The Theory of Metabolic Jet Lag in Bipolar Disorder: A Pilot Feasibility Study Exploring the Association Between Eating Rhythm Disruption and Illness Burden Parameters

INTRODUCTION: Changes in energy metabolism are commonly observed in bipolar disorder (BD) and have been linked to a more severe clinical course. 'Metabolic jet lag' (MJL) is a state of shift in circadian patterns of energy homeostasis, expressed through behavioral changes such as irregular meal timing. However, the relationship between MJL and the pathophysiology of BD remains unknown. The objective of this study is to determine the feasibility of an investigation assessing the association between MJL, evaluated through eating rhythm disruption, and markers of illness burden in ten individuals with DSM-5-defined BD type 1. PATIENTS AND METHODS: This is a 14-day longitudinal, naturalistic study that used the smartphone application 'RxFood' to elaborate a personalized, time-stamped "feedogram" for each participant. Illness burden and severity parameters were collected at baseline, and the Acceptability E-Scale was administered at the endpoint. Eating rhythm disruption scores were calculated based on a novel analytical approach applied to the "feedogram" data. RESULTS: The use of 'RxFood' demonstrated excellent feasibility and acceptability (94%) in individuals with BD and captured 628 eating occasions over the study period. Eating rhythm disruption scores varied between participants and correlated with the number of manic episodes (r = 0.718, p = 0.019), although the association was not significant after correcting for multiple comparisons. DISCUSSION: Ecological momentary assessment of eating rhythms is feasible in individuals with BD. Larger investigations evaluating the association between eating rhythm disruption and clinical illness trajectories are needed to delineate the role of MJL in the pathophysiology of BD.