Meal Frequency, Visceral Adiposity Index, and Atherogenic Index of Plasma in Adults with Overweight and Obesity

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Abstract
Objective: This study aimed to evaluate whether daily main meal count and snack frequency are independently associated with the Visceral adiposity index (VAI) and atherogenic index of plasma (AIP) in overweight and obese adults without known chronic disease or pharmacotherapy. Methods: This cross-sectional study included 347 adults aged 18–65 years with BMI ≥25 kg/m² who presented for a first cardiological assessment. Participants with diagnosed chronic disease or regular medication use were excluded. Meal frequency was recorded by structured interview as daily main meal count and snack frequency. VAI was calculated using sex-specific formulas incorporating waist circumference, BMI, triglycerides, and HDL-cholesterol. AIP was calculated as log₁₀ (triglycerides/HDL-cholesterol), using molar concentrations. Results: The mean age of participants was 40.8 ± 11.7 years, and 53.3% were female. Participants with obesity had significantly higher AIP and VAI values than overweight participants. In unadjusted analyses, main meal count was positively correlated with AIP, whereas snack frequency was inversely correlated with both AIP and VAI. Participants reporting one snack per day had lower AIP and VAI values than those reporting no snacks. However, neither main meal count nor snack frequency remained independently associated with AIP or VAI in the multivariable models. The AIP model was adjusted for age, sex, BMI, smoking status, and regular exercise, whereas the primary VAI model was constructed without BMI because BMI is a component of the VAI formula. Higher age, male sex, BMI, and lack of regular exercise were the main independent correlates of AIP. In the primary BMI-free VAI model, higher age and lack of regular exercise were independently associated with VAI, while meal-frequency variables remained non-significant. A BMI-adjusted sensitivity model yielded the same conclusion regarding meal-frequency variables. Conclusion: In medication-free overweight and obese adults without known chronic disease, meal frequency alone was not independently associated with AIP or VAI after adjustment for demographic, anthropometric, and lifestyle-related factors. These findings suggest that simple eating-occasion counts may be less informative than overall dietary quality, meal composition, timing, and physical activity in cardiometabolic risk assessment.

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