Recommending Small, Frequent Meals in the Clinical Care of Adults: A Review of the Evidence and Important Considerations

Small, frequent meals (SFMs) are a dietary regimen characterized by multiple small eating episodes throughout the day. Clinical nutrition guidelines recommend SFMs (eg, 6–10 meals) to patients experiencing common symptoms (eg, early satiety) and gastrointestinal‐related symptoms. However, whether the provision of SFMs palliatively improves morbidity of nutritionally at‐risk individuals has yet to be elucidated. This narrative review summarizes current clinical guidelines recommending SFMs for the management of diseases in adult patients (≥18 years), with supporting experimental and epidemiologic evidence, and it provides suggestions pertaining to this recommendation by drawing on potential considerations from investigations in healthy adults. Limited studies suggest that SFMs may promote higher energy and fluid intakes, reduce gastrointestinal‐related symptoms (including vomiting, bloating, and fullness), and prevent postprandial hypotension in patients with primary autonomic failure. Potential health complications related to SFMs include unwarranted weight gain, suboptimal nutrition quality, later meal times, sleep disturbances, limited intermittent fasting, and disordered eating that may exacerbate the underlying disease or related symptoms. Thus, it is prudent for health professionals to supplement SFM recommendations with additional guidance on meal size, frequency, and timing, with a strong emphasis on healthy meal quality. Future research should recognize a standardized definition for SFMs and utilize better methods to obtain reliable data on meal patterns.