Temporal Patterns of Diet and Physical Activity and of Diet Alone Have More Numerous Relationships With Health and Disease Status Indicators Compared to Temporal Patterns of Physical Activity Alone

Background Daily temporal patterns of energy intake (temporal dietary patterns [TDPs]) and physical activity (temporal physical activity patterns [TPAPs]) have been independently and jointly (temporal dietary and physical activity patterns [TDPAPs]) associated with health and disease status indicators. Objective The aim of this study was to compare the number and strength of association between clusters of daily TDPs, TPAPs, and TDPAPs and multiple health and disease status indicators. Design This cross-sectional study used 1 reliable weekday dietary recall and 1 random weekday of accelerometer data to partition to create clusters of participants repre-senting the 3 temporal patterns. Four clusters were created via kernel-k means clus-tering algorithm of the same constrained dynamic time warping distance computed over the time series for each temporal pattern. Participants/setting From the National Health and Nutrition Examination Survey (2003-2006), 1,836 US adults aged 20 through 65 years who were not pregnant and had valid diet, physical activity, sociodemographic, anthropometric, questionnaire, and health and disease status indicator data were included. Main outcome measures Health status indicators used as outcome measures were body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, tri-glycerides, high-density lipoprotein cholesterol, total cholesterol, and systolic and dia-stolic blood pressure; disease status indicators included obesity, type 2 diabetes mellitus, and metabolic syndrome. Statistical analyses performed Multivariate regression models determined associa-tions between the clusters representing each pattern and health and disease status indicators, controlling for confounders and adjusting for multiple comparisons. The number of significant differences among clusters and adjusted R2 and Akaike infor-mation criterion compared the strength of associations between clusters of patterns and continuous and categorical health and disease status indicators. Results TDPAPs showed 21 significant associations with health and disease status in-dicators, including body mass index, waist circumference, obesity, and type 2 diabetes; TDPs showed 19 significant associations; and TPAPs showed 8 significant associations. Conclusions TDPAPs and TDPs had stronger and more numerous associations with health and disease status indicators compared with TPAPs. Patterns representing the integration of daily dietary habits hold promise for early detection of obesity. J Acad Nutr Diet. 2023;123(12):1729-1748.