITION, AND
CHRONOEVERYTHING, IF YOU WILL,
HERE.
>>RIGHT.
>>THAT HAS TO BE A MESSAGE,
IMPORTANT MESSAGE.
>>I DON'T THINK IT'S
SUFFICIENT ANYMORE TO SAY THAT
WE'VE COLLECTED SAMPLES, THE
FASTED CONDITION.
>>HOW FREQUENTLY BLOOD
SAMPLING TO OCCUR TO BALANCE
BURDEN WITH BEING ABLE TO
CHARACTERIZE THESE SORT OF
CIRCADIAN PATTERNS BIOMARKERS
ARE OSCILLATING ON AS WE START
TO MOVE IN THAT DIRECTION.
WHICH I THINK IS REALLY
IMPORTANT, IF WE'RE STUDYING
HEMATOPOISES DON'T SEE
DIFFERENCE IN TERMS OF
CIRCULATING MONOCYTES EARLY IN
THE DAY BUT LATER IN THE DAY SEE
DIFFERENCE, WITHIN THE SAME DAY.
AND SO IT SORT OF UNDERSCORES
THE IMPORTANCE OF REALLY GETTING
THE DIURNAL OR CIRCADIAN
PATTERNS OF BIOMARKERS.
>>IT'S SOMETHING HIGHLIGHTED
ACROSS THE AFTERNOON, GOING
BEYOND FASTING MEASURES,
POSTPRANDIAL MEASURES.
WE KNOW PEOPLE EAT AROUND THE
CLOCK.
IF THEY ARE IN POSTPRANDIAL
STATE MOST OF THE DAY WHY ARE WE
FOCUSING ON FASTED MEASURES?
TAKING THOSE MEASURES, PEAKING
ATTEND TO POSTPRANDIAL PERIOD,
TO OVERNIGHT PERIOD AS WELL,
TAKING SAMPLES ACROSS THE
24-HOUR PERIOD TO BE ABLE TO
LOOK AT THOSE EFFECTS OF
INTERVENTION.
>>YEAH, AND KEN MADE THIS
POINT WELL EARLIER THAT WE NEED
24 HOUR ASSESSMENTS, JUST FOR
REFERENCE WE FOUND EVEN IF WE
ONLY MEASURE AT THE POSTPRANDIAL
LEVELS IN THE MORNING WE STILL
ARE MISSING MOST OF THE EFFECT.
IT'S LATER IN THE DAY AT LEAST
FOR TIME-RESTRICTED EATING.
>>IT DIFFERS BY MARKER.
>>ABSOLUTELY, I'M SURE IT
DOES.
>>ANYONE ELSE?
>>YES, I THINK ANOTHER
IMPORTANT CONCEPT IS THE IDEA OF
EVENING TYPE OR MORNING TYPE FOR
CLINICAL SETTING BECAUSE I THINK
THIS IS SOMETHING TO UNDERSTAND,
MANY PEOPLE KNOW THERE ARE MORE
EVENING OR MORNING, AND
THERAPIES SHOULD BE DIFFERENT,
AT LEAST THOSE RELATED TO
BEHAVIORAL CHANGES.
FOR EXAMPLE WE JUST PUBLISHED A
PAPER WITH FRANK ABOUT HOW
EVENING TYPE ARE MORE EMOTIONAL
PEOPLE, AND HAVE MORE SENSE OF
GUILT OR CRAVING FOR SPECIFIC
FOOD, THAN MORNING TIMES.
I THINK THAT'S IMPORTANT FOR
EXAMPLE FOR EATING THEY PERHAPS
FIND MORE DIFFICULTIES OR
CRAVING INCREASES WHEN THEY HAVE
TO BE IN A VERY BEHAVIOR,
EVENING TYPE OR MORNING TYPE IS
A CONCEPT, AND THE OTHER THING
KEN WRIGHT SAYS THAT EATING
AROUND SLEEP OR DOING ALL THIS
HIGHLIGHT SO WE SHOULD AVOID TO
DO THINGS AT NIGHT THAT SHOULD
BE DURING THE DAY SO THOSE
THINGS ARE VERY EASY TO
UNDERSTAND.
>>I WAS GOING TO CHANGE THE
TOPIC BUT TO BUILD ON WHAT MARTA
SAID DO YOU WANT TO GO FIRST?
>>YEAH, I WANTED TO MENTION
THE FACT THAT ONE OF THE GREAT
RESULTS FROM KEN'S WORK IN
RECENT YEARS IS THE FACT THAT
CHRONOTYPE CAN POTENTIALLY BE
EXPLAINED BY SENSITIVITY TO, FOR
EXAMPLE, LIGHT IN THE EVENING.
AND I WOULDN'T BE SURPRISED IF
THERE'S SIMILAR CHRONOTYPE
PHENOMENA, MAYBE IT'S NOT
SLEEP-WAKE, MAYBE IT'S
METABOLISM, THAT COULD BE
SIMILARLY IMPACTED BY TIMING OF
FOOD.
SO MAYBE ONE OF THE EFFECTS OF
TRE IS TO KIND OF BRING THE
CLOCKS BACK INTO RESONANCE IN A
WAY THAT SUPPORTS HEALTH, AND
SORT OF CHANGING THESE -- THERE
MIGHT BE -- DELETERIOUS EFFECTS
MIGHT BE A KNOCK-ON FROM THIS
LIKE MISTIMING JUST BASED ON
CIRCADIAN PROPERTIES OF HOW THEY
ENTRAIN.
>>I'M GOING TO CHANGE THE
TOPIC TO A GREAT POINT THAT WAS
BROUGHT UP YESTERDAY.
ONE OF THE THINGS THAT'S BEEN
VERY CHALLENGING FOR THOSE WHO
DO HUMAN RESEARCH, ALMOST
EVERYONE WHO DOES HUMAN RESEARCH
HERE DOES FAIRLY WELL CONTROLLED
OR INPATIENT OR IN-LAB STUDIES,
WITH ABOLISHMENT OF FUNDING FOR
GCRC IT'S BEEN DIFFICULT TO
MAINTAIN A POOL OF NURSES TO
CARRY OUT STUDIES, AS WAS SAID
YESTERDAY, SEVEN DAYS INPATIENT
IS HARD TO DO.
IF I THINK ABOUT WHAT NHLBI AND
OTHER INSTITUTES CAN DO TO HELP
US FIND A WAY TO MAKE THESE
SUSTAINABLE, FOR EXAMPLE KAREN
GAMBLE AND I COBBLED TOGETHER
THROUGH THE LUCK OF GRANT
FUNDING, FOUR OF US
INVESTIGATORS ARE FIVE TRIALS
THAT REQUIRE INPATIENT TESTING,
HAVE BEEN ABLE TO ASSEMBLE
NURSES, IT'S BEEN DIFFICULT,
TOOK TWO YEARS TO PULL OFF.
WE DON'T HAVE STABILITY TO DO
THESE STUDIES, MAYBE CENTER
FUNDING FOR A FEW SELECT CENTERS
TO SUSTAIN THIS TYPE OF
RESEARCH.
I HAD MY FORMER MENTOR SAY WE'LL
SEE IF YOU SURVIVE WITHOUT A
GCRC, THAT TELLS YOU THE STATE
OF HOW DIFFICULT IT IS TO DO
THESE STUDIES.
>>COURTNEY, THAT CAME UP
YESTERDAY FROM ANOTHER, I FORGET
WHO, ANOTHER INSTITUTION.
THAT'S AN ISSUE.
THE FUNDING IN GENERAL PRETTY
TRANSLATIONAL, WE'VE HAD FOR A
LONG TIME, ALSO GOING DOWN ON
TOP OF THAT.
SO, YEAH.
>>I WOULD LIKE TO ECHO
COURTNEY'S POINT.
I THINK IT WAS INDEED SAID
MULTIPLE TIMES.
YES, THE -- CONDUCTING INTENSIVE
IN-LAB STUDIES HAS BECOME
INCREASINGLY DIFFICULT, AND SO
HAVING SOME STABILITY AND LIKE
YOU SAID IN YOUR EXAMPLE,
COURTNEY, IT REALLY REQUIRES A
LARGER TEAM TO MAKE IT HAPPEN.
IF YOU HAVE A SINGLE P.I. IT'S
ALMOST IMPOSSIBLE TO MAKE IT --
TO COVER 24/7 COVER COVERAGE.
ONLY BY THE LUCK OF HAVING
MULTIPLE P.I.s IN THE SAME
SPACE CAN YOU MAKE IT WORK,
WHICH MAYBE THERE'S SOME
EXCEPTIONS.
YOU'RE ABLE TO PULL IT OFF
SOMEHOW.
BUT YOU'RE ONE OF THE FEW.
BUT FOR ALL OF US, IT HAS BECOME
INCREASINGLY DIFFICULT.
HAVING A STABLE CENTER FUNDING
OR OTHERWISE WOULD BE VERY
HELPFUL INDEED.
I WANTED TO CIRCLE BACK TO A
COMMENT MARTA BROUGHT UP ABOUT
CHRONOTYPE.
THREE THINGS.
IT WOULD BE GREAT TO MEASURE
CHRONOTYPE.
PEOPLE'S SLEEP.
AND THEN SOCIAL JET LAG.
SO USING THE SHORT REGRESSION
CAN DO ALL THREE.
AND SO I MEAN YOU WOULD NEED DAY
BY DAY DIARY IF YOU WANT IT DAY
BY DAY BUT AT LEAST IN THE SHORT
MUNICH CHRONOTYPE QUESTIONNAIRE,
GAVE YOU HABITUAL SLEEP-WAKE
CYCLE, CAN GIVE YOU CHRONOTYPE,
CAN GIVE YOU SOCIAL JET LAG,
SOMETHING WE'RE BUILDING INTO
STROKED TRIALS NOW WITH CLINICAL
TEAMS.
AND I THINK THIS IS MAYBE
SOMETHING SUITABLE TO RECOMMEND
FOR IMPLEMENTATION IN ALL LARGE
TRIALS.
>>I'D LIKE TO CLOSE OUT THIS
DISCUSSION SESSION FOR THIS
AFTERNOON AND TURN IT OVER TO
SHILPY DIXIT FOR THE WRAP-UP.
WE'VE HAD A LIVELY DISCUSSION,
GREAT INFORMATION.
HOPEFULLY THE -- I'M SURE THE
NIH IS LISTENING IN TO OUR NEEDS
TO HELP MOVE THE FIELD FORWARD.
WE CAN'T HEAR YOU, SHILPY.
YOUR MICROPHONE?
>>I TURNED IT ALL THE WAY DOWN
JUST TO BE SURE.
FROM THE NATIONAL CENTER ON
SLEEP DISORDERS RESEARCH AND
NHLBI I WANT TO THANK ALL OF THE
PANELISTS, SESSION CHAIRS,
FACILITATORS AROUND CO-CHAIRS,
MARIE-PIERRE AND KAREN,
EXCELLENT TWO DALES OF VALUABLE
INFORMATION.
I WANT TO THANK YOU FOR TAKING
THE TIME TO HELP US UNDERSTAND
BETTER WHAT'S NEEDED TO TAKE
CHRONONUTRITION AND
CHRONOBIOLOGY OVERALL INTO
CLINICAL PRACTICE AND MEDICINE.
HOUSEKEEPING THINGS.
THERE'S A LINK FOR A SURVEY IN
THE CHAT.
THIS WILL BE SENT OUT VIA E-MAIL
TO ALL WHO REGISTERED.
THE RECORDING OF THIS WORKSHOP
WILL BE AVAILABLE ON NIH
VIDEOCAST NEXT WEEK.
WE'LL HAVE THE EXECUTIVE SUMMARY
POSTED ON THE NHLBI EVENT PAGE
IN THE NEXT SIX WEEKS.
AND HOPEFULLY THE WORKSHOP
REPORT BY THE END OF THE YEAR.
AS ALWAYS, WE WANT TO THANK YOU
FOR JOINING USED THAT.
AND WE HOPE YOU HAVE A WONDERFUL
REST OF THE WEEK.
THANK YOU SO MUCH.