Adolescent Snacking Behaviors Are Associated with Dietary Intake and Weight Status

Impact of school and work status on diet and physical activity in rural Guatemalan adolescent girls: a qualitative study

In low‐ and middle‐income countries, gender norms and access to energy‐dense, nutrient‐poor foods are well‐studied determinants of food and physical activity choices for adolescent girls. However, most work has been done in urban and school settings. In many settings, a large proportion of the adolescent population is rural or not enrolled in school. We conducted in‐depth interviews with 20 adolescent girls (ages 15–19) in Tecpán, Guatemala, a rural, largely indigenous Maya community. Interviews were coded and themes analyzed for insights into eating habits, food choices, and physical activity. Twelve participants were enrolled in school and eight were employed and not in school. Girls enrolled in school had more disrupted eating schedules and consumed more energy‐dense, nutrient‐poor foods. Girls not enrolled in school had fewer opportunities for physical activity and were more sedentary. To our knowledge, this study is the first in a low‐ and middle‐income country to consider diet and physical activity of adolescent girls enrolled and not enrolled in school. Key implications include (1) the need to reduce exposure to nutrient‐poor foods and promote healthy eating schedules in schools, and (2) the need to create community‐based opportunities for the activity for girls no longer enrolled in school.

Associations between Snacking and Weight Status among Adolescents 12-19 Years in the United States

Snacking is a significant contributor to energy intake among adolescents, but its association with weight status is unclear. To elucidate this association, data from 6545 adolescents (12-19 years) in the 2005-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed. The mean number of daily snack occasions, mean snack size, and mean snack energy density were examined by weight classification (body mass index (BMI)-for-age percentiles: normal weight (NW) <85th; overweight (OW) ≥85th to <95th; obese (OB) ≥95th). Models included all snacking parameters, mean meal size, demographic characteristics, survey cycle year, and dietary reporting accuracy. Adolescents with NW consumed fewer snacks daily (1.69 (0.02) snacks/day) and smaller snacks per occasion (262.32 (4.41) calories (kcal)/snack) compared to adolescents with OW (1.85 (0.05) snacks/day, p = 0.005; 305.41 (8.84) kcal/snack, p < 0.001), and OB (1.97 (0.05) snacks/day; 339.60 (10.12) kcal/snack, both p < 0.001). Adolescents with OW and OB also consumed more added sugar, saturated fat and sodium from snacks, but had lower mean energy density per snack compared to snacks consumed by NW adolescents. US adolescents with OW and OB consume more snacks daily and more calories at each snacking occasion compared to adolescents with NW. Future studies should examine the prospective associations between snacking and weight status and impact on overall diet quality.

Daily Snacking Occasions, Snack Size, and Snack Energy Density as Predictors of Diet Quality among US Children Aged 2 to 5 Years

Whether snacks help young children meet nutritional needs or merely contribute to excessive intakes is debated. This research evaluated associations of snacking with dietary quality among US preschoolers (two to five years, n = 4217) in the 2005–2016 National Health Examination Survey (NHANES). Snacking occasions, size, and energy density (ED) were estimated from two 24-hr dietary recalls. Diet quality indices included the 2015 Healthy Eating Index (HEI-2015, 0–100), the mean adequacy ratio (MAR, 0–100) for five shortfall nutrients (vitamin D, calcium, fiber, potassium, and iron), and the mean % of recommended limits for added sugars, saturated fat, and sodium. Linear regressions included snacking parameters, demographics, and dietary reporting accuracy. Children had a mean HEI-2015 of 53.0, a MAR of 67.7, and intake of 121.4% of nutrients to limit. Daily snacking occasions were positively associated with HEI-2015 scores, whereas mean snack size and ED were negatively associated with HEI-2015 and MAR scores (all p < 0.05). Snack ED was positively associated with daily intakes of added sugar, saturated fat, and sodium (p < 0.001). These nationally representative findings reveal that more frequent, smaller, and less energy-dense snacks are associated with higher diet quality among US preschoolers.

Eating habits and weight status in Finnish adolescents

Objective:

To investigate the association between eating habits and weight status in adolescents in Finland.

Design:

Cross-sectional study.

Setting:

The Finnish Health in Teens (Fin-HIT) study is a cohort study conducted in adolescents attending third to sixth grade in 496 schools in forty-four municipalities in Southern, Middle and Northern Finland in 2011–2014.

Participants:

Analyses included 10 569 adolescents from the Fin-HIT study aged 9–14 years (5005 boys and 5564 girls). Adolescents were categorized by their eating habits: healthy eaters (44·1 %; n 4661), unhealthy eaters (12·3 %; n 1298), and fruit and vegetable avoiders (43·6 %; n 4610); and they were grouped into weight status: underweight (11·1 %), normal weight (73·6 %) and excess weight (15·3 %).

Results:

We found an increased risk of underweight in fruit and vegetable avoiders (OR = 1·28; 95 % CI 1·12, 1·46). An irregular breakfast pattern showed an inverse association with underweight (OR = 0·70; 95 % CI 0·59, 0·84) and an increased risk of excess weight (OR = 1·56; 95 % CI 1·37, 1·77) compared with a regular breakfast pattern. An irregular dinner pattern was inversely associated with underweight (OR = 0·83; 95 % CI 0·69, 0·99) compared with a regular dinner pattern.

Conclusions:

Avoiding fruits and vegetables and following irregular breakfast and dinner patterns were associated with underweight and excess weight in adolescents.

Snacking patterns among Chilean children and adolescents: is there potential for improvement?

OBJECTIVE

To examine snacking patterns, food sources and nutrient profiles of snacks in low- and middle-income Chilean children and adolescents.

DESIGN

Cross-sectional. Dietary data were collected via 24 h food recalls. We determined the proportion of snackers, snacks per day and energy from top food and beverage groups consumed. We compared the nutrient profile (energy, sodium, total sugars and saturated fat) of snacks v. meals.

SETTING

South-east region of Chile.

PARTICIPANTS

Children and adolescents from two cohorts: the Food Environment Chilean Cohort (n 958, 4-6 years old) and the Growth and Obesity Cohort Study (n 752, 12-14 years old).

RESULTS

With a mean of 2·30 (se 0·03) snacks consumed daily, 95·2 % of children and 89·9 % of adolescents reported at least one snacking event. Snacks contributed on average 1506 kJ/d (360 kcal/d) in snacking children and 2218 kJ/d (530 kcal/d) in snacking adolescents (29·0 and 27·4 % daily energy contribution, respectively). Grain-based desserts, salty snacks, other sweets and desserts, dairy foods and cereal-based foods contributed the most energy from snacks in the overall sample. For meals, cereal-based foods, dairy beverages, meat and meat substitutes, oils and fats, and fruits and vegetables were the top energy contributors.

CONCLUSIONS

Widespread snacking among Chilean youth provides over a quarter of their daily energy and includes foods generally considered high in energy, saturated fat, sodium and/or total sugars. Future research should explore whether snacking behaviours change as the result of Chile's national regulations on food marketing, labelling and school environments.

Snacking in nutrition and health

Many studies suggest that distributing energy and nutrient intake across 4-5 eating occasions/day (rather than across three standard meals) could favourably affect human health. The inclusion of 1-2 snacks in the daily pattern alleviates the potential digestive and metabolic overload caused by fewer heavier meals and might contribute to meet recommendations for food groups (e.g. fruits, dairy) and nutrients like fibre and vitamins. The snack composition should be evaluated taking into account the whole day's diet. In early and late ages, and for specific population groups, snacking may need to follow particular characteristics in order to be optimal, both in terms of composition and timing. This document, which is the result of a collaboration of experts across several fields of research, intends to provide a review of the current scientific literature on meal frequency and health, highlighting the beneficial effects of correct snack consumption across the human lifespan.

Within-person compensation for snack energy by US adults, NHANES 2007-2014

BACKGROUND

Most Americans snack and some snack several times a day; however, compensatory dietary and eating behaviors associated with snacking in free-living individuals are poorly understood.

OBJECTIVE

The aim of the study was to examine within-person differences in reported energy intake and eating patterns on a snack day relative to a no-snack day.

METHODS

We used 2 d of dietary recall data from the NHANES 2007-2014 to replicate the crossover nutrition study paradigm in a natural setting. Respondents reporting a snack episode in only one of two available dietary recalls were eligible for inclusion in the study (n = 1,917 men and 1,860 women). We used multivariable regression methods to compare within-person differences in quantitative, qualitative, and eating pattern outcomes between the snack and no-snack recall days.

RESULTS

On the snack day, snack episodes provided (mean difference and 95% CI) 493 (454, 532) kcal of energy in men and 360 (328, 392) kcal in women. The 24-h energy intake on snack day was higher by 239 (140, 337) kcal in men and 219 (164, 273) kcal in women (P < 0.0001). On the snack day, both men and women were more likely to skip main meals and reported lower energy intake from main meals (P < 0.0001); however, the energy density of foods or beverages reported on the snack compared with no-snack days were not different. Fruit servings were higher on the snack day (P ≤ 0.0004), but intakes of vegetables and key micronutrients did not differ. The 24-h ingestive period was longer on the snack day (P < 0.0001).

CONCLUSIONS

Free-living men and women partially compensated for snack energy by decreasing energy intake from main meals without adverse associations with qualitative dietary characteristics or time of meal consumption. Women compensated to a smaller extent than men. Thus, over the long term, snack episodes may contribute to positive energy balance, and the risk may be higher in women.

Development and Validation of the Vending Evaluation for Nutrient-Density (VEND)ing Audit

Background: This paper describes the development and validation of the Vending Evaluation for Nutrient-Density (VEND)ing audit to comprehensively evaluate vended products based upon healthfulness, price and promotion, and machine accessibility. Methods: A novel vending nutrient-density score was created to determine the healthfulness of vended snack/beverage products. Field tested in United States colleges, VENDing audit (∑nutrient-density + 10 × % healthy products) and Support sub-scores (price + promotion + accessibility) were calculated for snack/beverage machines. Higher scores indicate more healthful vending options and supports for choosing healthfully. Nutrition Environment Measures Survey-Vending (NEMS-V) was used to validate the nutrient-density score for a sub-sample of machines. Sensitivity and specificity were computed by comparing the number of healthy snacks/beverages determined by NEMS-V and the VENDing nutrient-density scores. Results: Researchers conducted the VENDing audit on 228 snack/beverage vending machines at 9 universities within the United States and used both VENDing and NEMS-V on 33 snack and 52 beverage vending machines. Mean VENDing audit scores were 4.5 ± 2.0 (2.6, 3.4) and 2.6 ± 2.0 (0, 12) for snack/beverage machines, respectively. The number of products considered healthy assessed with both the VENDing nutrient-density scores and the NEMS-V were positively correlated for beverages (r = 0.687, p < 0.001) and snacks (r = 0.366, p < 0.05). The sensitivity was excellent for beverages (0.83) and moderate for snacks (0.69); while the specificity was moderate for both beverages (0.66) and snacks (0.50). Conclusions: The VENDing audit uses unique, valid, and reliable nutrient-density scoring to evaluate snacks/beverages along a continuum of healthful criteria and comprehensively evaluates the full vending environment.

Variation of Adolescent Snack Food Choices and Preferences along a Continuum of Processing Levels: The Case of Apples

Food processing is used for transforming whole food ingredients into food commodities or edible products. The level of food processing occurs along a continuum from unprocessed to minimally processed, processed, and ultra-processed. Unprocessed foods use little to no processing and have zero additives. Minimally processed foods use finite processing techniques, including drying, freezing, etc., to make whole food ingredients more edible. Processed foods combine culinary ingredients with whole foods using processing and preservation techniques. Ultra-processed foods are manufactured using limited whole food ingredients and a large number of additives. Ultra-processed snack foods are increasing in food environments globally with detrimental implications for human health. This research characterizes the choices, consumption, and taste preferences of adolescents who were offered apple snack food items that varied along a processing level continuum (unprocessed, minimally processed, processed, and ultra-processed). A cross-sectional study was implemented in four elementary school classrooms utilizing a buffet of apple snack food items from the aforementioned four food processing categories. A survey was administered to measure students’ taste acceptance of the snacks. The study found that the students selected significantly (p < 0.0001) greater quantities of ultra-processed snack foods (M = 2.20 servings, SD = 1.23) compared to minimally processed (M = 0.56 servings, SD = 0.43) and unprocessed (M = 0.70 servings, SD = 0.37) snack foods. The students enjoyed the taste of ultra-processed snack foods (M = 2.72, SD = 0.66) significantly more (p < 0.0001) than minimally processed (M = 1.92, SD = 1.0) and unprocessed (M = 2.32, SD = 0.9) snack foods. A linear relationship was found between the selection and consumption quantities for each snack food item (R2 = 0.88). In conclusion, it was found that as processing levels increase in apple snack foods, they become more appealing and more heavily consumed by elementary school students. If applied broadly to snack foods, this conclusion presents one possible explanation regarding the high level of diet-related diseases and nutrient deficiencies across adolescents in America. Food and nutrition education, food product development, and marketing efforts are called upon to improve adolescent food choices and make less-processed snack food options more appealing and accessible to diverse consumers.

Parents Report Competing Priorities Influence Snack Choice in Youth Sports

OBJECTIVE

To describe parental perceptions of team snacks, factors that motivate snack choice, and perceptions of healthy snacking guidelines in youth sports.

METHODS

Six in-depth group interviews were conducted among parents (n = 22) of children aged 4-12 years in 2 Los Angeles County Baseball Little Leagues. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Parents perceived fruit as the ideal snack; this ideal was balanced with competing priorities, including children's preferences, cost, time, and social norms regarding snacks as rewards and team bonding. Although parents were supportive of promoting healthy snacks, they believed that snacking guidelines should not be mandated.

CONCLUSIONS AND IMPLICATIONS

Developing messages that align with parents' motivations when choosing snacks could promote healthier snacking in youth sports. Future studies are warranted to explore drivers of snacking with a broader sample and to examine how to promote healthy snacks effectively.

Multicontextual correlates of adolescent sugar-sweetened beverage intake

PURPOSE

To examine personal, home, peer, school, neighborhood, and media correlates of sugar-sweetened beverage (SSB) intake in a diverse sample of adolescents.

METHODS

Cross-sectional, population-based study (EAT 2010: Eating and Activity in Teens) of 2793 adolescents (54% female, mean age [SD] = 14.5 [2.0], 80% nonwhite) attending public secondary schools in Minneapolis-St. Paul, Minnesota. Adolescents completed a food frequency questionnaire and answered survey questions about their diet/health perceptions and behaviors. Socio-environmental data were collected from parents/caregivers, peers, school personnel, Geographic Information Systems (e.g., distance to food outlet), and a content analysis of favorite TV shows. Individual and mutually adjusted mixed-effects regression models examined associations between multi-contextual factors and estimated daily servings of SSB, controlling for relevant covariates.

RESULTS

The contextual factors examined accounted for 24% of the variance in adolescents' SSB consumption. The proportion of variance explained by each context was 13% personal, 16% home/family, 3% peer, 1% school, 0.1% media, and 0% neighborhood. The strongest correlate of SSB intake was home soda availability (adjusted for covariates: β = 0.26, p < 0.01; adjusted for all multi-contextual factors: β = 0.18, p < 0.01). Other significant correlates of SSB intake included personal behaviors (e.g., fast food intake, sleep), home/family factors (e.g., parent modeling) and peer influences (e.g., friends' SSB intake).

CONCLUSIONS

Public health policies and programs to reduce adolescent SSB intake should target personal behaviors (e.g., limit fast food, encourage adequate sleep), address the home setting (e.g., help parents to reduce SSB availability and model healthy eating habits) and involve peers (e.g., identify and enable peers to model healthy eating behaviors).

Eating breakfast and snacks while television viewing are associated with some cardio metabolic risk factors among Iranian children

AIM

We aimed to investigate the association of eating meals while television viewing (TVV) and screen-based behaviors with cardio metabolic risk factors (CRFs) among school-aged children in Shiraz.

MATERIALS AND METHODS

This cross-sectional study was done on 409 primary school children (217 boys), aged 6-9 years. Physical activity, time spent on screen-based behaviors and frequency of eating meals while TVV were measured using a questionnaire. Anthropometric indices, fasting blood sugar (FBS), blood lipids, blood pressure (BP), dietary intakes and physical activity were assessed. Association of eating while TVV with CRFs were assessed using linear regression, adjusted for potential confounders. All statistical analysis were conducted using the Stata 13 software.

RESULTS

Fully adjusted model showed that TVV time had significant positive association with waist circumferences (WC), and BP (p <0.05). Also, we found an inverse relationship between using Computer and Video games with TG level (β=-0.3; CI: -0.64, -0.09). Children who ate two or more breakfast meal while TVV had higher WC (β=2.02; CI: 0.51, 3.53) and FBS (β=3.58; CI: 0.39, 6.78) compared to who never ate breakfast while TVV. After adjustment for Screen time and BMI, eating snacks while TVV was positively associated with FBS and systolic BP. However, Eating dinner and lunch while TVV were not significantly associated with any of CRFs after adjustment for confounders.

CONCLUSIONS

We found that both eating breakfast and snacks while TVV were associated with WC, FBS and BP in children. Also, excessive TVV was associated with WC and BP.

Association of Weight Control Behaviors with Body Mass Index in Korean Adolescents: A Quantile Regression Approach

PURPOSE

Adolescents are interested in weight control but likely practice unhealthy weight control behaviors. This study aimed to examine weight control behaviors associated with body mass index (BMI) in Korean adolescents.

DESIGN AND METHODS

In this descriptive cross-sectional study of 16- to 19-year-old adolescents (97 girls and 90 boys), analyses were conducted of physical activity, sedentary behaviors, dietary behaviors, and self-efficacy for physical activity and diet. Daily steps were measured using pedometers. Height and weight were self-reported. We conducted descriptive statistics and quantile regression analysis using STATA 14.0.

RESULTS

About 10% were underweight, and 8.6% overweight and obese. Average weekday and weekend steps/day were <10,000. Only 4.3% reported performing moderate-to-vigorous physical activity (MVPA) daily. Less than half (42.5%) reported that they had three meals/day every day. Most (89.3%) had milk less than once/day. Quantile regression showed that, for the 5th BMI percentile group, (1) age (β = 0.941) and milk consumption (β = 2.148) were significantly positively associated with BMI, whereas (2) dietary self-efficacy (β = -0.083) was significantly negatively associated with BMI. For the 95th percentile group, having three meals/day (β = 2.558) was significantly positively associated with BMI, whereas MVPA (β = -5.440) and muscle-strengthening exercise (β = -3.392) were significantly negatively associated with BMI.

CONCLUSIONS

Milk consumption was positively associated with BMI of underweight adolescents, whereas physical activities were negatively associated with BMI of overweight and obese adolescents.

PRACTICE IMPLICATION

Weight control programs for adolescents may need to be tailored for differing BMI levels.

Snacking Behaviour and Its Determinants among College-Going Students in Coastal South India

BACKGROUND

Consumption of snacks in between the regular meals is a poor snacking behaviour. It is an established risk factor for several lifestyle-related disorders and has long-term effects among the younger individuals.

OBJECTIVES

To study the snacking behaviour and to assess their determinants among college-going students.

METHODS

This cross-sectional study was conducted among 865 college-going students in Mangaluru. Data were collected using a pretested pro forma that was coded and analyzed using Statistical Package for Social Sciences (SPSS) version 11.5. The chi-square test and random-effect logistic regression analyses were used.

RESULTS

Overall, there were 52.4% females and 47.6% males, and 76.8% of them were aged <20 years. More than half of the participants (54.3%) had the habit of snacking in between regular meals. Among them, a large proportion (78.7%) did not have any specific timings for snacking. Also, 51.1% of the students were snacking while watching TV, and 31.9% of them snacked while studying. Breakfast was the most commonly skipped meal (26.2%); of those missing the breakfast regularly, 123 (71.9%) had poor snacking behaviour. A significantly larger proportion of males had a higher frequency of snacking per day (69.3% versus 57.2%, p < 0.0001) and consumed aerated drinks more frequently (22.6% versus 15.8%, p=0.011), skipped meals more often (58.6% versus 50.6%, p=0.022), and preferred adding fruits in snacks (78.1% versus 69.4%, p=0.005). Snacking frequency was proportionately higher among students of private colleges (73.6%) than that in the government colleges (55.1%). Participants from nonscience stream, nonvegetarians, and those with a tendency to skip the regular meals had significantly higher levels of poor snacking behaviour.

CONCLUSIONS

The study population had a high level of poor snacking behaviour. Appropriate measures are needed among younger people to follow fixed eating patterns and avoid skipping of regular meals.

Association of eating while television viewing and overweight/obesity among children and adolescents: a systematic review and meta-analysis of observational studies

The objective of this systematic review and meta-analysis was to examine the association between eating while television viewing (TVV) and overweight or obesity in children (<18 years). A systematic search of PubMed, Scopus, Web of science, PreQuest and Embase was conducted up to April 2017; pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated using a random effects model. Of 4,357 articles identified, 20 observational studies met inclusion criteria (n = 84,825) and 8 of these 20 (n = 41,617) reported OR. Eating while TVV was positively associated with obesity-related anthropometric measurements in 15 studies (75%). The meta-analysis revealed that eating while TVV was positively associated with being overweight (OR = 1.28; 95% CI: 1.17, 1.39). Subgroup analyses showed similar positive associations in both girls and boys, as well as in children who ate dinner while TVV. There was no evidence of publication bias. The present systematic review and meta-analysis suggests that eating while TVV could be a risk factor for being overweight or obese in childhood and adolescents.

Beyond the dinner table: who's having breakfast, lunch and dinner family meals and which meals are associated with better diet quality and BMI in pre-school children?

OBJECTIVE

Having frequent family dinners is associated with better diet quality in children; however, it is unknown whether the frequency of certain family meal types (i.e. dinner) is more strongly associated with better child weight and diet quality compared with other meal types (i.e. breakfast, lunch). Thus, the current study examined the frequency of eating breakfast, lunch or dinner family meals and associations with pre-school children's overall diet quality (HEI-2010) and BMI percentile.

DESIGN

Cross-sectional baseline data (2012-2014) from two randomized controlled childhood obesity prevention trials, NET-Works and GROW, were analysed together.

SETTING

Studies were carried out in community and in-home settings in urban areas of Minnesota and Tennessee, USA.

SUBJECTS

Parent-child (ages 2-5 years) pairs from Minnesota (n 222 non-Hispanics; n 312 Hispanics) and Tennessee (n 545 Hispanics; n 55 non-Hispanics) participated in the study.

RESULTS

Over 80 % of families ate breakfast or lunch family meals at least once per week. Over 65 % of families ate dinner family meals ≥5 times/week. Frequency of breakfast family meals and total weekly family meals were significantly associated with healthier diet quality for non-Hispanic pre-school children (P<0·05), but not for Hispanic children. Family meal frequency by meal type was not associated with BMI percentile for non-Hispanic or Hispanic pre-school children.

CONCLUSIONS

Breakfast family meal frequency and total weekly family meal frequency were associated with healthier diet quality in non-Hispanic pre-school children but not in Hispanic children. Longitudinal research is needed to clarify the association between family meal type and child diet quality and BMI percentile.

Food consumption patterns of adolescents aged 14-16 years in Kolkata, India

Background

The nutrition transition has brought about rapid changes in the structure of the Indian diet. The replacement of traditional home-cooked meals with ready-to-eat, processed foods has contributed to an increased risk of chronic diseases in urban Indians. Improving the nutrition of Indians by promoting healthy food consumption in early life and in adolescence would help to reduce these health risks. However, little is known about the quality and quantity of foods and beverages consumed by urban Indian adolescents. Therefore, the aim of this study was to describe the food consumption patterns in a sample of urban Indian adolescents.

Methods

A self-administered, semi-quantitative, 59-item meal-based food frequency questionnaire (FFQ) was developed to assess the dietary intake of adolescents over the previous day. A total of 1026 students (aged 14–16 years) attending private, English-speaking schools in Kolkata, India completed the survey.

Results

Overall, the adolescents reported poor dietary intakes; over one quarter (30%) reported no consumption of vegetables and 70% reported eating three or more servings of energy-dense snacks, on the previous day. Nearly half of the respondents (45%) did not consume any servings of fruits and 47% reported drinking three or more servings of energy-dense beverages. The mean consumption of food groups in serves/day varied from 0.88 (SD = 1.36) for pulses and legumes to 6.25 (SD = 7.22) for energy-dense snacks. In general, girls had more nutritious dietary intakes than boys.

Conclusions

The Indian adolescents reported poor food consumption patterns, and these findings highlight the need to design effective nutrition promotion strategies to encourage healthy eating in adolescence and targeting food supply and availability.

Identifying Eating Occasion-Based Opportunities to Improve the Overall Diets of Australian Adolescents

Adolescents in Australia have a poor dietary intake, leading to large numbers of them being at risk for inadequate intake of micronutrients, and excessive intake of less healthful dietary components. This study examined dietary intakes at multiple eating occasions to identify opportunities for more targeted recommendations and strategies to improve dietary intakes among adolescents. Data from the first 24-h recall of 14-18 years old in the 2011-2012 National Nutrition and Physical Activity Survey were analysed (n = 772). Participant-defined eating occasions were classified as breakfast, lunch, dinner or other eating occasions combined. The mean percent contribution to the total day intake of top shortfall nutrients (calcium, magnesium, vitamin A, iron), discretionary calories, saturated fat, free sugars and sodium, as well as nutrient density, the foods consumed and the percent of consumers at each eating occasion, were calculated. Breakfast had the lowest prevalence of consumers (81%), contributed the least to total daily energy (14.6%) and almost a quarter of daily calcium and iron. Other eating occasions combined contributed 47.5% of free sugars and were top contributors of daily calcium (34.6%) and magnesium (31.7%). Discretionary foods contributed 32.4% of the energy at lunch, and the sodium content at lunch was 415 mg/1000 kJ. Key opportunities identified for adolescents were to increase breakfast consumption, given the high nutrient densities of breakfasts consumed; improve overall lunch quality, particularly the sodium content; promote the intake of milk, fruit and a variety of vegetables at both lunch and dinner; maintain healthful choices at in-between meal eating occasions while focusing on decreasing the intake of discretionary foods.

Non-Responsive Feeding Practices, Unhealthy Eating Behaviors, and Risk of Child Overweight and Obesity in Southeast Asia: A Systematic Review

Childhood obesity is increasing dramatically in many Southeast Asian countries, and becoming a significant public health concern. This review summarizes the evidence on associations between parental feeding practices, child eating behaviors, and the risk of overweight and obesity in Southeast Asian children 2–12 years old. We systematically searched five electronic academic/research (PubMed, PsycINFO, ProQuest Nursing, Medline, and CINAHL) databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for peer-reviewed studies published in English between January 2000 and December 2016. Fourteen observational studies met the inclusion criteria and were reviewed. Reviewed studies were examined separately for preschool- and school-aged children and revealed that non-responsive parental feeding practices and unhealthy child eating behaviors were associated with a risk of child overweight and obesity in several Southeast Asian countries. Nonetheless, due to the small number of identified studies (n = 14) and because only about half of the Southeast Asian countries (Thailand, Vietnam, Singapore, the Philippines, and Malaysia) were represented (5/11) in the examined studies, additional research is needed to further understand the factors associated with childhood obesity among children in Southeast Asia to develop interventions that are tailored to the specific needs of Southeast Asian countries and designed to address practices and behaviors that may promote childhood obesity.

Home Food Rules in Relation to Youth Eating Behaviors, Body Mass Index, Waist Circumference, and Percent Body Fat

PURPOSE

To investigate agreement and associations between parent and youth acknowledgment of home food rules, youth eating behaviors, and measures of body composition and excess weight.

METHODS

Parent-youth dyads (N = 413) completed the "rules for eating at home" scale (Active Where Survey) and reported dietary intake. Trained research staff obtained anthropometric data. Linear regression analyses separately evaluated relationships between youth and parent acknowledgment of rules and youth-reported eating behaviors and anthropometric outcomes. Food rules were evaluated as a 12-item scale and individually.

RESULTS

Score on the food rule scale was positively associated with fruit and vegetable servings by youth acknowledgment only (β = .09, p = .006), and not with anthropometric outcomes. The rule "no desserts except fruit" was positively associated with fruit and vegetable servings by youth (β = .72, p = .002) and parent (β = .53, p = .03) acknowledgment. The rules "no second helpings at meals" and "limited fast food" were positively associated with body mass index z-score by youth (β = .38, p = .002; β = .32, p = .02, respectively) and parent (β = .74, p < .001; β = .41, p = .006, respectively) acknowledgment, with similar results for waist circumference z-score and percent body fat.

CONCLUSIONS

Inverse associations between specific food rules and healthful eating behaviors but positive associations with anthropometric outcomes suggest potentially bidirectional relationships between food rule implementation and youth weight. Future studies should disentangle how food rules guide youth behavior in the context of youth weight status.

Daily exposure to either a high- or low-energy-dense snack food reduces its reinforcing value in adolescents

OBJECTIVE

To examine the impact of daily exposure to a low-energy-dense (LED) or a high-energy-dense (HED) snack food on its reinforcing value (RRV) in adolescents with healthy weight, overweight, or obesity.

METHODS

A parallel-group, randomized trial was used to assess RRV of LED or HED snack food at baseline and again after exposure to that snack food daily for 2 weeks in 77 adolescents, aged 13 to 17 years. Information on eating-related subject characteristics was also collected at baseline.

RESULTS

After 2 weeks of daily exposure, the RRV of the snack foods was significantly reduced in all participants, regardless of energy density or participant weight status. Among individuals who were high in dietary restraint only, those randomized to LED food found their snack food less reinforcing at baseline than those who were randomized to HED food. Baseline eating-related variables also differed as a function of weight status.

CONCLUSIONS

Daily exposure to snack food in adolescents reduces the RRV of that food regardless of snack food energy density or weight status of the adolescent. This finding differs from adults, suggesting that increases in RRV of HED food after repeated exposure may develop after adolescence.

Multicontextual correlates of energy-dense, nutrient-poor snack food consumption by adolescents

Frequent consumption of energy-dense, nutrient-poor snack foods is an eating behavior of public health concern. This study was designed to inform strategies for reducing adolescent intake of energy-dense snack foods by identifying individual and environmental influences. Surveys were completed in 2009-2010 by 2540 adolescents (54% females, mean age = 14.5 ± 2.0, 80% nonwhite) in Minneapolis-St. Paul, Minnesota schools. Daily servings of energy-dense snack food was assessed using a food frequency questionnaire that asked about consumption of 21 common snack food items, such as potato chips, cookies, and candy. Data representing characteristics of adolescents' environments were collected from parents/caregivers, friends, school personnel, Geographic Information System sources, and a content analysis of favorite television shows. Linear regression was used to examine relationships between each individual or environmental characteristic and snack food consumption in separate models and also to examine relationships in a model including all of the characteristics simultaneously. The factors found to be significantly associated with higher energy-dense snack food intake represented individual attitudes/behaviors (e.g., snacking while watching television) and characteristics of home/family (e.g., home unhealthy food availability), peer (friends' energy-dense snack food consumption), and school (e.g., student snack consumption norms) environments. In total, 25.5% of the variance in adolescents' energy-dense snack food consumption was explained when factors from within each context were examined together. The results suggest that the design of interventions targeting improvement in the dietary quality of adolescents' snack food choices should address relevant individual factors (e.g., eating while watching television) along with characteristics of their home/family (e.g., limiting the availability of unhealthy foods), peer (e.g., guiding the efforts of a peer leader in making healthy choices), and school environments (e.g., establishing student norms for selecting nutrient-dense snack foods).