The effect of snacking and eating frequency on dietary quality in British adolescents

Comparison of Meal Patterns Across Common Racial Groups in the UK and the USA, Examining Associations with Weight Status and Diet Quality: a Secondary Analysis of NDNS and NHANES Datasets

OBJECTIVE

Understanding diets of population subgroups is essential for monitoring health of diversifying populations, but currently, meal patterns of many population subgroups are not widely known. This paper aimed to identify meal patterns of racial groups in the UK and USA, considering if racial groups exhibit similar patterns of intake irrespective of location and relationships between meal patterns and health parameters.

DESIGN

Data were extracted from the UK (National Diet and Nutrition Survey) and the USA (National Health and Nutrition Examination Survey) national dietary surveys. Temporal and content meal patterns among racial groups in the UK and USA (White, Black, Asian and Other, n = 1780 and n = 4339, respectively) were examined. Kruskal-Wallis tests were applied to understand differences across groups. Logistic regression models identified associations between meal patterns and body mass index and diet quality.

RESULTS

Black groups consumed fewer eating occasions than White and Other groups in both countries, while UK racial groups consumed significantly more snacks than USA groups. Food group contribution to eating occasion consumption was similar across countries where Asian groups in the USA and UK had the lowest meat intake at lunch and dinner. Meal frequency was positively associated with diet quality.

CONCLUSIONS

Overall, meal patterns differ across racial groups within a single country, and some differences were observed within groups of the same race across countries. Learnings from this research highlight the differences in consumption patterns across racial groups and the importance of considering a meal-based approach to dietary guidelines by racial group.

Snack frequency, size, and energy density are associated with diet quality among US adolescents

OBJECTIVE

To evaluate snacking and diet quality among US adolescents.

DESIGN

Cross-sectional analysis examined snack frequency (snacks/day), size (kcal/snack) and energy density (kcal/g/snack) as predictors of diet quality using the mean of two 24-h dietary recalls. Diet quality was assessed using the Healthy Eating Index (HEI-2015, 0-100), a mean adequacy ratio (MAR, 0-100) for under-consumed nutrients (potassium, fibre, Ca, vitamin D) and mean percentage of recommended limits for over-consumed nutrients (added sugar, saturated fat, Na). Linear regression models examined total snacks, food only snacks and beverage only snacks, as predictors of diet quality adjusting for demographic characteristics and estimated energy reporting accuracy.

SETTING

2007-2018 National Health and Nutrition Examination Survey.

PARTICIPANTS

Adolescents 12-19 years (n 4985).

RESULTS

Snack frequency was associated with higher HEI-2015 (β = 0·7 (0·3), P < 0·05) but also with higher intake of over-consumed nutrients (β = 3·0 (0·8), P ≤ 0·001). Snack size was associated with lower HEI (β = -0·005 (0·001), P ≤ 0·001) and MAR (β = -0·005 (0·002), P < 0·05) and higher intake of over-consumed nutrients (β = 0·03 (0·005), P ≤ 0·001). Associations differed for food only and beverage only snacks. Food only snack frequency was associated with higher HEI-2015 (β = 1·7 (0·03), P ≤ 0·001), while food only snack size (β = -0·006 (0·0009), P ≤ 0·001) and food only snack energy density (β = -1·1 (0·2), P ≤ 0·001) were associated with lower HEI-2015. Conversely, beverage only snack frequency (β = 4·4 (2·1) P < 0·05) and beverage only snack size (β = 0·03 (0·01), P ≤ 0·001) were associated with higher intake of over-consumed nutrients.

CONCLUSIONS

Smaller, frequent, less energy-dense food only snacks are associated with higher diet quality in adolescents; beverages consumed as snacks are associated with greater intake of over-consumed nutrients.

Do British and Chinese adolescents snack for different reasons? A cross-country study using the Theory of Planned Behaviour and eating styles

Snacking is prevalent in adolescents and can have significant health impacts, but there is considerable individual and cross-country variation in determinants on adolescent snacking. The present study examined the role of eating styles (i.e. restrained eating, emotional eating, external eating, mindful eating) and the constructs of an extended Theory of Planned Behaviour (TPB) (i.e. attitudes, subjective norms, perceived behavioural control, habit strength) in predicting adolescent snacking, and the moderating effects of country. A survey was completed by adolescents aged 16-19 years from China (N = 182; mean age = 16.13, SD = 0.87) and England (N = 96; mean age = 17.04, SD = 0.74). Compared to British adolescents, Chinese adolescents showed higher restrained eating (p = .009), lower external eating (p = .004), less positive attitudes (p < .001) and subjective norms (p = .007) to, and less strong habit strength (p = .005) for unhealthy snacking. Mindful eating significantly predicted lower consumption of unhealthy snacks (p = .008) and beverages (p = .001), while restrained eating predicted higher consumption of fruit (p < .001) and vegetables (p < .001), regardless of country. Country showed significant moderating effects of TPB constructs on unhealthy beverages (p = .008) and fruit (p < .001) consumption, and effects on unhealthy snack (p = .023) and vegetable (p = .015) consumption approaching significance. Subjective norms predicted unhealthy snacking frequency regardless of country (p = .001). Habit strength predicted consumption of beverages (p < .001) and fruit (p < .001) only in English adolescents. Mindful eating may be a positive intervention approach to help reduce adolescent unhealthy snacking. TPB-based snacking interventions should carefully consider the country context. Acknowledging country-specific determinants of snacking are recommended.

Influence of income on diet quality and daily iron and zinc intake: analysis of the National Diet and Nutrition Survey of British females aged 11-14 and 15-18 years

PURPOSE

A negative socio-economic gradient exists for diet and health outcomes. Since cheaper diets are associated with increased energy and lower nutrient density, we investigated the influence of income on iron and zinc intakes and overall diet quality for adolescent (DQI-A) females aged 11-18 years.

METHODS

National Diet and Nutrition Survey (NDNS years 7 and 8) data for iron and zinc intake and overall diet quality was assessed by household income quintile across females aged 11-18 years.

RESULTS

Equivalised household income positively correlated with Diet quality index for adolescents (DQI-A) (P < 0.001) Females aged 15-18 years in income quintiles (IQs) I and 2, had a greater proportion of respondents with low to intermediate DQI-A score compared to higher IQs (P = 0.002). NDNS data showed intake was negatively influenced by income amongst females aged 11-14 years for iron (P = 0.009) and zinc (P = 0.001) with those from the lowest incomes consistently consuming significantly less than those from the highest. DQI-A was positively correlated with iron intakes for 11-14 (P = 0.001) and 15-18 years (P < 0.001). Forty-one percent of 15-18-year-olds plasma ferritin stores were below the 15 µg L^-1 and 21% had some form of anaemia. Cereal and cereal products were the greatest contributors to iron in all groups.

CONCLUSION

Females in the lowest income groups are at greater risk of lower overall diet quality and inadequate iron and zinc intakes. Amongst older adolescents, there is evidence of iron stores being depleted and an increased prevalence of anaemia.

Association of weight status with the types of foods consumed at snacking occasions among US adolescents

OBJECTIVE

This study aimed to evaluate snack food-group composition by weight status among United States adolescents.

METHODS

Cross-sectional analysis of adolescent food-group-component intake from snacking occasions using two 24-hour dietary recalls from the 2007 through 2018 National Health and Nutrition Examination Survey (NHANES; n = 5264; 12-19 years) was conducted. ANCOVA models evaluated food intakes by BMI percentile (BMI%; normal weight [NW]: <85th BMI%; overweight [OW]: 85th-95th BMI%; and obesity [OB]: ≥95th BMI%), adjusting for energy misreporting and key covariates.

RESULTS

Adolescents with OB consumed greater total daily energy from snacks (mean [SE]: NW = 424 [10] kcal; OW = 527 [16] kcal; OB = 603 [22] kcal; p < 0.001) than adolescents with OW and NW. Adolescents with OW or OB consumed higher amounts of refined grains, dairy, protein, oil, solid fat, and added sugar from snacks than adolescents with NW (p < 0.05-0.001).

CONCLUSIONS

Adolescents with OW or OB consume more calories and higher levels of overconsumed dietary components, i.e., added sugar, solid fats, and refined grains, from snacks than adolescents with NW. Age-specific snacking recommendations to inform dietary guidance are needed to prevent excess intake of overconsumed nutrients and calories.

Characterizing Adolescents' Dietary Intake by Taste: Results From the UK National Diet and Nutrition Survey

The taste of foods is a key factor for adolescents' food choices and intakes, yet, exploring taste characteristics of adolescents' diet is limited. Using food records for 284 adolescents (10–19 years old) from the National Diet and Nutrition Survey (NDNS), year 9 (2016–2017), we classified diets according to taste. Tastes for each food consumed were generated from a previous survey that asked participants to allocate one main taste to each food. Responses from that survey were processed and included in a Hierarchical Cluster Analysis (HCA) to identify taste clusters. The resulting tastes were then applied to the adolescents' food records in the NDNS. For each individual, the total weight of food per day for each taste was calculated. A linear regression model was used to explore dietary intakes from each taste. Findings reveal that adolescents' daily energy intake was highest (34%) from foods that taste sweet. Sweet foods were the main calorie contributors at breakfast and daytime snacking, while energy intake from neutral-tasting foods was higher at lunch and dinner. Sweet food intake was significantly positively associated with higher energy, sugar, and fat intakes. For each percentage increase in sweet foods, energy increased by 10 kcal/d (95% CI 6, 15; P &lt; 0.01). Savory food intake was lower in carbohydrates and sugars; with neutral food consumption inversely associated with energy, carbohydrate, sugars, saturated and total fat. Higher salty food intake was linked to higher saturated fat as well as sodium consumption. Sweet and neutral foods dominate the UK adolescent diet, followed by savory tastes. Balancing the contributions of different tasting foods could assist in improving adolescent diet quality.

Applied nutritional investigation Determinants of undernutrition among private and public primary school children: A comparative cross-sectional study toward nutritional transition in northwest Ethiopia

OBJECTIVES

Undernutrition is a major public health concern, particularly in children. The burden is higher in developing countries. Undernutrition is considered when there is one or more of the following: stunting, underweight, or wasting. Childhood undernutrition can have numerous long-term effects: a lower physical capacity for work, lower intellectual quotients, greater risk for morbidity and mortality, and cognitive impairment. Undernourished children also can have poor cognitive scores, a high absenteeism rate, and high class repetition compared with non-undernourished children. The aim of this study was to assess undernutrition and its associated factors among public and private primary school children in Gondar town, northwest Ethiopia.

METHODS

A school-based, cross-sectional study was conducted from March 5 to April 9, 2019. A multistage sampling technique was applied to select study participants. A simple random (lottery) sampling method was used to select seven public schools and five private schools. Systematic random sampling was used to select 774 study participants. The data were collected through face-to-face interviews. Multivariable logistic regressions were conducted to identify factors associated with undernutrition. The World Health Organization (WHO) AnthroPlus software was used to determine the status of undernutrition. Participants with a Z-score less than -2 were considered to be undernourished. Statistical significance was declared at P < 0.05 and odds ratios (ORs) were reported with a 95% confidence interval (CI).

RESULTS

The prevalence of undernutrition was higher among public school children (37.1%) than those attending private schools (28.3%). Not having family car (adjusted OR [aOR], 0.28; 95% CI, 0.09-0.84), snack frequency no more than twice a day (aOR, 5.29; 95% CI, 1.37-20.37), and vigorous intensity sports (aOR, 0.53; 95% CI, 0.32-0.91) were significantly associated with undernutrition among public primary school students. Family income below the median (aOR, 2.12; 95% CI, 1.23-3.53), no preference for sweets (aOR, 0.59; 95% CI, 0.36-0.97), and not habits while reading (aOR, 0.42; 95% CI, 0.19-0.89) were the factors significantly associated with undernutrition among private primary school students.

CONCLUSION

The prevalence of undernutrition was high. Children in public schools were highly vulnerable to undernutrition compared with those in private schools. Not having a family car, snack frequency no more than twice daily, and vigorous intensity sports increase the risk for undernutrition among public school children. Family income below the median, not preferring sweets, and not having a habit of eating while reading increase the risk for undernutrition among private school children. It is better to give attention to healthy dietary habits and healthy lifestyles to reduce childhood undernutrition.

Characterizing children's eating patterns: does the choice of eating occasion definition matter?

BACKGROUND

Recommendations to define eating occasions (EO) currently exist for research in adults, but not for children or adolescents. We examined how varying EO definitions affect the characterization of eating patterns in children and adolescents.

METHODS

Cross-sectional dietary data collected using a 24-h recall data during the 2011-12 Australian National Nutrition and Physical Activity Survey (1364 boys and 1337 girls aged 2-18 years) were analyzed. Eight definitions were applied: participant-identified, time-of-day, and 6 neutral definitions (EO separated by 15- or 60-min and/or an additional energy criterion of 21 or 210 kJ). Frequency of and total energy intake from meals, snacks, and all EO were estimated. F tests stratified by gender and age-group, were used to assess differences between definitions. Agreement between definitions of meal and snack frequencies was assessed using intraclass correlation coefficients (ICC). Linear regression was used to estimate the proportion of variance in total energy intake (kJ) and BMI z-score predicted by each definition.

RESULTS

Mean frequencies of meals and snacks differed between the participant-identified and time-of-day definitions, in boys and girls and for all age groups (P < 0.01). Across the six neutral definitions, there were differences between mean frequencies of EO with the largest mean difference observed for children aged 2-3 y (boys: 2.3, girls: 2.5; P < 0.003). Between the participant-identified and time-of-day definitions, there was good agreement for frequencies of snacks (ICC for both genders: 0.93) but not meals (boys: 0.36; girls: 0.38). The 15-min time interval plus 210 kJ definition of an EO consistently predicted the most variance in total energy intake (R2 range = 8.1-34.8). Definitions that delineated meals and snacks better predicted variance in BMI z-score, when compared to the neutral definitions.

CONCLUSIONS

How eating patterns are characterized vary depending on the EO definitions employed, particularly in young children. Variance in total energy intake was best predicted by a variation of the neutral definition whereas definitions that delineated meals and snacks performed better in relation to predicting BMI variance. Further international research that compares EO definitions in children will help inform a standard approach.

Development of a stand-alone index for the assessment of diet quality in elementary school-aged children

OBJECTIVE

To develop and evaluate a stand-alone Elementary School-aged Children's Index of Diet Quality (ES-CIDQ).

DESIGN

In this cross-sectional study, children filled in a food frequency questionnaire (FFQ) with twenty-nine multiple-item questions on the consumption of foods, portion sizes and eating frequency and a 5-d food diary. Nutrient intakes were calculated with nutrient analysis software. FFQ questions best reflecting a health-promoting diet with reference to dietary recommendations were identified by correlations, logistic regression modelling and receiver-operating characteristics curve analysis.

SETTING

Southwest and Eastern Finland.

PARTICIPANTS

Healthy elementary school-aged volunteers [n 266, mean (sd) age 9·7 (1·7) years] were recruited between March 2017 and February 2018.

RESULTS

A set of questions was identified from the FFQ that best depicted the children's diet quality as defined in the dietary recommendations. These fifteen questions were scored and formulated into a stand-alone index as a continuous index score (range 0-16·5 points) and a two-category score: good and poor diet quality. The cut-off score of six points for a good diet quality had a sensitivity of 0·60 and a specificity of 0·78. Children with a good diet quality (49·8 % of the children) had higher intakes of protein, dietary fibre, and several vitamins and minerals, and lower intakes of sucrose, total fat, SFA and cholesterol compared to children with a poor diet quality.

CONCLUSIONS

The developed short stand-alone index depicted diet quality as defined in the dietary recommendations. Thus, ES-CIDQ may be used for assessing diet quality in Finnish elementary school-aged children in school health care and nutrition research.

Development of a short food frequency questionnaire to assess diet quality in UK adolescents using the National Diet and Nutrition Survey

BACKGROUND

UK adolescents consume fewer fruits and vegetables and more free sugars than any other age group. Established techniques to understand diet quality can be difficult to use with adolescents because of high participant burden. This study aimed to identify key foods that indicate variation in diet quality in UK adolescents for inclusion in a short food frequency questionnaire (FFQ) and to investigate the associations between adolescent diet quality, nutritional biomarkers and socio-demographic factors.

METHODS

Dietary, demographic and biomarker data from waves 1-8 of the National Diet and Nutrition Survey rolling programme were used (n=2587; aged 11-18 years; 50% boys; n=≤997 biomarker data). Principal component analysis (PCA) was applied to 139 food groups to identify the key patterns within the data. Two diet quality scores, a 139-group and 20-group, were calculated using the PCA coefficients for each food group and multiplying by their standardised reported frequency of consumption and then summing across foods. The foods with the 10 strongest positive and 10 strongest negative coefficients from the PCA results were used for the 20-group score. Scores were standardised to have a zero mean and standard deviation of one.

RESULTS

The first PCA component explained 3.0% of variance in the dietary data and described a dietary pattern broadly aligned with UK dietary recommendations. A correlation of 0.87 was observed between the 139-group and 20-group scores. Bland-Altman mean difference was 0.00 and 95% limits of agreement were - 0.98 to 0.98 SDs. Correlations, in the expected direction, were seen between each nutritional biomarker and both scores; results attenuated slightly for the 20-group score compared to the 139-group score. Better diet quality was observed among girls, non-white populations and in those from higher socio-economic backgrounds for both scores.

CONCLUSIONS

The diet quality score based on 20 food groups showed reasonable agreement with the 139-group score. Both scores were correlated with nutritional biomarkers. A short 20-item FFQ can provide a meaningful and easy-to-implement tool to assess diet quality in large scale observational and intervention studies with adolescents.

A Cross-Sectional Survey of Salty Snack Consumption among Serbian Urban-Living Students and Their Contribution to Salt Intake

This study investigated the behavior of urban-living students related to the salty snacks consumption, and their contribution to salt daily intake. A cross-sectional survey on 1313 urban-living students (16–25 years, 61.4% university students and 38.6% high school students) used a pre-verified questionnaire created specifically for the study. The logistic regression analysis was performed to investigate the factors influencing snack consumption. The results of salt content and the snack consumption frequency were used to evaluate snack contribution to salt intake. All subjects consumed salty snacks, on average several times per week, more often at home and slightly more during periods of intensive studying, with 42% of the participants reporting to consume two or more packages per snacking occasion. Most of the participants consumed such products between main meals, but 10% of them took snacks immediately after the main meal. More high-school students than university students were in the “high snack group” (p < 0.05). The most frequently consumed salty snacks were those with the highest content of salt. Salt intake from snack products for a majority of participants ranged between 0.4 and 1 g/day. The research revealed younger age, home environment and significant contribution to salt intake as critical points in salty snack consumption among urban-living students important for the better understanding of their dietary habits.

The Adherence of Singaporean Students in Different Educational Institutions to National Food-Based Dietary Guidelines

There are currently limited data on the dietary habits of young Singaporeans. This study aimed to evaluate the adherence of 17–21 year olds attending different educational institutions using a novel diet-quality scoring method. Dietary data were collected using a single weekday 24 h dietary recall in a cross section of 536 Singaporeans aged 17–21 years. An 11 category scoring system (0.0–100.0) was used to define adherence to food based dietary guidelines. Demographic and self-reported data were also collected via a questionnaire, BMI status, and using Mann-Whitney and Kruskal-Wallis (non-parametric) tests, with post-hoc Bonferroni-corrected tests. The median diet quality score was 48.5 (IQR 40.5, 56.4) for this cohort, with component scores for “Total fruit”, “Whole fruit”, “Total vegetables”, “Dark green leafy & orange vegetables”, “Whole grains”, “Dairy products”, and “Sodium” frequently scoring the minimum value. Median diet quality scores were statistically different for groups by ethnic origin (p < 0.001) and by educational institution (p < 0.001). Intake of fruit, vegetables, and whole grains is minimal, while sodium intake is frequently too high in young Singaporeans. Differences across ethnic groups and types of educational institutions suggest the need for targeted interventions to improve dietary habits in this population.

Snacking in Japanese nursery school children aged 3-6 years: its characteristics and contribution to overall dietary intake

OBJECTIVE

This cross-sectional study evaluated the dietary characteristics of snacks, the contribution of snacks to daily nutrient intake and the association of energy intake (EI) from snacks with the prevalence of nutritional inadequacy in Japanese nursery school children.

DESIGN

Foods and nutrients consumed in each eating occasion were assessed by 3-d dietary records. The prevalence of inadequate intake of twenty nutrients assessed by the age- and sex-specific reference values in the Japanese Dietary Reference Intakes was compared according to tertile categories of EI from snacks.

SETTING

A multi-regional dietary survey based on nursery schools in Japan.

PARTICIPANTS

A total of 187 boys and 191 girls aged 3-6 years.

RESULTS

EI from snacks accounted for 19·5 % (sd 6·9) of total daily EI. Confectionaries accounted for the largest part of EI from snacks (35·3 %), followed by milk (19·5 %). Relative to their energy contribution, snacks accounted for a small proportion for all nutrients examined, except for free sugar, calcium, SFA and riboflavin. Although a higher EI from snacks was associated with favourable profiles for intakes of calcium, iron, thiamine and riboflavin, excessive intakes of free sugar and Na were more prevalent among children with a higher EI from snacks.

CONCLUSIONS

Although snacks are effective in meeting the requirement of some nutrients among Japanese nursery school children, snacks are generally not nutrient-dense and have an impact on excessive intake of some nutrients. There is hence room for improvement in food choices at snack time.

Next Steps for Interventions Targeting Adolescent Dietary Behaviour

Adolescents in many countries consume poor quality diets that include high intakes of sugary drinks and fast food and low intakes of vegetables. The aims of this Special Issue on adolescent dietary behaviour were to identify methods and approaches for successful interventions to improve diet quality in this age group and identify at risk subgroups that need particular attention. In total, 11 manuscripts were published in this Special Issue-three qualitative studies which included a systematic review, five cross-sectional studies and three quantitative evaluations of interventions. This Editorial discusses the contribution of the studies and provides suggestions to improve the success of future interventions in adolescents. It is important that adolescents are involved in the design of interventions to improve social and cultural acceptability and relevance. Interventions targeting schools or communities framed within a larger food system such as issues around climate change and the carbon footprint of food may improve engagement. Furthermore, targeting adolescents in areas of lower deprivation is a priority where diet quality is particularly poor. Potentially successful interventions also include environmental policies that impact on the cost and marketing of food and drinks, although evaluations of these were not included in this issue.

Determinants of Portion Size in Children and Adolescents: Insights from the UK National Diet and Nutrition Survey Rolling Programme (2008-2016)

Large portion sizes have been identified as contributing to overweight and obesity, particularly in children and adolescents. This study examined predictors of portion sizes of high energy snack foods eaten by children aged 1.5–18 years. Specifically, we examined whether portion sizes were adjusted for age, and what external features of the environment might be linked to large portion sizes. Portion sizes were derived from four-day food diaries that form the UK National Diet and Nutrition Survey. Diaries from 5942 children were examined and multilevel models were used to discover whether age, gender, location, time of day, household income, and watching TV while eating predicted portion sizes of savoury snacks, chocolate, confectionery and biscuits. Portion sizes of all the target foods were predicted by age. Boys had larger portions, and portion sizes were larger when target foods were consumed later in the day. Portion sizes were larger outside the home, for example in leisure venues, but the target foods were eaten more frequently in the home. As dietary patterns change to include more snack intake outside the home, these locations could be an important space to target for interventions for portion control.

The impact of a higher eating frequency on the diet quality and nutritional status of women with breast cancer undergoing chemotherapy

The present study investigated the association between eating frequency (EF), diet quality and nutritional status of fifty-five women with breast cancer (BC) undergoing chemotherapy (CT), with three follow-ups, before the first cycle (T0), after the intermediate cycle (T1) and after the last cycle of CT (T2). Dietary data were obtained by nine 24-h dietary recalls (24HR), and the Brazilian Healthy Eating Index Revised (BHEI-R) was used for qualitative analysis of diet. The average EF was established by adding the number of daily eating episodes in the three 24HR of each time. Anthropometric variables were obtained at three times. Women who reported higher EF (equal to or above median value (T0 and T1: 4·67; T2: 4·33 eating episodes)) presented better anthropometric parameters, in T0 and T1, as well as higher scores for BHEI-R specific groups and BHEI-R Total score in T1 and T2. In generalised linear models, the continuous variable EF was negatively associated with all the anthropometric variables in T0 and with the waist:height ratio in T1. There were positive associations for the BHEI-R groups at the three times: Total Fruit; Whole Fruit; Total Vegetables; Dark Green and Orange Vegetables and Legumes. At T1 and T2 the EF was positively associated with the BHEI-R Total score, and also with Whole Grains in T1. The results suggest that a higher EF was associated with a better diet quality during CT in women with BC. In contrast, an inverse association was observed between EF and anthropometric parameters before the first cycle of treatment.

The Contribution of Snacking to Overall Diet Intake among an Ethnically and Racially Diverse Population of Boys and Girls

BACKGROUND

Children in low-income and minority populations are at risk for poor dietary quality. At least one-third of the calories consumed by children are eaten between meals (ie, snacks). The contribution of snacking to diet quality among children is poorly understood.

OBJECTIVE

The current study examined associations between snacking and children's diet quality along with differences across ethnicity or race, sex, and weight status.

DESIGN

Cross-sectional data came from Phase I of the Family Matters Study, an observational study.

PARTICIPANTS/SETTING

This study included 150 families with children aged 5 to 7 years old from six ethnic or racial groups (n=25 from each: African American, Hispanic, Hmong, Native American, Somali, non-Hispanic white); data were collected in Minneapolis-Saint Paul, MN in 2017-2018.

MAIN OUTCOME MEASURES

Total daily energy (kilocalories), overall diet quality using the Healthy Eating Index (HEI-2010), and food group intakes (eg, fruit, vegetables, refined grains, sugar-sweetened beverages [SSB]) were assessed using three 24-hour dietary recalls.

STATISTICAL ANALYSES PERFORMED

Conditional fixed effects estimators (within-child variation) were used in regression analyses to characterize the relationship between daily snacking and dietary intake relative to dietary intake at all other daily meal occasions. Mean (±standard deviation) overall dietary intake including all meals and snacks was compared with mean (±standard deviation) intake of meals only.

RESULTS

Among boys, snacking was found to contribute positively to HEI-2010 scores (HEI-2010=57.6, HEI-2010 without snacks=55.0; effect size [ES]=0.28, P=0.03). Snacking was an important source of fruit (ES=0.71) and dairy (ES=0.53), but also contributed to children's consumption of refined grains (ES=0.68) and SSB (ES=0.31). Very few vegetables were consumed as snacks. Furthermore, snacks contributed more to the overall diet quality (HEI-2010) of Native American (ES=0.30) and Somali (ES=0.35) youth as compared with youth from other ethnic or racial backgrounds.

CONCLUSIONS

Findings suggest that snacks have the potential to improve diet quality in children. Future research should examine influences on children's food choices at snack times and barriers to serving more healthful foods as snacks that are faced by ethnically or racially diverse families.

Development of a Food-Based Diet Quality Score from a Short FFQ and Associations with Obesity Measures, Eating Styles and Nutrient Intakes in Finnish Twins

We constructed a food-based diet quality score (DQS) and examined its association with obesity measures, eating styles and nutrient intakes. Participants were 3592 individuals (764 dizygotic [DZ] and 430 monozygotic [MZ] twin pairs) from the FinnTwin16 study. The DQS (0–12 points) was constructed from a short 14 item food frequency questionnaire. Anthropometric measures and eating styles were self-reported. Nutrient intakes were calculated from food diaries completed in a subsample of 249 individuals (45 same-sex DZ and 60 MZ twin pairs). Twins were analyzed both as individuals and as twin pairs. The DQS was inversely associated with body mass index (β = −0.12, per one-unit increase in DQS, p < 0.001), waist circumference (β = −0.34, p < 0.001), obesity (odds ratio [OR]: 0.95, p = 0.004) and abdominal obesity (OR: 0.88, p < 0.001), independent of sex, age, physical activity and education. A higher DQS was associated with health-conscious eating, having breakfast, less snacking, fewer evening meals, and a higher frequency and regularity of eating. The DQS was positively correlated with the intakes of protein, fiber and magnesium and negatively correlated with the intakes of total fat, saturated fat and sucrose. Within twin pairs, most of the associations between the DQS with eating styles and some nutrients remained, but the DQS was not associated with obesity measures within twin pairs. The DQS is an easy-to-use tool for ranking adults according to diet quality and shows an association with obesity measures, eating styles and key nutrients in the expected direction.

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.

The cross-sectional relationships between consumption of takeaway food, eating meals outside the home and diet quality in British adolescents

OBJECTIVE

The present study aimed to evaluate the association of frequency of consuming takeaway meals and meals out with diet quality of UK adolescents.

DESIGN

The Diet Quality Index for Adolescents (DQI-A) tool was used to assess diet quality, where adolescents' food intake was based on 4d diary records obtained from the UK cross-sectional National Diet and Nutrition Survey (NDNS) rolling programme Years 1-6. Models included confounders.

SETTING

The DQI-A relies on three components, specifically diet quality, diversity and equilibrium, which reflect the degree of adherence of an adolescent's diet with food-based dietary guidelines.ParticipantsBritish (n 2045) adolescents aged 11-18 years.

RESULTS

Mean diet quality score for all adolescents was 20·4 % (overall DQI-A score range: -33 to 100 %). After adjusting for age, gender and equivalised household income, DQI-A% score was higher for low and moderate takeaway consumers by 7·4 % (95 % CI 5·5, 9·2; P&lt;0·01) and 3·5 % (95 % CI 1·9, 5·1; P&lt;0·01), respectively, v. frequent consumers. Significant differences were also observed between low, moderate and frequent takeaway consumers among all DQI-A components and sub-components (P&lt;0·05), except for the diet adequacy sub-component (DAx). Results for frequent consumption of meals out were similar but attenuated and not statistically significant for individual components before or after adjusting for confounders.

CONCLUSIONS

Frequent consumption of takeaway meals may have a negative impact on adolescents' diet quality and therefore policies to reduce the intake of takeaways should be considered in this age group.

High-risk environments for eating foods surplus to requirements: a multilevel analysis of adolescents' non-core food intake in the National Diet and Nutrition Survey (NDNS)

OBJECTIVE

Interventions to reduce adolescents' non-core food intake (i.e. foods high in fat and sugar) could target specific people or specific environments, but the relative importance of environmental contexts v. individual characteristics is unknown.

DESIGN

Cross-sectional.

SETTING

Data from 4d food diaries in the UK National Diet and Nutrition Survey (NDNS) 2008-2012 were analysed. NDNS food items were classified as 'non-core' based on fat and sugar cut-off points per 100g of food. Linear multilevel models investigated associations between 'where' (home, school, etc.) and 'with whom' (parents, friends, etc.) eating contexts and non-core food energy (kcal) per eating occasion (EO), adjusting for variables at the EO (e.g. time of day) and adolescent level (e.g. gender).ParticipantsAdolescents (n 884) aged 11-18 years.

RESULTS

Only 11 % of variation in non-core energy intake was attributed to differences between adolescents. In adjusted models, non-core food intake was 151 % higher (ratio; 95 % CI) in EO at 'Eateries' (2·51; 2·14, 2·95) and 88 % higher at 'School' (1·88; 1·65, 2·13) compared with 'Home'. EO with 'Friends' (1·16; CI 1·03, 1·31) and 'Family &amp; friends' (1·21; 1·07, 1·37) contained 16-21 % more non-core food compared with eating 'Alone'. At the individual level, total energy intake and BMI, but not social class, gender or age, were weakly associated with more non-core energy intake.

CONCLUSIONS

Regardless of individual characteristics, adolescents' non-core food consumption was higher outside the home, especially at eateries. Targeting specific eating contexts, not individuals, may contribute to more effective public health interventions.

Diet Quality through Adolescence and Early Adulthood: Cross-Sectional Associations of the Dietary Approaches to Stop Hypertension Diet Index and Component Food Groups with Age

Late adolescence to early adulthood is the period of life when prevalence of overweight and obesity rises the fastest, and an important time to understand changes in dietary risk factors. In this study we assess the variation in diet quality through analysis of cross-sectional data from 2957 individuals aged 13 to 30 from the National Diet and Nutrition Study (2008–2016). Diet data were self-reported using four-day food diaries and coded to give diet quality using the dietary approaches to stop hypertension (DASH) index (range 0–80) and DASH component food groups (grams/day). The mean DASH index score was low at 34.8 (95% confidence interval (CI) = 34.3–35.4). The regression of diet quality score and food groups on age categories revealed no significant change in diet quality score with age category in males, but an improved diet quality score among females aged 19–21 (β = 2.04, 95% CI = 0.05–4.02), 25–27 (β = 3.77, 95% CI = 1.36–6.18) and 28–30 (β = 2.39, 95% CI = 0.53–4.26), compared to age 13–15. Both sexes showed increased vegetable intake with age. Dairy intake was lower in early adult ages among males, while in females there was an increase in the proportion of low-fat dairy consumed with age. Further research should address the determinants of changes in diet in early adulthood to provide evidence for the targeting of public health policy.

Feasibility and impact study of a reward-based mobile application to improve adolescents' snacking habits

OBJECTIVE

Adolescents' snacking habits are driven by both explicit reflective and implicit hedonic processes. Hedonic pathways and differences in sensitivity to food rewards in addition to reflective determinants should be considered. The present study evaluated the feasibility and impact of a mobile phone-delivered intervention, incorporating explicit reflective and implicit rewarding strategies, on adolescents' snack intake.

DESIGN

Adolescents (n 988; mean age 14·9 (sd 0·70) years, 59·4 % boys) completed a non-randomized clustered controlled trial. Adolescents (n 416) in the intervention schools (n 3) were provided with the intervention application for four weeks, while adolescents (n 572) in the control schools (n 3) followed the regular curriculum. Outcomes were differences in healthy snacking ratio and key determinants (awareness, intention, attitude, self-efficacy, habits and knowledge). Process evaluation data were collected via questionnaires and through log data of the app.

RESULTS

No significant positive intervention effects on the healthy snack ratio (b=-3·52 (se 1·82), P>0·05) or targeted determinants were observed. Only 268 adolescents started using the app, of whom only fifty-five (20·5 %) still logged in after four weeks. Within the group of users, higher exposure to the app was not significantly associated with positive intervention effects. App satisfaction ratings were low in both high and low user groups. Moderation analyses revealed small positive intervention effects on the healthy snack ratio in high compared with low reward-sensitive boys (b=1·38 (se 0·59), P<0·05).

CONCLUSIONS

The intervention was not able to improve adolescents' snack choices, due to low reach and exposure. Future interventions should consider multicomponent interventions, teacher engagement, exhaustive participatory app content development and tailoring.

Weekday snacking prevalence, frequency, and energy contribution have increased while foods consumed during snacking have shifted among Australian children and adolescents: 1995, 2007 and 2011-12 National Nutrition Surveys

Background

There are limited data on the evolution of eating habits, including snacking, in Australia. This study aimed to understand snacking trends among Australian children over three previous National Nutrition Surveys.

Methods

Data were analysed from a single weekday 24-h recall in the National Nutrition Surveys 1995, 2007, 2011–12 among children 2-16y (n = 8258). A snacking occasion was defined as an eating occasion that occurred between meals based on time of day.

Results

The percentage of children snacking increased over time (92.5 ± 0.5(SE) % in 1995, 98.1 ± 0.3% in 2007, and 95.8 ± 0.4% in 2011–12) (P < 0.001), particularly among those having four or more snacking occasions (7.1 ± 0.5% in 1995, 17.9 ± 0.6% in 2007, and 18.5 ± 0.8% in 2011–2) (P < 0.001). The mean number of snacking occasions increased from 2.0 ± 0.0 in 1995, to 2.5 ± 0.0 in 2007 and 2011–12 (P < 0.001). The energy contribution from snacking increased from 24.1 ± 0.3% in 1995 to 27.7 ± 0.3% in 2007 and 30.5 ± 0.4% in 2011–12 (P < 0.001), while the energy from discretionary food during snacking decreased from 56.5 ± 0.7% in 1995 to 47.3 ± 0.5% in 2007 and 47.9 ± 0.7% in 2011–12 (P < 0.001). There were differences in the top foods consumed during snacking: non-alcoholic beverages were prominent contributors in 1995 but not in 2007 or 2011, and pome fruit was the second top energy contributor during snacking in 2007 and 2011 but only fourth in 1995.

Conclusions

Snacking is a prominent dietary pattern that has increased over time in frequency and energy contribution. Foods and beverages consumed during snacking occasions include a mix of core foods and discretionary foods, and while the contribution of discretionary foods has decreased, there is still an opportunity to encourage consumption of more nutrient dense foods during snacking.

Electronic supplementary material

The online version of this article (10.1186/s12937-017-0288-8) contains supplementary material, which is available to authorized users.

Dietary patterns associated with overweight and obesity among Brazilian schoolchildren: an approach based on the time-of-day of eating events

Several studies reported that the timing of eating events has critical implications in the prevention of obesity, but dietary patterns regarding the time-of-day have not been explored in children. The aim of this study was to derive latent food patterns of daily eating events and to examine their associations with overweight/obesity among schoolchildren. A population-based cross-sectional study was conducted with 7–10-year-old Brazilian schoolchildren (n 1232) who completed the Previous Day Food Questionnaire, illustrated with twenty-one foods/beverages in six daily eating events. Latent class analysis was used to derive dietary patterns whose association with child weight status was evaluated by multivariate multinomial regression. Four mutually exclusive latent classes of dietary patterns were identified and labelled according to the time-of-day of eating events and food intake probability (FIP): (A) higher FIP only at lunch; (B) lower FIP at all eating events; (C) higher FIP at lunch, afternoon and evening snacks; (D) lower FIP at breakfast and at evening snack, higher FIP at other meals/snacks. The percentages of children within these classes were 32·3, 48·6, 15·1 and 4·0 %, respectively. After controlling for potential confounders, the mean probabilities of obesity for these classes were 6 % (95 % CI 3·0, 9·0), 13 % (95 % CI 9·0, 17·0), 12 % (95 % CI 6·0, 19) and 11 % (95 % CI 5·0, 17·0), in the same order. In conclusion, the children eating traditional lunch with rice and beans as the main meal of the day (class A) had the lowest obesity risk, thus reinforcing the importance of both the food type and the time-of-day of its intake for weight status.

Sugars and health: a review of current evidence and future policy

The automation of the process of extracting sugars in the 1900s reduced cost and increased availability of sugars leading to a dramatic rise in consumption, which reached a peak in the 1970s. There are different definitions for sugars not naturally available in foods, and free sugars is the term used by WHO. The epidemiological evidence of the associations between sugars and obesity and type 2 diabetes mellitus is fairly strong and consistent, particularly for sugar sweetened drinks in adults. The Department of Health in the UK and many other countries have recently updated their recommendations for free sugars as a result of this scientific evidence. In the UK the recommended amount of free sugars is currently 5 % of energy (reduced from 10 %), which is difficult to meet and very different from current British dietary patterns. Reducing intakes of free sugars is a challenge and will necessitate a range of different actions and policies. Public Health England has put forward eight suggestions but the four most likely to improve dietary behaviour based on available evidence are social marketing, reduction of marketing of high sugar foods and drinks to children, reformulation and reductions in portion size and a sugar excise tax. Any action taken needs to be evaluated to check inequalities are not widened. The new childhood obesity strategy has incorporated some but not all of these strategies and may not go far enough. It is likely that government policies alone will not be sufficient and a change in the food culture is necessary to see real progress.

A systematic review of factors affecting energy intake of adolescent girls

BACKGROUND

Adolescence is considered a critical period marked by an increase in energy intake to meet the body's physiological needs especially during puberty. This study reviews existing literature and critically analyses factors associated with eating habits and energy intake of adolescent girls.

METHODS

A comprehensive search was conducted to identify at least 200 peer reviewed articles which dealt with the factors affecting energy intake (EI) and eating habits of adolescent girls. Studies were identified using a reference period between 1994 and 2016, based primarily on the PubMed/ CINL/ Science Direct/Google Scholar databases using keywords adolescent/ teenagers, factors/determinants and energy intake.

RESULTS

No studies investigated all factors affecting energy intake among adolescents. Some studies found mixed association among the determinants of EI in adolescent girls. However, a number of reviews confirm that many factors namely physical activity level, socio-economic status, diet, individual and social factors do contribute to either a higher or a lower EI of adolescents.

CONCLUSION

There is a dire need to consider factors associated with EI when designing nutritional intervention programs to prevent health problems in adulthood. The goal is not to change behavior of all but to increase the percentage of people adopting healthier lifestyle.