Original Article Obesity

EPIDEMIOLOGY/GENETICS

Chronotype Differences in Timing of Energy

and Macronutrient Intakes: A Population-Based
Study in Adults
Mirkka Maukonen, Noora Kanerva, Timo Partonen, Erkki Kronholm, Heli Tapanainen,
Jukka Kontto, and Satu M€
annist€
o

Objective: To examine the association between chronotype and timing of energy and macronutrient
intakes in adults.
Methods: The study sample included 1,854 participants from the National FINRISK 2007 and FINDIET
2007 studies, aged 25 to 74 years. Diet was assessed with 48-hour dietary recalls. Chronotype was
€
assessed with a shortened version of Horne and Ostberg’s Morningness–eveningness Questionnaire.
Associations between chronotype and intakes of energy and macronutrients in the morning (by 10 AM)
and in the evening (after 8 PM) were analyzed with linear regression and ANOVA followed by Bonferroni
post hoc test.
Results: In the morning, evening types had lower energy and macronutrient intakes (except for sucrose
of which they had a higher intake) than morning types (P < 0.05), while in the evening, evening types had
higher intakes of energy, sucrose, fat, and saturated fatty acids than morning types (P < 0.05). On the
weekend, chronotype differences in evening intakes of energy, sucrose, and fat intake were more pro-
nounced, and evening types had more eating occasions and more irregular meal times than morning
types.
Conclusions: Postponed energy and macronutrient intake timing of evening types with unfavorable die-
tary patterns may put them at higher risk of obesity and metabolic disturbances in the future.
Obesity (2017) 25, 608-615. doi:10.1002/oby.21747

Introduction adverse metabolic changes (e.g., poorer glycemic control, higher

Circadian clock aligns individuals’ behavior and physiology with
environmental changes (1). Circadian clock adapts to the time-
giving signals, mainly the light–dark cycle as well as nutrient cycle
of fasting–feeding, creating a circadian rhythm of approximately
24 hours. In addition to these external factors, genetic components
also affect the timing of the circadian rhythm (chronotype) and
accordingly individuals can be classified from extreme morning
types to extreme evening types (2-4). Evening types are more prone
to misalignment of the circadian clock resulting from desynchrony
between chronotype and social demands, e.g., due to work schedules
(5). Furthermore, numerous studies have shown that as compared
with morning types, evening types have unhealthier behavior (e.g.,
unhealthier dietary habits, poorer sleep patterns, smoking) and
risk of type 2 diabetes) (6-11).
Recent literature suggests that timing of energy intake may have
major effects on metabolic health. Animal trials as well as interven-
tion and epidemiological studies on humans have shown that abnor-
mal circadian timing of energy intake may lead to metabolic dys-
functions (12-14) and weight gain (15-17). Whether chronotype
affects timing of energy intake and its association with metabolic
health is not well known. Only few small-scale studies have exam-
ined chronotype in relation to energy intake timing (18-20). Their
findings indicated that evening types have higher energy and macro-
nutrient intakes after 8 PM and altered meal patterns, such as shorter
duration between breakfast and lunch.

Department of Health, National Institute for Health and Welfare, Helsinki, Finland. Correspondence: Mirkka Maukonen (mirkka.maukonen@thl.fi)

Funding agencies: This study was supported by the Academy of Finland (136895 and 263836), the Juho Vainio Foundation, and the Yrjo € Jahnsson Foundation (6454).
Disclosure: TP reports personal fees from Dila, Finnair, Helen, Helsinki Fair, Heureka, Labquality, Lundbeck, MCD-Team, Mercuria Business College, MSD Finland, Servier
Finland, Speakersforum Finland, Va €esto€liitto Fertility Clinics, and YTHS, as well as other financial relationships with Duodecim Medical Publications, Oxford University
Press, and Terve Media, outside the submitted work. The other authors declared no conflict of interest.
Author contributions: MM participated in designing the research, analyzed the data, wrote the manuscript, and had primary responsibility for the final content. NK and
TP participated in designing the research and provided critical input on drafts of the manuscripts. EK provided critical input on drafts of the manuscripts. HT and JK
provided statistical consulting. SM participated in designing the research and provided critical input on drafts of the manuscripts. All authors critically reviewed the
manuscript and accepted the final content.
Received: 6 September 2016; Accepted: 14 November 2016; Published online 23 February 2017. doi:10.1002/oby.21747

608 Obesity | VOLUME 25 | NUMBER 3 | MARCH 2017 www.obesityjournal.org

Original Article
EPIDEMIOLOGY/GENETICS
We examined the association between chronotype and timing of
energy and macronutrient (carbohydrate, sucrose, fiber, protein, fat,
saturated fatty acids, and alcohol) intakes in Finnish adult popula-
tion. We also examined differences in timing of energy and macro-
nutrient intakes between weekdays and weekends. We expected eve-
ning types to have postponed energy and macronutrient intakes and
that they would consume less energy before 10 AM and more after 8
PM as compared with morning types and that these differences would
be more pronounced on weekends.
Methods
Subjects
The national FINRISK 2007 Study monitoring cardiovascular risk
factors in Finland was conducted between January and March target-
ing a random sample of 10,000 subjects aged 25 to 74 years from
the national population register in five large geographical areas (21).
Of the invited, 6,258 (response rate 63%) participated in a health
examination and completed a self-administered health questionnaire
that had specific questions on socioeconomic background and on
health-related behaviors such as their preference to time the daily
€
activities assessed with a shortened version of Horne and Ostberg s
(2) Morningness–eveningness Questionnaire, MEQ. One third (n 5
3,286) of the FINRISK 2007 Study participants were invited to the
national FINDIET 2007 Survey on dietary habits, including a 48-
hour dietary recall covering two previous consecutive days (22). In
all, 2,054 (63%) participants completed the recall and 2,038 (62%)
recalls were accepted. The final study sample included 1,854 partici-
pants with 48-hour dietary recalls and morningness–eveningness
(ME) score. Both of these studies were conducted according to the
guidelines of the Declaration of Helsinki and the research protocols
were approved by the Ethics Committee of the Hospital District of
Helsinki and Uusimaa. Written informed consent was obtained from
all participants.
Energy and macronutrient intake timing
Mean daily energy and macronutrient (carbohydrate, sucrose, fiber,
protein, fat and saturated fatty acids, and alcohol) intakes by hours
were assessed with 48-hour dietary recalls. Trained interviewers re-
corded all foods and beverages consumed and consumption time
(22). Portion sizes were estimated with food photograph booklet
(23). The 48-hour recall did not cover Fridays because of the study
design (22). Daily intakes of energy and macronutrients were calcu-
lated using the National Food Composition Database (FineliV R ) devel-
oped by the Finnish National Institute for Health and Welfare (22).
We examined energy and macronutrient intakes in the evening (8:00
PM till 2:59 AM) and in the morning (3:00 AM till 9:59 AM). Selected
time periods were based on the previous studies (18-20) and on
average timing of morning and evening meals of Finnish population
(24). Furthermore, timing of energy intake was presented as cumula-
tive intake across the day and by hours.
Energy and macronutrient intake timing
on weekdays and weekends
We also analyzed timing of energy and macronutrient intakes sepa-
rately for weekdays (Monday to Friday) and weekends (Saturday
and Sunday). Because the whole sample (48-hour dietary recalls)
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Obesity
did not cover Fridays, we used a subgroup of the FINDIET 2007 Sur-
vey with 3-day food records in addition to the 48-hour dietary recalls
(22). By combining dietary data from these two methods we got data
from all days of the week and a larger sample size (from n 5 792 to
n 5 831) for weekend analysis than using 48-hour dietary recalls. The
3-day food records were asked to be completed at home starting from
the day following the 48-hour dietary recall from approximately half
of the participants (n 5 1,646) invited to the 48-hour dietary recall
(22). In all, 935 food records were returned and 912 (55%) accepted.
Final weekday and weekend analysis included 831 participants with
48-hour dietary recalls, 3-day food records, and ME score.
Before combining data from these two methods, we compared the
mean differences in average total daily energy and macronutrient
intakes with paired samples t-test followed by Cohen’s d test for
effect size. Cohen’s d expresses the standardized difference between
two means in standard deviation units and can be used to determine
practical significance of the difference between two means (25).
According to t-test, the mean differences were generally small
between 48-hour dietary recalls and 3-day food records. The effect
sizes of Cohen’s d were 0.2 for energy and for all macronutrient
intakes (except for alcohol d 5 0.24, with actual mean difference of
2.9 g). According to Cohen (1992), the difference between two
means can be considered practically insignificant when d  0.2 and
small when d 5 0.2-0.3. The small effect size found on alcohol
intake could be explained by the fact that 48-hour dietary recalls did
not cover Fridays. Thus, based on these results we combined the
data from these two methods.
Timing of energy and macronutrient intakes on weekdays were gen-
erally similar than of the whole sample (48-hour dietary recalls) and
therefore we only reported results concerning weekend intakes in
addition to the results from the whole sample.
Morningness–eveningness score
Chronotype was assessed using a shortened six-item version of the
original 19-item MEQ (2). Shortened version included items 4, 7, 9,
15, 17, and 19, accounting for 83% of the total variance of the origi-
nal MEQ (26). These six items assessed individual differences in
daytime preference to do various activities such as wake up, work,
or perform hard physical tasks. The final ME score of the six
selected items varied from 6 (extreme eveningness) to 27 (extreme
morningness). In the analyses, the ME score was used either as a
continuous variable or as a categorical variable by dividing the ME
€
score into thirds based on Horne and Ostberg’s (2) cutoff values for
chronotypes (evening type 6-12 points, intermediate 13-18 points,
and morning type 19-27 points).
Anthropometric, sociodemographic,
and lifestyle variables
At the study site, trained nurses measured weight and height using
standardized international protocols (27) with participants wearing
light clothing and no shoes. Height was measured to the nearest
0.1 cm using a wall-attached stadiometer and weight to the nearest
0.1 kg using a beam balance scale. BMI was calculated as kg/m2.
Socioeconomic and lifestyle information were obtained from self-
administered questionnaires. Education was assessed by asking partici-
pants to report the total number of their school years, which were then
Obesity | VOLUME 25 | NUMBER 3 | MARCH 2017 609
Obesity Energy/Macronutrient Intake Timing of Chronotypes Maukonen et al.

TABLE 1 Participants’ means (SEM) or % of background variables by chronotypes (n 5 1,854)

Chronotype
Morning, Intermediate, Evening,
n 5 904 (49%) n 5 726 (39%) n 5 224 (12%) Pa,b Ptrenda,c

ME score (range) 19-27 13-18 6-12

Male sex (%) 50.1 43.3 37.5 0.003 0.002
Agea (y) 53.4 (0.4) 48.4 (0.5) 43.9 (0.9) <0.001 <0.001
High education (%)d 31.4 37.7 41.0 0.002 <0.001
Physically inactive (%)e 14.2 20.8 29.4 <0.001 <0.001
Current smokers (%) 18.1 19.4 29.9 0.005 0.004
BMI (kg/m2)a 27.1 (0.2) 26.7 (0.2) 27.6 (0.3) 0.44 0.66
Sleep 10 h/night (%) 0.9 1.9 4.1 0.004 0.001
Sleep 5 h/night (%) 3.8 3.6 5.5 0.040 0.045
Experienced insufficient sleep (%)f 8.7 16.3 32.1 <0.001 <0.001
Insomnia (%)g 53.0 60.3 70.0 <0.001 <0.001
Good self-rated health (%)h 62.8 60.1 50.0 <0.001 <0.001
Good self-rated physical fitness (%)h 55.2 46.5 34.8 <0.001 <0.001

a
Adjusted for age and sex (adjusting variables not included in the model when examined as dependent variable).
b
P value for difference between morning and evening types (ME score was used as a categorical variable) was determined with multiple comparisons post hoc test with
Bonferroni correction for continuous variables and with logistic regression for categorical variables.
c
P value for trend (ME score was used as a continuous variable) was determined with linear regression for continuous variables and with logistic regression for categorical
variables.
d
Highest tertile of self-reported total school years according to birth cohort to adjust for the extension of the basic education system and the increase of average school
years over time.
e
Self-reported leisure-time physical inactivity (light activities such as watching television and reading).
f
Percentage of participants experiencing insufficient sleep often or always.
g
Percentage of participants reporting having insomnia sometimes or often.
h
Percentage of participants rating their health/physical fitness as very good or fairly good.
ME score, morningness–eveningness score; SEM, standard error of mean.

categorized into tertiles (low, middle, and high) according to sex and birth
cohort. This was done to adjust for the extension of the basic education
system and the increase of average school years over the last decades.
Participants’ smoking status was determined using three level scale
(never smoker, former smoker (quit 6 months ago), and current smoker)
based on questions on their smoking history and current smoking habits.
Average leisure-time physical activity over the previous 12 months com-
prised of the activity outside work and was assessed according to four cat-
egories: inactive (light activities such as reading and watching television),
moderately active (walking, gardening, or other activities 4 h/wk);
active (running, swimming, or other physically demanding activities
3 h/wk), very active (competition or other heavy sports several times
per week). Answers were then categorized into three categories (inactive,
moderately active, and active). Participants were asked average hours of
sleep a night and accordingly sleeping hours were categorized as sleep
10 h/night, 6 to 9 h/night, and 5 h/night. Participants’ subjective sleep
sufficiency was assessed with four-level scale (always sufficient, often
sufficient, seldom or never sufficient or cannot say). Participants were
asked if they experienced insomnia often, sometimes, or never. General
health status was determined by asking participants to rate their current
health and physical fitness status using a five level scale (very good, fairly
good, satisfactory, fairly poor, very poor).
Statistical analysis
Data was analyzed together for men and women, since chronotype
and sex of the participant did not generally have significant
interaction when timing of energy and macronutrient intakes were
analyzed. Macronutrient intakes that did not satisfy the normality
assumption were log transformed. Results were presented accord-
ing to chronotype including means and standard errors of means
(SEM) for continuous variables (age, BMI, energy, and macronu-
trient intakes) and percentages for categorical variables (education,
smoking, physical activity, smoking, sleep variables, self-rated
health, and physical fitness). The P value for difference between
morning and evening types (ME score as a categorical variable)
for continuous variables was analyzed with analysis of variance
(ANOVA) followed by Bonferroni multiple comparisons post hoc
test and for categorical variables with logistic regression. The P
value for trend (ME score as a continuous variable) for the associa-
tion between chronotype and continuous variables was determined
with linear regression and for the association between chronotype
and categorical variables with logistic regression. Cumulative
energy intake across the day and per hour was also calculated. All
analyses were adjusted for age and sex, however, when energy and
macronutrient intakes were examined we further adjusted the
model for possible confounding factors (education, leisure-time
physical activity, smoking, and experienced sufficiency of sleep).
The results were generally similar but attenuated, to some extent,
in further adjusted model (especially alcohol intake) and therefore
we reported results from the further adjusted model. All analyses
were performed with the SPSS statistical computing software, ver-
sion 22.0 (IBM SPSS Statistics). A P value of <0.05 was consid-
ered significant.

610 Obesity | VOLUME 25 | NUMBER 3 | MARCH 2017 www.obesityjournal.org

Original Article
EPIDEMIOLOGY/GENETICS
Results
Mean ME 6 SEM score was 17.9 6 0.1. Of the participants, 49%
were morning, 39% intermediate, and 12% evening types (Table 1).
Evening types were more significantly associated with women,
younger people, highly educated, physically inactive, and current
smokers than morning type (P < 0.01). Higher proportion of evening
types than morning types reported sleeping 10 h/night or 5 h/night
and experienced insufficient sleep and insomnia (P < 0.05). Lower
proportion of evening types rated themselves as being in good health
or in good physical fitness (P < 0.001). These significant associations
were also found when testing trends for ME score (P < 0.05).
Both, evening and morning types had four energy intake peaks
across the day (Figure 1A). Energy intake peaks of evening types
Figure 1 Average (A) hourly and (B) cumulative energy intakes of morning and evening types including all days of the week (except Fridays) and average (C) hourly
and (D) cumulative energy intakes of morning and evening types on weekends.
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Obesity
were about an hour later than the energy intake peaks of morning
types. Furthermore, cumulative energy intake of evening types
tended to be lower from the beginning of the day until 10 PM
(Figure 1B). On weekends, evening types had six peaks of energy
intake while morning types had three (Figure 1C). For evening
types the highest energy intake peak was at 7 PM, whereas the
three peaks for morning types at 8 AM, at 12 AM and at 5 PM were
about the same height. Cumulative energy intake of evening types
tended to be lower from the beginning of the day until 1 AM
(Figure 1D).
Total daily energy intake did not differ between morning and evening
types (P 5 1.00) (Table 2). Of the macronutrients, evening types had lower
total daily intake of protein than morning types (P 5 0.0170). Furthermore,
Obesity | VOLUME 25 | NUMBER 3 | MARCH 2017 611
Obesity Energy/Macronutrient Intake Timing of Chronotypes Maukonen et al.

TABLE 2 Means (SEM) of energy and macronutrient intakes by chronotypes (n 5 1,854)a

Chronotypeb
Morning, Intermediate, Evening,
n 5 904 n 5 726 n 5 224 Pb,c Ptrendb,d

ME score (range) 19-27 13-18 6-12

Total daily intake
Energy (kJ)e 7,808 (170) 7,960 (171) 7,881 (210) 1.00 0.11
Carbohydrate (E%) 48.6 (0.6) 48.1 (0.6) 48.8 (0.7) 1.00 0.95
Sucrose (E%) 9.5 (0.4) 9.4 (0.4) 10.1 (0.5) 0.46 0.020
Fiber (E%) 2.5 (0.1) 2.4 (0.1) 2.5 (0.1) 1.00 0.075
Fat (E%) 31.7 (0.6) 32.1 (0.6) 32.3 (0.7) 0.81 0.18
Saturated fatty acid (E%) 11.6 (0.3) 11.9 (0.3) 11.8 (0.3) 1.00 0.29
Protein (E%) 17.3 (0.3) 17.4 (0.3) 16.4 (0.3) 0.017 0.034
Alcohol (g) 4.6 (1.5) 4.3 (1.5) 9.7 (1.9) 0.57 0.037
By 10 AMf
Energy (kJ)e 1,505 (70) 1,328 (70) 1,157 (87) <0.001 <0.001
Energy (%)g 18.7 (0.7) 16.4 (0.7) 14.3 (0.9) <0.001 <0.001
Carbohydrate (E%) 52.8 (1.3) 50.5 (1.3) 47.1 (1.6) <0.001 <0.001
Sucrose (E%) 10.7 (1.0) 10.9 (1.0) 11.3 (1.2) <0.001 <0.001
Fiber (E%) 2.8 (0.1) 2.6 (0.1) 2.4 (0.2) 0.008 <0.001
Fat (E%) 23.8 (1.0) 23.3 (1.0) 19.6 (1.2) <0.001 0.002
Saturated fatty acid (E%) 9.0 (0.5) 9.0 (0.5) 7.3 (0.6) 0.002 0.018
Protein (E%) 16.8 (0.6) 16.1 (0.6) 13.6 (0.7) <0.001 <0.001
Alcohol (g)h 0.13 (0.1) 0.003 (0.1) 0.49 (0.1) 0.69 0.47
After 8 PMi
Energy (kJ)e 1,153 (76) 1,371 (76) 1,581 (94) <0.001 <0.001
Energy (%)g 14.0 (0.9) 16.7 (0.9) 20.0 (1.1) <0.001 <0.001
Carbohydrate (E%) 48.8 (2.0) 51.3 (2.0) 51.2 (2.4) 0.84 0.008
Sucrose (E%) 12.5 (1.2) 13.4 (1.2) 13.6 (1.5) 0.002 <0.001
Fiber (E%) 2.9 (0.2) 2.8 (0.2) 2.8 (0.2) 1.00 0.58
Fat (E%) 21.5 (1.2) 23.4 (1.2) 26.1 (1.5) 0.002 <0.001
Saturated fatty acid (E%) 8.8 (0.6) 9.7 (0.6) 10.3 (0.7) 0.033 <0.001
Protein (E%) 12.4 (0.8) 13.1 (0.8) 13.4 (0.9) 0.67 0.041
Alcohol (g) 1.8 (0.7) 1.9 (0.7) 4.0 (0.9) 0.088 0.018

a
Including all days of the week (except Fridays).
b
Adjusted for age, sex, education, leisure-time physical activity, smoking, and experienced sufficiency of sleep.
c
P value for difference between morning and evening types (ME score was used as a categorical variable) was determined using multiple comparisons post hoc test with
Bonferroni correction.
d
P value for trend (ME score was used as a continuous variable) was determined with linear regression.
e
Alcohol was not included in energy intake.
f
Intakes between 3:00 AM and 9:59 AM.
g
Percentage of the total daily energy intake.
h
In all, 13 participants had alcohol intake >0 g by 10 AM Adjusted for age and sex because of the high amount of zero intakes.
i
Intakes between 8:00 PM and 2:59 AM.
E%, percentage of energy intake; ME score, morningness–eveningness score; SEM, standard error of mean.

evening types had higher alcohol intake but when further adjusted the dif-
ference did not reach statistical significance (P 5 0.57). In regression anal-
ysis, intakes of sucrose and alcohol increased while the intake of protein
decreased with lower ME score values (evening type) (P < 0.05).
Almost all morning types (99%) had energy intake >0 kJ in the
morning (by 10 AM) while 80% of evening types, respectively. Eve-
ning types had on average 350 kJ lower energy intake in the morn-
ing, which corresponds to 4% less of total energy intake in the
morning hours as compared with morning types (P < 0.001) (Table
2). Furthermore, evening types had lower intakes of all macronu-
trients (except for sucrose of which they had a higher intake) than
morning types (P < 0.01). These significant associations were also
found when testing trends for ME score (P < 0.05).
In the evening (after 8 PM) 81% of morning and 94% of evening
types had energy intake >0.00 kJ. Evening types had on average
430 kJ higher energy intake in the evening, which corresponds to

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Original Article Obesity
EPIDEMIOLOGY/GENETICS

TABLE 3 Means (SEM) of energy and macronutrient intakes on weekends by chronotypes (n 5 831)

Chronotypea
Morning, Intermediate, Evening,
n5 408 n 5 341 n 5 82 Pa,b Ptrendb,c

ME score, range 19-27 13-18 6-12

Total daily intake
Energy (kJ)d 7,841 (283) 7,871 (283) 7,992 (367) 1.00 0.52
Carbohydrate (E%) 49.6 (0.8) 48.8 (0.8) 47.8 (1.0) 0.089 0.042
Sucrose (E%) 10.3 (0.5) 10.0 (0.5) 9.7 (0.7) 0.91 0.87
Fiber (E%) 2.5 (0.1) 2.4 (0.1) 2.4 (0.1) 1.00 0.043
Fat (E%) 31.1 (0.7) 32.0 (0.7) 33.1 (0.9) 0.045 0.004
Saturated fatty acid (E%) 11.2 (0.4) 11.7 (0.4) 12.2 (0.5) 0.059 0.008
Protein (E%) 16.8 (0.4) 16.7 (0.4) 16.7 (0.5) 1.00 0.35
Alcohol (g) 10.2 (2.7) 11.5 (2.7) 11.7 (3.5) 1.00 0.96
By 10 AMe
Energy (kJ)d 1,407 (105) 1,144 (105) 1,026 (137) 0.004 <0.001
Energy (%)f 18.2 (1.2) 14.7 (1.2) 12.8 (1.5) <0.001 <0.001
Carbohydrate (E%) 52.6 (2.4) 48.3 (2.4) 48.5 (3.1) 0.36 0.003
Sucrose (E%) 12.3 (1.4) 11.1 (1.4) 12.8 (1.9) 1.00 0.36
Fiber (E%) 2.9 (0.2) 2.5 (0.2) 2.4 (0.3) 0.072 0.001
Fat (E%) 22.6 (1.6) 20.3 (1.5) 18.8 (2.0) 0.096 0.001
Saturated fatty acid (E%) 8.3 (0.7) 7.1 (0.7) 6.4 (0.9) 0.048 <0.001
Protein (E%) 14.8 (0.9) 13.6 (0.9) 11.4 (1.2) 0.003 <0.001
Alcohol (g)g 0.03 (0.2) 0.01 (0.2) 0.4 (0.2) 0.62 0.061
After 8 PMh
Energy (kJ)d 977 (132) 1,214 (132) 1,565 (171) <0.001 <0.001
Energy (%)f 11.7 (1.4) 14.6 (1.4) 18.7 (1.9) <0.001 <0.001
Carbohydrate (E%) 46.3 (3.4) 50.3 (3.4) 49.8 (4.4) 1.00 0.089
Sucrose (E%) 10.2 (1.9) 13.8 (1.9) 13.3 (2.5) 0.025 <0.001
Fiber (E%) 2.6 (0.3) 2.6 (0.3) 2.7 (0.4) 1.00 0.98
Fat (E%) 17.3 (2.0) 20.0 (2.0) 26.0 (2.6) 0.001 <0.001
Saturated fatty acid (E%) 6.8 (1.0) 7.9 (1.0) 10.3 (1.2) 0.003 0.001
Protein (E%) 11.6 (1.3) 12.7 (1.3) 14.2 (1.7) 0.25 0.060
Alcohol (g) 4.4 (1.7) 5.1 (1.7) 6.8 (2.2) 0.63 0.085

a
Adjusted for age, sex, education, leisure-time physical activity, smoking, and experienced sufficiency of sleep.
b
P value for difference between morning and evening types (ME score was used as a categorical variable) was determined using multiple comparisons post hoc test with
Bonferroni correction.
c
P value for trend (ME score was used as a continuous variable) was determined with linear regression.
d
Alcohol was not included in energy intake.
e
Intakes between 3:00 AM and 9:59 AM.
f
Percentage of the total daily energy intake.
g
In all, five participants had alcohol intake >0 g by 10 AM. Adjusted for age and sex because of the high amount of zero intakes.
h
Intakes between 8:00 PM and 2:59 AM.
E%, percentage of energy intake; ME score, morningness–eveningness score; SEM, standard error of mean.

6% more of total energy intake in the evening hours as compared
with morning types (P < 0.001) (Table 2). Of macronutrients, eve-
ning types had 1.1 E% units more sucrose, 5.0 E% units more fat,
and 1.5 E% units more saturated fatty acids (P < 0.05). These signif-
icant associations were also found when testing trends for ME score
(P < 0.001). Furthermore, intakes of carbohydrate, protein and alco-
hol increased with lower ME score values (P < 0.05).
At weekend, evening types had higher total daily intake of fat
(P 5 0.045) (Table 3). In regression analysis, ME score was
positively associated with carbohydrate and fiber intakes and inver-
sely with fat and saturated fatty acid intakes (P < 0.05).
On weekend mornings, evening types had on average 380 kJ lower
energy intake than morning types (P < 0.01) (Table 3). Of the mac-
ronutrients, evening types had 1.9 E% units less saturated fatty acids
and 3.4 E% units less protein than morning types (P < 0.05). Posi-
tive trend between ME score and these variables also emerged
(P < 0.001). Furthermore, ME score associated positively with car-
bohydrate, fiber, and fat intakes (P < 0.01).

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Obesity
In the evening hours of weekends, evening types had on average
590 kJ more energy than morning types, which corresponds to 7%
more of total energy intake in the evening hours as compared with
morning types (P < 0.001) (Table 3). Of the macronutrients evening
types had 3.1 E% units more sucrose, 8.7 E% units more fat, and
3.5 E% units more saturated fatty acids (P < 0.05). These significant
associations were also found when testing trends for ME score
(P < 0.05). Also ME score was inversely associated with alcohol
intake but when further adjusted the inverse trend did not reach sta-
tistical significance (P 5 0.085).
Discussion
This is the first population-based study that examined the association
between chronotype and timing of energy and macronutrient intakes.
Evening type was associated with postponed energy and macronu-
trient intake timing, and they had generally lower intakes of energy
and macronutrients in the morning and higher in the evening than
morning types. Differences were found also for the timing of week-
end intakes.
In our study, energy intake peaks of evening types were on average
an hour later than energy intake peaks of morning types. Although
the total daily energy intake of chronotypes did not differ, differen-
ces were found on the morning and the evening intakes of energy.
In the morning (before 10 AM), evening types had lower energy
intake, while in the evening (after 8 PM) they had higher energy
intake than morning types. On total daily intakes of macronutrients,
evening types had lower intake of protein. In the morning hours,
evening types had higher intake of sucrose while the intakes of all
the other macronutrients were lower than morning types’. In the
evening hours, evening types had higher intakes of sucrose, fat and
saturated fatty acids. On the weekend, differences in evening intakes
of energy, sucrose, and fat were pronounced. Furthermore, evening
types seemed to have more irregular meal times and twice as many
eating occasions on the weekend than morning types. Thus, from
these data for evening types as compared with morning types, a con-
sumption pattern with more sucrose in the morning, and that with
more sucrose and more fat in the evening emerged.
Only few small-scale studies have examined chronotype in relation
to energy and macronutrient intake timing. A U.S. study (n 5 52)
including intermediate and evening types found that evening types
had twice as much energy (18) and macronutrients (carbohydrate,
fat, and protein) (19) after 8 PM than intermediate types. Another
U.S. study on sleep-deprived individuals with obesity (n 5 119)
assessed differences in timing of energy and macronutrient intakes
of morning and evening types on working and nonworking days
(20). They found that evening types had twofold energy intake after
8 PM as compared with morning types, and that on working days
evening types had larger portions sizes and ate less frequently than
morning types. This study, however, did not found differences in the
intakes of carbohydrates, fat, and protein after 8 PM. None of these
studies assessed energy and macronutrient intakes in the morning.
Later timing of energy intake in evening types may simply reflect
their later circadian rhythms. In our study, however, the differences
were smaller than in the previous studies (18-20). In those studies,
the data were not randomly selected, and they might have more
614 Obesity | VOLUME 25 | NUMBER 3 | MARCH 2017
Energy/Macronutrient Intake Timing of Chronotypes Maukonen et al.
participants with flexible schedules and living more according to
their intrinsic circadian rhythm, such as students, retired, or
unemployed.
Previous studies have found that evening types have unhealthier
food and nutrient intakes, such as higher consumption of soft drinks
and intakes of fat and saturated fat and lower consumption vegeta-
bles and intakes of carbohydrates and fiber, as well as lower overall
diet quality (8,11,18,28). Later energy intake timing of evening
types may provide one explanation for the unhealthier dietary habits
of evening types. Epidemiological studies have shown that eating
breakfast associates with higher carbohydrate intake and with con-
sumption of fiber rich foods, whereas in evening hours people are
more likely to eat fatty foods and especially foods with saturated fat
(29,30). In addition, an intervention study suggested that it was eas-
ier to make healthier food choices in the morning than in the eve-
ning, because self-control tends to reduce as the day wears on (31).
Energy intake timing may have substantial effect on metabolism
independent of total energy intake and quality of diet. In mice,
timed high-fat diet resulted in 12% lower body weight, as compared
with ad libitum low-fat diet with equal energy intake (32). Another
study on mice demonstrated that mice fed during the rest period
gained more weight than mice fed during the active period with
equal amount of energy (16). Findings from epidemiological studies
have shown that higher energy intake in the morning associates with
lower BMI while higher energy intake in the evening associates
with higher BMI (15,17,33). Findings from clinical trials of break-
fast on weight, however, are inconclusive (34), while breakfast/con-
suming most of the daily energy in the first part of the day may
have a positive effect on carbohydrate metabolism (e.g. increased
insulin sensitivity) (14,35,36). Furthermore, laboratory studies on
healthy volunteers have demonstrated that eating and sleeping at
“wrong” or inappropriate circadian time resulted in metabolic dys-
functions, such as reduced glucose tolerance and decreases in satiety
hormone leptin (12,13). None of these studies, however, have taken
chronotype into account. A small-scale U.S. study found association
between higher BMI and energy intake after 8 PM independent of
circadian preference (18). They also found that protein intake in the
4 hours before sleep was associated with higher BMI (19). A 20-
week weight-loss study on Mediterranean participants with over-
weight/obesity found that late eaters (lunch after 3 PM) had slower
weight loss than early eaters, despite equal energy intake (37). Late
eaters were more often evening types. These results suggested the
importance of energy intake timing in metabolic health, however,
the role of chronotype in the association between energy intake tim-
ing and metabolic health requires further studying. Furthermore, tim-
ing of different macronutrients in relation to metabolic health needs
to be examined more intensively.
The strengths of this study included a random sample and a
population-based approach. Furthermore, chronotype was assessed
using a validated method (26) and analyses were adjusted for several
potential confounding factors. This study has certain limitations as
well. The cross-sectional design cannot reveal causality. Also, dietary
intakes and the assessment of chronotype were based only on self-
reported data. Thus, possible memory and reporting biases may affect
the data to some extent. Dietary intake timing was assessed with 48-
hour dietary recall covering 2 consecutive days and there is likely
some correlation between the days. Furthermore, though we success-
fully combined the results from two dietary intake methods to assess
www.obesityjournal.org
Original Article
EPIDEMIOLOGY/GENETICS
intake timings for weekdays and weekends, we cannot completely rule
out the possibility of methodical differences affecting the results. In
addition, the present findings may have been affected to some extent
by the fact that especially women and people with obesity often tend
to misreport their food intake (38), and also by the fact that health-
conscious people are more likely to participate in health surveys (39).
In conclusion, the postponed timing of energy and macronutrient
intake of evening types with unfavorable dietary patterns may put
them at higher risk of obesity and metabolic disturbances in the
future. This hypothesis, however, requires longitudinal exploration
in future studies.O
C 2017 The Obesity Society
V tables, figures and summary in English). Publications of the National Public Health
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