Fundamental Research Grant Scheme Phase1 (2023)
Research Title:
A Paradigm Shift in Diabetes Management: Understanding the Effect of Meal-Timing and Chrononutrition on Glycemia Measures in Malaysian Prediabetic Individuals by Using 24-Hour Continuous Glucose Monitoring System
Principal Investigator:
Associate Professor Dr. Koo Hui Chin (TAR UMT, FOAS)
Co-researchers:
Associate Professor Dr. Tan Hui Yin (TAR UMT, FOAS)
Associate Professor Dr. Satvinder Kaur A/P Nachatar Singh (UCSI)
Mrs. Siah Woan Yie (MOH)
Associate Professor Dr. Loy See Ling (DUKE-NUS)
Dr. Nadia Binti Abdul Bari (MOH)
Mrs. Chong Guey Yong (TAR UMT)
Project Summary & Impact:
This project aims to explore the association between meal timing, chrononutrition, and glycemic control in prediabetic adults through a prospective longitudinal study. Chrononutrition, which examines the impact of meal timing on nutritional outcomes, is emerging as a significant factor in glycemic control. This study involves 120 prediabetic individuals from Malacca healthcare clinics, with a mean age of 54±18 years. Key data collected include socio-demographic information, anthropometric measurements, 3-day dietary records (3DDR), chrononutrition patterns, and light exposure. Glycemic measures such as fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPPG), glycated hemoglobin (HbA1c), and ambulatory glucose profiles through continuous glucose monitoring (CGM) are monitored over six months. Participants are categorized into daytime eaters (meals within 0700h to 1900h) and non-daytime eaters (eating before 0700h or after 1900h). Statistical analyses, including generalized estimating models or generalized linear models, determine associations between chrononutrition and glycemic measures.
Findings reveal that 83% of participants are non-daytime eaters, who have significantly later last meal times (19:54 ± 01:45), longer eating windows (11.1 ± 2.0 hours), higher total energy intake (504 ± 225 kcal/day), and greater evening protein consumption (14 ± 5% energy) compared to daytime eaters. Non-daytime eaters exhibit an increase in 2hPPG levels by 1.02 mmol/L after six months (95% CI: 0.16, 1.88) and a significant association with higher mean glucose levels (β: 0.61 mmol/L, 95% CI: 0.28, 0.95), greater glucose management index (β: 2.52 mmol/mol, 95% CI: 1.10, 3.93), and higher 24-hour interstitial glucose levels over three days (β: 0.61 mmol/L, 95% CI: 0.23, 0.99) and seven days (β: 0.46 mmol/L, 95% CI: 0.15, 0.77). Overall, the study demonstrates that prediabetic individuals consuming meals outside the solar time window of 0700h to 1900h experience higher blood glucose levels. These findings suggest that aligning meal timing with solar time could be a strategic intervention for better glycemic control and reversing prediabetes naturally.
This study provides compelling evidence linking chrononutrition to glycemic control, emphasizing the necessity of meal timing alignment with natural circadian rhythms. Such insights are invaluable for healthcare professionals in developing dietary strategies aimed at improving glycemic outcomes and potentially reversing prediabetes. Furthermore, these findings can inform policymakers in designing public health guidelines that advocate for optimal meal timing as part of diabetes prevention programs. Stakeholders, including healthcare providers, nutritionists, and public health officials, play crucial roles in translating these insights into practical interventions and educational campaigns to enhance public awareness. This research contributes to promoting effective dietary interventions for glycemic control in prediabetes. By integrating these findings into national health policies, stakeholders can ensure that preventive measures are both evidence-based and widely implemented, ultimately improving health outcomes at the population level.
Publications & Awards:
Chong, G. Y., Satvinder, K., Ruzita, A. T., Loy, S. L., Tan, H. Y., Harjit Singh, S. S., Rosmiza, B. A., Hanisah, B. M., Siah, W. Y., & Koo, H. C. (2022). Chronotype, chrononutrition and glucose tolerance among prediabetic individuals: research protocol for a prospective longitudinal study Chrono-DMTM. BMC Primary Care, 23(1).193. https://doi.org/10.1186/s12875-022-01815-7
Chong, G. Y., Satvinder, K., Ruzita, A. T., Loy, S. L., Siah, W. Y., Tan, H. Y., Harjit Singh, S. S., Rosmiza, B. A., Hanisah, B. M., Lee, Y. H., & Koo, H. C. (2022). Translation, validation, and reliability of the Malay version chrononutrition profile-questionnaire (CPQ-M) in Malaysian adult populations. Biological Rhythm Research. 54(2). https://doi.org/10.1080/09291016.2022.2105536
Guey Yong Chong, Satvinder Kaur, Abd. Talib Ruzita, Kok Hoe Wilfred Mok, Hui Yin Tan, See Ling Loy, Ling-Wei Chen, Woan Yie Siah, Geok Pei Lim, Yin Yin Chee, Ee Mun June Lem & Hui Chin Koo (2024): Scoping review: Exploring the relationship between chrononutrition and glycemic responses in the adult population, Chronobiology International, DOI: 10.1080/07420528.2024.2360742
Chong, G. Y., Satvinder, K., Ruzita, A. T., Loy, S. L., Tan, H. Y., Harjit Singh, S. S., Rosmiza, B. A., Hanisah, B. M., Siah, W. Y., & Koo, H. C. (2022). What Is the Difference between the Nature Eating Rhythm and the Actual Eating Behaviours in Malaysian Adults? A Cross-Sectional Study of Circadian Misalignment, Current Developments in Nutrition, 6(1). 894. https://doi.org/10.1093/cdn/nzac067.014
G. Y. Chong; S. K. Nachatar Singh; R. Abd Talib; S. L. Loy; W.Y. Siah; H. Y. Tan; S. S. Harjit Singh; R. Binti Abdullah; H. Binti Mahmud; H. C. Koo. 2022. The Translation, validation and reliability of a chrononutrition assessment tool for Malaysian Population. Obesity Reviews. Supplement Article. 1-222. https://doi.org/10.1111/obr.13503.
Guey Yong Chong, Hui Chin Koo, See Ling Loy, Satvinder Kaur, Woan Yie Siah, Ruzita Abd Talib, Hui Yin Tan, Chee Cheong Kee, Lay Kim Tan. A paradigm shift in diabetes management: chrono-nutrition and its association with glycemia outcomes in prediabetic individuals. Diabetes Technology & Therapeutics 2024 26: S2, A-1-A-376. https://doi.org/10.1089/dia.2024.2525.abstracts.
Guey Yong Chong, Satvinder Kaur D/O Nachatar Singh, Ruzita Abd Talib, Hui Yin Tan, Kok Hoe Wilfred Mok, See Ling Loy, Ling-Wei Chen, Woan Yie Siah, Geok Pei Lim, Yin Yin Chee, Ee Mun June Lem, Hui Chin Koo. The association between chrononutrition characteristics and glucose outcomes in the adult population: a scoping review. Diabetes Technology & Therapeutics 2024 26: S2, A-1-A-376. https://doi.org/10.1089/dia.2024.2525.abstracts.
Guey Yong Chong, Hui Chin Koo, See Ling Loy, Satvinder Kaur, Woan Yie Siah, Ruzita Abd Talib, Hui Yin Tan, Chee Cheong Kee, Lay Kim Tan. The Preliminary Findings of Chrono-DM: Chronotype and Its Association with Body Composition in Prediabetic Individuals. Diabetes Technology & Therapeutics 2024 26: S2, A-1-A-376. https://doi.org/10.1089/dia.2024.2525.abstracts.
Guey Yong Chong, Satvinder Kaur, Ruzita A Talib, See Ling Loy, Hui Yin Tan, Sarjit Singh, Rosmiza Binti Abdullah, Hanisah Binti Mahmud, Woan Yie Siah, Hui Chin Koo. 2023. The findings of ChronoDMTM: chrononutrition, chronotype, and glycemic outcomes in prediabetes population. Malaysian Association Study of Obesity Scientific Conference on Obesity, Third Prize for Oral Presentation.
Guey Yong Chong, Satvinder Kaur, Ruzita Abd Talib, See Ling Loy, Hui Yin Tan, Rosmiza Binti Abdullah, Hanisah Binti Mahmud, Woan Yie Siah, Lay Kim Tan, Chee Cheong Kee, Hui Chin Koo. 2024. Later chronotype is associated with poor glycemic outcomes in adults with prediabetes: Findings from Chrono-DMTM study. National Conference on Integrating Research in Agriculture, Food, and Communicable Disease, Third Prize for Oral Presentation.
Woan Yie Siah, Guey Yong Chong, Satvinder Kaur, Ruzita Abd Talib, See Ling Loy, Hui Yin Tan, Rosmiza Binti Abdullah, Hanisah Binti Mahmud, Lay Kim Tan, Chee Cheong Kee, Hui Chin Koo. 2024. Circadian eating time is associated with blood glucose responses in prediabetes individuals: Findings from ChronoDMTM study. Dietitian’s Quality and Research Convention, Third Prize for Poster Presentation.