AWM: Eating Frequency and Patterns (2013)

Lundgren JD, Smith BM, Spresser C, Harkins P, Zolton L, Williams K. The relationship of night eating to oral health and obesity in community dental clinic patients. Gen Dent 2010; 58 (3): e134-139.
PubMed ID: 20478791
Study Design:
Cross-Sectional Study
D - Click here for explanation of classification scheme.
Quality Rating:
Neutral NEUTRAL: See Quality Criteria Checklist below.
Research Purpose:

To assess the prevalence of night eating in a community dental clinic patient population, determine the relationship between self-reported evening and nocturnal eating and clinician-documented oral disease when controlling for confounding variables, and examine the relationship between evening and nocturnal eating and body mass in a community sample.

Inclusion Criteria:
  • Patients were seeking care at a faculty dental practice clinic at the University of Missouri-Kansas City between June 2007 and August 2007
  • Patients provided written informed consent.
Exclusion Criteria:

Patients who did not return the Night Eating Questionnaire (NEQ) before leaving their dental appointment or because their dental chart or self-reported data were incomplete were excluded.

Description of Study Protocol:


  • Patients were recruited from a faculty dental practice clinic at the University of Missouri-Kansas City (UMKC) between June 2007 and August 2007
  • Patients were recruited during their regularly scheduled dental appointment
  • Patients provided informed consent and received $5 upon completion of the study.


Cross-sectional study

Blinding used

The licensed dentist was blinded to the patients' self-reported assessment results including nighttime eating patterns.


Not applicable

Statistical Analysis

  • Frequencies were run to assess the prevalence of evening hyperphagia and nocturnal ingestion of food
  • Preliminary bivariate analyses were performed to determine which potential predictors were related to oral disease variables
  • Stepwise multiple regressions were used to determine if evening and nocturnal eating predicted the number of missing teeth, the number of periodontal pockets and the number of active dental carious lesions
  • Correlation and logistic regression was used to assess the relationship between evening and nocturnal eating and body mass
  • Part r2 was evaluated to assess the contribution of predictor variables to the model
  • All analyses were conducted with SPSS v 15.0.1.


Data Collection Summary:

Timing of Measurements

Dental clinic patients were recruited for participation at their regularly scheduled dental appointment between June and August 2007.

 Dependent Variables

  • Prevalence of oral disease: Oral health and dental data from the previous three years was obtained from a licensed dentist
  • Odds of becoming overweight or obese: Height and weight without shoes using the Healthometer Digital Medical Scale.

Independent Variables

  • Night eating
  • Subjects completed the night eating questionnaire (NEQ) that evaluates the behavioral and psychological symptoms of night eating syndrome (NES).

Control Variables

  • Age
  • Education
  • Body mass index (BMI)
  • Diabetes diagnosis
  • Tobacco use.


Description of Actual Data Sample:
  • Initial N: 234 men and women
  • Attrition (final N): 183 participants (61.5% female)
  • Age: Average age 57.9±15.2 (range 19-86)
  • Ethnicity:
    • 84.5% Caucasian
    • 6.9% African-American
    • 2.9% Asian
    • 2.3% Hispanic
    • 3.4% Multiracial, other, or did not indicate
  • Other relevant demographics: 54% had a four-year degree or higher
  • Anthropometrics: Average BMI (kg/m2) 28.5± 5.9 (range 18.0-44.5)
  • Location: University of Missouri-Kansas City (UMKC).


Summary of Results:

Key Findings

  • Evening hyperphagia (7.1%) and frequent nocturnal eating upon awakening (2.2%) were not prevalent in this sample and reflect prevalence estimates of night eating syndrome in the general population
  • Individuals who reported nocturnal ingestions of food were 4.4 times more likely to be obese (95% CI 1.2-15.4) than those who did not, P=0.02
  • Evening hyperphagia was not associated with an increased risk of being overweight or obese
  • 13 participants (7.1%) reporting consuming 25% or more of their total daily food intake after dinner while seven participants (3.8%) reported consuming 50% or more of their daily food intake after dinner and two participants reported consuming more than 75% of their total daily food intake after the evening meal
  • 85 (46.4%) of the sample reported reported that they did not get up in the middle of the night to eat, while 33 (18%) reported at least occasional nocturnal ingestions of food upon wakening at night during the previous month, and four participants (2.2%) reported usually or always consuming food in the middle of the night.

Other Findings

  • Frequency of nocturnal ingestions and units of tobacco per day were significant in the final regression model that predicted the severity of periodontal disease, (R=0.403; P<0.001)
  • Nocturnal eating was a significant predictor of missing teeth, periodontal disease, and active decay, however, evening hyperphagia was not a significant predictor of oral disease.


Author Conclusion:

The study found an association between night eating behavior and oral disease. The results suggest that individuals who awake from their sleep and ingest food are more likely to be obese compared to those who do not engage in nocturnal eating.

Funding Source:
University/Hospital: University of Missouri-Kansas City Dental School
Reviewer Comments:

Several limitations to this study were noted. First, the age of participants varied (19-86) years and the average age was 58, therefore these findings may not be generalizable to a younger sample that is more likely to engage in nocturnal eating. Second, data on oral hygiene was not available and data related to salivary flow was not assessed. Finally, clinical interviews such as the night eating syndrome history and inventory, prospective food records, and dietary recalls were not used to confirm actual NES diagnostic status.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? ???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? No
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? Yes
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? Yes
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? Yes
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? Yes
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? ???
  7.1. Were primary and secondary endpoints described and relevant to the question? N/A
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? ???
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? Yes
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? Yes
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes